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https://www.readbyqxmd.com/read/29049114/alternatives-to-opioids-in-the-pharmacologic-management-of-chronic-pain-syndromes-a-narrative-review-of-randomized-controlled-and-blinded-clinical-trials
#1
REVIEW
Andrea L Nicol, Robert W Hurley, Honorio T Benzon
Chronic pain exerts a tremendous burden on individuals and societies. If one views chronic pain as a single disease entity, then it is the most common and costly medical condition. At present, medical professionals who treat patients in chronic pain are recommended to provide comprehensive and multidisciplinary treatments, which may include pharmacotherapy. Many providers use nonopioid medications to treat chronic pain; however, for some patients, opioid analgesics are the exclusive treatment of chronic pain...
November 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28979762/ketamine-for-pain
#2
REVIEW
Kelly Jonkman, Albert Dahan, Tine van de Donk, Leon Aarts, Marieke Niesters, Monique van Velzen
The efficacy of the N-methyl-D-aspartate receptor antagonist ketamine as an analgesic agent is still under debate, especially for indications such as chronic pain. To understand the efficacy of ketamine for relief of pain, we performed a literature search for relevant narrative and systematic reviews and meta-analyses. We retrieved 189 unique articles, of which 29 were deemed appropriate for use in this review. Ketamine treatment is most effective for relief of postoperative pain, causing reduced opioid consumption...
2017: F1000Research
https://www.readbyqxmd.com/read/29135598/cardiac-arrest-in-the-operating-room-resuscitation-and-management-for-the-anesthesiologist-part-1
#3
Vivek K Moitra, Sharon Einav, Karl-Christian Thies, Mark E Nunnally, Andrea Gabrielli, Gerald A Maccioli, Guy Weinberg, Arna Banerjee, Kurt Ruetzler, Gregory Dobson, Matthew McEvoy, Michael F O'Connor
Cardiac arrest in the operating room and procedural areas has a different spectrum of causes (ie, hypovolemia, gas embolism, and hyperkalemia), and rapid and appropriate evaluation and management of these causes require modification of traditional cardiac arrest algorithms. There is a small but growing body of literature describing the incidence, causes, treatments, and outcomes of circulatory crisis and perioperative cardiac arrest. These events are almost always witnessed, frequently known, and involve rescuer providers with knowledge of the patient and their procedure...
November 10, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29181841/epidural-therapy-for-the-treatment-of-severe-pre-eclampsia-in-non-labouring-women
#4
REVIEW
Amita Ray, Sujoy Ray
BACKGROUND: Pre-eclampsia is a pregnancy-specific multi-organ disorder, which is characterised by hypertension and multisystem organ involvement and which has significant maternal and fetal morbidity and mortality. Failure of the placental vascular remodelling and reduced uteroplacental flow form the etiopathological basis of pre-eclampsia. There are several established therapies for pre-eclampsia including antihypertensives and anticonvulsants. Most of these therapies aim at controlling the blood pressure or preventing complications of elevated blood pressure, or both...
November 28, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28542848/change-of-transfusion-and-treatment-paradigm-in-major-trauma-patients
#5
P Stein, A Kaserer, K Sprengel, G A Wanner, B Seifert, O M Theusinger, D R Spahn
Trauma promotes trauma-induced coagulopathy, which requires urgent treatment with fixed-ratio transfusions of red blood cells, fresh frozen plasma and platelet concentrates, or goal-directed administration of coagulation factors based on viscoelastic testing. This retrospective observational study compared two time periods before (2005-2007) and after (2012-2014) the implementation of changes in trauma management protocols which included: use of goal-directed coagulation management; admission of patients to designated trauma centres; whole-body computed tomography scanning on admission; damage control surgery; permissive hypotension; restrictive fluid resuscitation; and administration of tranexamic acid...
November 2017: Anaesthesia
https://www.readbyqxmd.com/read/29115823/an-overview-of-the-clinical-uses-pharmacology-and-safety-of-modafinil
#6
Eric Murillo-Rodríguez, André Barciela Veras, Nuno Barbosa Rocha, Henning Budde, Sérgio Machado
Modafinil (MOD) is a wakefulness-inducing compound prescribed for treatment of excessive daytime sleepiness as a consequence of sleep disturbances such as shift work sleep disorder, obstructive sleep apnea, restless leg syndrome, or narcolepsy. While providing effective results in patients with sleepiness, MOD also produces positive outcomes in the management of fatigue associated with different conditions including depression, cancer, or tiredness in military personnel. Although there is clear evidence of the stimulant effects of MOD, current data also show that administration of this drug apparently induces positive neurobiological effects, such as improvement in memory...
February 21, 2018: ACS Chemical Neuroscience
https://www.readbyqxmd.com/read/29126680/anesthetic-and-perioperative-considerations-for-combined-heart-kidney-transplantation
#7
Santiago Mc Loughlin, Juan C Bianco, Ricardo G Marenchino
OBJECTIVE: To describe detailed perioperative features of combined heart and kidney transplant (HKT). DESIGN: Retrospective study. SETTING: Tertiary care university hospital. PARTICIPANTS: All consecutive HKT recipients aged 18 years and older. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: After approval of the Institutional Review Board, the authors studied all consecutive adult patients who underwent HKT between January 2013 and July 2016...
February 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29169671/enhanced-recovery-in-patients-having-free-tissue-transfer-for-head-and-neck-cancer-does-it-make-a-difference
#8
M Bater, W King, J Teare, J D'Souza
Programmes for Enhanced Recovery after Surgery (ERAS) accelerate recovery, reduce morbidity, and shorten hospital stay in a wide range of surgical specialties. We established a standardised multimodal ERAS pathway for patients who were being treated by free tissue transfer for head and neck cancer to evaluate its benefit. Our primary outcome was duration of hospital stay, and secondary outcomes included complications, number of days to first mobilisation, and readmission rates. We compared 100 consecutive patients who followed the ERAS programme with a control group of 40 consecutive patients who had free tissue transfer before the ERAS programme was introduced...
December 2017: British Journal of Oral & Maxillofacial Surgery
https://www.readbyqxmd.com/read/29122652/how-can-we-best-reduce-pain-catastrophizing-in-adults-with-chronic-noncancer-pain-a-systematic-review-and-meta-analysis
#9
REVIEW
Robert Schütze, Clare Rees, Anne Smith, Helen Slater, Jared M Campbell, Peter O'Sullivan
Pain catastrophizing (PC), defined as an exaggerated negative cognitive-affective orientation toward pain, is one of the strongest psychological predictors of pain outcomes. Although regularly included as a process variable in clinical trials, there have been no comprehensive reviews of how it can be modified. Using a registered protocol (PROSPERO 2016 CRD42016042761), we searched MEDLINE, PsychINFO, EMBASE, CINAHL, and CENTRAL up to November 2016 for all randomized controlled trials measuring PC in adults with chronic noncancer pain...
March 2018: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/28932964/treatment-strategies-for-the-opioid-dependent-patient
#10
REVIEW
Shweta Teckchandani, Meredith Barad
PURPOSE OF REVIEW: This review is intended to help the headache physician think through and plan for management issues concerning the use of opioids. We ask the headache physician to consider if there are instances where prescribing or continuing prescriptions of opiates is plausible, and if so, how can the physician proceed as safely as possible. Our goal is to start a conversation regarding the inevitable encounter with a patient on opiates or requesting opiates. RECENT FINDINGS: The use of opiates in our society has reached a crisis in staggering death and addiction rates...
September 20, 2017: Current Pain and Headache Reports
https://www.readbyqxmd.com/read/28132136/multimodal-analgesia-current-concepts-and-acute-pain-considerations
#11
REVIEW
Erik M Helander, Bethany L Menard, Chris M Harmon, Ben K Homra, Alexander V Allain, Gregory J Bordelon, Melville Q Wyche, Ira W Padnos, Anna Lavrova, Alan D Kaye
PURPOSE OF REVIEW: Management of acute pain following surgery using a multimodal approach is recommended by the American Society of Anesthesiologists whenever possible. In addition to opioids, drugs with differing mechanisms of actions target pain pathways resulting in additive and/or synergistic effects. Some of these agents include alpha 2 agonists, NMDA receptor antagonists, gabapentinoids, dexamethasone, NSAIDs, acetaminophen, and duloxetine. RECENT FINDINGS: Alpha 2 agonists have been shown to have opioid-sparing effects, but can cause hypotension and bradycardia and must be taken into consideration when administered...
January 2017: Current Pain and Headache Reports
https://www.readbyqxmd.com/read/25255012/preemptive-preventive-multimodal-analgesia-what-do-they-really-mean
#12
Eric B Rosero, Girish P Joshi
To improve postoperative pain management, several concepts have been developed, including preemptive analgesia, preventive analgesia, and multimodal analgesia. This article will discuss the role of these concepts in improving perioperative pain management. Preemptive analgesia refers to the administration of an analgesic treatment before the surgical insult or tissue injury. Several randomized clinical trials have, however, provided equivocal evidence regarding the benefits of preincisional compared with postincisional analgesic administration...
October 2014: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/21802958/is-flexible-bronchoscopy-necessary-to-confirm-the-position-of-double-lumen-tubes-before-thoracic-surgery
#13
Mario de Bellis, Rosanna Accardo, Massimo Di Maio, Carmine La Manna, Carmine Lamanna, Giovanni Battista Rossi, Maria Caterina Pace, Vincenzo Romano, Gaetano Rocco
OBJECTIVES: Flexible bronchoscopy is recommended to confirm correct placement of double-lumen tubes used for thoracic anesthesia. However, there is still controversy over routine bronchoscopic confirmation of their position. This study aimed to verify the usefulness of flexible bronchoscopy for confirming the position of double-lumen tubes after blind intubation. METHODS: During a 9-month period, consecutive patients undergoing elective oncologic thoracic surgery were prospectively enrolled in the study...
October 2011: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/27687397/analgesic-efficacy-of-pregabalin-in-acute-postmastectomy-pain-placebo-controlled-dose-ranging-study
#14
RANDOMIZED CONTROLLED TRIAL
Diab Fuad Hetta, Montaser A Mohamed, Mohammad Farouk Mohammad
STUDY OBJECTIVE: We hypothesized that oral administration of a single dose of pregabalin 2 hours before modified radical mastectomy (MRM) would produce dose-related reduction in postoperative opioid consumption. DESIGN: Prospective randomized controlled clinical trial. SETTING: Postanesthesia care unit. PATIENTS: One hundred twenty adult women scheduled for unilateral (MRM) with axillary evacuation. INTERVENTIONS: Patients were randomized to receive either, placebo capsule, pregabalin 75 mg, pregabalin 150 mg, or pregabalin 300 mg...
November 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27646054/surgical-intervention-during-a-can-t-intubate-can-t-oxygenate-cico-event-emergency-front-of-neck-airway-fona
#15
EDITORIAL
J P Pracy, L Brennan, T M Cook, A J Hartle, R J Marks, B A McGrath, A Narula, A Patel
No abstract text is available yet for this article.
October 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/26446688/anesthetic-considerations-in-hellp-syndrome
#16
REVIEW
M del-Rio-Vellosillo, J J Garcia-Medina
BACKGROUND: HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) is an obstetric complication with heterogonous presentation and multisystemic involvement. It is characterized by microangiopathic hemolytic anemia, elevated liver enzymes by intravascular breakdown of fibrin in hepatic sinusoids and reduction of platelet circulation by its increased consumption. METHODS: In terms of these patients' anesthetic management, it is essential to consider some details: (1) effective, safe perioperative management by a multidisciplinary approach, and quick, good communication among clinical specialists to achieve correct patient management; (2) neuroaxial block, particularly spinal anesthesia, is the first choice to do the cesarean if there is only moderate, but not progressive thrombocytopenia; (3) if a general anesthesia is required, it is necessary to control the response to stress produced by intubation, especially in patients with either severe high blood pressure or neurological signs, or to prevent major cerebral complications; (4) invasive techniques, e...
February 2016: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/26178308/a-national-common-massive-transfusion-protocol-mtp-is-a-feasible-and-advantageous-option-for-centralized-blood-services-and-hospitals
#17
J Chay, M Koh, H H Tan, J Ng, H J Ng, N Chia, P Kuperan, J Tan, E Lew, L K Tan, P L Koh, K A Desouza, S Bin Mohd Fathil, P M Kyaw, A L Ang
BACKGROUND: A common national MTP was jointly implemented in 2011 by the national blood service (Blood Services Group) and seven participating acute hospitals to provide rapid access to transfusion support for massively haemorrhaging patients treated in all acute care hospitals. METHODS: Through a systematic clinical workflow, blood components are transfused in a ratio of 1:1:1 (pRBC: whole blood-derived platelets: FFP), together with cryoprecipitate for fibrinogen replacement...
January 2016: Vox Sanguinis
https://www.readbyqxmd.com/read/25888032/detection-of-acute-traumatic-coagulopathy-and-massive-transfusion-requirements-by-means-of-rotational-thromboelastometry-an-international-prospective-validation-study
#18
MULTICENTER STUDY
Jostein S Hagemo, Sarah C Christiaans, Simon J Stanworth, Karim Brohi, Pär I Johansson, J Carel Goslings, Paal A Naess, Christine Gaarder
INTRODUCTION: The purpose of this study was to re-evaluate the findings of a smaller cohort study on the functional definition and characteristics of acute traumatic coagulopathy (ATC). We also aimed to identify the threshold values for the most accurate identification of ATC and prediction of massive transfusion (MT) using rotational thromboelastometry (ROTEM) assays. METHODS: In this prospective international multicentre cohort study, adult trauma patients who met the local criteria for full trauma team activation from four major trauma centres were included...
March 23, 2015: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27546565/anemia-or-blood-transfusions-there-is-no-winner
#19
Andra E Duncan
No abstract text is available yet for this article.
November 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27503067/palliative-care-and-cardiovascular-disease-and-stroke-a-policy-statement-from-the-american-heart-association-american-stroke-association
#20
REVIEW
Lynne T Braun, Kathleen L Grady, Jean S Kutner, Eric Adler, Nancy Berlinger, Renee Boss, Javed Butler, Susan Enguidanos, Sarah Friebert, Timothy J Gardner, Phil Higgins, Robert Holloway, Madeleine Konig, Diane Meier, Mary Beth Morrissey, Tammie E Quest, Debra L Wiegand, Barbara Coombs-Lee, George Fitchett, Charu Gupta, William H Roach
The mission of the American Heart Association/American Stroke Association includes increasing access to high-quality, evidence-based care that improves patient outcomes such as health-related quality of life and is consistent with the patients' values, preferences, and goals. Awareness of and access to palliative care interventions align with the American Heart Association/American Stroke Association mission. The purposes of this policy statement are to provide background on the importance of palliative care as it pertains to patients with advanced cardiovascular disease and stroke and their families and to make recommendations for policy decisions...
September 13, 2016: Circulation
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