Minerva anestesiologica
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Minerva anestesiologica · Nov 2005
Informed consent to proposed course of medical treatment: recent case law stances.
Developments in ethics, deontology and case law, along with the related increasing demand for patient autonomy in decision-making in health care, led the President of SIAARTI in 2000 to request the Bioethics Commission to revise the documentation on informed content the Study Group on Anesthesia Safety had issued. In response to the request, a multidisciplinary study group was called to examine the ethical, psychological, clinical, legal and medicolegal issues related to informed consent and to draw up a document that would provide for the implementation of the procedure for information and consent proposed in the model of disclosed information and consent for anesthesia approved by the SIAARTI Advisory Board. ⋯ Since 1992, the failure to obtain consent has become part of case law, an exemplary instance of which is the case of a surgeon that was closed in 2002 with the judgment of the Corte di Cassazione (Italian Supreme Court), section I, of 29/05/2002. The judgment found that, in the absence of express implementation of the Oviedo Convention, a physician is always legitimated to performed therapeutic treatment deemed necessary for preserving the life of a patient in his or her care, even in the absence of explicit consent, with the sole but significant exception of unequivocal refusal of treatment.
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In the light of the most recent acquisitions published in the international literature, this review analyzes the pharmacologic features and modes of use of tramadol, one of the most widely used, on a worldwide scale, analgesic agents in acute and chronic pain of moderate to severe intensity. The action of the 2 enantiomers of tramadol--which exert different pharmacologic effects--and of metabolite M1, is differentiated. The global activity of tramadol results from the sum of their specific actions. ⋯ Moreover, tramadol maintains a good tolerability profile in the elderly subjects and a good analgesic efficacy in the long-term treatments with reduced pharmacological interactions and a low incidence of constipation. These global features assured its inclusion into the most recent guidelines on the management of chronic pain. Furthermore, data from literature showed that tramadol is devoid of immunosuppressive activity, has a poor tendency to tolerance and a minimum risk of addiction and abuse.
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Postoperative pain treatment is the challenge of the new century; we know that even starting from the 24(th) week of gestational age, the fetus can feel pain and that memory of uncontrolled pain can change the pain threshold in children. We have now new drugs and new tools for an optimal pain control also in children and this review is an update on the new therapies and devices which can help us in the daily clinical practice.