Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2018
ReviewThe opioid epidemic and the current prevalence of substance use disorder in anesthesiologists.
There has been a substantial increase in prescription and illicit opioid abuse in the general population observed over the last two decades. Initially fueled by an influx of prescription opioid medications, the opioid epidemic now includes increasingly potent heroin and illicit fentanyl. Younger anesthesiologists, those currently in training or recent graduates, have come of age in a society where opioid abuse is much more prevalent. ⋯ The increasing incidence of substance use disorder in anesthesia residents may reflect the significantly increased number of persons addicted to opioids and other drugs of abuse in the general population. Despite educational and surveillance programs put in place to prevent diversion, susceptible individuals with access are still abusing anesthetic agents.
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Curr Opin Anaesthesiol · Jun 2018
ReviewSevere perineal lacerations after vaginal delivery: are they an anesthesiologist's problem?
Perineal tears or lacerations are common occurrences after vaginal delivery. Understanding the degree of severity of these tears and the immediate and long-term complications of severe perineal lacerations can assist anesthesiologists with the management of these patients in the immediate postpartum period. ⋯ Neuraxial labor analgesia does not directly predispose parturients to the development of perineal lacerations, and may even be protective against these injuries.
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High-quality analgesia has been linked to improved patient satisfaction as well as improved short-term and long-term postoperative outcomes. Acute surgical pain is a modifiable risk factor for development of chronic postoperative pain, which is reported by up to 26% of gynecologic surgical patients. In other surgical populations, multimodal analgesia has shown improved pain control and decreased reliance on opioids. This review examines recent evidence for various analgesic modalities applied specifically to the gynecologic surgical population. ⋯ Multimodal analgesia had demonstrated advantages for all types of gynecological surgeries in terms of improving postoperative pain control and minimizing opioid-related adverse effects. Multimodal analgesia includes acetaminophen, NSAIDS, and gamma-aminobutyric acid analogs combined with intraoperative nonopioid analgesics such as ketamine, regional anesthesia or intrathecal morphine. Further research should focus on determining most effective combinations and doses of multimodal analgesia.
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The review examines the different preventive measures that have been found to be useful to abolish or decrease the negative effects of burnout and increase resilience in anesthesiologists. ⋯ Burnout is a pathological syndrome that is triggered by constant levels of high stress. A combination of individual efforts as well as structural interventions can help to increase wellbeing in physicians.
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Curr Opin Anaesthesiol · Jun 2018
ReviewIs spinal anaesthesia in young infants really safer and better than general anaesthesia?
Concerns regarding the potential neurotoxic effects of general anaesthesia have seen resurgence in awake spinal anaesthesia in neonates and infants. This review includes recently published data from a large prospective randomized controlled trial with view to determining if spinal anaesthesia is safer and better than general anaesthesia in this population. ⋯ Spinal anaesthesia represents a suitable alternative to general anaesthesia in neonates and infants undergoing minor surgery avoiding the need for endotracheal intubation and ventilation. Spinal anaesthesia has some advantages but a significant failure rat and has not been demonstrated to improve neurodevelopmental outcome.