Articles: chronic.
-
Anaesth Intensive Care · Mar 2022
ReviewThe complications of opioid use during and post-intensive care admission: A narrative review.
Opioids are a commonly administered analgesic medication in the intensive care unit, primarily to facilitate invasive mechanical ventilation. Consensus guidelines advocate for an opioid-first strategy for the management of acute pain in ventilated patients. ⋯ Consequently, there is a challenge of optimising analgesia while minimising these adverse effects. This narrative review will discuss the characteristics of opioid use in the intensive care unit, outline the potential short-term and long-term adverse effects of opioid therapy in critically ill patients, and outline a multifaceted strategy for opioid minimisation.
-
Anesthesia and analgesia · Mar 2022
Association Between Changes in Postoperative Opioid Utilization and Long-Term Health Care Spending Among Surgical Patients With Chronic Opioid Utilization.
There is growing interest in identifying and developing interventions aimed at reducing the risk of increased, long-term opioid use among surgical patients. While understanding how these interventions impact health care spending has important policy implications and may facilitate the widespread adoption of these interventions, the extent to which they may impact health care spending among surgical patients who utilize opioids chronically is unknown. ⋯ Among patients with chronic opioid utilization before surgery, subsequent increases in opioid utilization during the first postoperative year were associated with increased health care spending during that timeframe, while subsequent decreases in opioid utilization were associated with decreased health care spending.
-
A 37-year-old woman presented to the ED in Singapore with a 6-month history of chronic cough and dyspnea that was associated with small volume hemoptysis, night sweats and occasional fever. Of note, she had no sick contacts or recent travel. Systemic review revealed no loss of weight or appetite and no autoimmune features. She had no other medical history and was a lifelong nonsmoker and was not an alcoholic.
-
A 33-year-old man with obesity, systemic arterial hypertension, and psoriasis who had been treated previously with little success by a pulmonologist for chronic unproductive irritant cough came to the outpatient pulmonary department because of profuse cough and short syncope (probably cough-induced). Chest radiography revealed widened mediastinum with lobular, polycyclic contours that was suspected to be a large mediastinal lymphadenopathy or mediastinal mass.
-
A 74-year-old man presented to the ED with acute chronic exertional dyspnea of 5-day duration. As part of his previous evaluation, 5 months earlier, he had undergone cardiopulmonary stress testing, routine laboratory evaluation, and chest radiography that were unremarkable. Over the subsequent months, he had waxing and waning exercise capacity until his incident hospitalization; the exercise was limited to < 40 meters. ⋯ On physical examination, he was afebrile and normotensive with a sinus tachycardia of 125 beats per minute. He was noted to be tachypneic with a respiratory rate of 24 breaths per minute and saturation of 95% on room air. Examination of the chest showed diminished breath sounds over left lower lung fields with scattered end expiratory wheezing.