European journal of anaesthesiology. Supplement
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Eur J Anaesthesiol Suppl · May 1995
ReviewPre-emptive analgesia: evidence, current status and future directions.
Although some studies of pre-emptive analgesia have reported small reductions in post-operative pain or analgesic consumption in favour of pre-incisional vs. post-incisional or post-operative treatment, most have not demonstrated any benefit at all. This paper reviews recent evidence supporting the effectiveness of pre-emptive analgesia and discusses factors that may be responsible for the lack of consistent results. ⋯ Given the constraints of clinical research and current standards of practice, it is unlikely that studies of pre-emptive analgesia using conventional analgesics or local anaesthetics will yield large reductions in post-operative pain or analgesic consumption. Extending the pre-emptive treatment well into the post-operative period using balanced, multimodal analgesia, may prolong the initial advantage conferred by the pre-operative blockade and possibly interfere with the development of long-lasting pain.
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Day surgery has a remarkable overall record of safety. To provide safe anaesthesia and as little post-anaesthetic psychomotor and cognitive impairment as possible after longer and more extensive operations performed in ambulatory surgical facilities, we must carefully assess home readiness and instruct patients in such a way that they receive and understand all relevant information. ⋯ Recommendations not to drive after anaesthesia or sedation vary between 24 and 48 hours, depending on the duration of anaesthesia. It is hoped that the recently introduced short-acting drugs will further improve outcome of day surgery by providing fast exit and early return to normal daily activities.
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Eur J Anaesthesiol Suppl · May 1995
Randomized Controlled Trial Clinical TrialEffect of premedication on 'Diprifusor' TCI.
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Good analgesia does not normalize post-operative pulmonary function but is important in allowing measures such as post-operative physiotherapy to be applied following major abdominal or thoracic surgery. Clinical studies have generally failed to duplicate animal work on the effectiveness of pre-emptive analgesia possibly because the nociceptor stimuli persist as long as there is wound pain. Anaesthetic techniques which include sensory blockade are associated with a lower incidence of several post-operative complications and this improvement is more marked in high-risk patients. ⋯ There is no evidence that multimodal 'balanced' analgesia offers any advantages in terms of improved outcome or reduction in adverse events. Whilst sophisticated methods for providing post-operative pain relief, such as PCA and PCEA, are highly effective, they are appropriate for only a minority of surgical operations. An Acute Pain Service can delivery a traditional intermittent opioid regime effectively at relatively low cost.
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Constant and episodic hypoxaemia are common after major operations in the late post-operative period in the surgical ward. Recent studies have shown that hypoxaemia may be related to the development of myocardial ischaemia and cardiac arrhythmias. ⋯ Finally, mental confusion and surgical delirium may be related to inadequate arterial oxygenation during the late post-operative period. Late post-operative constant and episodic hypoxaemia may therefore be important surgical risk factors, and further studies on the pathogenesis, prophylaxis and treatment are warranted.