Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2010
ReviewTopical application of analgesics: a clinical option in day case anaesthesia?
To examine the available and emerging evidence of the use of topically applied analgesics with particular reference to day case anaesthesia. ⋯ A variety of targets for peripherally applied analgesics exists, some of which can be accessed using currently available drugs, whereas others may need development of new formulations before they can be clinically targeted.
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Curr Opin Anaesthesiol · Dec 2010
ReviewThe role of multimodal analgesia in pain management after ambulatory surgery.
As outpatient (day-case) surgery had continued to grow throughout the world, many more complex and potentially painful procedures are being routinely performed in the ambulatory setting. Opioid analgesics, once considered the standard approach to preventing acute postoperative pain, are being replaced by a combination of nonopioid analgesic drugs with diverse modes of action as part of a multimodal approach to preventing pain after ambulatory surgery. This review will provide an update on the topic of multimodal pain management for ambulatory (day-case) surgery. ⋯ This article discusses recent evidence from the peer-reviewed literature regarding the role of local anesthetics, NSAIDs, gabapentinoids, and acetaminophen, as well as alpha-2 agonists, ketamine, esmolol, and nonpharmacologic approaches (e.g., transcutaneous electrical stimulation) as parts of multimodal pain management strategies in day-case surgery.
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Curr Opin Anaesthesiol · Dec 2010
ReviewWound infiltration with local anaesthetics in ambulatory surgery.
Wound infiltration analgesia using local anaesthetics has been used for several decades. Recently, newer techniques to prolong analgesia have developed, including the use of catheters and injection of local anaesthetics or other adjuvants, and local infiltration analgesia using large volumes of local anaesthetics injected into different tissue planes. The aim of this review is to present the current status of wound infiltration analgesia in management of postoperative pain and to highlight the risks of this technique in clinical practice. ⋯ Used correctly and in adequate doses, wound infiltration analgesia can be used in a multimodal analgesic regime without major complications. It offers the benefit of providing analgesia at a low cost when used as a single injection.
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To summarize recent developments in the study of perioperative handovers, when patients are transferred between various hospital locations (emergency room, ward, operating room, recovery room, intensive care unit) and handovers between care providers (doctors and nurses) when changing shifts. ⋯ There is now widespread consensus that robust, structured handover processes are critical for safe patient care. Checklists and software tools to facilitate the handover process may improve the reliability of handovers and relieve the stress on residents of handing over their patients to the incoming resident. However, there is no 'one size fits all' solution to the problems of handover. Handover improvements will need to be tailored to the specific care setting and handover type.
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Curr Opin Anaesthesiol · Dec 2010
ReviewBeta-blockers, calcium channel blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers: should they be stopped or not before ambulatory anaesthesia?
As day surgery continues to expand, more patients will be encountered who are chronically taking a range of cardiovascular medications for the management of hypertension and ischaemic heart disease. This review will consider the available evidence relating to whether or not these medications should be continued throughout the perioperative period in ambulatory surgical patients. ⋯ Patients should continue to take beta-blockers and calcium channel blockers on the day of surgery. Continuing angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers increases the likelihood of intraoperative hypotension. This can be reduced by withholding these drugs, but will also respond to simple treatments without any apparent adverse outcomes. It may therefore simplify instructions to patients if they are told to take all cardiac medications as normal.