Consensus Guidelines for the Management of Postoperative Nausea and Vomiting

Anesthesia & Analgesia, Journal Year: 2013, Volume and Issue: 118(1), P. 85 - 113

Published: Dec. 20, 2013

The present guidelines are the most recent data on postoperative nausea and vomiting (PONV) an update 2 previous sets of published in 2003 2007. These were compiled by a multidisciplinary international panel individuals with interest expertise PONV under auspices Society for Ambulatory Anesthesia. members critically systematically evaluated current medical literature to provide evidence-based reference tool management adults children who undergoing surgery at increased risk PONV. identify patients children; recommend approaches reducing baseline risks PONV; effective antiemetic single therapy combination regimens prophylaxis, including nonpharmacologic approaches; strategies treatment when it occurs; algorithm as well steps ensure prevention implemented clinical setting.

Language: Английский

---

Clinical Pharmacokinetics and Pharmacodynamics of Dexmedetomidine

Clinical Pharmacokinetics, Journal Year: 2017, Volume and Issue: 56(8), P. 893 - 913

Published: Jan. 19, 2017

Dexmedetomidine is an α2-adrenoceptor agonist with sedative, anxiolytic, sympatholytic, and analgesic-sparing effects, minimal depression of respiratory function. It potent highly selective for α2-receptors α2:α1 ratio 1620:1. Hemodynamic which include transient hypertension, bradycardia, hypotension, result from the drug's peripheral vasoconstrictive sympatholytic properties. exerts its hypnotic action through activation central pre- postsynaptic in locus coeruleus, thereby inducting a state unconsciousness similar to natural sleep, unique aspect that patients remain easily rousable cooperative. rapidly distributed mainly hepatically metabolized into inactive metabolites by glucuronidation hydroxylation. A high inter-individual variability dexmedetomidine pharmacokinetics has been described, especially intensive care unit population. In recent years, multiple pharmacokinetic non-compartmental analyses as well population studies have performed. Body size, hepatic impairment, presumably plasma albumin cardiac output significant impact on pharmacokinetics. Results regarding other covariates inconclusive warrant further research. Although initially approved intravenous use up 24 h adult only, applications clinical practice widened over past few years. Procedural sedation was additionally US Food Drug Administration 2003 appeared useful off-label such pediatric sedation, intranasal or buccal administration, adjuvant local analgesia techniques.

Language: Английский

---

Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting

Anesthesia & Analgesia, Journal Year: 2020, Volume and Issue: 131(2), P. 411 - 448

Published: May 27, 2020

This consensus statement presents a comprehensive and evidence-based set of guidelines for the care postoperative nausea vomiting (PONV) in both adult pediatric populations. The are established by an international panel experts under auspices American Society Enhanced Recovery Ambulatory Anesthesia based on search review literature up to September 2019. provide recommendation identifying high-risk patients, managing baseline PONV risks, choices prophylaxis, rescue treatment as well recommendations institutional implementation protocol. In addition, current focus evidence newer drugs (eg, second-generation 5-hydroxytryptamine 3 [5-HT ] receptor antagonists, neurokinin 1 (NK1) dopamine antagonists), discussion regarding use general multimodal management part enhanced recovery pathways. have been endorsed 23 professional societies organizations from different disciplines (Appendix 1). What Other Guidelines Are Available Topic? currently available include iterations guideline we previously published, which was last updated 6 years ago 1–3 ; published Health System Pharmacists 1999 4 brief 5 focused Obstetricians Gynecologists Canada, Association Paediatric Anaesthetists Great Britain & Ireland 7 Perianesthesia Nursing 8 several other languages. 9–12 Why Was Guideline Developed? developed perioperative practitioners with up-to-date, guidance risk stratification, prevention, adults children. also provides within How Does Differ From Existing Guidelines? previous October 2011. Several guidelines, since, either limited specific populations or do not address all aspects management. 13 systematic through includes recent studies pharmacological agents such (5-HT ) antagonist, antagonists novel combination therapies. it contains We discussed prophylaxis at-risk surgical patients expert panel.

Language: Английский

---

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

International Journal of Gynecological Cancer, Journal Year: 2019, Volume and Issue: 29(4), P. 651 - 668

Published: March 15, 2019

Background

This is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery.

Methods

A database search of publications using Embase and PubMed was performed. Studies on each item within ERAS protocol were selected with emphasis meta-analyses, randomized controlled trials, large prospective cohort studies. These studies then reviewed graded according to Grading Recommendations, Assessment, Development Evaluation (GRADE) system.

Results

All recommendations items are based best available evidence. The level evidence presented accordingly.

Conclusions

base recommendation pathway by ERAS® this review.

Language: Английский

---

Persistent Postsurgical Pain

Anesthesiology, Journal Year: 2018, Volume and Issue: 129(3), P. 590 - 607

Published: May 9, 2018

The development of chronic pain is considered a major complication after surgery. Basic science research in animal models helps us understand the transition from acute to by identifying numerous molecular and cellular changes that occur peripheral central nervous systems. It now well recognized inflammation nerve injury lead long-term synaptic plasticity amplifies also maintains signaling, phenomenon referred as sensitization. In context surgery humans, sensitization both responsible for an increase postoperative via expression wound hyperalgesia critical factor persistent postsurgical pain. Using specific drugs block processes reduces prevents This narrative review literature describes clinical investigations evaluating different preventative pharmacologic strategies are routinely used anesthesiologists their daily practices preventing Nevertheless, further efforts needed basic identify preclinical novel therapeutics targets. There remains need more patient numbers research, reliable data, safest most effective limit incidence

Language: Английский

---

Postoperative pain—from mechanisms to treatment

PAIN Reports, Journal Year: 2017, Volume and Issue: 2(2), P. e588 - e588

Published: March 1, 2017

Abstract Introduction: Pain management after surgery continues to be suboptimal; there are several reasons including lack of translation results from basic science studies and scientific clinical evidence into praxis. Objectives: This review presents discusses findings generated within the last 2 decades in field acute postoperative pain. Methods: In first part review, we give an overview about that have investigated pathophysiology pain by using rodent models incisional up July 2016. The second focus lies on treatment recommendations based guidelines evidence, eg, fourth edition “Acute Management: Scientific Evidence” Australian New Zealand College Anaesthetists Faculty Medicine. Results: Preclinical characterized responses primary afferent nociceptors dorsal horn neurons as one neural basis for behavior resting pain, hyperalgesia, movement-evoked or anxiety- depression-like behaviors surgery. Furthermore, role certain receptors, mediators, neurotransmitters involved peripheral central sensitization incision were identified; many these very specific, relate some modalities only, unique Future should targets develop therapeutic agents effective well few side effects. translate studies. is able point towards useful (and less useful) elements multimodal analgesia reduce opioid consumption, improve management, enhance recovery. Conclusion: Understanding mechanisms identify strategies may patients' outcome

Language: Английский

---

Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways

Canadian Journal of Anesthesia/Journal canadien d anesthésie, Journal Year: 2014, Volume and Issue: 62(2), P. 203 - 218

Published: Dec. 9, 2014

Language: Английский

---

A Review of Opioid-Sparing Modalities in Perioperative Pain Management: Methods to Decrease Opioid Use Postoperatively

Anesthesia & Analgesia, Journal Year: 2017, Volume and Issue: 125(5), P. 1749 - 1760

Published: Oct. 20, 2017

There is an epidemic of opioid use, abuse, and misuse in the United States, which results significant morbidity mortality. It may be difficult to reduce perioperative use given known acute surgical trauma resultant pain; however, discrete often limited nature postoperative pain also make management easier part by utilizing nonopioid modalities, such as regional anesthesia/analgesia, multimodal analgesia, decrease need for powerful opioids. This article reviews relevant literature describing adjunct medications, anesthesia analgesic techniques, block additives context providing adequate control while lessening use.

Language: Английский

---

Pain after knee arthroplasty: an unresolved issue

Knee Surgery Sports Traumatology Arthroscopy, Journal Year: 2013, Volume and Issue: 22(8), P. 1744 - 1758

Published: Nov. 7, 2013

Language: Английский

---

Preoperative Opioid Use and Its Association With Perioperative Opioid Demand and Postoperative Opioid Independence in Patients Undergoing Spine Surgery

Spine, Journal Year: 2014, Volume and Issue: 39(25), P. E1524 - E1530

Published: Nov. 25, 2014

Prospective cohort.To assess whether preoperative opioid use is associated with increased perioperative demand and postoperative independence in patients undergoing spine surgery.Previous work has demonstrated requirements during the intraoperative immediate period high levels of use. Despite this, they remain a common agent class used for management pain prior to surgery.A total 583 were included. Self-reported daily consumption was obtained preoperatively converted into morphine equivalent amounts recorded at 12-month time. Intraoperative calculated. Linear regression analyses while logistic 12 months including relevant covariates such as depression anxiety performed.The median amount cohort 8.75 mg, 55% reporting some degree Younger age, more invasive surgery, anxiety, primary surgery significantly (P < 0.05). greater More revision decreased incidence postoperatively 0.01).Greater predicts independence. Psychiatric diagnoses those using opioids predictors continued months. Patients may benefit from counseling that emphasizes minimizing surgery.2.

Language: Английский

---