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Best Practice & Research. Clinical Anaesthesiology

journal
https://www.readbyqxmd.com/read/29739543/special-indications-for-opioid-free-anaesthesia-and-analgesia-patient-and-procedure-related-including-obesity-sleep-apnoea-chronic-obstructive-pulmonary-disease-complex-regional-pain-syndromes-opioid-addiction-and-cancer-surgery
#1
REVIEW
Adrian Sultana, David Torres, Roman Schumann
Opioid-free anaesthesia (OFA) is a technique where no intraoperative systemic, neuraxial or intracavitary opioid is administered with the anaesthetic. Opioid-free analgesia similarly avoids opioids in the perioperative period. There are many compelling reasons to avoid opioids in the surgical population. A number of case reports and, increasingly, prospective studies from all over the world support its benefits, especially in the morbidly obese population with or without sleep apnoea. A derivative technique is opioid sparing, where the same techniques are used but some opioid use is allowed...
December 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29739542/different-protocols-used-today-to-achieve-total-opioid-free-general-anesthesia-without-locoregional-blocks
#2
REVIEW
Eckhard Mauermann, Wilhelm Ruppen, Oliver Bandschapp
With increasing awareness of both short- and long-term problems associated with liberal perioperative opioid administration, the need for routinely and clinically feasible alternatives is greater than ever. Opioid-free anesthesia-previously reserved for bariatric surgery-is receiving increasing attention in mainstream anesthesia. In this review, we present the truly multimodal concept of opioid-free anesthesia, which circumvents a number of opioid-related problems. For a concrete clinical perspective, we present in depth our opioid-free protocol for bariatric surgery...
December 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29739541/stable-anesthesia-with-alternative-to-opioids-are-ketamine-and-magnesium-helpful-in-stabilizing-hemodynamics-during-surgery-a-systematic-review-and-meta-analyses-of-randomized-controlled-trials
#3
REVIEW
Patrice Forget, Juan Cata
INTRODUCTION: The role of ketamine and magnesium in improving postoperative pain and diminish opioid consumption has been largely described. Synthetic opioids are known to provide hemodynamic stability when given for major noncardiac surgery. Definitive evidence on the role of ketamine and/or magnesium on intraoperative hemodynamic control would support their potential as alternatives to opioids during surgery. METHODS: The available literature published on PubMed/Medline and EMBASE was reviewed systematically to perform meta-analyses of randomized controlled trials (RCTs) assessing the effect of ketamine and/or magnesium on hemodynamic response to surgery as the primary outcome...
December 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29739540/intravenous-lidocaine
#4
REVIEW
Jean-Pierre Estebe
Lidocaine has analgesic effect and antihyperalgesic and anti-inflammatory properties, which enable its use as a general anesthetic adjuvant. Lidocaine can reduce nociception and/or cardiovascular responses to surgical stress, postoperative pain, and/or analgesic requirements. However, its mechanisms of action remain unclear, despite its different known properties. Although the exact mechanism of action remains uncertain, initial bolus followed by a continuous lidocaine infusion has clear analgesic benefits...
December 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29739539/additives-used-to-reduce-perioperative-opioid-consumption-1-alpha2-agonists
#5
REVIEW
Peter H Tonner
Because of their significant side effects, especially in obese patients, the routine perioperative use of opioids has been questioned recently. Alpha2 -agonists are drugs with a considerable analgesic potency with the potential to reduce opioid consumption. Alpha2 -agonists bind to alpha2 -adrenergic receptors in the CNS and peripherally. They inhibit the central sympathetic outflow, resulting in an attenuation of blood pressure and heart rate and in a sparing effect on anaesthetics and analgesics. In the postoperative period alpha2 -agonists provide an analgesic effect without respiratory depression and other known opioid side effects...
December 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29739538/opioid-related-side-effects-postoperative-ileus-urinary-retention-nausea-and-vomiting-and-shivering-a-review-of-the-literature
#6
REVIEW
Hans Donald de Boer, Olivier Detriche, Patrice Forget
Opioids are widely used in clinical anesthesia. However, side effects include postoperative nausea and vomiting, shivering, ileus, and urine retention and are specifically discussed here. From the available evidence, it appears that the use of opioids is strongly associated with impaired gastrointestinal motility. Therefore, to prevent postoperative ileus, the use of opioids should be minimized and opioids should be replaced by other drugs. With regard to the risk of postoperative urinary retention, one problem is the lack of standardized definition...
December 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29739537/opioid-free-anesthesia-opioid-side-effects-tolerance-and-hyperalgesia
#7
REVIEW
Patricia Lavand'homme, Arnaud Steyaert
Opioids are the most potent drugs used to control severe pain. However, neuroadaptation prevents opioids' ability to provide long-term analgesia and produces opposite effects, i.e., enhancement of existent pain and facilitation of chronic pain development. Neuroadaptation to opioids use results in the development of two interrelated phenomena: tolerance and "opioid-induced hyperalgesia" (OIH). Tolerance, a pharmacologic concept, and OIH, a clinical syndrome, have been mostly observed under experimental conditions in animals and in human volunteers...
December 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29739536/opioids-respiratory-depression-and-sleep-disordered-breathing
#8
REVIEW
Mahesh Nagappa, Toby N Weingarten, Gaspard Montandon, Juraj Sprung, Frances Chung
The increasing use of opioids in the perioperative period has increased opioid-associated morbidity and mortality. There is a well-established connection between opioids, sleep-disordered breathing (SDB), and respiratory depression. The treatment of postoperative pain with opioids in patients with SDB may result in respiratory depression. In an unmonitored setting, it may lead to life-threatening respiratory events. More studies are required to evaluate the effective management and prevention of respiratory depression in patients with SDB...
December 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29739535/do-we-feel-pain-during-anesthesia-a-critical-review-on-surgery-evoked-circulatory-changes-and-pain-perception
#9
REVIEW
A Cividjian, F Petitjeans, N Liu, M Ghignone, M de Kock, L Quintin
The difficulty of defining the three so-called components of « an-esthesia » is emphasized: hypnosis, absence of movement, and adequacy of anti-nociception (intraoperative « analgesia »). Data obtained from anesthetized animals or humans delineate the activation of cardiac and vasomotor sympathetic reflex (somato-sympathetic reflex) and the cardiac parasympathetic deactivation observed following somatic stimuli. Sympathetic activation and parasympathetic deactivation are used as monitors to address the adequacy of intraoperative anti-nociception...
December 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29739534/opioid-free-general-anesthesia-a-new-paradigm
#10
EDITORIAL
J Mulier, M Dekock
No abstract text is available yet for this article.
December 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29248148/acute-kidney-injury-in-pediatric-patients
#11
REVIEW
David M Kwiatkowski, Scott M Sutherland
Acute kidney injury (AKI) is highly prevalent among hospitalized children, especially those who are critically ill. The incorporation of pediatric elements into consensus definitions has led to a greater understanding of pediatric AKI epidemiology, risk factors, and outcomes. The best available data suggest that AKI occurs in 5% and 27% of non-critically ill and critically ill children, respectively. Additionally, AKI and fluid overload are independently associated with worse outcomes including mortality. Currently, the diagnosis of AKI relies upon urine output and creatinine measurements, both of which pose unique problems in children...
September 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29248147/sequelae-of-aki
#12
REVIEW
Samir S Patel, Carlos E Palant, Vrinda Mahajan, Lakhmir S Chawla
Large epidemiologic studies in a variety of patient populations reveal increased morbidity and mortality that occur months to years after an episode of acute kidney injury (AKI). Even milder forms of AKI have increased associated morbidity and mortality. Residual confounding may account for these findings, but considering the huge number of individuals afflicted with AKI, the sequelae of AKI may be a very large public health burden. AKI may simply be a marker for increased risk, but there is increasing evidence that it is part of the causal pathway to chronic kidney disease...
September 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29248146/renal-recovery
#13
REVIEW
Ivan Göcze, Christina Wiesner, Hans J Schlitt, Tobias Bergler
Recovery patterns after acute kidney injury (AKI) have increasingly become the focus of research, because currently available preventive measures and specific therapeutic intervention are limited. Moreover, changes in renal functional reserve are recognized as a "hidden" indicator of kidney susceptibility to either acute kidney injury or chronic kidney disease. Understanding these phenomena and their association with outcome may enable the initiation of strategies that facilitate fast and sustained recovery during the time course of AKI and limit AKI progression towards chronic kidney disease...
September 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29248145/renal-replacement-therapy-and-anticoagulation
#14
REVIEW
Timo Brandenburger, Thomas Dimski, Torsten Slowinski, Detlef Kindgen-Milles
Today, up to 20% of all intensive care unit patients require renal replacement therapy (RRT), and continuous renal replacement therapies (CRRT) are the preferred technique. In CRRT, effective anticoagulation of the extracorporeal circuit is mandatory to prevent clotting of the circuit or filter and to maintain filter performance. At present, a variety of systemic and regional anticoagulation modes for CRRT are available. Worldwide, unfractionated heparin is the most widely used anticoagulant. All systemic techniques are associated with significant adverse effects...
September 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29248144/renal-replacement-therapy-for-aki-when-how-much-when-to-stop
#15
REVIEW
Stefano Romagnoli, William R Clark, Zaccaria Ricci, Claudio Ronco
Severe acute kidney injury (AKI) requiring renal replacement therapy (RRT) is a serious clinical disorder in the intensive care unit (ICU), occurring in a significant proportion of critically ill patients. However, many questions remain about the optimal administration of RRT with regard to several important considerations, including treatment dose, timing of treatment initiation and cessation, therapy mode, type of anticoagulation, and management of fluid overload. While Level 1 evidence exists for RRT dosing in AKI, all the studies contributing to this evidence base employed fixed-dose regimens throughout a patient's continuous RRT (CRRT) course, without regard for the possibility of individualizing treatment dose according to the clinical status of a given patient at a specific time...
September 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29248143/prevention-of-acute-kidney-injury
#16
REVIEW
Melanie Meersch, Stephanie Volmering, Alexander Zarbock
Acute kidney injury is a prevalent but underdiagnosed complication that is associated with increased in-hospital morbidity and mortality. The importance of this complication is being increasingly recognized. The lack of timely diagnostic methods and effective preemptive and therapeutic strategies make its perioperative management challenging. To reduce the incidence of acute kidney injury, it is crucial to focus the resources on high-risk patients who can be identified by clinical scoring systems with a high predictive value and newly developed renal biomarkers...
September 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29248142/impact-of-e-alert-systems-on-the-care-of-patients-with-acute-kidney-injury
#17
REVIEW
Crystal M Breighner, Kianoush B Kashani
With the recent advancement in electronic health record systems and meaningful use of information technology incentive programs (i.e., the American Recovery and Reinvestment Act, the Health Information Technology for Economic and Clinical Health Act, and the Centers for Medicare & Medicaid Services), interest in clinical decision support systems has risen. These systems have been used to examine a variety of different syndromes with variable reported effects. In recent years, electronic alerts (e-alerts) have been implemented at various institutions to decrease the morbidity associated with acute kidney injury (AKI)...
September 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29248141/impact-of-volume-status-and-volume-therapy-on-the-kidney
#18
REVIEW
David A Roberts, Andrew D Shaw
Volume resuscitation to correct hypotension in surgical and critically ill patients is a common practice. Available evidence suggests that iatrogenic volume overload is associated with worse outcomes in established acute kidney injury. Intraoperative arterial hypotension is associated with postoperative renal dysfunction, and prompt correction with fluid management protocols that combine inotrope infusions with volume therapy targeted to indices of volume responsiveness should be considered. From the perspective of renal function, the minimum amount of intravenous fluid required to maintain perfusion and oxygen delivery is desirable...
September 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29248140/biomarkers-in-acute-kidney-injury-aki
#19
REVIEW
Su Hooi Teo, Zoltán Huba Endre
Acute kidney injury is common in critically ill patients and portends a significant impact on mortality, progressive chronic kidney disease, and cardiovascular disease and mortality. Though most physicians alter therapy depending on changes in serum creatinine, this often represents delayed intervention. Various AKI biomarkers have been discovered and validated to improve timely detection, differentiation and stratification into risk groups for progressive renal decline, need for renal replacement therapy or death...
September 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29248139/the-macro-and-microcirculation-of-the-kidney
#20
REVIEW
Philippe Guerci, Bulent Ergin, Can Ince
Acute kidney injury (AKI) remains one of the main causes of morbidity and mortality in the intensive care medicine today. Its pathophysiology and progress to chronic kidney disease is still under investigation. In addition, the lack of techniques to adequately monitor renal function and microcirculation at the bedside makes its therapeutic resolution challenging. In this article, we review current concepts related to renal hemodynamics compromise as being the event underlying AKI. In doing so, we discuss the physiology of the renal circulation and the effects of alterations in systemic hemodynamics that lead to renal injury specifically in the context of reperfusion injury and sepsis...
September 2017: Best Practice & Research. Clinical Anaesthesiology
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