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Med. Clin. North Am. · Jan 2022
Review Case ReportsPerioperative Buprenorphine Management: A Multidisciplinary Approach.
Buprenorphine formulations (including buprenorphine/naloxone) are effective treatments of pain and opioid use disorder (OUD). Historically, perioperative management of patients prescribed buprenorphine involved abstinence from buprenorphine sufficient to allow for unrestricted mu-opioid receptor availability to full agonist opioid (FAO) treatment. Evidence is mounting that a multimodal analgesic strategy, including simultaneous administration of buprenorphine and FAO, nonopioid adjuncts such as acetaminophen and nonsteroidal anti-inflammatory drugs, and regional anesthesia, is a safe and effective perioperative strategy for the patient prescribed long-term buprenorphine treatment of OUD. This strategy will likely simplify management and more seamlessly provide continuous buprenorphine treatment of OUD after hospital discharge.
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Multicenter Study
Long-Term, Prospective, Multicenter Study of Poly-4-Hydroxybutyrate Mesh (Phasix Mesh) for Hernia Repair in Cohort at Risk for Complication: 60-Month Follow-Up.
Long-term resorbable mesh represents a promising technology for ventral and incisional hernia repair (VIHR). This study evaluates poly-4-hydroxybutyrate mesh (P4HB; Phasix Mesh) among comorbid patients with CDC class I wounds. ⋯ Five-year outcomes after VIHR with P4HB mesh were associated with infrequent complications and durable hernia repair outcomes. This study provides a framework for anticipated long-term hernia repair outcomes when using P4HB mesh.
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Ann Fr Anesth Reanim · Jan 1995
[Effects of mechanical ventilation with PEEP on right to left intra-cardiac shunt caused by patent foramen ovale].
To assess the presence of a patent foramen ovale (PFO) using colloid contrast transoesophageal echocardiography in mechanically ventilated patient with and without PEEP and it repercussion on PaO2. ⋯ This study suggests that mechanical ventilation with PEEP enhances an intracardiac right-to-left shunt through a PFO. This condition is responsible for the lack of improvement in blood oxygenation when PEEP is added. When a PFO is present all over the respiratory cycle, or when the oxygenation is worsened with PEEP, this positive pressure ventilation should be avoided. The deleterious consequences of mechanical ventilation on venous return may be minimized by partial ventilation and weaning from ventilator.
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The core pathology of coronavirus disease 2019 (COVID-19) is infection of airway cells by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that results in excessive inflammation and respiratory disease, with cytokine storm and acute respiratory distress syndrome implicated in the most severe cases. Thrombotic complications are a major cause of morbidity and mortality in patients with COVID-19. Patients with pre-existing cardiovascular disease and/or traditional cardiovascular risk factors, including obesity, diabetes mellitus, hypertension and advanced age, are at the highest risk of death from COVID-19. ⋯ We highlight the distinct contributions of coagulopathy, thrombocytopathy and endotheliopathy to the pathogenesis of COVID-19 and discuss potential therapeutic strategies in the management of patients with COVD-19. Harnessing the expertise of the biomedical and clinical communities is imperative to expand the available therapeutics beyond anticoagulants and to target both thrombocytopathy and endotheliopathy. Only with such collaborative efforts can we better prepare for further waves and for future coronavirus-related pandemics.
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Int J Obstet Anesth · May 2021
Observational StudyIncidence, severity, and determinants of uterine contraction pain after vaginal delivery: a prospective observational study.
Postpartum uterine contraction pain has not been studied sufficiently. We aimed to assess the incidence, intensity, and risk factors for postpartum uterine contraction pain. ⋯ Postpartum uterine contraction pain is common and severe in some women. Parity and history of dysmenorrhea are significant risk factors for significant postpartum uterine contraction pain.