Articles: postoperative.
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Frontiers in pharmacology · Jan 2014
ReviewIntraoperative use of remifentanil and opioid induced hyperalgesia/acute opioid tolerance: systematic review.
The use of opioids has been increasing in operating room and intensive care unit to provide perioperative analgesia as well as stable hemodynamics. However, many authors have suggested that the use of opioids is associated with the expression of acute opioid tolerance (AOT) and opioid-induced hyperalgesia (OIH) in experimental studies and clinical observations in dose and/or time dependent exposure even when used within the clinically accepted doses. Recently, remifentanil has been used for pain management during anesthesia as well as in the intensive care units because of its rapid onset and offset. ⋯ AOT - defined as an increase in the required opioid dose to maintain adequate analgesia, and OIH - defined as decreased pain threshold after chronic opioid treatment, should be suspected with any unexplained pain report unassociated with the disease progression. The clinical significance of these findings was evaluated taking into account multiple methodological issues including the dose and duration of opioids administration, the different infusion mode, the co-administrated anesthetic drug's effect, method assessing pain sensitivity, and the repetitive and potentially tissue damaging nature of the stimuli used to determine the threshold during opioid infusion. Future studies need to investigate the contribution of remifentanil induced hyperalgesia to chronic pain and the role of pharmacological modulation to reverse this process.
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National reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely to rise as the population ages, this review summarises the evidence on which such guidance is based, and provides information about how anaesthetists might participate in audit and research aimed at improving local and national outcomes for these most vulnerable of patients.
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Frontiers in pharmacology · Jan 2014
ReviewThe effect of transdermal scopolamine for the prevention of postoperative nausea and vomiting.
Postoperative nausea and vomiting (PONV) is one of the most common and undesirable complaints recorded in as many as 70-80% of high-risk surgical patients. The current prophylactic therapy recommendations for PONV management stated in the Society of Ambulatory Anesthesia (SAMBA) guidelines should start with monotherapy and patients at moderate to high risk, a combination of antiemetic medication should be considered. Consequently, if rescue medication is required, the antiemetic drug chosen should be from a different therapeutic class and administration mode than the drug used for prophylaxis. ⋯ Clinical trials with transdermal scopolamine have consistently demonstrated its safety and efficacy in PONV. Thus, scopolamine is a promising candidate for the management of PONV in adults as a first line monotherapy or in combination with other drugs. In addition, transdermal scopolamine might be helpful in preventing postoperative discharge nausea and vomiting owing to its long-lasting clinical effects.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2014
Review[Coagulation disorders in the context of cardiac surgery - Clinical basics and mechanism based therapy].
Intra- and postoperative bleeding disorders are common in cardiac surgery. The etiology of perioperative coagulopathy frequently becomes apparent as a combination of several acquired and inherited disorders. ⋯ Point-of-care-systems can provide fast bed-sided analysis, which contribute to early diagnosis and intervention. Individual and regularly revised algorithms, adapted to the individualized institutional infrastructure, may facilitate resource-saving treatment of perioperative coagulopathy.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2014
Review[Nausea and vomiting after anaesthesia for children - Big problems for little patients].
Postoperative nausea and vomiting are undesirable and unpleasant side effects after surgery and anaesthesia associated with delayed oral intake and postoperative recovery, and impaired parental satisfaction. Since current modalities against PONV are cheap, highly effective, and almost free from relevant side-effects - providing contraindications are appropriately considered -, recommendations tend to move away from risk-score guided administration of antiemetic towards a more liberal administration policy or even favour routine administration to children undergoing general anaesthesia for surgery combined with total-intrevanous anaesthesia using propfol and reduction of perioperative opioid administration.