Expert opinion on pharmacotherapy
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Neuromuscular blocking agents are currently used during anesthesia but put patients at risk of postoperative paralysis. If the residual neuromuscular blockade is not reversed properly at the end of anesthesia, there is a risk of hypoxemia and pulmonary complication. Sugammadex is able to fully reverse different degrees of neuromuscular blockade induced by steroidal neuromuscular blocking agents. ⋯ Sugammadex provides an original mechanism of reversing the effect of neuromuscular steroidal agent by direct inactivation in plasma. Although its effect is spectacular, it is questionable whether this drug will change current practice.
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Multimodal postoperative pain management targeted at diminishing harmful outcomes should include pregabalin in cases that need opioid reduction and when the risk of developing chronic neuropathic postsurgical pain is present. Gabapentanoids have grown in importance due to their opioid-sparing effects. They may also contribute to the prevention of chronic postsurgical pain. ⋯ Pregabalin is a safe and effective medication that may decrease perioperative opioid use in patients with more acute neuropathic pain than acute inflammatory pain. When surgery involves more neuropathic-type acute pain there is growing evidence that pregabalin may decrease the incidence of chronic pain.
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Expert Opin Pharmacother · Nov 2010
ReviewAntihypertensive therapy and de-stiffening of the arteries.
There is no doubt as to the existence of a significant relationship between the pulsatile blood pressure component and cardiovascular risk. In hypertensive subjects, cardiovascular event risk reduction is mainly associated with the normalization of systolic blood pressure. Systolic blood pressure and pulse pressure in the ascending aorta exceeds brachial systolic and pulse pressure significantly. ⋯ It is possible to obtain a selective and long-term reduction of brachial and - even more importantly - central pulse pressure by decreasing arterial stiffness and/or wave reflections.