Anesthesiology clinics
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Anesthesiology clinics · Dec 2014
ReviewPerioperative management of the opioid tolerant patient for orthopedic surgery.
The prevalence of opioid use in the North America and some countries of the European Union has resulted in an increase in the number of patients who may exhibit opioid tolerance when requiring postoperative pain management. The approach to postoperative pain control in these patients is different from the strategies used in opioid-naïve patients. Better understanding of the cellular mechanisms of opioid tolerance in animals has resulted in the transfer of these concepts from the basic research to the clinical arena. This article presents new developments in opioid tolerance and how this knowledge can be applied to clinical practice.
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Anesthesiology clinics · Dec 2014
ReviewOptimizing perioperative care for patients with hip fracture.
Hip fracture is one of the most common orthopedic conditions associated with significant morbidity and mortality. Patients with hip fracture are usually older, with significant comorbidities. ⋯ Hereby clinicians are presented with the challenge to optimize the complex hip fracture within a short time period. This article reviews the evidence regarding preoperative, intraoperative, and postoperative considerations, and provides insights into the best strategies with which to optimize the patient's condition and improve perioperative outcomes.
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Anesthesiology clinics · Dec 2014
ReviewEvidence-based medicine for ultrasound-guided regional anesthesia.
Available evidence favoring the use of ultrasound for regional anesthesia is reviewed, updated, and critically assessed. Important outcome advantages include decreased time to block onset; decreased risk of local anesthetic systemic toxicity; and, depending on the outcome definition, increased block success rates. Ultrasound guidance, peripheral nerve blocks, and central neuraxial blocks are discussed.
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Successful implementation of an acute pain management service involves a team approach in which team members have clearly defined roles. Clinical protocols are designed to help address common problems and prevent errors. As the complexity of surgery and patients' diseases continues to increase, current knowledge of new analgesic medications, acute pain literature, and skills in regional anesthesia techniques is imperative. Emphasizing a multimodal approach can improve analgesia and decrease opioid-related side effects.
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Anesthesiology clinics · Dec 2014
ReviewRegional anesthesia-analgesia: relationship to cancer recurrence and infection.
The basic principles of perioperative immune function with regard to cancer recurrence and infection are reviewed. The role of regional anesthesia-analgesia in preservation of immune function and available published data are discussed.