Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2023
Opioid-Free Versus Opioid-Based Anesthesia on Postoperative Pain After Thoracoscopic Surgery: The Use of Intravenous and Epidural Esketamine.
The effectiveness and safety of opioid-free anesthesia (OFA) regimens in distinct types of surgeries remain controversial. In this study, we investigated whether OFA could reduce the occurrence of chronic postoperative pain in patients receiving video-assisted thoracoscopic surgery (VATS). ⋯ Replacement of opioids by esketamine, intraoperatively as intravenous injection and epidural infusion and postoperatively as epidural infusion, reduces the incidence of mild chronic postoperative pain and side effects in patients after VATS.
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Anesthesia and analgesia · Jun 2023
Meta AnalysisClinical Performance of Decision Support Systems in Anesthesia, Intensive Care, and Emergency Medicine: A Systematic Review and Meta-Analysis.
Medical technology is expanding at an alarming rate, with its integration into health care often reflected by the constant evolution of best practices. This rapid expansion of available treatment modalities, when coupled with progressively increasing amounts of consequential data for health care professionals to manage, creates an environment where complex and timely decision-making without the aid of technology is inconceivable. Decision support systems (DSSs) were, therefore, developed as a means of supporting the clinical duties of health care professionals through immediate point-of-care referencing. The integration of DSS can be especially useful in critical care medicine, where the combination of complex pathologies, the multitude of parameters, and the general state of patients require swift informed decision-making. The systematic review and meta-analysis were performed to evaluate DSS outcomes compared to the standard of care (SOC) in critical care medicine. ⋯ DSSs were associated with a beneficial impact in critical care medicine on a continuous and binary scale; however, the ED subgroup was found to be inconclusive. Additional RCTs are required to determine the effectiveness of DSS in critical care medicine.
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Anesthesia and analgesia · Jun 2023
Examining Subjective Psychological Experiences of Postoperative Delirium in Older Cardiac Surgery Patients.
Postoperative delirium (POD) is an acute syndrome including inattention and impaired cognition that affects approximately 42% of older cardiac surgical patients. POD is linked to adverse outcomes including morbidity, mortality, and further cognitive decline. Less is known about the subjective psychological experience of POD and its ongoing impact on well-being. ⋯ Our findings emphasize the multidimensional experience of POD and long-term effects on psychological wellbeing. Our research highlights the beneficial role multidisciplinary clinicians play in managing POD including strategies that may be embedded into clinical practice and helps anesthesiologists understand why patients who have experienced POD in the past may present with specific concerns should they require subsequent surgery.
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Anesthesia and analgesia · Jun 2023
Randomized Controlled TrialOutpatient Treatment With Gabapentin in Women With Severe Acute Pain After Cesarean Delivery Is Ineffective: A Randomized, Double-Blind, Placebo-Controlled Trial.
Most of the 1.1 million women who deliver by cesarean in the United States each year have an uncomplicated recovery. However, severe pain resistant to standard multimodal therapy within the first days after surgery is associated with an increased risk for prolonged pain and opioid use. The best outpatient management for parturients with severe resistant early onset pain is not known. ⋯ Outpatient supplementation with gabapentin did not reduce time to opioid cessation, pain, anxiety, depression, fatigue, or improve physical function in women with severe pain after cesarean delivery. Gabapentin should not be routinely added to the standard outpatient multimodal regimen of ibuprofen, acetaminophen, and opioids.
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Anesthesia and analgesia · Jun 2023
Direct Comparison of Peak Bulk Flow Rate of Programmable Intermittent Epidural Bolus and Manual Epidural Bolus Using a Closed-End Multiorifice Catheter: An Experimental Study.
The programmable intermittent epidural bolus (PIEB) has been popularized as the optimal delivery technique for labor analgesia. Suggested advantages of this method are less local anesthetic consumption, improved maternal satisfaction, potentially shorter duration of labor, and decreased workload requirements for the anesthesia providers. However, a manual bolus is still routinely used for breakthrough pain when the PIEB is underperforming. ⋯ Our study found that manual boluses produced a higher flow rate compared to the CADD-Solis epidural pump (Smiths Medical). This study also found that the placement of a particulate filter reduces the flow rates generated while bolusing. Bulk flow rate is directly correlated with induced pressure and solution spread. Because higher bolus pressure has been shown to provide a more efficient distribution of local anesthetic and more efficient pain relief, these results may have impactful clinical significance and will pave the way for future studies.