Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Dec 2002
ReviewUnderstanding the physiology and pharmacology of epidural and intrathecal opioids.
Epidural and intrathecal opioid administration has become an important part of contemporary medical practice in a variety of clinical settings. It has been widely assumed that any opioid placed in the epidural or intrathecal spaces will produce highly selective spinally mediated analgesia that is superior to that produced by other analgesic techniques. ⋯ In fact, multiple opioids are currently employed for spinal use despite the fact that clinical evidence has shown that spinal administration does not produce analgesia with a selective spinal mechanism or that the analgesia produced is not superior to that produced by intravenous administration. This chapter presents the basic science and clinical data available to assist clinicians in identifying which opioids are appropriate for spinal use and which are not.
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Best Pract Res Clin Anaesthesiol · Dec 2002
ReviewDrug combinations in pain treatment: a review of the published evidence and a method for finding the optimal combination.
The evidence of the usefulness of drug combinations in pain management is reviewed and the problem of finding the optimal combination is presented. For post-operative pain, adding a non-steroidal anti-inflammatory drug (NSAID) or paracetamol to intravenous morphine is beneficial. Adding ketamine to intravenous morphine may be advantageous, but ketamine has a narrow therapeutic window. ⋯ Adding NSAIDs or ketamine to opioids may be useful in cancer pain. Because of the enormous number of possible combinations, randomized controlled trials may fail to test the optimal combination. A stepwise optimization model that has been applied in clinical investigations is presented.
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Best Pract Res Clin Anaesthesiol · Dec 2002
ReviewFrom pain research to pain treatment: the role of human experimental pain models.
There is no objective measure of a complete pain perception; we can, however, measure different aspects of nociceptive processing and pain perception. Earlier, experimental pain models often only involved induction of cutaneous pain using a single stimulus modality. Recently new experimental models have been developed eliciting various modalities of deep and visceral pain which more closely resemble clinical pain conditions. ⋯ However, in spite of our immense knowledge, we still do not know how to prevent and treat this hyperexcitability efficiently. Our understanding of nociceptive mechanisms involved in acute and chronic pain and the effects of anaesthetic drugs or combinations of drugs on these mechanisms in humans may also be expanded using human experimental models. This mechanism-based approach may help us to develop and test therapeutic regimes in patients with acute and chronic pain.
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Best Pract Res Clin Anaesthesiol · Sep 2002
Evolution of the anaesthetic workload--the French experience.
The use of anaesthesia has shown major growth during the period 1975-1985. Increases safety in anaesthesia safety have permitted its use in surgery and in other exploratory procedures involving older patients and those with more severe clinical conditions. A survey, designed by the French Society of Anaesthesiologists, collected and analysed data relating to anaesthesia performed in France in 1996 from a representative sample collected in all French hospitals and clinics; the results of this survey were compared with an earlier survey performed in 1980. ⋯ The practice of epidural anaesthesia for deliveries has developed markedly in France during recent years, increasing from 1.5 to 51% of all deliveries between 1980 and 1996. This survey has offered an interesting overview of recent developments in anaesthesia--which are probably representative of the evolutionary trends in most industrialized countries. These changes can be summarized in three major points: (i) a global increase in the use of anaesthesia related to improvements in its safety; (ii) a significantly increased use of anaesthesia in elderly patients; and (iii) a marked increase in regional anaesthesia.
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Best Pract Res Clin Anaesthesiol · Sep 2002
The place of research and the role of academic anaesthetists in anaesthetic departments.
The specialty of anaesthesia developed because of its fundamental contribution to health care, including the prevention of pain from surgery, respiratory, and critical care medicine, cardiopulmonary resuscitation and pain medicine. Through these contributions anaesthesia became an important component of the medical profession. ⋯ The challenges to the anaesthetist-scientist include evaluation, funding, conflicts of interest, legal and fraud. The future of the anaesthetic profession is mainly with its intellectual resources, especially research as the basis of improved patient care, and to have a major impact on the future of medicine overall.