Opioid Free Anesthesia
|
|
- Camron Moody
- 5 years ago
- Views:
Transcription
1 Opioid Free Anesthesia Michael H Wilhelm, CRNA, APRN Opioid Free Anesthesia Michael H Wilhelm, CRNA, APRN 1
2 Why is pain important? Primary contributor to post-operative distress 56% of patients state that this is the major concern about surgery 75% of patients state that inadequate pain management during their care at a facility This can lead to certain factors: Prolonged hospital stays Unnecessary readmissions Increased morbidity Increased healthcare costs Can lead to chronic pain syndromes Indications for Opioid Free Anesthesia Obese Patients Obstructive Sleep Apnea Acute and Chronic Opioid Addiction Previous Hyperalgesia Problems Patients with severe PONV 2
3 Contraindications to Opioid Free Anesthesia Absolute Allergy to any of the adjuvant drugs Relative Consider side effects of adjuvant drug side effects Do we need a new method of anesthesia? Aims of a surgical anesthetic Amnesia Analgesia Control of autonomic effects Rapid Emergence Opioids were the ideal product to meet this aim, but are they still as necessary with less cardiovascular suppressant anesthetic drugs. 3
4 Why should we practice opioid sparing/free Opioids have traditionally been the first line therapy for surgical pain control Opioid drugs produce pharmacologic properties by binding to opiate receptors, located in the CNS, supraspinal and spinal and peripheral sites Side effects of opioid unwanted effects are seen about 30% Can exacerbate obstructive sleep apnea and increase its severity Opioid tolerance can happen even after a single dose Decrease the chances of opioid related side effects such as: Delayed emergence GI side effects such as ileus, constipation, nausea and vomiting Respiratory Depression Pruritus Urinary Retention Tolerance by desensitization Reduced cardiac output Short duration of central muscle stiffness Acute Tolerance and Hyperalgesia Potent opioids may be rapidly eliminated and lead to acute tolerance which may lead to increased postoperative pain This has been labeled the opioid paradox The more opioids given intraoperatively the more is needed postoperatively and the higher pain scores will be Prolonged exposure to opioids shifts the dose-response curve in such a way that larger doses of opioids are needed over time to render the same level of analgesia (Opioid Tolerance) 4
5 Drugs Available to Reduce Opioid Requirements We need to block the sympathetic system Opioids at one time were the only option Today we have many drugs that that can work in the same manners Direct Central or peripheral sympathetic block Clonidine Dexmedetomidine Beta-Blockers Indirect Blockers Calcium Channel Blockers Lidocaine Magnesium Sulfate Inhalational Agents Multimodal pain management is the best way to reduce opioid consumption. Multimodal analgesia includes local anesthetic as well as systemic drugs and aim to reduce the dose of any single agent thereby reducing the potential for adverse effects A stable anesthetic can be delivered with the multimodal approach of sympatholytic drugs and non-opioid analgesics This can result in the reduction or avoidance of opioids in the postoperative area 5
6 What are the options to lead to opioid free? Different drug classes that can be used to help with pain relief Regional Anesthesia Alpha-2 Agonists Pharmacologically they are suitable for a multimodal approach Can cause sedation, hypnois, anxioloysis, sympatholysis and analgesia Clonidine was used in this fashion in the 1980 s Today dexemedtomidine is a better replacement Intial Bolus leads to activiation of alpha-2 receptors on vascular smooth muscle Intial vasoconstriction and a transient increased blood pressure with a reflex bradycardia Following the bolus a more gradual central effect is seen with sedatin and decrease in sympathetic outflow The antinociceptive effect is belived to be from the a2-adreno receptors in the central nervous sytem and spinal cord 6
7 Lidocaine Sodium Channel Blocker Can provide excellent pain relief when given intravenously Analgesic, antihyperalgesic and anti-inflammatory effects Advantages Decreased intraoperative anesthetic requirements Reduces opioid requirements with a reduction of opioid side effects Faster return of bowel function Good for abdominal cases Decreased duration of hospital stay Shown to decrease hospital stay by one day In the outpatient setting it demonstrated less opioid requirements, faster discharge and decreased PONV Lidocaine Meta-Analysis by Dunn & Duriex (2017) stated that lidocaine infusions can be delivered in various fashions but that the most common was as follows: Bolus on Induction 1.5 mg/kg followed by an infusion of 1-3mg/kg/hr The infusion could be discontinued on emergence but could also be continued in PACU and the floor for up to 2 days. 7
8 Esmolol Ultra-Short Acting cardioselective beta1 adrenergic receptor antagonist Rapidly hydrolyzed by red blood cell esterases Duration of action of about 9 minutes Can be targeted to attenuate unwanted autonomic responses Studies have demonstrated that it also has analgecis properties In the past has been recommended in replacement of opioids Advantages Has been shown to result in earlier discharge Because of reduced narcotics, reduced incidence of PONV Increased patient satisfaction Esmolol In a study by Margarita et al. (2001) they utilized an esmolol infusion instead of a remifentanil infusion during outpatient GYN Cases Less Nausea 4% with esmolol vs 35% in remi group Faster discharge times 112 min with esmolol vs 151 min with remi Esmolol dose on induction was 1mg/kg followed by infusion prior to skin incision of 5mcg/kg/min and discontinued on completion of case. 8
9 Magnesium Activates NMDA receptors causing calcium entry into the cell and triggering central sensitization NMDA receptors control ion channels and depolarization of 2nd order neurons Works as a non-competitive antagonist of NMDA glutamate receptors Leads to a voltage dependant block of NMDA receptors by blocking the entry of calcium and sodium into the cells Prevents depolarization and transmission of pain signals Ketamine receptor prevents efflux of potassium Magnesium Ryu, Kang, Park and Do (2008) demonstrated in a double blind, prospective study that Magnesium reduced the amount of Rocuronium used in a case and also improved the quality of postoperative analgesia. Rocuronium use on Group Magnesium was 35 mcg/kg/min vs Group Saline 44 mcg/kg/min Propofol and Remifentanil delivery were similar in both groups Postoperative pain scores, cumulative analgesic consumption and shivering incidents were significantly reduced. On induction Magnesium was delivered with a bolus of 50 mg/kg followed by an infusion of 15 mg/kg/hr. 9
10 Ketamine Unique intravenous anesthetic with analgesic properties Small doses ( mg/kg) have shown to provide opioid sparing effect Greater patient and physician acceptance because of the less frequency of side effects Studies show mixed results with regard to benefit, but no demonstration of harm Pretreatment with ketamine has shown attenuation of opioid induced hyperalgesia. Seems to hold particular benefits for the opioid tolerant patient and significantly improves the postoperative management during the first few days following surgery. Ketamine At doses of 0.5mg/kg as a bolus or infusions exceeding 0.5mg/kg/hr have been found to be associated with increased neuropsychiatric effects. 4 At doses less that 0.5mg/kg it reduces postoperative analgesic needs and this is especially seen in the opioid tolerant patient. 4 Some authors recommend that opioid tolerant patients should receive a 5-10mg/hr ketamine infusion postoperatively and this may be continued for weeks. 5 10
11 Dexamethasone Potent corticosteroid lacking of mineralocorticoid effects Used as an antiemetic when given at a dose of 50mcg/kg on induction At doses of 100mcg/kg it has been demonstrated to have analgesic properties 6 Reduced pain scores and decreased narcotic need by patient shown within 24 hours of procedure It is believed that this if from the anti-inflammatory properties leading to less edema formation and less pain at operated site 6,7 Suggested to be given prior to incision as this may limit inflammation, preoperative administration may be more beneficial as onset of action is 1-2 hours, but we may see the painful perineal sensation 7 Optimal dose suggested in literature is mg/kg 7 Gabapentinoids Limits facilitation of pain transmission by inhibiting the voltage gated calcium channels on sensory neurons Has demonstrated benefits in the management of neuropathic pain Multiple studies have shown a role for acute postoperative pain Reduces opioid consumption by about 33% when given as a premedication 5 Side effect of dizziness and lack of coordination 11
12 Case Example - Pre-Op Procedure: Laparoscopic Total Hysterectomy with removal of Fallopian Tubes and Ovaries. Patient Information: kg BMI-36 Age-52 Allergies: Codeine and PCN PMH: HTN, Denies OSA, Denies Smoking, GERD PSH: Lap Chole, D&C, Toe Surgery, C-Section X 2 Airway: MPII, teeth intact no cervical limitations Induction Pt was brought to the OR uneventful and attached to all monitors and preoxygenated with O2. Premedicated with Versed 2mg Induction Fentanyl 50mcg, Propofol 100mg, Magnesium 2gms, Lidocaine 1.5mg/kg, Rocuronium 50mg Intubation was uneventful and ETT placed Pt was given a TAP Block Bilateral with 30ml 0.25% Bupivicaine on each side 12
13 Intra-Op After induction the following was done: Ofirmev 1000mg IV Lidicaine 2mg/kg/hr for duration of case Decadron 10mg Zofran 4mg Toradol 30mg Lopressor 2mg Anesthesia was maintained with Sevoflurane at 2% and Rocuronium was redosed for a total of 30mg Emergence Pt reversed with Sugammadex 200mg Lidocaine infusion was discontinued Emergence and extubation was uneventful Patient delivered to PACU with normal order set and after visiting the patient later in the day only received another 12.5mcg Fentanyl and was sent to the floor and discharged the following day. During stay at hospital patients pain resulting in only one incident of 6/10 pain all others were 5/10 or below. Pt pain was managed with Ibuprofen and Tylenol during stay till discharge. 13
14 References 1. Dunn LK, Durieux ME. Perioperative Use of Intravenous Lidocaine. Anesthesiology. 2017;126(4): doi: /aln Coloma, M, Chiu, J, White, P & Armbruster, P. The Use of Esmolol As an Alternative to Remifentanil During Desflurane Anesthesia for Fast-Track Outpatient Gynecologic Laparoscopic Surgery. Survey of Anesthesiology. 2001;45(6): doi: / Ryu J-H, Kang M-H, Park K-S, Do S-H. Effects of magnesium sulphate on intraoperative anaesthetic requirements and postoperative analgesia in gynaecology patients receiving total intravenous anaesthesia. British Journal of Anaesthesia. 2008;100(3): Hodgson, E. Sticky concepts in anaesthetic practice. FMM Viscomi, CM. Postoperative analgesia: elements of successful recovery. Anesthesiology. 2013; 55(25). 6. De Oliveira, GS, Almeida, MD, Benzon, HT, McCarthy, RJ. Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology. 2011; 115(3): Waldron NH, Jones CA, GAN TJ, Allen TK, Habib AS. Impact of perioperative dexamethasone on postoperative analgesia and side effects: systematic review and meta-analysis. British Journal of Anaesthesia. 2013; 110(2):
Anesthesia for OutPatient Spine Surgery. Michael A. Kellams, D.O.
Anesthesia for OutPatient Spine Surgery Michael A. Kellams, D.O. DISCLOSURE None! Hot Topics 2017 -Multimodal Analgesia/ERAS -TAP block -Inpatient procedures outpatient (Fusions) Multimodal Analgesia -Using
More informationSatisfactory Analgesia Minimal Emesis in Day Surgeries. (SAME-Day study) A Randomized Control Trial Comparing Morphine and Hydromorphone
Satisfactory Analgesia Minimal Emesis in Day Surgeries (SAME-Day study) A Randomized Control Trial Comparing Morphine and Hydromorphone HARSHA SHANTHANNA ASSISTANT PROFESSOR ANESTHESIOLOGY MCMASTER UNIVERSITY
More informationSEEING KETAMINE IN A NEW LIGHT
SEEING KETAMINE IN A NEW LIGHT BobbieJean Sweitzer, M.D., FACP Professor of Anesthesiology Director of Perioperative Medicine Northwestern University Bobbie.Sweitzer@northwestern.edu LEARNING OBJECTIVES
More informationIntravenous lidocaine infusions. Dr Ian McConachie FRCA FRCPC
Intravenous lidocaine infusions Dr Ian McConachie FRCA FRCPC Thank the organisers for inviting me. No conflicts or disclosures Lidocaine 1 st amide local anesthetic Synthesized in 1943 by Lofgren in Sweden.
More informationMinimal Opioid Anesthetic In Patient With History Of Substance Abuse: A Case Study
University of New England DUNE: DigitalUNE Nurse Anesthesia Capstones School of Nurse Anesthesia 4-2015 Minimal Opioid Anesthetic In Patient With History Of Substance Abuse: A Case Study Sarah E. Varney
More informationChapter 25. General Anesthetics
Chapter 25 1. Introduction General anesthetics: 1. Analgesia 2. Amnesia 3. Loss of consciousness 4. Inhibition of sensory and autonomic reflexes 5. Skeletal muscle relaxation An ideal anesthetic: 1. A
More informationThe Pain of Pain: or Patience for Patients
The pain of pain or: Patience for Patients Alan Bielsky Objectives Discuss mechanisms of acute on chronic pain Explain the practical use of multimodal analgesia Detail different regimens that may benefit
More informationObjectives 9/7/2012. Optimizing Analgesia to Enhance the Recovery After Surgery CME FACULTY DISCLOSURE
Optimizing Analgesia to Enhance the Recovery After Surgery Francesco Carli, M.D.. McGill University, Montreal, QC, Canada. ASPMN, Baltimore, 2012 CME FACULTY DISCLOSURE Francesco Carli has no affiliation
More informationLearning Objectives. Perioperative goals. Acute Pain in the Chronic Pain Patient for Ambulatory Surgery 9/8/16
Acute Pain in the Chronic Pain Patient for Ambulatory Surgery Danielle Ludwin, MD Associate Professor of Anesthesiology Division of Regional and Orthopedic Anesthesia Columbia University Medical Center
More informationAs laparoscopic surgeries are gaining popularity, Original Article. Maharjan SK 1, Shrestha S 2 1. Introduction
, Vol. 1, No. 1, Issue 1, Jul.-Sep., 2012 Original Article Maharjan SK 1, Shrestha S 2 1 Associate Professor, 2 Assistant Professor, Department of Anaesthesiology and Intensive Care Kathmandu Medical College,
More informationMD (Anaesthesiology) Title (Plan of Thesis) (Session )
S.No. 1. COMPARATIVE STUDY OF CENTRAL VENOUS CANNULATION USING ULTRASOUND GUIDANCE VERSUS LANDMARK TECHNIQUE IN PAEDIATRIC CARDIAC PATIENT. 2. TO EVALUATE THE ABILITY OF SVV OBTAINED BY VIGILEO-FLO TRAC
More informationRemifentanil. Addressing the challenges of ambulatory orthopedic procedures 1-3
Remifentanil Addressing the challenges of ambulatory orthopedic procedures 1-3 INDICATIONS AND IMPORTANT RISK INFORMATION INDICATIONS ULTIVA (remifentanil HCl) for Injection is indicated for intravenous
More informationAwake regional versus general anesthesia in preterms and ex-preterm infants for herniotomy
Awake regional versus general anesthesia in preterms and ex-preterm infants for herniotomy Department of Anaesthesia University Children s Hospital Zurich Switzerland Epidemiology Herniotomy needed in
More informationCurrent evidence in acute pain management. Jeremy Cashman
Current evidence in acute pain management Jeremy Cashman Optimal analgesia Best possible pain relief Lowest incidence of side effects Optimal analgesia Best possible pain relief Lowest incidence of side
More informationGeneral Anesthesia. Mohamed A. Yaseen
General Anesthesia Mohamed A. Yaseen M.S,c Surgery Before Anesthesia General Anesthesia ( GA ) Drug induced absence of perception of all sensation allowing surgery or other painful procedure to be carried
More informationCOBISS.SR-ID EFFECTIVNESS OF DEXAMETASONE VS. MAGNESIUM SULPHATE IN POSTOPERA- TIVE ANALGESIA (DEXAMETASONE VS. MAGNESIUM SULPHATE)
COBISS.SR-ID 222299404 616-089.5-06:616.33-008.3 615.243.6 Original article EFFECTIVNESS OF DEXAMETASONE VS. MAGNESIUM SULPHATE IN POSTOPERA- TIVE ANALGESIA (DEXAMETASONE VS. MAGNESIUM SULPHATE) Brikena
More informationShow Me the Evidence: Epidurals, PVBs, TAP Blocks Christopher L. Wu, MD Professor of Anesthesiology The Johns Hopkins Hospital
Show Me the Evidence: Epidurals, PVBs, TAP Blocks Christopher L. Wu, MD Professor of Anesthesiology The Johns Hopkins Hospital Overview Review overall (ERAS and non-eras) data for EA, PVB, TAP Examine
More informationproblems with, 29, 98 psychiatric patients, 96 rheumatic conditions, 97
180 ACE inhibitors, 26 acetaminophen, see paracetamol acupressure, anti-emetic effect, 143 acute drugs, 64 5 adenoidectomy, 161 adrenaline, 64 α-2-chloroprocaine, 74, 81 age impact on patient selection,
More informationINTRAVENOUS LIDOCAINE INFUSIONS AND INTRALIPID RESCUE
INTRAVENOUS LIDOCAINE INFUSIONS AND INTRALIPID RESCUE Acute Pain Service-LHSC VH and UH sites HISTORY Lidocaine and procaine used by IV infusion in the 1950s and 1960s for general analgesia Often continued
More informationLabor Epidural: Local Anesthetics and Beyond
Goals: Labor Epidural: Local Anesthetics and Beyond Pedram Aleshi MD The Changing Practice of Anesthesia September 2012 Review Concept of MLAC Local anesthetic efficacy Local anesthetic sparing effects:
More informationSedation For Cardiac Procedures A Review of
Sedation For Cardiac Procedures A Review of Sedative Agents Dr Simon Chan Consultant Anaesthesiologist Department of Anaesthesia and Intensive Care Prince of Wales Hospital Hong Kong 21 February 2009 Aims
More informationGeneral anesthetics. Dr. Shamil AL-Noaimy Lecturer of Pharmacology Dept. of Pharmacology College of Medicine
General anesthetics Dr. Shamil AL-Noaimy Lecturer of Pharmacology Dept. of Pharmacology College of Medicine Rationale General anesthesia is essential to surgical practice, because it renders patients analgesic,
More informationHypotension after induction, corrected with 20 mg ephedrine x cc LR EBL 250cc Urine output:
Terry C. Wicks, CRNA, MHS Catawba Valley Medical Center Hickory, North Carolina 63 y.o., 5 2, 88 kg female for hand assisted laparoscopic tranversecolectomy Co-morbidities include: Hypertension controlled
More informationDigital RIC. Rhode Island College. Linda M. Green Rhode Island College
Rhode Island College Digital Commons @ RIC Master's Theses, Dissertations, Graduate Research and Major Papers Overview Master's Theses, Dissertations, Graduate Research and Major Papers 1-1-2013 The Relationship
More informationPerioperative Pain Management
Perioperative Pain Management Overview and Update As defined by the Anesthesiologist's Task Force on Acute Pain Management are from the practice guidelines from the American Society of Anesthesiologists
More informationLumbar Fusion. Reference Guide for PACU CLINICAL PATHWAY. All patient variances to the pathway are to be circled and addressed in the progress notes.
Reference Guide for PACU Lumbar Fusion CLINICAL PATHWAY All patient variances to the pathway are to be circled and addressed in the progress notes. This Clinical Pathway is intended to assist in clinical
More informationERAS: Enhanced Recovery After Surgery. Christopher L. Wu, M.D. Professor of Anesthesiology The Johns Hopkins University; Baltimore, Maryland
ERAS: Enhanced Recovery After Surgery Christopher L. Wu, M.D. Professor of Anesthesiology The Johns Hopkins University; Baltimore, Maryland Overview History and basic principles of ERAS Review published
More informationENHANCED RECOVERY PROTOCOLS FOR KNEE REPLACEMENT
ENHANCED RECOVERY PROTOCOLS FOR KNEE REPLACEMENT Jeff Gadsden, MD, FRCPC, FANZCA Associate Professor Duke University Department of Anesthesiology Regional Anesthesia and Acute Pain Medicine DISCLOSURES
More informationChildhood Obesity: Anesthetic Implications
Childhood Obesity: Anesthetic Implications The Changing Practice of Anesthesia 2015 UCSF Department of Anesthesia and Perioperative Care Marla Ferschl, MD Associate Professor of Anesthesia University of
More informationAcute Postoperative Pain. David Radvinsky, MD March 24, 2016
Acute Postoperative Pain David Radvinsky, MD March 24, 2016 Objectives 1. Discuss the multimodal approach to pain management and discuss the various classes of drugs based on receptor mechanism. 2. Give
More informationGeneral anesthesia. No single drug capable of achieving these effects both safely and effectively.
General anesthesia General anesthesia is essential to surgical practice, because it renders patients analgesic, amnesia, and unconscious reflexes, while causing muscle relaxation and suppression of undesirable
More informationMeasure Abbreviation: PONV 01 (MIPS 430)
Measure Abbreviation: PONV 01 (MIPS 430) *PONV 01 is built to the specification outlined by the Merit Based Incentive Program (MIPS) 430: Prevention of Post-Operative Nausea and Vomiting (PONV) Combination
More informationMay 2013 Anesthetics SLOs Page 1 of 5
May 2013 Anesthetics SLOs Page 1 of 5 1. A client is having a scalp laceration sutured and is to be given Lidocaine that contains Epinephrine. The nurse knows that this combination is desgined to: A. Cause
More informationBeta Blockers for ENT Surgery
Beta Blockers for ENT Surgery Dr. Giuliano Michelagnoli U.O. Anestesia e Rianimazione Nuovo Ospedale di Prato Perioperative Beta-Blockade 1. Reduction of perioperative cardiovascular risk 2. Multimodal
More informationMD (Anaesthesiology) Title (Plan of Thesis) (Session )
S.No. 1. Comparative Assessment of Sequential organ failure Assessment (SOFA) score and Multiple Organ Dysfunction Score (Mode) in Outcome Prediction among ICU Patients. 2. Comparison of Backpain after
More informationMeasure Abbreviation: PONV 01 (MIPS 430)
Measure Abbreviation: PONV 01 (MIPS 430) *PONV 01 is built to the specification outlined by the Merit Based Incentive Program (MIPS) 430: Prevention of Post-Operative Nausea and Vomiting (PONV) Combination
More informationAcute pain management in opioid tolerant patients. Muhammad Laklouk
Acute pain management in opioid tolerant patients Muhammad Laklouk General principles An adequate review and assessment Provision of effective analgesia (including attenuation of tolerance and hyperalgesia)
More informationTo staple or to sew. Zeng Xuan Hu
To staple or to sew Zeng Xuan Hu Fast Track Surgery Multimodal Rehabilitation Accelerated recovery Accelerated rehabilitation Enhanced recovery Optimize perioperative care by reducing the expected stress
More informationResearch Article. Shital S. Ahire 1 *, Shweta Mhambrey 1, Sambharana Nayak 2. Received: 22 July 2016 Accepted: 08 August 2016
International Journal of Research in Medical Sciences Ahire SS et al. Int J Res Med Sci. 2016 Sep;4(9):3838-3844 www.msjonline.org pissn 2320-6071 eissn 2320-6012 Research Article DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20162824
More informationAnalgesia for ERAS programs. Dr Igor Lemech VMO Anaesthetist Wagga Wagga Base Hospital
Analgesia for ERAS programs Dr Igor Lemech VMO Anaesthetist Wagga Wagga Base Hospital Disclosure I have received honoraria from Mundipharma and MSD The new Wagga Wagga Rural Referral Centre Scope Analgesic
More informationThe Role of Ketamine in the Management of Complex Acute Pain
The Role of Ketamine in the Management of Complex Acute Pain Dr James Bennett Consultant Anaesthetist Consultant Lead for Inpatient Pain Service East Sussex Healthcare NHS Trust STAPG Committee Member
More informationMD (Anaesthesiology) Title (Plan of Thesis) (Session )
S.No. 1. To study the occurrence of postoperative hyponatremia in paediatric patients under 2 years of age 2. Influence of timing of intravenous fluid therapy on maternal hemodynamics in patients undergoing
More informationAnaesthesia and Pain Management for Endo Exo Femoral Prosthesis (EEFP) Bridging the Gap from Surgery to Rehabilitation
Anaesthesia and Pain Management for Endo Exo Femoral Prosthesis (EEFP) Bridging the Gap from Surgery to Rehabilitation Dr Ajay Kumar Senior Lecturer Macquarie and Melbourne University Introduction Amputee
More informationBalanced Analgesia With NSAIDS and Coxibs. Raymond S. Sinatra MD, Ph.D
Balanced Analgesia With NSAIDS and Coxibs Raymond S. Sinatra MD, Ph.D Prostaglandins and Pain The primary noxious mediator released from damaged tissue is prostaglandin (PG) PG is responsible for nociceptor
More informationbuteykobreathing.co.nz Melanie Kalmanowicz, MD Department of Anesthesia, Critical Care and Pain Medicine Beth Israel Deaconess Medical Center
buteykobreathing.co.nz Melanie Kalmanowicz, MD Department of Anesthesia, Critical Care and Pain Medicine Beth Israel Deaconess Medical Center PMH: hypertension, hyperlipidemia, asthma, hypothyroidism
More informationAnesthetic Techniques in Endoscopic Sinus and Skull Base Surgery
Anesthetic Techniques in Endoscopic Sinus and Skull Base Surgery Martha Cordoba Amorocho, MD Iuliu Fat, MD Supplement to Cordoba Amorocho M, Fat I. Anesthetic techniques in endoscopic sinus and skull base
More informationOptimal sedation and management of anxiety in patients undergoing endobronchial ultrasound (EBUS)
Optimal sedation and management of anxiety in patients undergoing endobronchial ultrasound (EBUS) Georgios Dadoudis Anesthesiologist ICU DIRECTOR INTERBALKAN MEDICAL CENTER Optimal performance requires:
More informationInnovative Approaches and New Technology to Gain Access
Innovative Approaches and New Technology to Gain Access The following is intended only for presentation to the Reimbursement and Access 2017 audience, August 17, 2017. This information is not for promotional
More informationSufentanil Sublingual Tablet System 15mcg vs IV PCA Morphine: A Comparative Analysis of Patient Satisfaction and Drug Utilization by Surgery Type
Sufentanil Sublingual Tablet System 15mcg vs IV PCA Morphine: A Comparative Analysis of Patient Satisfaction and Drug Utilization by Surgery Type 2016 European Society of Regional Anesthesia Congress Maastricht,
More informationLaparoscopic Colorectal Surgery
Laparoscopic Colorectal Surgery 20 th November 2015 Dr Adam Cichowitz General Surgeon Laparoscopic Colorectal Surgery Introduced in early 1990s Uptake slow Steep learning curve Requirement for equipment
More informationType of intervention Anaesthesia. Economic study type Cost-effectiveness analysis.
Comparison of the costs and recovery profiles of three anesthetic techniques for ambulatory anorectal surgery Li S T, Coloma M, White P F, Watcha M F, Chiu J W, Li H, Huber P J Record Status This is a
More informationManagement of Acute Pain in the Chronic Pain Patient. Eric Cannon, MD Mountain West Anesthesia December 1, 2017
Management of Acute Pain in the Chronic Pain Patient Eric Cannon, MD Mountain West Anesthesia December 1, 2017 Objectives 1. Describe the unique challenges of managing acute pain episodes in patients being
More informationAcute Pain NETP: SEPTEMBER 2013 COHORT
Acute Pain NETP: SEPTEMBER 2013 COHORT Pain & Suffering an unpleasant sensory & emotional experience associated with actual or potential tissue damage, or described in terms of such damage International
More informationOpioid Free Anaesthesia Why, when and how to avoid opioids in obese patients
Opioid Free Anaesthesia Why, when and how to avoid opioids in obese patients Daniela Godoroja Lead Anaesthetist, Ponderas Academic Hospital Assistant Professor, University Carol Davila Bucharest, Romania
More informationPOST OPERATIVE PAIN MANAGEMENT: PAIN AND COMPLICATIONS
POST OPERATIVE PAIN MANAGEMENT: PAIN AND COMPLICATIONS November 9, 2018 Aimee LaMere, CNP Molly McNaughton, CNP Leslie Weide, MSW, LICSW, ACM Disclosures: Conflict of interest statement: We certify that,
More informationResearch and Reviews: Journal of Medical and Health Sciences
Research and Reviews: Journal of Medical and Health Sciences Evaluation of Epidural Clonidine for Postoperative Pain Relief. Mukesh I Shukla, Ajay Rathod, Swathi N*, Jayesh Kamat, Pramod Sarwa, and Vishal
More informationGeneral Anesthesia. My goal in general anesthesia is to stop all of these in the picture above (motor reflexes, pain and autonomic reflexes).
General Anesthesia General anesthesia is essential to surgical practice, because it renders patients analgesic, amnesia and unconscious reflexes, while causing muscle relaxation and suppression of undesirable
More informationHow to Administer an Opioid-Free General Anesthetic
How to Administer an Opioid-Free General Anesthetic Christine Oryhan, MD Virginia Mason Medical Center WSSA/BCAS Joint Winter Meeting December 8 th, 2018 Disclosures I have no disclosures. Learning objectives
More informationAcute Peri-Operative Pain Management Strategies
Slide 1 Acute Peri-Operative Pain Management Strategies Phillip Gallegos, MD USAP Pinnacle Anesthesiologist Director of Anesthesia and Peri-Operative Medicine BOSHA Slide 2 ERAS Enhanced Recovery After
More informationEvaluation of the Effect of Magnesium Sulphate as Adjunct to Epidural Bupivacaine: An Institutional Based Study
Original article: Evaluation of the Effect of Magnesium Sulphate as Adjunct to Epidural Bupivacaine: An Institutional Based Study RajulSubhash Karmakar 1, ShishirRamachandra Sonkusale 1* 1Associate Professor,
More informationEfficacy of a single-dose ondansetron for preventing post-operative nausea and vomiting
European Review for Medical and Pharmacological Sciences 2001; 5: 59-63 Efficacy of a single-dose ondansetron for preventing post-operative nausea and vomiting after laparoscopic cholecystectomy with sevoflurane
More informationPeripheral nerve blocks provide several benefits
Intravenous Dexamethasone for Prolonged Duration of Axillary Nerve Blockade Dorothy Lim, CRNA Michele Gold, PhD, CRNA Pain management among patients undergoing orthopedic surgery is often a challenge.
More informationMultimodal perioperative pain management protocols
Multimodal perioperative pain management protocols Nader M. Hebela, MD كليفالند كلينك أبوظبي Dhabi Cleveland Clinic Abu معهد األعصاب Institute Neurological slide count: 30 January 2016 title slide explained
More informationNMDA Receptor Antagonists. Tanyanun Ngam-ek-eu Samita Pirotesak Supervised by Assist.Prof. Nantthasorn Zinboonyahgoon
NMDA Receptor Antagonists Tanyanun Ngam-ek-eu Samita Pirotesak Supervised by Assist.Prof. Nantthasorn Zinboonyahgoon NMDA Receptor N-metyl-D-aspartic-acid receptors Glutamate-gated cation channels with
More informationPost Tonsillectomy Pain Presented by: Dr.Z.Sarafraz Otolaryngologist
Post Tonsillectomy Pain Presented by: Dr.Z.Sarafraz Otolaryngologist Tonsillectomy is a common surgery in children Post tonsillectomy pain is an important concern. Duration &severity of pain depend on:
More informationOP01 [Mar96] With regards to pethidine s physical properties: A. It has an octanol coefficient of 10 B. It has a pka of 8.4
Opioid MCQ OP01 [Mar96] With regards to pethidine s physical properties: A. It has an octanol coefficient of 10 B. It has a pka of 8.4 OP02 [Mar96] Which factor does NOT predispose to bradycardia with
More informationNeurobiology of Pain Adjuvant analgesia
Neurobiology of Pain Adjuvant analgesia Jason Brooks Consultant Anaesthesia and Pain Management BCH March 2017 The Brief A broad overview of the abnormal and normal anatomy and physiology of pain pathways
More informationGabapentin Does Not Improve Analgesia Outcomes For Total Joint Replacement. Manyat Nantha-Aree, MD
Gabapentin Does Not Improve Analgesia Outcomes For Total Joint Replacement Manyat Nantha-Aree, MD Objective n Preliminary results of MOBILE study in total hip and knee arthroplasty Background n Gabapentin=
More informationPOST-INTUBATION ANALGESIA AND SEDATION. August 2012 J Pelletier
POST-INTUBATION ANALGESIA AND SEDATION August 2012 J Pelletier Intubated patients experience pain and anxiety Mechanical ventilation, endotracheal tube Blood draws, positioning, suctioning Surgical procedures,
More informationKetofol: risky or revolutionary: CPD article IV
Ketofol: risky or revolutionary: CPD article IV Abstract Ketofol, a sedative/analgesic combination of ketamine and propofol, which can be administered as a mixture in the same syringe or independently,
More informationEffective pain management begins with OFIRMEV (acetaminophen) injection FIRST Proven efficacy with rapid reduction in pain 1
Effective pain management begins with OFIRMEV (acetaminophen) injection FIRST Proven efficacy with rapid reduction in pain 1 Fast onset of pain relief with 7% reduction in visual analog scale (VAS) scores
More informationCorporate Medical Policy
Corporate Medical Policy Intravenous Anesthetics for the Treatment of Chronic Pain File Name: Origination: Last CAP Review: Next CAP Review: Last Review: intravenous_anesthetics_for_the_treatment_of_chronic_pain
More informationAnaesthetic Plan And The Practical Conduct Of Anaesthesia. Dr.S.Vashisht Hillingdon Hospital
Anaesthetic Plan And The Practical Conduct Of Anaesthesia Dr.S.Vashisht Hillingdon Hospital Anaesthetic Plan Is based on Age / physiological status of the patient (ASA) Co-morbid conditions that may be
More informationAnaesthetic pharmacology for children. Noel Roberts Monash Children s Hospital
Anaesthetic pharmacology for children Noel Roberts Monash Children s Hospital Aims To briefly summarize the evidence concerning neurotoxicity and its implications for pediatric anaesthetic practice To
More information10/12/2018. Multimodal Analgesic Alternatives. Standard Disclaimer. Session Objectives
Multimodal Analgesic Alternatives Opioid Minimizing & Opioid Free Strategies Lois Stewart, PhD, CRNA Doctor of Nursing Practice Nurse Anesthesia Program Assistant Professor, Leighton School of Nursing
More informationDEXAMETHASONE WITH EITHER GRANISETRON OR ONDANSETRON FOR POSTOPERATIVE NAUSEA AND VOMITING IN LAPAROSCOPIC SURGERY
DEXAMETHASONE WITH EITHER GRANISETRON OR ONDANSETRON FOR POSTOPERATIVE NAUSEA AND VOMITING IN LAPAROSCOPIC SURGERY Alia S. Dabbous *, Samar I. Jabbour-Khoury **, Viviane G Nasr ***, Adib A Moussa ***,
More informationNON-OPIOID ANALGESIA & THE IMPLICATIONS OF ANESTHETIC DRUGS IN THE PERI-ANESTHETIC ARENA AMANDA AFFLECK CRNA
NON-OPIOID ANALGESIA & THE IMPLICATIONS OF ANESTHETIC DRUGS IN THE PERI-ANESTHETIC ARENA AMANDA AFFLECK CRNA OR, ANESTHESIA, WHY DO THEY DO THAT? OUTLINE Neurotransmission of pain Arachidonic Acid pathway
More informationRECENT ADVANCES IN ANALGESIA
4th ERAS UK Conference RECENT ADVANCES IN ANALGESIA Dr William J Fawcett Royal Surrey County Hospital, Guildford University of Surrey, Guildford November 14th 2014 Conflict of interests Paid honoraria
More informationCOMPARISON OF INDUCTION WITH SEVOFLURANE-FENTANYL AND PROPOFOL-FENTANYL ON POSTOPERATIVE NAUSEA AND VOMITING AFTER LAPAROSCOPIC SURGERY
RESEARCH ARTICLE COMPARISON OF INDUCTION WITH SEVOFLURANE-FENTANYL AND PROPOFOL-FENTANYL ON POSTOPERATIVE NAUSEA AND VOMITING AFTER LAPAROSCOPIC SURGERY ABSTRACT Ghanta.V. Nalini Kumari 1,*, Sushma Ladi
More informationComparison of fentanyl versus fentanyl plus magnesium as post-operative epidural analgesia in orthopedic hip surgeries
Original Research Article Comparison of fentanyl versus fentanyl plus magnesium as post-operative epidural analgesia in orthopedic hip surgeries P V Praveen Kumar 1*, Sreemanth 2 1 Associate Professor,
More informationAn Evaluation of a Single Dose of Magnesium to Supplement Analgesia After Ambulatory Surgery: Randomized Controlled Trial
An Evaluation of a Single Dose of Magnesium to Supplement Analgesia After Ambulatory Surgery: Randomized Controlled Trial Martin R. Tramèr, MD, DPhil* Chris J. Glynn, FRCA, MSc BACKGROUND: Previous studies
More informationANESTHESIA EXAM (four week rotation)
SPARROW HEALTH SYSTEM ANESTHESIA SERVICES ANESTHESIA EXAM (four week rotation) Circle the best answer 1. During spontaneous breathing, volatile anesthetics A. Increase tidal volume and decrease respiratory
More informationJournal of Anesthesia & Pain Medicine
Research Article ISSN: 2474-9206 Journal of Anesthesia & Pain Medicine Evaluating the Effect of Various Doses of Magnesium Sulfate on Quality of Cataract Intra Operative Sedation and Recovery Mojtaba Rahimi
More informationFrederic J., Gerges MD. Ghassan E. Kanazi MD., Sama, I. Jabbour-Khoury MD. Review article from Journal of clinical anesthesia 2006.
Frederic J., Gerges MD. Ghassan E. Kanazi MD., Sama, I. Jabbour-Khoury MD. Review article from Journal of clinical anesthesia 2006 Introduction Laparoscopic surgery started in the mid 1950s. In recent
More informationProceedings of the World Small Animal Veterinary Association Sydney, Australia 2007
Proceedings of the World Small Animal Sydney, Australia 2007 Hosted by: Next WSAVA Congress REDUCING THE PAIN FACTOR AN UPDATE ON PERI-OPERATIVE ANALGESIA Sandra Forysth, BVSc DipACVA Institute of Veterinary,
More informationCurrent Trends in Opioid Free Anesthesia
Current Trends in Opioid Free Anesthesia M E G A N A. H O R N Y A K, S R N A U P M C H A M O T S C H O O L O F A N E S T H E S I A / G A N N O N U N I V E R S I T Y Objectives Understand the impact of
More informationPHYSICIAN COMPETENCY FOR ADULT DEEP SEDATION (Ages 14 and older)
Name Score PHYSICIAN COMPETENCY FOR ADULT DEEP SEDATION (Ages 14 and older) 1. Pre-procedure evaluation for moderate sedation should involve all of the following EXCEPT: a) Airway Exam b) Anesthetic history
More informationAdolescent Substance Abuse
Adolescent Substance Abuse WHY IT S A PROBLEM AND WHAT WE NEED TO KNOW AS ANESTHESIA PROVIDERS BRIDGET L. MULDOWNEY MD ASSISTANT PROFESSOR OF ANESTHESIOLOGY UNIVERSITY OF WISCONSIN- SCHOOL OF MEDICINE
More informationIntro Who should read this document 2 Key practice points 2 What is new in this version 3 Background 3 Guideline Subsection headings
Enhanced Recovery for Major Urology and Gynaecological Classification: Clinical Guideline Lead Author: Dr Dominic O Connor Additional author(s): Jane Kingham Authors Division: Anaesthesia Unique ID: DDCAna3(12)
More informationTable of Contents. Pharmacology
ANESTHESIA ABSTRACTS PROVIDING THE CLINICAL ANESTHETIST WITH UP-TO-DATE RESOURCES FOR EVIDENCE BASED PRACTICE. Table of Contents EDITOR Michael A. Fiedler, PhD, CRNA CONTRIBUTING EDITORS Mary A. Golinski,
More informationSleep Apnea and ifficulty in Extubation. Jean Louis BOURGAIN May 15, 2016
Sleep Apnea and ifficulty in Extubation Jean Louis BOURGAIN May 15, 2016 Introduction Repetitive collapse of the upper airway > sleep fragmentation, > hypoxemia, hypercapnia, > marked variations in intrathoracic
More informationEffect of preoperative oral amantadine on intraoperative anesthetic and analgesic requirements in female patients during abdominoplasty
Egyptian Journal of Anaesthesia (2013) 29, 7 11 Egyptian Society of Anesthesiologists Egyptian Journal of Anaesthesia www.elsevier.com/locate/egja www.sciencedirect.com Research Article Effect of preoperative
More informationMeasure Summary: The opioid equivalency measure examines opioid administration for patients who undergo a surgical procedure.
Measure Abbreviation: Opioid Equivalency Data Collection Method: This informational measure (there is no threshold or target) is calculated based on data extracted from the electronic medical record combined
More informationBariatric Surgery. Keitha Kirkham RN, BScN
Bariatric Surgery Keitha Kirkham RN, BScN Civic Campus BMI Obesity Definition Underweight with BMI lower than 20 Normal weight with a BMI between 20 and 25 Overweight with a BMI between 25 and 30 Obese
More informationOpioid reduction strategies in an academic tertiary medical center
Opioid reduction strategies in an academic tertiary medical center Terry Bosen, PharmD Medication Safety Program Director Vanderbilt University Medical Center Tennessee MME data per capita MME = Morphine
More informationThe intensity of preoperative pain is directly correlated with the amount of morphine needed for postoperative analgesia
The intensity of preoperative pain is directly correlated with the amount of morphine needed for postoperative analgesia This study has been published: The intensity of preoperative pain is directly correlated
More informationContinuous Wound Infusion and Postoperative Pain Current status?
Continuous Wound Infusion and Postoperative Pain Current status? Pr Patricia Lavand homme Department of Anesthesiology St Luc Hospital University Catholic of Louvain Medical School Brussels, Belgium Severe
More informationLUNCH AND LEARN. Sterile Drug Products Used in the Anesthesia Practice Setting: Part 2. February 10, 2017
LUNCH AND LEARN Sterile Drug Products Used in the Anesthesia Practice Setting: Part 2 February 10, 2017 Featured Speaker: Julie A. Golembiewski, PharmD Clinical Associate Professor, Department of Pharmacy
More informationEnhanced Recovery after Surgery - A Colorectal Perspective. R Sim Centre for Advanced Laparoscopic Surgery, TTSH
Enhanced Recovery after Surgery - A Colorectal Perspective R Sim Centre for Advanced Laparoscopic Surgery, TTSH Conventional Surgery Postop care Nasogastric tube Enteral feeds when ileus resolves Opioid
More information