European journal of anaesthesiology
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Opioid addiction represents an exaggerated organic and psychological comorbidity and should be regarded as a high-risk problem. Particular features seen perioperatively are tolerance, hyperalgesia and higher analgesic requirement together with physical and psychological withdrawal symptoms. Adequate pain management should have a high priority even for these patients. ⋯ This article intends to simplify the management of drug-dependent patients and offers strategies for perioperative analgesia that include stabilisation of physical dependency by substitution with methadone or μ-agonists; avoidance of stress; use of regional techniques in combination with non-opioids or opioids with higher doses than those used in non-addicts; avoidance of inadequate analgesic dosing; effective use of the opioid-sparing effect of different co-analgesics; and psychological support wherever appropriate. Those caring for abstinent patients should note that an inadequate dosage of analgesics can potentially reactivate addiction. After successful withdrawal of opioids and prolonged abstinence, opioid therapy can result in an exaggerated response.
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Randomized Controlled Trial Clinical Trial Retracted Publication
Accuracy of noninvasive haemoglobin measurement by pulse oximetry depends on the type of infusion fluid.
Measurement of blood haemoglobin concentration by pulse oximetry could be of value in determining when erythrocytes should be transfused during surgery, but the effect of infusion fluids on the results is unclear. ⋯ The bias of measuring haemoglobin concentration by pulse oximetry is dependent on whether a crystalloid or a colloid fluid is infused.