Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Dec 2017
ReviewAdditives used to reduce perioperative opioid consumption 1: Alpha2-agonists.
Because of their significant side effects, especially in obese patients, the routine perioperative use of opioids has been questioned recently. Alpha2-agonists are drugs with a considerable analgesic potency with the potential to reduce opioid consumption. Alpha2-agonists bind to alpha2-adrenergic receptors in the CNS and peripherally. ⋯ Intraoperatively, a complete replacement of the synthetic opioid fentanyl by the alpha2-agonist dexmedetomidine has been demonstrated. Although alpha2-agonists have a sedative action, recovery times are not prolonged compared to those of opioids. Cardiovascular side effects such as bradycardia and hypotension have to be observed and treated.
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Best Pract Res Clin Anaesthesiol · Dec 2017
ReviewDifferent protocols used today to achieve total opioid-free general anesthesia without locoregional blocks.
With increasing awareness of both short- and long-term problems associated with liberal perioperative opioid administration, the need for routinely and clinically feasible alternatives is greater than ever. Opioid-free anesthesia-previously reserved for bariatric surgery-is receiving increasing attention in mainstream anesthesia. ⋯ For a concrete clinical perspective, we present in depth our opioid-free protocol for bariatric surgery. However, clinicians must be aware of potential problems related to opioid-free anesthesia.
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Lidocaine has analgesic effect and antihyperalgesic and anti-inflammatory properties, which enable its use as a general anesthetic adjuvant. Lidocaine can reduce nociception and/or cardiovascular responses to surgical stress, postoperative pain, and/or analgesic requirements. However, its mechanisms of action remain unclear, despite its different known properties. ⋯ It clearly improves the postoperative outcomes with increased patient satisfaction. Such procedures should be included wisely in the enhanced recovery after surgery protocols. By using the recommended protocols, a high safety and efficacy of lidocaine can be achieved.
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Best Pract Res Clin Anaesthesiol · Dec 2017
ReviewOpioid-free anesthesia opioid side effects: Tolerance and hyperalgesia.
Opioids are the most potent drugs used to control severe pain. However, neuroadaptation prevents opioids' ability to provide long-term analgesia and produces opposite effects, i.e., enhancement of existent pain and facilitation of chronic pain development. Neuroadaptation to opioids use results in the development of two interrelated phenomena: tolerance and "opioid-induced hyperalgesia" (OIH). ⋯ Conversely, observations of improved patient's recovery after opioid-sparing anesthesia techniques stand as an indirect evidence that perioperative opioid administration deserves caution. To date, perioperative OIH has rarely been objectively assessed by psychophysics tests in patients. A direct relationship between the presence of perioperative OIH and patient outcome is missing and certainly deserves further studies.