Minerva anestesiologica
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Minerva anestesiologica · Apr 2018
Perioperative pain management in cardiac surgery: a systematic review.
Every year, more than 1.5 million patients, who undergo cardiac surgery worldwide, are exposed to a series of factors that can trigger acute postoperative pain associated with hemodynamic instability, respiratory complications, and psychological disorders. Through an evaluation of literature data about postoperative pain in cardiac surgery we define unmet needs and potential objectives for future research on this often-underestimated problem. ⋯ Over the past 17 years, opioids are still the most extensively used therapy, whereas we found only few trials investigating other drugs (e.g. paracetamol). Regional anesthesia techniques, especially thoracic epidural analgesia and intrathecal morphine administration, can effectively treat pain, but have not yet showed any significant impact on major clinical outcomes, with several concerns related to their potential complications. To date multimodal analgesia with implementation of regional analgesia seems to be the best choice. In the future, better-designed studies should consider other drugs stratifying groups according to comorbidities and risk factors, as well as using standardized units of measurement.
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There is an increased interest in the current literature to evaluate the potential clinical benefit of a sustained deep neuromuscular blockade (i.e. a post-tetanic count ≤3) during various laparoscopic surgical procedures. This deep block concept represents a new area of clinical research, which concerns both, anesthesiologists and surgeons. We reviewed a selection of recent publications about the indications and the potential benefits of a maintained deep neuromuscular blockade during different laparoscopic procedures. ⋯ Moreover, first evidence suggests that deep block may reduce perioperative surgical complications and improve patient's outcome. There are situations during laparoscopic surgery where a better communication between surgeon and anesthesiologist may improve patient's outcome. Moreover, clinical research has now to identify which additional procedures and type of patients may benefit most from this new deep block concept and ultimately, whether the implementation of a routine deep neuromuscular block may affect patient's outcome.