Journal of anaesthesiology, clinical pharmacology
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J Anaesthesiol Clin Pharmacol · Oct 2018
ReviewA comparative analysis of femoral nerve block with adductor canal block following total knee arthroplasty: A systematic literature review.
Patients undergoing total knee arthroplasty suffer from moderate-to-severe postoperative pain resulting in immobility-related complications and prolonged hospitalization. Femoral nerve block is associated with reduction in the quadriceps strength and increasing incidence of falls. Adductor canal block has been shown to be as effective as femoral nerve block without causing quadriceps weakness. ⋯ Mobilization and ambulation, which are both important for recovery after total knee arthroplasty are both inhibited less by adductor canal block.
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J Anaesthesiol Clin Pharmacol · Apr 2018
ReviewPharmacogenomics of analgesics in anesthesia practice: A current update of literature.
The field of pharmacogenomics seeks to understand how an individual's unique gene sequence can affect their response to certain drugs. It is particularly relevant in anesthesia when the interindividual response to pain medication is essential. Codeine and tramadol are prodrugs metabolized by CYP2D6, polymorphisms of which can cause dangerous or even fatal levels of their metabolites, or decrease the level of metabolites to decrease their analgesic effect. ⋯ Certain haplotypes of COMT have been demonstrated to have an effect on opioid requirements. The OPRM1 gene codes for the mu-opioid receptor, and there is conflicting data regarding its effect on analgesia and opioid requirements. Overall, there is a fair amount of conflicting data in the above topics, suggesting that there is still a lot of research to be done on these topics, and that pain perception is multifactorial, likely including many common genetic variants.
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J Anaesthesiol Clin Pharmacol · Jul 2017
ReviewTemperature management under general anesthesia: Compulsion or option.
Administration of general anesthesia requires continuous monitoring of vital parameters of the body including body temperature. However, temperature continues to be one of the least seriously monitored parameters perioperatively. ⋯ Various warming and cooling devices are available which help maintain perioperative normothermia. This article discusses the physiology of thermoregulation, effects of anesthesia on thermoregulation, various temperature monitoring sites and methods, perioperative warming devices, guidelines for perioperative temperature management and inadvertent temperature complications (hypothermia/hyperthermia) and measures to control it in the operating room.
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J Anaesthesiol Clin Pharmacol · Jan 2017
ReviewThe effect of perioperative esmolol on early postoperative pain: A systematic review and meta-analysis.
Esmolol has been shown to improve postoperative pain and reduce opioid requirements. The aim of this systematic review was to evaluate the effect of perioperative esmolol as an adjunct on early postoperative pain intensity, recovery profile, and anesthetic requirement. Databases were searched for randomized placebo-controlled trials evaluating the effects of esmolol during general anesthesia. ⋯ Esmolol had no effect on the emergence time. Perioperative esmolol as an adjunct may reduce postoperative pain intensity, opioid consumption, and postoperative nausea vomiting. Given the heterogeneity, larger clinical trials are warranted to confirm these findings.
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J Anaesthesiol Clin Pharmacol · Jan 2017
ReviewVasopressors: Do they have any role in hemorrhagic shock?
The priority in the management of patients with traumatic hemorrhagic shock is to control the bleeding with simultaneous volume resuscitation to maintain adequate tissue perfusion. Fluid replacement remains the mainstay of initial resuscitation in hemorrhagic shock. Traditionally, vasopressors are contraindicated in the early management of hemorrhagic shock due to their deleterious consequences, although vasopressors may have a role in resuscitation when vasoplegic shock ensues and blood pressure cannot be maintained by fluids alone. ⋯ The role of vasopressors remains controversial with no clear guidelines on the timing, type, and dose of these drugs in hemorrhagic shock. Among vasopressors, norepinephrine and vasopressin have been used in the majority of the trials, although not many studies compare the effect of these two on long-term survival in trauma patients. This article reviews the pathophysiology of hemorrhagic shock, adverse effects of fluid resuscitation, and the various experimental and clinical studies on the use of vasopressors in the early phase of resuscitation in hemorrhagic shock.