Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses
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The Food and Drug Administration (FDA) issued a letter to health care providers on December 4, 2001, concerning the medication, droperidol. The purpose of the warning was to alert health care providers to the possible role of droperidol in the development of torsades de pointes (TdP) in susceptible patients. The purpose of this article is to explore the role of droperidol in the development of TdP in susceptible patients and current recommendations for the use of droperidol as an antiemetic.
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J. Perianesth. Nurs. · Apr 2006
ReviewThe surgical team and outcomes management: focus on postoperative ileus.
Postoperative ileus (POI) is defined as the impairment of bowel motility that occurs almost universally after major open abdominal procedures, as well as other abdominal and nonabdominal procedures. For the majority of affected patients, POI generally lasts approximately three to five days, but longer duration is not uncommon. The causes of POI are multifactorial, but can be broadly categorized into two groups: those related to the surgical procedure and those related to pharmacologic interventions (opioids). ⋯ Depending on the individual team member's role, different perspectives and strategies may be used to achieve improved outcomes, including but not limited to hospitalization costs related to care and length of stay, resource utilization, and, perhaps most critically, patient quality of life not only immediately after surgery but also after discharge. The ability to reliably and significantly decrease the duration of POI should be readily recognized as an important objective in the management of this condition. Opioids will continue to be a mainstay of postoperative care regimens, but new agents such as peripherally acting mu-opioid-receptor antagonists may offer a unique clinical advantage by helping to reduce the adverse gastrointestinal effects of opioids while preserving their desired benefits for postoperative analgesia.
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J. Perianesth. Nurs. · Apr 2006
ReviewPeripherally acting mu-opioid-receptor antagonists and the connection between postoperative ileus and pain management: The anesthesiologist's view and beyond.
The adverse effects of opioids are well documented. Because opioid receptors have a wide-ranging anatomic distribution, the effects subsequent to opioid binding, both good and bad, occur centrally and in the periphery. Postoperative strategies to reduce opioid burden, therefore, are in the patient's best interest. ⋯ In addition, they do not pass the blood-brain barrier or diminish opioid-mediated analgesia. Advanced clinical trials have already demonstrated the ability of one of these agents, alvimopan, to reduce POI and improve other postoperative outcomes while maintaining adequate analgesia. Combined with other options aimed at reducing opioid burden, alvimopan and similar drugs in development hold promise as part of multimodal protocols to optimize pain management while minimizing postoperative morbidities.
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J. Perianesth. Nurs. · Apr 2006
ReviewNurses are everywhere: a practical perspective on the surgical team in managing postoperative ileus.
Because the availability of new, peripherally acting mu-opioid-receptor antagonists is expected soon, it is important for all members of the surgical team to familiarize themselves with new approaches and also re-evaluate older approaches to help improve patient outcomes. "Preop nurses" have numerous responsibilities, among which are mitigating some of the adverse outcomes of surgery such as postoperative ileus (POI), making these nursing personnel indispensable to the proper implementation of multimodal management protocols for POI. Establishing basic preoperative procedures is an important primary consideration. Preoperative evaluation of general health, medical history (including surgical history), and an assessment of gastrointestinal (GI) function and habits should all be part of careful up-front assessment for each patient, especially because POI and other GI adverse effects are so often encountered in the PACU. ⋯ Where new agents may fit into multimodal regimens that optimally incorporate preoperative and postanesthesia protocols remains to be determined. What is clear is that as nurses and the entire surgical team strive to enhance patient satisfaction, nursing personnel must assume leadership roles in how new multimodal strategies are implemented and executed. Advanced clinical data for the new peripherally acting mu-opioid-receptor antagonist alvimopan, and for the drug class as a whole, have contributed to a greater impetus on reassessing perioperative protocols and policy, helping to broach innovative clinical frontiers of how we treat pain and POI, and thus improve patient outcomes.
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J. Perianesth. Nurs. · Apr 2006
ReviewCurrent choices--good or bad--for the proactive management of postoperative ileus: A surgeon's view.
Postoperative ileus (POI) is frequently experienced by many patients undergoing abdominal operations and other surgical procedures. Postoperative ileus causes physical discomfort and may increase risk for prolonged hospital length of stay. Despite its prevalence, there is currently no accepted standard definition of POI and, consequently, no standardized mode of prevention or treatment; it is no wonder that a variety of management approaches for POI have been developed. ⋯ To date, alvimopan has been shown in phase 3 clinical trials to significantly reduce the duration of POI while maintaining satisfactory analgesia and reducing length of hospital stay. Combinations of strategies with demonstrated effectiveness such as early feeding, epidural analgesia, laparoscopic surgery, and peripherally acting mu-opioid-receptor antagonists may help transform the management of POI into an effective multimodal paradigm that targets the diverse etiologic factors leading to this common clinical problem. Clearly, all surgical team members are crucial in the optimal implementation of such multimodal approaches.