Anesthesia and Analgesia Commons^™

Opioid Free Anesthesia In Arthroscopic Knee Surgery: A Feasible Approach To Patient Care, Carson Gifford, Denise Vidal, Dail Kim, Austin Goff, Paul Reynolds

HCA Healthcare Journal of Medicine

Background

The opioid epidemic has prompted exploration of opioid-free anesthesia (OFA) techniques, but the optimal approach is still debated. While some OFA protocols substitute opioids with other agents, these alternatives can introduce their own risks. The objective of this study was to investigate whether eliminating intraoperative opioids without analgesic substitution in arthroscopic knee procedures affects postoperative pain control and opioid requirements.

Methods

We conducted a retrospective analysis of 205 patients who underwent arthroscopic knee procedures between August and November 2023. Patients were divided into 2 groups: those who received intraoperative fentanyl (25-200 mcg, n = 144) and those who received …

5x-Multiplier Vs 3-Tier Model For Discharge Opioid Prescriptions After Intra-Abdominal Cancer Surgery: Randomized Clinical Trial Protocol, Brittany C. Fields, Timothy E. Newhook, Heather A. Lillemoe, Wei Qiao, Jose A. Karam, Surena F. Matin, Larissa A. Meyer, Ching-Wei D. Tzeng

Advances in Cancer Education and Quality Improvement

Background

Surgeons provide up to 10% of total opioid prescriptions across all specialties, and more than one-third of surgeon-prescribed medications are opioids. Patient-reported opioid consumption and risk of persistent opioid use beyond the postoperative recovery period correlate with the initial opioid quantity prescribed at discharge. Interventions to reduce postoperative opioid prescribing have demonstrated no adverse effects on pain control or increased need for prescription refill; however, in the absence of standardized prescription protocols, opioid prescribing practices vary widely.

Objective

The study objective is to identify the opioid prescribing model that provides the lowest oral morphine equivalents (OME) volume prescribed at …

Persistent Improvement In Opioid Perceptions And Prescribing For Cancer Surgery: 5-Year Follow-Up, Brittany C. Fields, Timothy E. Newhook, Heather A. Lillemoe, Jessica E. Maxwell, Jose M. Soliz, Keyuri U. Popat, Christina L. Roland, Jean-Nicolas Vauthey, Matthew H. G. Katz, Ching-Wei D. Tzeng

Advances in Cancer Education and Quality Improvement

Background and Objectives

We previously reported that implementation of a department-wide opioid education program led to post-education improvements in opioid perceptions and prescription recommendations, with one-month and one-year retention. With ongoing programmatic and quality improvement efforts, we sought to re-evaluate the retention of these improvements five years after initial efforts.

Methods

Attending surgeons, clinical fellows, and advanced practice providers were surveyed five years after implementation of a comprehensive, departmental opioid reduction framework in August 2018. This framework initially consisted of dedicated opioid education sessions and retrospective assessment of prescribing practices, and subsequently expanded over time to include prospective quality improvement …

Comparison Of Transversus Abdominis Plane Block Versus Intrathecal Clonidine In Lower Segment Caesarean Section - A Prospective Observational Study, Christy Maria Paul, Dr Somsundar R G Associate Professor, Dr Archana B N Assistant Professor, Dr. Shivakumar G Pofessor And Hod

Digital Journal of Clinical Medicine

Comparison of Transversus Abdominis Plane Block versus Intrathecal Clonidine in Lower Segment Caesarean Section - A Prospective Observational Study

Background and Objective: In the majority of abdominal procedures, transverse abdominis plane block, one of the fascial plane blocks, has been used extensively to treat post-operative pain. Ultrasound has gained popularity in the management of cesarean patients due to its ease of use and reduced adverse effects.To assess the effectiveness of ultrasound guided transverse abdominus plane block with intrathecal clonidine for post surgical pain control in lower segment cesarean patients.

Material and Methods: This prospective observational study was done in …

The Effects Of Propofol On Doppler Echocardiographic Values Of The Aorta, Main Pulmonary Artery, And Mitral E Wave In New Zealand White Rabbits, Mehmet Alper Çetinkaya, Mahir Kaya

The Thai Journal of Veterinary Medicine

The aim of this study was to determine the effects of propofol on acceleration time (AT), ejection time (ET), AT / ET ratio obtained from the aorta (Ao) and main pulmonary artery (MPA) and Doppler echocardiographic values of mitral E wave (E) in New Zealand white rabbits. Echocardiographic evaluation was performed in 40 conscious rabbits and repeated after propofol administration. The baseline mean values were 0.028±0.006 second (s) for Ao-AT, 0.116±0.017 s for Ao-ET, 0.24±0.036 for Ao-AT / ET, 0.05±0.01 s for MPA- AT, 0.137±0.018 s for MPA-ET, 0.38±0.037 s for MPA-AT/ET, 84.13±18.26 cm/s for E peak velocity, 3.06±1.38 mmHg …

The Effects Of Transcutaneous Electrical Nerve Stimulation On Pain And Function In Patients With Knee Osteoarthritis: A Critically Appraised Topic, P. Drake Short, Rileigh T. Ricken, Jennifer L. Volberding

Internet Journal of Allied Health Sciences and Practice

Purpose: Knee osteoarthritis (OA) is a common condition that impacts upwards of 40% of patients over the age of 70, and transcutaneous electrical stimulation (TENS) is a common treatment protocol. To date, there is no consensus on the effectiveness of TENS as a modality for knee OA. Thus, this critically appraised topic (CAT) aims to determine the impact of TENS on the pain and functional outcome of patients with knee OA. Methods: To assess the therapeutic efficacy of TENS, a systematic search of the available literature was conducted, focusing on pain and function in knee osteoarthritis. Online databases were searched …

Stellate Ganglion Block For Refractory Raynaud’S Phenomenon- A Case Report, William J. Naber Ii, Derik J. Scribner, Gabriel Howard

Graduate Medical Education Research Journal

Introduction: Raynaud’s phenomenon (RP) is predominately a sympathetically mediated ischemic vasospastic disease involving the distal limbs and is associated with sharp pains, numbness, and dermatological color changes. The symptoms are commonly induced by cold weather, stress, and trauma and it is known to affect 4.85% of the population. There are few well-defined treatments for patients with RP that are refractory to 1st-line therapies. We present a case of intractable RP with corresponding response to stellate ganglion block (SGB) which demonstrates the efficacy profile and safety of SNS blocks in treatment of resistant RP.

Methods: Per Bon Secours Mercy Health …

Sample Article, Sample Author

Jurnal Anestesi Perioperatif

Abstract here.

Sample Article, Sample Author

Jurnal Anestesi Perioperatif

Abstract here.

Sample Article, Sample Author

Jurnal Anestesi Perioperatif

Abstract here.

Comparison Between Honey Produced By Bees, Aphids And Wasps In Kurdistan Region - Iraq Based On Biochemical Parameters, Jian Lateif Hussein

Al-Bahir

Honey is a sweet substance that has been valued by humans for its taste and health benefits. It is produced by honey bees from the sugary secretions of plants. However, other insects, such as aphids and wasps, also produce honey-like substances. This study aimed to compare the physical and biochemical properties of honey produced by honey bees, aphids, and wasps in the Kurdistan Region of Iraq. To achieve this, samples of honey, bitter honey, honeydew, and wasp honey were collected and examined. The samples were analyzed for total sugar, sucrose, water, Hydroxymethylfurfural (HMF), acidity, total acidity, diastase activity, total phenolic …

Three-Dimensional Evaluation Of The Mandibular Lingula On Cone-Beam Computed Tomographic Images In The Turkish Population, Zerrin Unal Erzurumlu, Damla Torul

Journal of Dentistry Indonesia

Objective: The purpose of this study was to provide morphometric and anatomical data for mandibular lingula (Li) in The Turkish population using three dimensional-cone beam computed tomography (3D-CBCT) images. Methods: CBCT images of the patients taken between July 2020 and March 2021, were retrieved from the archival records. A total of 100 Li’s of 50 patients who met the criteria of this study were evaluated. The distances between the tip of the Li and ramal landmarks/occlusal plane were measured and the shape of the Li was evaluated on 3D-CBCT images. Results: CBCT images of the 50 patients (19 males and …

10-Minute Ebd: Preferred Analgesia For Orthodontic Tooth Movement: Acetaminophen Or Nsaids?, Ryan N. Mcgovern

The Journal of the Michigan Dental Association

This 10-Minute EBD column explores the choice between acetaminophen and NSAIDs for managing pain during orthodontic tooth movement. The author presents a scenario involving a patient's discomfort after archwire adjustment and delves into the impact of tooth movement on the periodontium. The PICO question focuses on the effectiveness of NSAIDs and acetaminophen in controlling discomfort without impeding tooth movement. The literature search reveals varying recommendations on analgesics, with some studies favoring acetaminophen. The evidence suggests that acetaminophen and short-term celecoxib are suitable choices for orthodontic analgesia. However, caution is advised in extrapolating findings from animal studies to human conditions.

J Mich Dent Assoc April 2022

The Journal of the Michigan Dental Association

Monthly, The Journal of the Michigan Dental Association brings news, information, and feature articles to our state's oral health community and the MDA's 6,200+ members. No publication reaches more Michigan dentists!

In this April 2022 issue, the reader will find the following original content:

• A cover feature “Protect Your Patients and Yourself: The Complete and Honest Medical History”
• A feature article “The Foundation for Dental Care: The Patient Interview and Dental/Medical Health History”
• A 10-Minute EBD “The Preferred Analgesia for Orthodontic Tooth Movement: Acetaminophen or NSAIDs?”
• News you need: an Editorial, a "Reminder about Antitrust Law", and regular department articles, …

Managing Concurrent Discitis And Epidural Abscess Following Tfesi Arising From Unlikely Bacterial Species: The Importance Of Post-Procedure Education, Adlai Pappy, Robert Louis, Vinita Singh

Advances in Clinical Medical Research and Healthcare Delivery

Introduction:

Transforaminal epidural steroid injection (TFESI) can provide pain relief when patients’ radicular pain is refractory to medication and physical therapy. However, it is important that clinicians understand potential signs and symptoms of TFESI complications to prevent long-term sequelae. Literature has not documented both discitis and an epidural abscess concurrently following a lumbar TFESI.

Case:

We present a patient with stage 3c melanoma on the right lower extremity (RLE) with worsening lower extremity and foot pain. The pain was refractory to his current medication regimen of Gabapentin, and he wanted an alternative to opioids. A right L2-L5 TFESI was …

J Mich Dent Assoc October 2021

The Journal of the Michigan Dental Association

Every month, The Journal of the Michigan Dental Association brings news, information, and features about Michigan dentistry to our state's oral health community and the MDA's 6,200+ members. No publication reaches more Michigan dentists!

In this issue, the reader will find the following original content:

• A cover story, “Welcoming Colleagues from Different Practice Models”.
• A feature article from the Journal’s DEI series, “Diversity, Equity, and Inclusion: Perspectives from an LGBTQ Dentist”.
• A feature article, “Congratulations, 2021 MDA Life Members!”.
• News you need, Editorial and regular department articles on MDA Foundation activities, Dentistry and the Law, Staff Matters, and component news. …

Anesthetic Use In Status Epilepticus: A Concise Review, Furkan M. Yilmaz, Lauren A. Igneri, Yasir A. Yilmaz, Evren Burakgazi-Dalkilic

Cooper Rowan Medical Journal

The purpose of this review is to summarize the recent literature focusing on intravenous (IV) administration of commonly used anesthetics, including midazolam, pentobarbital/ thiopental, propofol, and ketamine in the treatment of status epilepticus (SE). Anesthetics should be reserved as third-line therapy for the treatment of SE when benzodiazepines and other second-line agents fail to terminate the seizure. We have reviewed the literature related to the treatment of status epilepticus, refractory status epilepticus, super-refractory status epilepticus, anesthetics, midazolam, pentobarbital/thiopental, propofol, and ketamine. This paper focuses on the pharmacology, dosages, major side effects, and clinical use of IV anesthetics in the treatment …

The Clinical Relevance Of Cement Volume In Percutaneous Vertebral Augmentation, Ravi G. Mirpuri, Madhuri Are, Virginia Hardie, Michael J. Warden, Robin High

Graduate Medical Education Research Journal

Introduction: Vertebroplasty and Kyphoplasty are two forms of percutaneous vertebral augmentation (PVA), in which polymethylmethacrylate cement is used to stabilize vertebral compression fractures (VCF). This study sought to evaluate the relationship between cement volume and clinical outcomes, including pain reduction, opioid use, and complication rate.

Methods: Retrospective chart review produced 88 patients who received PVA at a tertiary care outpatient pain clinic. Cement volume, type of PVA, gender, level (thoracic vs lumbar) were collected, as well as clinical outcomes of numeric pain score (NPS) reduction, opioid percent change (OPC), and complications. Both pre-procedure and post-procedure (between 2-4 weeks) data were …

Ponv Prophylaxis Failure Disproportionately Affects Female Patients, Despite Intraoperative Computerized Decision Support Guidance, Karl A. Krieser, John B. Riley Iii, Jospeh E. Baus, Julie T. Hoffman, James N. Sullivan Md, Robert L. Lobato

Graduate Medical Education Research Journal

Objectives: To compare postoperative nausea and vomiting (PONV) prophylaxis treatment and outcomes based on patients’ sex, using a retrospective cohort. The setting was the operating room and post-anesthesia care unit of a tertiary care university medical center.

Patients: A total of 678 adult male and female patients with American Society of Anesthesiologist (ASA) scores of 1-4 underwent surgery with general anesthesia. All patients received preoperative PONV risk assessment. PONV prophylaxis was administered at the discretion of the anesthesia care team members with guidance from a computerized decision support system.

Measurements: Adequacy of prophylaxis was retrospectively determined based on individual patient …

Npo Or Ama? Patients Allowed Clear Liquids Up To 2 Hours Pre-Procedure Have Equivalent Aspiration Risk And Increased Patient Satisfaction, Erich Smith

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Itou K, Fukuyama T, Sasabuchi Y, et al. Safety and efficacy of oral rehydration therapy until 2 h before surgery: a multicenter randomized controlled trial. Journal of Anesthesia. 2012;26(1):20-27. doi: 10.1007/s00540-011-1261-x.

Protecting Patients Who Lack A Voice, Rainer Spiegel

Animal Sentience

Neither human young today nor future human generations nor non-human species have a voice in protecting the biosphere. Treves et al. propose courts and trustees for defending their interests. I describe an analogy with attempts to represent the interests of children and comatose patients in medicine.

Non-Human Animals Providing Rescue In Medical Emergencies, Rainer Spiegel

Animal Sentience

In their target article, Chapman & Huffman challenge the quotation of Sir William Osler that the desire to take medication distinguishes humans from non-human animals. They provide examples of self-medication in non-human animals. Based on these examples, it can be inferred that non-human animals practice at least some form of medicine for symptom control. I would like to extend this view by showing that non-human animals not only provide self-medication, but also rescue others facing emergencies.

Apoptotic Neurodegeneration In The Developing Human Brain: Possible Role Of General Anesthetics In Its Genesis, And Of L-Carnitine In Its Reversal, Yisroel Yitzchok Rosenfeld

The Science Journal of the Lander College of Arts and Sciences

Recent studies suggest that general anesthetic (GA) agents administered to developing rats, through its mechanism as an NMDA antagonist or a GABAa mimetic, may damage developing neural cells by inducing a higher rate of programmed cell death (apoptosis). Similar heightened degeneration was also apparent in higher primates such as the monkey. This warrants strong concern, as every year thousands of pregnant women and children below 1 year of age undergo a surgical procedure in which GAs are used. A spike in neuroapoptosis may lead to long term cognitive deficiencies lingering into adulthood. Are humans vulnerable to these affects? Different pathways …

Cerebral Anoxia And Its Residuals: I. Historical Introduction, Cyril B. Courville

Medical Arts and Sciences: A Scientific Journal of the College of Medical Evangelists

No abstract provided.