Articles: postoperative.
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New developments in analgesic drugs and techniques are being applied to the pediatric population. Appropriate pain management for ambulatory surgery patients helps to facilitate early discharge and minimize postoperative morbidity. ⋯ Recent data on techniques for pain management after pediatric ambulatory surgery will help the anesthetist develop a comprehensive plan for the postoperative period.
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To review the current recommendations and literature on training in regional anesthesia and suggest an improved model to prepare graduating residents better in the practice of regional anesthesia. ⋯ A structured regional anesthesia rotation, a dedicated team of mentors with training in regional anesthesia, and adequate clinical volume are a pre-requisite for adequate training, but they may not be available in many anesthesia residency training programs. As the demand for regional anesthesia continues to increase in the years to come, it is imperative to ensure adequate education of graduating residents to meet this demand. In order to achieve this goal, the present recommendations should be re-evaluated, and perhaps a proficiency in a core group of widely applicable and relatively simple nerve blocks should be mastered by all graduates.
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The present overview describes recent contributions to the literature with regard to choice of anesthetic techniques, approaches to anesthetic management of elderly outpatients undergoing arthroscopy and other procedures, reconsideration of the problem of postoperative delirium in the elderly patient, and a general summary of perioperative management and assessment of anesthetic risk in older adults. ⋯ The efficiency and speed with which outpatient surgery and anesthetic recovery can be conducted in older adults continue to improve. Monitors of depth of anesthesia, ultra-short-acting agents, and combined techniques have minimized minor complications such as nausea and vomiting, and have improved the speed with which these patients recover from anesthesia. A small proportion of elderly surgical outpatients remain at risk for residual postoperative cognitive dysfunction.
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A recent article in the New Scientist argued that women were under-represented in clinical trials which, until now, had masked the finding that ibuprofen 400 mg was ineffective in women. ⋯ There is no clinically meaningful difference in the efficacy of ibuprofen 400 mg between men and women experiencing moderate to severe postoperative pain and women were well represented.
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The alpha(2)-adrenoceptor agonist clonidine is one of the most widely investigated substances in anaesthesia and pain therapy. Recently, numerous experimental and clinical studies have allowed a better understanding of its underlying mechanisms of action and interactions with other analgesic drugs. ⋯ During the past decade clonidine has been investigated as an adjuvant for general and regional anaesthesia and in the postoperative period. There is no doubt that clonidine improves analgesia after systemic, spinal or peripheral opioids, and prolongs the analgesic action of most local anaesthetics. The side-effects of usual doses of clonidine are predictable. Given the clinical experience of an increasing number of hospitals, clonidine should no longer be considered an experimental drug, but a useful addendum to the pharmacological armamentarium.