Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2003
ReviewOpioid tolerance and dependence: an inevitable consequence of chronic treatment?
Although opioids provide effective analgesia, largely unsubstantiated concerns about opioid-induced tolerance, physical dependence and addiction have limited their appropriate use. As a consequence, many patients receive inadequate treatment for both malignant and non-malignant pain. However, it has been shown that analgesic tolerance develops less frequently during chronic opioid administration in a clinical context than in animal experiments, and that instituting an appropriate dosing regimen can minimise withdrawal symptoms. ⋯ New treatment regimens may also reduce the risk of tolerance, physical dependence and addiction. Long-acting preparations, such as transdermal fentanyl and possibly some forms of other slow release opioids, which maintain constant opioid concentrations in the plasma, minimise the occurrence of the 'between-dose' symptoms such as withdrawal and opioid-induced euphoria. This review discusses the development of tolerance, physical dependence and addiction during opioid therapy, and the influence of these factors on the choice of treatment.
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Acta Anaesthesiol Belg · Jan 2003
ReviewBeta-adrenergic blocking drugs in the perioperative period.
During the last years increasing evidence has indicated that patients at risk for coronary artery disease may benefit from beta-adrenergic blocking therapy in the perioperative setting. It has been demonstrated that even a relatively brief treatment with beta-adrenergic blocking drugs decreases the incidence of perioperative myocardial ischemia. ⋯ We organized a meeting to search for the major objectives that keep anesthetists from implementing prophylactic beta blocking therapy in their daily clinical practice. In this brief review we summarize the results of this meeting and discuss the current knowledge on this subject.
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Acta Anaesthesiol Belg · Jan 2003
Meta Analysis Comparative StudyColloids versus crystalloids as priming solutions for cardiopulmonary bypass: a meta-analysis of prospective, randomised clinical trials.
Using Cochrane methodology a review was performed of prospective randomized clinical trials comparing colloidal pump priming solutions for cardiopulmonary bypass. Dextrans were not considered. Database searches from 1966 through December 2002 delivered 265 articles. ⋯ To conclude, using mere crystalloids produced more pronounced positive fluid balances and their avoidance as a single pump-prime component can be suggested. Since albumin is not necessarily associated with better outcomes and is more expensive, it is hard to continue its use. However, there is still insufficient evidence available to allow definitive conclusions.
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Acta Anaesthesiol Belg · Jan 2003
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of mandibular nerve block on opioid consumption, nausea and vomiting in bilateral mandibular osteotomies.
The purpose of this study was to compare the efficacy of a mandibular nerve block to placebo, in patients undergoing mandibular osteotomy surgery, regarding opioid consumption and adverse opioid induced side effects. Forty healthy individuals with a mean age of 19.7 years participated in the study. All subjects received lidocaïn 2% + adrenaline 1/80,000 versus placebo for mandibular nerve block in a randomized double-blind manner. Opioid consumption and opioid related side effect such as postoperative nausea and vomiting (PONV), and respiratory depression were assessed. ⋯ The mandibular block during mandibular osteotomy reduces intra-operative opioid consumption but does not alternate the opioid related side-effects in the postoperative phase.