Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Dec 2002
ReviewCellular mechanisms of opioid tolerance and the clinical approach to the opioid tolerant patient in the post-operative period.
The high prevalence of opioid use for recreational purposes in the USA and the European Union, as well as the use of opioids for the treatment of chronic non-malignant pain, has resulted in an increase in the number of patients with opioid tolerance who undergo surgery and require post-operative pain management. The approach to post-operative pain control in these patients is significantly different to the strategies used in opioid naïve patients. Fortunately, better understanding of the cellular mechanisms of opioid tolerance in animals has resulted in the transfer of concepts from the 'bench' to the clinical arena. This chapter describes the new developments in opioid tolerance and how this knowledge can be applied to clinical practice.
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Best Pract Res Clin Anaesthesiol · Dec 2002
ReviewEpidural and intrathecal analgesia for cancer pain.
The three-step analgesic ladder approach developed by the World Health Organization works well in treating the vast majority (70-90%) of patients suffering from pain related to cancer. In those patients who do not get pain relief by this three-step approach, intraspinal agents can be a fourth step in managing pain of malignant origin. ⋯ Many non-opioid agents have also been used intraspinally either alone or in combination with opioids in the treatment of intractable cancer pain. This chapter summarizes the clinical use of these agents with some practical points.
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Best Pract Res Clin Anaesthesiol · Dec 2002
ReviewFrom pain research to pain treatment: the role of human experimental pain models.
There is no objective measure of a complete pain perception; we can, however, measure different aspects of nociceptive processing and pain perception. Earlier, experimental pain models often only involved induction of cutaneous pain using a single stimulus modality. Recently new experimental models have been developed eliciting various modalities of deep and visceral pain which more closely resemble clinical pain conditions. ⋯ However, in spite of our immense knowledge, we still do not know how to prevent and treat this hyperexcitability efficiently. Our understanding of nociceptive mechanisms involved in acute and chronic pain and the effects of anaesthetic drugs or combinations of drugs on these mechanisms in humans may also be expanded using human experimental models. This mechanism-based approach may help us to develop and test therapeutic regimes in patients with acute and chronic pain.
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Best Pract Res Clin Anaesthesiol · Sep 2002
Anaesthetic team and the role of nurses--European perspective.
The only evidence in favour of the provision of assistance for anaesthesiologists seems to be that single-handed anaesthesiologists generate higher anaesthetic mortality than does a team system. In mainland Europe, the independent scope of the practice of nurse anaesthetists has been constrained while possible new roles for nurses have been suggested in the United Kingdom. ⋯ To attract people of this calibre, their role will have to offer some degree of clinical autonomy over the management of general anaesthesia. Considerations of safety will constrain this autonomy but the introduction of a monitor of anaesthetic depth and sophisticated communication systems will relieve anxiety about this development.
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Best Pract Res Clin Anaesthesiol · Sep 2002
Anaesthetic team and the role of nurses--North American perspective.
Anaesthesia is an American invention but the development of anaesthesia practice took two paths at its inception. The American-based ether anaesthetic technique allowed for non-physician personnel to administer the drug. ⋯ This article discusses the historical events leading to the development of nurse anaesthesia practice in the USA. The current status of physician and nurse anaesthetist interactions--both harmonious and acrimonious--are presented.