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
ReviewShould we reconsider triggers for red blood cell transfusion?
Very few randomized controlled trials on the benefits of red blood cell (RBC) transfusions in humans have been published. Consequently, most clinical practice guidelines remain based on expert opinion, animal studies and the limited human trials available. In the absence of definitive outcome studies, numerous theoretical arguments have been put forward either to support or to condone the classic transfusion threshold of 10 g/dL. ⋯ All RBC transfusions must be tailored to the patient's needs, at the moment the need arises. In conclusion most published recommendations are appropriate but their conclusions are limited, as they are commensurate with existing knowledge. Reliable monitors to guide transfusion therapy and well conducted trials to determine optimal transfusion strategies are required.
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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.