Nociception monitoring : Method for intraoperative opioid control?

Anaesthesist. 2021 Aug 23. doi: 10.1007/s00101-021-01022-6. Online ahead of print.ABSTRACTThe intraoperative dosing of opioids is a challenge in routine anesthesia as the potential effects of intraoperative overdosing and underdosing are not completely understood. In recent years an increasing number of monitors were approved, which were developed for the detection of intraoperative nociception and therefore should enable a better control of opioid titration. The nociception monitoring devices use either continuous hemodynamic, galvanic or thermal biosignals reflecting the balance between parasympathetic and sympathetic activity, measure the pupil dilatation reflex or the nociceptive flexor reflex as a reflexive response to application of standardized nociceptive stimulation. This review article presents the currently available nociception monitors. Most of these monitoring devices detect nociceptive stimulations with higher sensitivity and specificity than changes in heart rate, blood pressure or sedation depth monitoring devices. There are only few studies on the effect of opioid titration guided by nociception monitoring and the possible postoperative benefits of these devices. All nociception monitoring techniques are subject to specific limitations either due to perioperative confounders (e.g. hypovolemia) or special accompanying medical conditions (e.g. muscle relaxation). There is an ongoing discussion about the clinical relevance of nociceptive stimulation in general ...
Source: Der Anaesthesist - Category: Anesthesiology Authors: Source Type: research

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Background Opioids can induce significant respiratory depression when administered as analgesics for the treatment of acute, postoperative, and chronic pain. There are currently no pharmacologic means of reversing opioid-induced respiratory depression without interfering with analgesia. Further, there is a growing epidemic of opioid overdose that could benefit from therapeutic advancements. The aim of this study was to test the ability of two partial agonists of α4β2 nicotinic acetylcholine receptors, varenicline (used clinically for smoking cessation) and ABT 594 (tebanicline, developed as an analgesic), to red...
Source: Anesthesiology - Category: Anesthesiology Source Type: research
Conclusion: Our results suggest that the AT1R mediated hypertensive response to angiotensin II within the NTS in normotensive rats is GABA and NO dependent. Nitric oxide produced within the NTS tonically potentiates local GABA and glutamate release. Introduction The central nervous system network that regulates the level of sympathetic tone and, hence, blood pressure, is located in the brainstem and consists mainly of the rostral ventrolateral medulla (RVLM), the paraventricular nucleus (PVN) of the hypothalamus and the nucleus tractus solitarii (NTS) (Guyenet, 2006). It is well-established that the RVLM, the so-ca...
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
Due to wide variation in patient responses, both intended and adverse, it is impossible to successfully sedate all patients. Choosing the right drug and dose regimen can be challenging, especially in patients who are na ïve to anesthesia. Underdosing can lead to pain perception, patient movement and combativeness, awareness with recall, and the sympathetic neuroendocrine stress response. Overdosing can lead to unintended loss of upper airway tone, hypoventilation/apnea, adverse cardiovascular changes, and prolonge d sedation (with its attendant problems).
Source: Oral and Maxillofacial Surgery Clinics - Category: ENT & OMF Authors: Source Type: research
Abstract Due to wide variation in patient responses, both intended and adverse, it is impossible to successfully sedate all patients. Choosing the right drug and dose regimen can be challenging, especially in patients who are naïve to anesthesia. Underdosing can lead to pain perception, patient movement and combativeness, awareness with recall, and the sympathetic neuroendocrine stress response. Overdosing can lead to unintended loss of upper airway tone, hypoventilation/apnea, adverse cardiovascular changes, and prolonged sedation (with its attendant problems). PMID: 29622310 [PubMed - in process]
Source: The Surgical Clinics of North America - Category: Surgery Authors: Tags: Oral Maxillofac Surg Clin North Am Source Type: research
Publication date: May 2018 Source:Oral and Maxillofacial Surgery Clinics of North America, Volume 30, Issue 2 Author(s): Robert C. BosackTeaser Due to wide variation in patient responses, both intended and adverse, it is impossible to successfully sedate all patients. Choosing the right drug and dose regimen can be challenging, especially in patients who are naïve to anesthesia. Underdosing can lead to pain perception, patient movement and combativeness, awareness with recall, and the sympathetic neuroendocrine stress response. Overdosing can lead to unintended loss of upper airway tone, hypoventilation/apnea, advers...
Source: Oral and Maxillofacial Surgery Clinics of North America - Category: ENT & OMF Source Type: research
By KAREN SIBERT, MD Just say No to Fentanyl. No, I’m not talking about putting fentanyl into my own veins — a remarkably bad idea. I’m questioning the habitual, reflex use of fentanyl, a synthetic opioid, in clinical anesthesiology practice. I’ve been teaching clinical anesthesiology, supervising residents and medical students, in the operating rooms of academic hospitals for the past 18 years. Anesthesiology residents often ask if I “like” fentanyl, wanting to know if we’ll plan to use it in an upcoming case. My response always is, “I don’t have emotional relationship...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Uncategorized Source Type: blogs
BACKGROUND: Immediate postoperative pain could be prevented by the administration of long-lasting analgesics before the end of the anaesthesia. However, to prevent over or underdosing of analgesics under anaesthesia, tools are required to estimate the analgesia–nociception balance. OBJECTIVE: We investigated whether the pupillary dilation reflex (PDR) and the nociceptive flexion reflex (NFR) at the end of general anaesthesia correlate with immediate postoperative pain, as a sign of analgesic underdosing, and with delayed tracheal extubation as a sign of analgesic overdosing. DESIGN: Prospective observational study....
Source: European Journal of Anaesthesiology - Category: Anesthesiology Tags: Pain Source Type: research
I received a text message with this image: "Cardioversion didn't work.  Any thoughts?" What do you think?  The heart rate is 180.I was viewing this on my phone, but I saw what I thought were P-waves.  I could barely see them in lead II:There are probable P-waves at the arrows, but I wasn't certainI texted back: "Could be very fast sinus."There is also a wide QRS at 113 ms and a large R-wave in aVR, so sodium channel blockade is likely.   Common culprits in this situation are tricyclic overdose and cocaine toxicity (remember cocaine not only increases dopamine in central syn...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
The Asheville teenager whomade Yahoo yesterday for changing her legal name to "CutOutDissection.com" madeCNN today.After jumping through hoop after hoop . . . after three years of blogging . . . after writing gadzillions of words and composing both short versions and long versions of my story-of-woe . . . this "health-care hero" (yes, that was sarcasm) has lost track of the people who've told her she needs a " hook " or " angle " or " gimmick " in order to get a reporter's attention (that, of course, would be a REAL reporter - outside of Asheboro or Greensbor...
Source: Dr.J's HouseCalls - Category: American Health Source Type: blogs
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