Pub Date : 2012-01-01DOI: 10.1097/ASA.0b013e31825e10c0
J. Mhyre
Learning Objectives: As a result of completing this activity, the participant will be able to Identify women at risk for major obstetric hemorrhage List the options available to control and mitigate the consequences of obstetric hemorrhage Discuss how contemporary transfusion practices apply in the obstetric setting Draw from published guidelines and protocols to inform both individual clinical practice and systems solutions in the preparation for these emergencies
{"title":"Postpartum Hemorrhage on Labor and Delivery","authors":"J. Mhyre","doi":"10.1097/ASA.0b013e31825e10c0","DOIUrl":"https://doi.org/10.1097/ASA.0b013e31825e10c0","url":null,"abstract":"Learning Objectives: As a result of completing this activity, the participant will be able to Identify women at risk for major obstetric hemorrhage List the options available to control and mitigate the consequences of obstetric hemorrhage Discuss how contemporary transfusion practices apply in the obstetric setting Draw from published guidelines and protocols to inform both individual clinical practice and systems solutions in the preparation for these emergencies","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"40 1","pages":"105–113"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e31825e10c0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62019980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-01-01DOI: 10.1097/ASA.0b013e31825f1b6a
T. A. Danloff
The use of herbal supplements is on the rise. From 22 to 34% of preoperative adults admit to taking them. As many as one in five patients use herbal supplements while taking prescription medication. Blanck et al. found that 61% of patients with a chronic disease did not discuss their use of dietary herbal supplements with their physicians. Furthermore, 70% of preoperative adults did not disclose their use of herbal supplements even when specifically asked during their preanesthetic assessment (Supplemental Digital Content 1, http://links.lww.com/ASA/A189). Of 601 children presenting for ambulatory surgery, 10.1% had taken herbal supplements in the past and 6.4% were taking herbs currently. Of these, 85% of the parents had not told their child’s physician about the supplements and 90% had not told their surgical team (Supplemental Digital Content 2, http://links.lww.com/ASA/A190). Among children in this survey who were taking herbal supplements, 16% were using herbs that could impact perioperative care. In a survey of parturients, 15% were using herbal supplements and 41% of these patients did not think of the supplements as drugs. Because patients often do not view herbal supplements as drugs, it is very important to ask about them specifically when obtaining a history (Supplemental Digital Content 3, http://links.lww.com/ASA/A191). The Dietary Supplement Health and Education Act became law in the United States in 1994. It is an amendment to the Federal Food, Drug and Cosmetic Act and states that the manufacturer, not the Food and Drug Administration (FDA), is responsible for the safety of the supplement. Dietary supplements are legally considered ‘‘foods,’’ not drugs (Supplemental Digital Content 4, http://links.lww.com/ASA/A192). They include vitamins, minerals, herbs or other botanicals, amino acids, concentrates, metabolites, constituents, extracts, or ‘‘a dietary substance for use by man to supplement the diet by increasing the total dietary intake (e.g., enzymes or tissues from organs or glands).’’ All supplements carry the following disclaimer: ‘‘This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease.’’ Regardless of the pharmacological action of the supplement, according to the Dietary Supplement Health and Education Act, only a drug can legally make that claim. All supplements marketed before the Dietary Supplement Health and Education Act are included and do not need approval from the
{"title":"Anesthesia and Herbal Supplements","authors":"T. A. Danloff","doi":"10.1097/ASA.0b013e31825f1b6a","DOIUrl":"https://doi.org/10.1097/ASA.0b013e31825f1b6a","url":null,"abstract":"The use of herbal supplements is on the rise. From 22 to 34% of preoperative adults admit to taking them. As many as one in five patients use herbal supplements while taking prescription medication. Blanck et al. found that 61% of patients with a chronic disease did not discuss their use of dietary herbal supplements with their physicians. Furthermore, 70% of preoperative adults did not disclose their use of herbal supplements even when specifically asked during their preanesthetic assessment (Supplemental Digital Content 1, http://links.lww.com/ASA/A189). Of 601 children presenting for ambulatory surgery, 10.1% had taken herbal supplements in the past and 6.4% were taking herbs currently. Of these, 85% of the parents had not told their child’s physician about the supplements and 90% had not told their surgical team (Supplemental Digital Content 2, http://links.lww.com/ASA/A190). Among children in this survey who were taking herbal supplements, 16% were using herbs that could impact perioperative care. In a survey of parturients, 15% were using herbal supplements and 41% of these patients did not think of the supplements as drugs. Because patients often do not view herbal supplements as drugs, it is very important to ask about them specifically when obtaining a history (Supplemental Digital Content 3, http://links.lww.com/ASA/A191). The Dietary Supplement Health and Education Act became law in the United States in 1994. It is an amendment to the Federal Food, Drug and Cosmetic Act and states that the manufacturer, not the Food and Drug Administration (FDA), is responsible for the safety of the supplement. Dietary supplements are legally considered ‘‘foods,’’ not drugs (Supplemental Digital Content 4, http://links.lww.com/ASA/A192). They include vitamins, minerals, herbs or other botanicals, amino acids, concentrates, metabolites, constituents, extracts, or ‘‘a dietary substance for use by man to supplement the diet by increasing the total dietary intake (e.g., enzymes or tissues from organs or glands).’’ All supplements carry the following disclaimer: ‘‘This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease.’’ Regardless of the pharmacological action of the supplement, according to the Dietary Supplement Health and Education Act, only a drug can legally make that claim. All supplements marketed before the Dietary Supplement Health and Education Act are included and do not need approval from the","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"40 1","pages":"7–17"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e31825f1b6a","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62020282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-01-01DOI: 10.1097/ASA.0b013e31825f1b07
G. Joshi
Learning Objectives: As a result of completing this activity, the participant will be able to Describe preoperative evaluation and preparation of morbidly obese and sleep apnea patients Explain the perioperative challenges in these patients Justify appropriate selection of these patients for ambulatory surgical procedures, including bariatric surgery List anesthetic considerations that minimize perioperative risks in these patients Name criteria for discharge home of these outpatients
{"title":"Ambulatory Surgery in the Adult Patient With Morbid Obesity and/or Sleep Apnea Syndrome","authors":"G. Joshi","doi":"10.1097/ASA.0b013e31825f1b07","DOIUrl":"https://doi.org/10.1097/ASA.0b013e31825f1b07","url":null,"abstract":"Learning Objectives: As a result of completing this activity, the participant will be able to Describe preoperative evaluation and preparation of morbidly obese and sleep apnea patients Explain the perioperative challenges in these patients Justify appropriate selection of these patients for ambulatory surgical procedures, including bariatric surgery List anesthetic considerations that minimize perioperative risks in these patients Name criteria for discharge home of these outpatients","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"40 1","pages":"80–86"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e31825f1b07","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62020177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-01-01DOI: 10.1097/ASA.0b013e31826305ed
T. Lubenow, Matthew P. Jaycox
Complex regional pain syndrome (CRPS) is a painful and debilitating disorder affecting mainly one or more extremities. The key features are spontaneous pain, hyperalgesia, allodynia, edema, temperature change, abnormal vasomotor and sudomotor activity, trophic changes, and motor dysfunction (see Appendix). CRPS has two types, and the International Association for the Study of Pain (IASP) has established diagnostic criteria for both. The criteria required to diagnose CRPS type I include: (1) the presence of an initiating noxious event or a cause of immobilization; (2) continuing pain, allodynia, or hyperalgesia with pain disproportionate to the inciting event; (3) evidence at some time of edema, changes in skin blood flow, or abnormal sudomotor activity in the region of the pain; and (4) the exclusion of medical conditions that would otherwise account for the degree of pain and dysfunction. CRPS type II requires: (1) the presence of continuing pain, allodynia, or hyperalgesia after a nerve injury, not necessarily limited to the distribution of the injured nerve; (2) evidence at some time of edema, changes in skin blood flow, or abnormal sudomotor activity in the region of the pain; and (3) the exclusion of any medical condition that would otherwise account for the degree of pain and dysfunction (Table 1).
{"title":"Current Trends in the Diagnosis and Treatment of Complex Regional Pain Syndrome","authors":"T. Lubenow, Matthew P. Jaycox","doi":"10.1097/ASA.0b013e31826305ed","DOIUrl":"https://doi.org/10.1097/ASA.0b013e31826305ed","url":null,"abstract":"Complex regional pain syndrome (CRPS) is a painful and debilitating disorder affecting mainly one or more extremities. The key features are spontaneous pain, hyperalgesia, allodynia, edema, temperature change, abnormal vasomotor and sudomotor activity, trophic changes, and motor dysfunction (see Appendix). CRPS has two types, and the International Association for the Study of Pain (IASP) has established diagnostic criteria for both. The criteria required to diagnose CRPS type I include: (1) the presence of an initiating noxious event or a cause of immobilization; (2) continuing pain, allodynia, or hyperalgesia with pain disproportionate to the inciting event; (3) evidence at some time of edema, changes in skin blood flow, or abnormal sudomotor activity in the region of the pain; and (4) the exclusion of medical conditions that would otherwise account for the degree of pain and dysfunction. CRPS type II requires: (1) the presence of continuing pain, allodynia, or hyperalgesia after a nerve injury, not necessarily limited to the distribution of the injured nerve; (2) evidence at some time of edema, changes in skin blood flow, or abnormal sudomotor activity in the region of the pain; and (3) the exclusion of any medical condition that would otherwise account for the degree of pain and dysfunction (Table 1).","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"40 1","pages":"95–104"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e31826305ed","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62020715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-01-01DOI: 10.1097/ASA.0b013e3182299ee8
S. Barker
Introduction The interpretation and application of arterial blood-gas (ABG) data is a task that anesthesiologists must often perform under difficult circumstances. The time is 3:00 AM; we are fatigued and distracted by multiple other simultaneous tasks; we need to take action on these ABG results now. In this setting, which bears similarities to piloting an aircraft on instruments in bad weather, it is useful to have a simple algorithm or “check-list,” both to ensure consistency and obtain a correct answer within a short time. The purpose of this talk is to develop such an algorithm and apply it to specific clinical examples, wherein we shall interpret both oxygenation and acid-base status, and then prescribe appropriate treatment.
{"title":"Arterial Blood-Gas Analysis Interpretation and Application for the Nonchemist","authors":"S. Barker","doi":"10.1097/ASA.0b013e3182299ee8","DOIUrl":"https://doi.org/10.1097/ASA.0b013e3182299ee8","url":null,"abstract":"Introduction The interpretation and application of arterial blood-gas (ABG) data is a task that anesthesiologists must often perform under difficult circumstances. The time is 3:00 AM; we are fatigued and distracted by multiple other simultaneous tasks; we need to take action on these ABG results now. In this setting, which bears similarities to piloting an aircraft on instruments in bad weather, it is useful to have a simple algorithm or “check-list,” both to ensure consistency and obtain a correct answer within a short time. The purpose of this talk is to develop such an algorithm and apply it to specific clinical examples, wherein we shall interpret both oxygenation and acid-base status, and then prescribe appropriate treatment.","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"39 1","pages":"1–5"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e3182299ee8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62018932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-01-01DOI: 10.1097/ASA.0B013E31822881BB
A. Ross, W. Ames
Several issues must be considered when presented with a child for an emergency procedure. The airway must, of course, be managed along with ensuring adequate breathing and circulation. At the same time, the urgency of the proposed intervention needs to be determined. It is a great disservice to a patient when a thorough preoperative workup and attempts at optimizing nil per os (NPO) status have been abandoned for a procedure that is, in fact, elective. Intravenous (IV) access may also prove challenging in the pediatric patient undergoing emergency surgery. It would be extremely unlikely for an adult in an emergency situation to present to the operating room without an IV, whereas a child may be sent from a clinic or emergency department without an established one. Most emergency procedures dictate the presence of an IV before induction. Another consideration unique to children is the desire for parental presence at anesthetic induction. Consideration should be taken to determine whether having a parent present poses an unnecessary distraction and places the child at risk due to the emergent nature of the situation. Parental presence need not be an expectation in such cases.
{"title":"Anesthetic Management of Common Pediatric Emergencies","authors":"A. Ross, W. Ames","doi":"10.1097/ASA.0B013E31822881BB","DOIUrl":"https://doi.org/10.1097/ASA.0B013E31822881BB","url":null,"abstract":"Several issues must be considered when presented with a child for an emergency procedure. The airway must, of course, be managed along with ensuring adequate breathing and circulation. At the same time, the urgency of the proposed intervention needs to be determined. It is a great disservice to a patient when a thorough preoperative workup and attempts at optimizing nil per os (NPO) status have been abandoned for a procedure that is, in fact, elective. Intravenous (IV) access may also prove challenging in the pediatric patient undergoing emergency surgery. It would be extremely unlikely for an adult in an emergency situation to present to the operating room without an IV, whereas a child may be sent from a clinic or emergency department without an established one. Most emergency procedures dictate the presence of an IV before induction. Another consideration unique to children is the desire for parental presence at anesthetic induction. Consideration should be taken to determine whether having a parent present poses an unnecessary distraction and places the child at risk due to the emergent nature of the situation. Parental presence need not be an expectation in such cases.","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"39 1","pages":"142-148"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0B013E31822881BB","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62019094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-01-01DOI: 10.1097/ASA.0b013e318229b37d
D. Merrill
Learning Objectives: As a result of completing this activity, the participant will be able to Describe the challenges that make up the role of medical director of an Ambulatory Surgery Center Apply some creative approaches to managing those challenges Evaluate the potential impact on the role of the medical director of future changes in regulatory, corporate, and competitive environments in health care
{"title":"The Anesthesiologist as Administrator: Succeeding or Failing as the Medical Director of an Ambulatory Surgery Center","authors":"D. Merrill","doi":"10.1097/ASA.0b013e318229b37d","DOIUrl":"https://doi.org/10.1097/ASA.0b013e318229b37d","url":null,"abstract":"Learning Objectives: As a result of completing this activity, the participant will be able to Describe the challenges that make up the role of medical director of an Ambulatory Surgery Center Apply some creative approaches to managing those challenges Evaluate the potential impact on the role of the medical director of future changes in regulatory, corporate, and competitive environments in health care","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"39 1","pages":"106–114"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e318229b37d","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62019431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-01-01DOI: 10.1097/ASA.0b013e318229af36
N. Glass
Learning Objectives: As a result of completing this activity, the participant will be able to List the 3 primary factors motivating individuals in the workplace and apply these motivators to plan and implement needed changes in organizations Detect the individual pushback on needed changes and describe ways to address this natural resistance Construct a change initiative to improve likelihood of success Analyze why change initiatives in his/her own institution have failed, and plan more effectively for needed changes Recognize that change management is largely an issue of managing complex systems, not rogue doctors
{"title":"Changing Physician Behavior","authors":"N. Glass","doi":"10.1097/ASA.0b013e318229af36","DOIUrl":"https://doi.org/10.1097/ASA.0b013e318229af36","url":null,"abstract":"Learning Objectives: As a result of completing this activity, the participant will be able to List the 3 primary factors motivating individuals in the workplace and apply these motivators to plan and implement needed changes in organizations Detect the individual pushback on needed changes and describe ways to address this natural resistance Construct a change initiative to improve likelihood of success Analyze why change initiatives in his/her own institution have failed, and plan more effectively for needed changes Recognize that change management is largely an issue of managing complex systems, not rogue doctors","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"39 1","pages":"50–56"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e318229af36","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62019580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-01-01DOI: 10.1097/ASA.0b013e318229b05d
J. Katz
Learning Objectives: As a result of completing this activity, the participant will be able to Describe many of the occupational hazards to which anesthesiologists are potentially exposed in their daily practice Employ strategies for avoiding, preventing, or treating some of the occupationally related diseases that have been associated with the practice of anesthesiology Detect and avoid the vulnerabilities and diseases most commonly associated with disability and death among anesthesiologists Explain some of the benefits and advantages of the modern practice of anesthesiology
{"title":"Occupational Health Considerations for Anesthesiologists: From Ergonomics to Economics","authors":"J. Katz","doi":"10.1097/ASA.0b013e318229b05d","DOIUrl":"https://doi.org/10.1097/ASA.0b013e318229b05d","url":null,"abstract":"Learning Objectives: As a result of completing this activity, the participant will be able to Describe many of the occupational hazards to which anesthesiologists are potentially exposed in their daily practice Employ strategies for avoiding, preventing, or treating some of the occupationally related diseases that have been associated with the practice of anesthesiology Detect and avoid the vulnerabilities and diseases most commonly associated with disability and death among anesthesiologists Explain some of the benefits and advantages of the modern practice of anesthesiology","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"39 1","pages":"65–71"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e318229b05d","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62019644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-01-01DOI: 10.1097/ASA.0b013e31822a11ee
E. Viscusi, T. Witkowski
Patients with postoperative pain continue to have unmet needs. Despite guidelines for pain management and improving technology, patient experiences with pain have not significantly improved after surgery. Although more effective application of current therapies would likely improve patient experience, available technologies still leave much to be desired. Although effective, intravenous patient-controlled analgesia (IV-PCA) is a burdensome technology. Further, medication errors, pump programming errors, and other technology-related problems may lead to patient injury and under or over dosing. Continuous epidural analgesia by catheter has frequent failures and it requires a high level of staffing. Moreover, recent efforts to reduce the incidence of postoperative venous thromboembolism by the use of anticoagulants has placed limitations on the use of indwelling epidural catheters. No large series have examined the failure rates of continuous peripheral nerve blocks. Current standard therapies in postoperative pain management largely depend on cumbersome technologies requiring pumps and indwelling catheters. In addition to the opportunities for failure and medical errors, these technologies are inherently complex and place a heavy labor burden on the healthcare team. Patients spend an inordinate amount of time tethered to equipment that limits ambulation, physical therapy, and activities of daily living. Opioids remain commonly used in postoperative pain management. Unfortunately, the well-known side effects (nausea, vomiting, sedation, respiratory depression, confusion, constipation) are not only dangerous but cause significant patient misery. Patients treated with opioids typically attempt to find a balance between analgesia and side effects. Patients will often choose less complete pain relief to avoid opioid side effects. Almost all patients require parenteral therapy at some point during the perioperative period. Unfortunately, the choices for injectable nonopioid pain therapies are limited. Clearly, improvements are needed. There is ample room for new and emerging technologies.
{"title":"Acute Pain Medicine: Novel Analgesic Techniques","authors":"E. Viscusi, T. Witkowski","doi":"10.1097/ASA.0b013e31822a11ee","DOIUrl":"https://doi.org/10.1097/ASA.0b013e31822a11ee","url":null,"abstract":"Patients with postoperative pain continue to have unmet needs. Despite guidelines for pain management and improving technology, patient experiences with pain have not significantly improved after surgery. Although more effective application of current therapies would likely improve patient experience, available technologies still leave much to be desired. Although effective, intravenous patient-controlled analgesia (IV-PCA) is a burdensome technology. Further, medication errors, pump programming errors, and other technology-related problems may lead to patient injury and under or over dosing. Continuous epidural analgesia by catheter has frequent failures and it requires a high level of staffing. Moreover, recent efforts to reduce the incidence of postoperative venous thromboembolism by the use of anticoagulants has placed limitations on the use of indwelling epidural catheters. No large series have examined the failure rates of continuous peripheral nerve blocks. Current standard therapies in postoperative pain management largely depend on cumbersome technologies requiring pumps and indwelling catheters. In addition to the opportunities for failure and medical errors, these technologies are inherently complex and place a heavy labor burden on the healthcare team. Patients spend an inordinate amount of time tethered to equipment that limits ambulation, physical therapy, and activities of daily living. Opioids remain commonly used in postoperative pain management. Unfortunately, the well-known side effects (nausea, vomiting, sedation, respiratory depression, confusion, constipation) are not only dangerous but cause significant patient misery. Patients treated with opioids typically attempt to find a balance between analgesia and side effects. Patients will often choose less complete pain relief to avoid opioid side effects. Almost all patients require parenteral therapy at some point during the perioperative period. Unfortunately, the choices for injectable nonopioid pain therapies are limited. Clearly, improvements are needed. There is ample room for new and emerging technologies.","PeriodicalId":91163,"journal":{"name":"Refresher courses in anesthesiology","volume":"39 1","pages":"149–155"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/ASA.0b013e31822a11ee","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62019665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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