Anesthesiology clinics of North America
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This review focuses on perioperative blood conservation techniques and the role of transfusion triggers and algorithms, preoperative autologous donation, acute normovolemic hemodilution, intraoperative blood salvage, deliberate hypotension, and preoperative recombinant human erythropoietin in avoiding allogeneic blood transfusion in pediatric patients.
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Procedure-specific postoperative pain management guidelines arguably are more helpful to the clinician than general pain guidelines or guidelines based on the use of the Oxford League Tables. Two sources, the United States Veteran's Health Administration and the European Prospect Working Group, offer websites that include surgical procedure-specific postoperative pain management guidelines, which are available and currently updated.
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Postoperative, incisional pain is a unique but common form of acute pain. Because effective postoperative analgesia reduces morbidity following surgery, new treatments continue to be sought. It is through the development of investigational models and studies of the mechanisms that perioperative medicine can be advanced. This article reviews studies on a rat plantar hindpaw model for postoperative pain and proposes mechanisms for enhanced excitability of sensory neurons caused by incisions.
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Anesthesiol Clin North America · Mar 2005
ReviewPostoperative care of the chronic opioid-consuming patient.
Recently, there has been a significant increase in the use of opioid analgesics for chronic pain in the outpatient setting. As a result, anesthesiologists are commonly presented with the dilemma of treating acute postoperative pain in patients who do not receive adequate analgesia with conventional doses of opioid. This article presents a practical approach to treating postoperative pain in the chronic opioid-consuming patient. Specifically, a technique based on pharmacokinetic modeling is described that predicts safe and therapeutic opioid dosing in these patients.
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Anesthesiol Clin North America · Mar 2005
ReviewOrganization, function, and implementation of acute pain service.
Undertreatment of postoperative pain continues to be a major problem internationally. The solution does not seem to be the development of new analgesic drugs or technologies but the development of an appropriate organization that utilizes existing expertise. ⋯ Although the number of hospitals with an APS is increasing, the literature is unclear about the optimal structure, staffing, and function. There is a need for the development of well-defined APS criteria with which to assess performance and compare with national standards.