Articles: postoperative.
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Anesthesia and analgesia · Jan 2018
Increased Hyperalgesia and Proinflammatory Cytokines in the Spinal Cord and Dorsal Root Ganglion After Surgery and/or Fentanyl Administration in Rats.
Perioperative fentanyl has been reported to induce hyperalgesia and increase postoperative pain. In this study, we tried to investigate behavioral hyperalgesia, the expression of proinflammatory cytokines, such as interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α), and the activation of microglia in the spinal cord and dorsal root ganglion (DRG) in a rat model of surgical plantar incision with or without perioperative fentanyl. ⋯ The surgical plantar incision with or without perioperative fentanyl induced significant mechanical and thermal hyperalgesia, an increased expression of IL-1β, IL-6, TNF-α in the spinal cord and DRG, and activation of microglia in the spinal cord.
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Pediatr Crit Care Me · Jan 2018
Measurement of Dead Space Fraction Upon ICU Admission Predicts Length of Stay and Clinical Outcomes Following Bidirectional Cavopulmonary Anastomosis.
Increased alveolar dead space fraction has been associated with prolonged mechanical ventilation and increased mortality in pediatric patients with respiratory failure. The association of alveolar dead space fraction with clinical outcomes in patients undergoing bidirectional cavopulmonary anastomosis for single ventricle congenital heart disease has not been reported. We describe an association of alveolar dead space fraction with postoperative outcomes in patients undergoing bidirectional cavopulmonary anastomosis. ⋯ Following bidirectional cavopulmonary anastomosis, alveolar dead space fraction in excess of 0.28 or arterial oxyhemoglobin saturation less than 78% upon ICU admission indicates an increased likelihood of requiring intervention prior to hospital discharge. Increasing alveolar dead space fraction and decreasing arterial oxyhemoglobin saturation are associated with increased lengths of stay.
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OPRM1-A118G polymorphism (A > G, rs1799971) is associated with interindividual variability in both response to postoperative pain and opioid treatment. The aim of this meta-analysis is to identify the predictive strength in the current literature of OPRM1-A118G polymorphism to postoperative anesthetic reactions, including nausea, vomiting, pruritus and dizziness. ⋯ OPRM1-A118G polymorphism (A > G) is associated with a reduced risk of postoperative vomiting, but not nausea, pruritus and dizziness. The results should be interpreted with caution due to limited sample and possible heterogeneity between the included studies. Well-designed and large-scale studies are necessary to confirm our results.
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Clinical case reports · Jan 2018
Case ReportsLiposomal bupivacaine for the management of postsurgical donor site pain in patients with burn injuries: a case series from two institutions.
Donor site pain associated with skin graft procedures is frequently intense and difficult to treat. Liposomal bupivacaine, a prolonged-release local anesthetic indicated for single-dose administration to produce postsurgical analgesia, may be a viable option in managing donor site pain.
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Pain following orthopedic surgery can be intense due to the nature of the surgical procedure. Pain is a multilevel phenomenon that includes physiological and psychosocial components. Interventions that address body, mind, and spirit are needed to provide holistic management of pain. Guided imagery is a mind-body intervention that can address all aspects of the patient's pain experience. ⋯ Based on the evidence reviewed, it is recommended that guided imagery be used as an adjunct for pain management in patients undergoing orthopedic surgery. However, additional research in this area is needed. Future research: Two topics for further research were identified. The first is a need to identify an optimal frequency of use of guided imagery. The second is to identify how to ensure patients are using the intervention as recommended.