Anesthesiology clinics of North America
-
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.
-
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.
-
Anesthesiol Clin North America · Mar 2005
ReviewMultimodal analgesia techniques and postoperative rehabilitation.
The concept of multimodal analgesia involves the use of different classes of analgesics and different sites of analgesic administration to provide superior dynamic pain relief with reduced analgesic-related side effects. Although multimodal analgesia techniques have assumed increasing importance in the management of perioperative pain, it has become increasingly apparent that postoperative outcome may not be improved. Nevertheless, the integration of multimodal analgesia techniques with a multimodal and multidisciplinary rehabilitation program may enhance recovery, reduce hospital stay, and facilitate early convalescence.
-
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.
-
Anesthesiol Clin North America · Dec 2004
ReviewThe transplant recipient for nontransplant surgery.
The transplant recipient has traded a life-threatening illness for a chronically immunosuppressed state. Subsequent anesthetic management for non-transplant surgical procedures may be challenging. The anesthesia provider must be aware of the degree of post-transplant organ dysfunction and alter anesthesia techniques accordingly. This article reviews the anesthetic concerns for patients who have undergone a variety of organ transplants.