Anesthesiology clinics
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Anesthesiology clinics · Mar 2011
An anesthesiology department leads culture change at a hospital system level to improve quality and patient safety.
At New York-Presbyterian Hospital, Weill Cornell Medical Center, an innovative approach to involving housestaff in quality and patient safety, policy and procedure creation, and culture change was led by the Department of Anesthesiology of the Weill Medical College of Cornell University. A Housestaff Quality Council was started in 2008 that has partnered with hospital leadership and clinical departments to engage the housestaff in quality and patient safety initiatives, resulting in measurable improvements in several patient care projects and enhanced working relationships among various clinical constituencies. Ultimately this attempt to change culture has found great success in fostering a relationship between the housestaff and the hospital in ways that have and will continue to improve patient care.
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Acetaminophen has unique analgesic and antipyretic properties. It is globally recommended as a first-line agent for the treatment of fever and pain due to its few contraindications. ⋯ This use may have important implications for management of postoperative pain and fever. This review summarizes recent clinical trial experiences with intravenous acetaminophen for the treatment of postoperative pain and fever in adult and pediatric subjects.
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Anesthesiology clinics · Dec 2010
ReviewAdvances in perioperative pain management: use of medications with dual analgesic mechanisms, tramadol & tapentadol.
Recovery from ambulatory surgical procedures can be limited by postoperative pain. Inadequate analgesia may delay or prevent patient discharge and can result in readmission. More frequently, postoperative pain produces discomfort and interrupts sleep, contributing to postoperative fatigue. ⋯ In contrast to pure opioid agonists, both drugs are believed to have lower risks of respiratory depression, tolerance, and dependence. The Food and Drug Administration has approved both drugs for the treatment of moderate-to-severe acute pain in adults. This article provides an evidence-based account of the role of tramadol and tapentadol in modern clinical practice.
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Anesthesiology clinics · Dec 2010
ReviewSugammadex: cyclodextrins, development of selective binding agents, pharmacology, clinical development, and future directions.
Neuromuscular blocking agents are widely used in perioperative medicine to aid in endotracheal intubation, facilitate surgery, and in critical care/emergency medicine settings. Muscle relaxants have profound clinical uses in current surgical and intensive care and emergency medical therapy. This article reviews cyclodextrins, development of selective binding agents, clinical development, and future directions of sugammadex.
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Anesthesiology clinics · Dec 2010
ReviewCurrent and developing methods of patient-controlled analgesia.
Moderate-to-severe acute postoperative pain is commonly controlled with opioids administered via programmable intravenous (IV) patient-controlled analgesia (PCA) infusion pumps. Intravenously administered opioids provide effective relief of postoperative pain, and IV PCA enables patients to control their level of analgesia, which has advantages over nurse-administered approaches, including more satisfied patients and improved pain relief. Unfortunately, commonly used opioid analgesics can cause significant adverse effects. ⋯ Consequently, respiratory depression, excessive sedation, and inadequate pain control can occur. Furthermore, the technical assembly of an infusion pump is often complex and time-consuming. PCA modalities that incorporate superior opioid analgesics, such as sufentanil, and novel noninvasive routes of administration offer great promise for enhancing the patient and caregiver experience with the use of postoperative PCA.