Journal of anaesthesiology, clinical pharmacology
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J Anaesthesiol Clin Pharmacol · Apr 2018
ReviewPharmacogenomics of analgesics in anesthesia practice: A current update of literature.
The field of pharmacogenomics seeks to understand how an individual's unique gene sequence can affect their response to certain drugs. It is particularly relevant in anesthesia when the interindividual response to pain medication is essential. Codeine and tramadol are prodrugs metabolized by CYP2D6, polymorphisms of which can cause dangerous or even fatal levels of their metabolites, or decrease the level of metabolites to decrease their analgesic effect. ⋯ Certain haplotypes of COMT have been demonstrated to have an effect on opioid requirements. The OPRM1 gene codes for the mu-opioid receptor, and there is conflicting data regarding its effect on analgesia and opioid requirements. Overall, there is a fair amount of conflicting data in the above topics, suggesting that there is still a lot of research to be done on these topics, and that pain perception is multifactorial, likely including many common genetic variants.
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J Anaesthesiol Clin Pharmacol · Apr 2018
Ultrasound-guided adductor canal block versus femoral nerve block for arthroscopic anterior cruciate ligament repair under general anesthesia.
Adductor canal block (ACB) is now an established component of multimodal analgesia for knee replacement surgery and is slowly replacing femoral nerve block (FNB). It is also gaining popularity for providing pain relief in knee arthroscopies including anterior cruciate ligament reconstruction surgery (ACLR). Data is lacking from the Indian subcontinent on comparing ACB to the traditional FNB for ACLR. Hence, we conducted the present study to compare ACB and FNB in ACLR under general anesthesia. ⋯ ACB preserves quadriceps motor strength while providing analgesia comparable to FNB in patients undergoing ACLR. However, patient satisfaction score is better with FNB than ACB.
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J Anaesthesiol Clin Pharmacol · Apr 2018
Comparative study to assess the quality of analgesia of bupivacaine and bupivacaine with dexmedetomidine in ultrasound-guided pectoral nerve block type I and II in breast surgeries.
Dexmedetomidine has been demonstrated to be safe and efficacious in prolonging the duration of peripheral nerve blocks. This study was designed to compare the duration, quality of postoperative analgesia, hemodynamic stability, and patient's satisfaction with addition of dexmedetomidine to bupivacaine versus plain bupivacaine in pectoral nerve block (Pecs) type I and II in breast surgeries. ⋯ Dexmedetomidine as an adjunct to bupivacaine helps prolong the duration and improves the quality of postoperative analgesia in pecs I and II block without serious side effects.
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J Anaesthesiol Clin Pharmacol · Jan 2018
Intraoperative neurophysiological monitoring team's communiqué with anesthesia professionals.
Intraoperative neurophysiological monitoring (IONM) is the standard of care during many spinal, vascular, and intracranial surgeries. High-quality perioperative care requires the communication and cooperation of several multidisciplinary teams. One of these multidisciplinary services is intraoperative neuromonitoring (IONM), while other teams represent anesthesia and surgery. Few studies have investigated the IONM team's objective communication with anesthesia providers. We conducted a retrospective review of IONM-related quality assurance data to identify how changes in the evoked potentials observed during the surgery were communicated within our IONM-anesthesia team and determined the resulting qualitative outcomes. ⋯ Based on our institutions' protocol and algorithm for intervention during IONM-supported surgeries, our findings of resolution in alerts and notifications indicate that successful communications between the two teams could potentially lead to improved anesthetic care and patient safety.
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J Anaesthesiol Clin Pharmacol · Jan 2018
Comparison of ropivacaine (0.2%) with or without clonidine 1 μg/kg for epidural labor analgesia: A randomized controlled study.
The aim is to determine the effect of addition of clonidine to ropivacaine for epidural labor analgesia with regard to onset of analgesia, duration of analgesia, neonatal outcome, and quality of analgesia. ⋯ We conclude that clonidine in low doses is a useful adjuvant to local anesthetics for epidural labor analgesia and a good alternative to opioids.