Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2022
ReviewMoving Beyond the Pandemic: Insights from a Shared Experience.
For over two years the resilience of humanity was tested with the coronavirus outbreak. At its outset the scientific community rallied and did its very best to disseminate accumulating knowledge in real time to contain the outbreak. Sobering lessons were learned in managing such a global crisis. ⋯ These considerations are summarized in this infographic. It is heartening to see an article and an accompanying editorial in this issue that address what we have learned from our collective experience. It is a testament to the will of the scientific community and health care providers to evolve and overcome, to move beyond discouragement and prevail.
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Anesthesia and analgesia · Nov 2022
Rescue Treatment of Postoperative Nausea and Vomiting: A Systematic Review of Current Clinical Evidence.
Although prophylactic antiemetics are commonly used perioperatively, an estimated 30% of surgical patients still suffer from postoperative nausea and vomiting (PONV). Very few prospective trials have studied rescue treatment of PONV after failure of prophylaxis, providing limited evidence to support clinical management. ⋯ For many antiemetics currently used in PONV rescue, significant uncertainty remains around the effective dose range, speed of onset, duration of effect, safety, and overall risk-benefit ratio. As prompt, effective PONV rescue after failure of prophylaxis is important to optimize postoperative recovery and resource utilization, we conduct this systematic review to summarize the current evidence available on the topic.
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Anesthesia and analgesia · Nov 2022
Observational StudyAssociation Between Race and Opioid-Induced Respiratory Depression: An International Post Hoc Analysis of the Prediction of Opioid-induced Respiratory Depression In Patients Monitored by Capnography Trial.
Opioid-induced respiratory depression (OIRD) is common on the medical and surgical wards and is associated with increased morbidity and health care costs. While previous studies have investigated risk factors for OIRD, the role of race remains unclear. We aim to investigate the association between race and OIRD occurrence on the medical/surgical ward. ⋯ This post hoc analysis of PRODIGY found a novel association between Asian race and increased OIRD incidence. Further study is required to elucidate its underlying mechanisms and develop targeted care pathways to reduce OIRD in susceptible populations.
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Anesthesia and analgesia · Nov 2022
Characterization of 2 Different Prothrombin Complex Concentrates by Different Hemostatic Assays in an In Vitro Hemodilution Model.
Viscoelastically guided coagulation factor concentrate-based algorithms for the treatment of trauma-induced coagulopathy include the administration of prothrombin complex concentrates (PCCs). However, the exact role of PCC preparations in this context is a matter of debate. Particularly, the ideal diagnostic trigger for their administration and potential differences between heparin-containing and heparin-free preparations remain unclear. We investigated the hypothesis that 2 different PCCs might have distinct influences on in vitro blood coagulation. ⋯ Both PCC preparations (ie, irrespective of heparin content) induced significant elevation of thrombin generation, which was not depicted by conventional coagulation tests or VHA. Our in vitro results suggest that diagnostic assays routinely used to guide PCC administration might not adequately reflect thrombin generation in bleeding patients.