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Increased Hyperalgesia and Proinflammatory Cytokines in the Spinal Cord and Dorsal Root Ganglion After Surgery and/or Fentanyl Administration in Rats.
CONCLUSIONS: The surgical plantar incision with or without perioperative fentanyl induced significant mechanical and thermal hyperalgesia, an increased expression of IL-1β, IL-6, TNF-α in the spinal cord and DRG, and activation of microglia in the spinal cord.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. PMID: 29135586 [PubMe...
Source: Anesthesia and Analgesia - November 10, 2017 Category: Anesthesiology Authors: Chang L, Ye F, Luo Q, Tao Y, Shu H Tags: Anesth Analg Source Type: research

Fundamentals of Anaesthesia, 4th ed.
PMID: 29135587 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - November 10, 2017 Category: Anesthesiology Authors: Maclean SA, Applegate RL Tags: Anesth Analg Source Type: research

In Response.
PMID: 29135588 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - November 10, 2017 Category: Anesthesiology Authors: Bhatia A, Cohen SP Tags: Anesth Analg Source Type: research

Safety and Effectiveness of a Novel Facemask for Positive Pressure Ventilation.
Abstract BACKGROUND: Manual positive pressure ventilation is an essential skill in a variety of clinical situations. The C&E technique is commonly used with standard facemasks to provide effective ventilation. The Tao mask is a novel design that allows a more ergonomic grip. A seal between the mask and face is made with downward pressure of the palm, centered on the mask, and jaw lift is achieved with 4 fingers centered under the mandible. The purpose of this study was to evaluate the safety and effectiveness of the Tao mask compared to a standard mask before and after the administration of neuromuscular block...
Source: Anesthesia and Analgesia - November 10, 2017 Category: Anesthesiology Authors: Brown TA, Szabo TA, Bridges KH, Sabbagh MJ, Hand WR, Wolf BJ, Warters RD Tags: Anesth Analg Source Type: research

The Analgesic Effect of Ultrasound-Guided Quadratus Lumborum Block After Cesarean Delivery: A Randomized Clinical Trial.
r AR Abstract BACKGROUND: Landmark and ultrasound-guided transversus abdominis plane blocks have demonstrated an opioid-sparing effect postoperatively after cesarean delivery. The more posterior quadratus lumborum (QL) might provide superior local anesthetic spread to the thoracolumbar fascia and paravertebral space. The aim of our study was to evaluate the efficacy of the QL block after cesarean delivery. METHODS: A randomized, double-blind, controlled trial was performed. Forty parturients undergoing cesarean delivery received bilateral ultrasound-guided QL blocks with either 2 mg/mL ropivacaine or saline p...
Source: Anesthesia and Analgesia - November 10, 2017 Category: Anesthesiology Authors: Krohg A, Ullensvang K, Rosseland LA, Langesæter E, Sauter AR Tags: Anesth Analg Source Type: research

In Response.
PMID: 29135591 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - November 10, 2017 Category: Anesthesiology Authors: Amar D, Pedoto A, Desiderio DP Tags: Anesth Analg Source Type: research

Hypoxia and Postoperative Stroke: The Picture Is Still Not Clear.
PMID: 29135592 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - November 10, 2017 Category: Anesthesiology Authors: Charchaflieh JG, Zafar JE Tags: Anesth Analg Source Type: research

Ultrasound-Guided Dynamic Needle Tip Positioning Technique Versus Palpation Technique for Radial Arterial Cannulation in Adult Surgical Patients: A Randomized Controlled Trial.
Abstract BACKGROUND: Radial arterial cannulation is most commonly done using palpation, but the use of ultrasound has increased the cannulation success rate. This improvement, albeit significant, has not led to a very high success rate especially in trainees. A modified ultrasound technique for vascular cannulation (dynamic needle tip positioning) has been described for peripheral venous cannulation. We therefore assessed the success rate of this technique compared to the palpation technique for radial artery cannulation in adult surgical patients. METHODS: We enrolled patients who were having nonemergent ope...
Source: Anesthesia and Analgesia - November 10, 2017 Category: Anesthesiology Authors: Kiberenge RK, Ueda K, Rosauer B Tags: Anesth Analg Source Type: research

In Response.
PMID: 29135594 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - November 10, 2017 Category: Anesthesiology Authors: Dunham AM, Brown CH, Gottesman RF Tags: Anesth Analg Source Type: research

Least Injurious Mechanical Ventilation in Pulmonary Resection Surgery.
PMID: 29135595 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - November 10, 2017 Category: Anesthesiology Authors: Zochios V Tags: Anesth Analg Source Type: research

General Anesthetics to Treat Major Depressive Disorder: Clinical Relevance and Underlying Mechanisms.
Abstract Major depressive disorder is a frequent and devastating psychological condition with tremendous public health impact. The underlying pathophysiological mechanisms involve abnormal neurotransmission and a relatedly impaired synaptic plasticity. Since general anesthetics are potent modulators of neuronal activity and, thereby, can exert long-term context-dependent impact on neural networks, an intriguing hypothesis is that these drugs could enhance impaired neural plasticity associated with certain psychiatric diseases. Clinical observations over the past few decades appear to confirm this possibility. Inde...
Source: Anesthesia and Analgesia - November 10, 2017 Category: Anesthesiology Authors: Vutskits L Tags: Anesth Analg Source Type: research

Society for Obstetric Anesthesia and Perinatology 2017 Meeting Report.
PMID: 29135597 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - November 10, 2017 Category: Anesthesiology Authors: Chau A Tags: Anesth Analg Source Type: research

Cardiac Arrest in the Operating Room: Resuscitation and Management for the Anesthesiologist: Part 1.
Abstract Cardiac arrest in the operating room and procedural areas has a different spectrum of causes (ie, hypovolemia, gas embolism, and hyperkalemia), and rapid and appropriate evaluation and management of these causes require modification of traditional cardiac arrest algorithms. There is a small but growing body of literature describing the incidence, causes, treatments, and outcomes of circulatory crisis and perioperative cardiac arrest. These events are almost always witnessed, frequently known, and involve rescuer providers with knowledge of the patient and their procedure. In this setting, there can be for...
Source: Anesthesia and Analgesia - November 10, 2017 Category: Anesthesiology Authors: Moitra VK, Einav S, Thies KC, Nunnally ME, Gabrielli A, Maccioli GA, Weinberg G, Banerjee A, Ruetzler K, Dobson G, McEvoy M, O'Connor MF Tags: Anesth Analg Source Type: research

Neuroplasty Is a Safe, Effective Procedure.
PMID: 29135599 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - November 10, 2017 Category: Anesthesiology Authors: Racz G, Candido K, Helm S Tags: Anesth Analg Source Type: research

Effect of Beam Steering on Echogenic and Nonechogenic Needle Visibility at 40 °, 50°, and 60° Needle Insertion Angles.
Effect of Beam Steering on Echogenic and Nonechogenic Needle Visibility at 40°, 50°, and 60° Needle Insertion Angles. Anesth Analg. 2017 Nov 07;: Authors: Prabhakar C, Uppal V, Sondekoppam RV Abstract Currently, there is little understanding of the role of echogenic needles and beam steering at moderate angles of needle insertion. The ultrasound images of the echogenic and nonechogenic needles inserted into pork at 40°, 50°, and 60° were scored by anesthesiologists on a scale of 0-10. The effect of different levels of beam steer was also explored. At 40°, steep beam steerin...
Source: Anesthesia and Analgesia - November 7, 2017 Category: Anesthesiology Authors: Prabhakar C, Uppal V, Sondekoppam RV Tags: Anesth Analg Source Type: research

Validation of a New Method to Automatically Select Cases With Intraoperative Red Blood Cell Transfusion for Audit.
Abstract BACKGROUND: Hospitals review allogeneic red blood cell (RBC) transfusions for appropriateness. Audit criteria have been published that apply to 5 common procedures. We expanded on this work to study the management decision of selecting which cases involving transfusion of at least 1 RBC unit to audit (review) among all surgical procedures, including those previously studied. METHODS: This retrospective, observational study included 400,000 cases among 1891 different procedures over an 11-year period. There were 12,616 cases with RBC transfusion. We studied the proportions of cases that would be audit...
Source: Anesthesia and Analgesia - November 7, 2017 Category: Anesthesiology Authors: Dexter F, Epstein RH, Ledolter J, Dasovich SM, Herman JH, Maga JM, Schwenk ES Tags: Anesth Analg Source Type: research

Antiemetic Prophylaxis as a Marker of Health Care Disparities in the National Anesthesia Clinical Outcomes Registry.
CONCLUSIONS: Our analyses of NACOR anesthesia records raise concerns that patients with lower socioeconomic status may receive inferior anesthesia care provided by individual anesthesiologists, as indicated by less antiemetics administered. Effects persisted after we controlled for important patient characteristics and for procedure and provider influences. Findings were robust to sensitivity analyses. Our results challenge the notion that anesthesia providers do not contribute to health care disparities. PMID: 29116968 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - November 7, 2017 Category: Anesthesiology Authors: Andreae MH, Gabry JS, Goodrich B, White RS, Hall C Tags: Anesth Analg Source Type: research

Healthcare Professionalism: Improving Practice Through Reflections on Workplace Dilemmas.
PMID: 29116969 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - November 7, 2017 Category: Anesthesiology Authors: Malinzak EB Tags: Anesth Analg Source Type: research

Assessment of Tricuspid Annular Motion by Speckle Tracking in Anesthetized Patients Using Transesophageal Echocardiography.
Abstract BACKGROUND: The perioperative assessment of right ventricular (RV) function remains a challenge. Tricuspid annular plane systolic excursion (TAPSE) using M-mode is a widely used measure of RV function. However, accurate alignment of the ultrasound beam with the direction of annular movement can be difficult with transesophageal echocardiography (TEE) to measure TAPSE, precluding effective use of M-mode to measure annular excursion. Tracking of specular reflectors in the myocardium may provide an angle-independent method to assess annular motion with TEE. We hypothesized that TEE speckle tracking of the la...
Source: Anesthesia and Analgesia - November 7, 2017 Category: Anesthesiology Authors: Shen T, Picard MH, Hua L, Burns SM, Andrawes MN Tags: Anesth Analg Source Type: research

Only New Red Blood Cells for Orthotopic Liver Transplant?
PMID: 29116971 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - November 7, 2017 Category: Anesthesiology Authors: Ariza F, Raffan F Tags: Anesth Analg Source Type: research

Low Cardiac Output Syndrome After Adult Cardiac Surgery: Predictive Value of Peak Systolic Global Longitudinal Strain.
Abstract BACKGROUND: Peak systolic global longitudinal strain (GLS) is increasingly used to quantify left ventricular systolic function. The primary objective of this study was to assess whether GLS obtained during intraoperative transesophageal echocardiogram, performed before cardiopulmonary bypass, improves the prediction of postoperative low cardiac output syndrome (LCOS) after adult cardiac surgery. METHODS: GLS from 275 patients undergoing on-pump cardiac surgery was calculated retrospectively using two-dimensional- speckle tracking echocardiography (aCMQ module from Qlab software version 10.5, Philips ...
Source: Anesthesia and Analgesia - November 7, 2017 Category: Anesthesiology Authors: Amabili P, Benbouchta S, Roediger L, Senard M, Hubert MB, Donneau AF, Brichant JF, Hans GA Tags: Anesth Analg Source Type: research

The Pediatric Anesthesiology Workforce: Projecting Supply and Trends 2015-2035.
CONCLUSIONS: If historical trends continue, the growth in pediatric anesthesiologist supply may exceed the growth in both the pediatric population and inpatient procedures in the 20-year period from 2015 to 2035. PMID: 29116973 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - November 7, 2017 Category: Anesthesiology Authors: Muffly MK, Singleton M, Agarwal R, Scheinker D, Miller D, Muffly TM, Honkanen A Tags: Anesth Analg Source Type: research

In Response.
PMID: 29116974 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - November 7, 2017 Category: Anesthesiology Authors: Wang Y, Wu R Tags: Anesth Analg Source Type: research

Colloids and the Microcirculation.
This article reviews the physiochemical properties of the various types of colloid solutions (eg, gelatin, dextrans, hydroxyethyl starches, and albumin) and the effects that they have under various conditions of hypovolemia in experimental and clinical scenarios. PMID: 29099424 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - November 1, 2017 Category: Anesthesiology Authors: He H, Liu D, Ince C Tags: Anesth Analg Source Type: research

Unexpected Cardiac Computed Tomography Findings in Patients With Postoperative Myocardial Injury.
Abstract BACKGROUND: Postoperative myocardial injury (PMI) is a strong predictor of mortality after noncardiac surgery. PMI is believed to be attributable to coronary artery disease (CAD), yet its etiology is largely unclear. We aimed to quantify the prevalence of significant CAD in patients with and without PMI using coronary computed tomography angiography (CCTA). METHODS: This prospective cohort study included patients of 60 years or older without a history of cardiac disease and with and without PMI after intermediate- to high-risk noncardiac surgery. PMI was defined as any serum troponin I level ≥60 n...
Source: Anesthesia and Analgesia - November 1, 2017 Category: Anesthesiology Authors: Grobben RB, van Waes JAR, Leiner T, Peelen LM, de Borst GJ, Vogely HC, Grobbee DE, Doevendans PA, van Klei WA, Nathoe HM, CHASE Investigators Tags: Anesth Analg Source Type: research

Teacher and Trustee: Examining the Ethics of Experiential Learning in Transesophageal Echocardiography Education.
PMID: 29099426 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - November 1, 2017 Category: Anesthesiology Authors: Ivascu NS, Meltzer EC Tags: Anesth Analg Source Type: research

Artificial Ventilation: A Basic Clinical Guide.
PMID: 29099427 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - November 1, 2017 Category: Anesthesiology Authors: Perchiazzi G Tags: Anesth Analg Source Type: research

Neuroprotective Effects of Fasudil, a Rho-Kinase Inhibitor, After Spinal Cord Ischemia and Reperfusion in Rats.
We examined the neuroprotective effects of pre- and posttreatment with fasudil (a Rho-kinase inhibitor) in a rat transient spinal cord ischemia-reperfusion model under normothermic conditions. METHODS: After approval by our animal research committee, male Sprague-Dawley rats were assigned to 1 of 6 groups: pre- and postcontrol (C); pre- and postfasudil (F); and pre- and postsham (S). Fasudil (10 mg/kg) or normal saline was administered intravenously over 30 minutes before ischemia in the pre-F or pre-C groups, and over 30 minutes after reperfusion in the post-F or post-C groups. Sham groups were not subjected to ische...
Source: Anesthesia and Analgesia - November 1, 2017 Category: Anesthesiology Authors: Ohbuchi M, Kimura T, Nishikawa T, Horiguchi T, Fukuda M, Masaki Y Tags: Anesth Analg Source Type: research

The Society for Obstetric Anesthesia and Perinatology Consensus Statement on the Anesthetic Management of Pregnant and Postpartum Women Receiving Thromboprophylaxis or Higher Dose Anticoagulants.
Abstract Venous thromboembolism is recognized as a leading cause of maternal death in the United States. Thromboprophylaxis has been highlighted as a key preventive measure to reduce venous thromboembolism-related maternal deaths. However, the expanded use of thromboprophylaxis in obstetrics will have a major impact on the use and timing of neuraxial analgesia and anesthesia for women undergoing vaginal or cesarean delivery and other obstetric surgeries. Experts from the Society of Obstetric Anesthesia and Perinatology, the American Society of Regional Anesthesia, and hematology have collaborated to develop this c...
Source: Anesthesia and Analgesia - November 1, 2017 Category: Anesthesiology Authors: Leffert L, Butwick A, Carvalho B, Arendt K, Bates SM, Friedman A, Horlocker T, Houle T, Landau R, Dubois H, Fernando R, Houle T, Kopp S, Montgomery D, Pellegrini J, Smiley R, Toledo P, members of the SOAP VTE Taskforce Tags: Anesth Analg Source Type: research

Tricuspid Regurgitation Due to Absent Tricuspid Valve Leaflet: Utility of Three-Dimensional Echocardiography.
PMID: 29099430 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - November 1, 2017 Category: Anesthesiology Authors: Amhaz H, Kretzer A, Podgoreanu M, Glower D, Nicoara A Tags: Anesth Analg Source Type: research

Can Lung Ultrasound Be the First-Line Tool for Evaluation of Intraoperative Hypoxemia?
a G, Torp K PMID: 29099431 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - November 1, 2017 Category: Anesthesiology Authors: Díaz-Gómez JL, Renew JR, Ratzlaff RA, Ramakrishna H, Via G, Torp K Tags: Anesth Analg Source Type: research

Is It Time to Reconsider the Concepts of "Universal Donor" and "ABO Compatible" Transfusions?
Is It Time to Reconsider the Concepts of "Universal Donor" and "ABO Compatible" Transfusions? Anesth Analg. 2017 Nov 01;: Authors: Refaai MA, Cahill C, Masel D, Schmidt AE, Heal JM, Kirkley SA, Blumberg N PMID: 29099432 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - November 1, 2017 Category: Anesthesiology Authors: Refaai MA, Cahill C, Masel D, Schmidt AE, Heal JM, Kirkley SA, Blumberg N Tags: Anesth Analg Source Type: research

The Anesthesia Records of Harvey Cushing and Ernest Codman.
Abstract Hundreds of thousands of anesthesia records are created each day. The earliest records were prepared by 2 medical students in late 19th-century Boston. Ernest Codman and Harvey Cushing went on to become prominent surgeons and contributed much to the safety of the surgical patient. Cushing's career is celebrated due to his associations with William Stewart Halsted, Peter Bent Brigham Hospital, Yale University, in New Haven, Connecticut, and his biography of Sir William Osler. Codman is remembered for introducing the morbidity and mortality conference as well as his drive to improve outcomes and patient saf...
Source: Anesthesia and Analgesia - November 1, 2017 Category: Anesthesiology Authors: Sundararaman LV, Desai SP Tags: Anesth Analg Source Type: research

Type B Aortic Dissection Diagnosed by Left-Sided Transthoracic Ultrasonography in a Woman With Preeclampsia.
PMID: 29099434 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - November 1, 2017 Category: Anesthesiology Authors: Winiszewski H, Pili-Floury S, Capellier G, Piton G, Besch G Tags: Anesth Analg Source Type: research

Percutaneous Closure of Complex Membranous Ventricular Septal Defect Under Transesophageal Echocardiographic Guidance.
PMID: 29099435 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - November 1, 2017 Category: Anesthesiology Authors: Agarwal S, Sharma GK, Ratanapo S, Odo N, Javaheri SP Tags: Anesth Analg Source Type: research

Molecular Targets for Pain Management: More Than Just Mu.
PMID: 29049101 [PubMed - in process] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - October 20, 2017 Category: Anesthesiology Authors: Wanderer JP, Nathan N Tags: Anesth Analg Source Type: research

Unraveling the Mystery of THC: Cannabinoids and Neuropathic Pain.
PMID: 29049102 [PubMed - in process] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - October 20, 2017 Category: Anesthesiology Authors: Nathan N Tags: Anesth Analg Source Type: research

"Houston, We Have a Problem!": The Role of the Anesthesiologist in the Current Opioid Epidemic.
"Houston, We Have a Problem!": The Role of the Anesthesiologist in the Current Opioid Epidemic. Anesth Analg. 2017 Nov;125(5):1429-1431 Authors: Yaster M, Benzon HT, Anderson TA PMID: 29049103 [PubMed - in process] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - October 20, 2017 Category: Anesthesiology Authors: Yaster M, Benzon HT, Anderson TA Tags: Anesth Analg Source Type: research

The Opioid Crisis in the United States: Chronic Pain Physicians Are the Answer, Not the Cause.
PMID: 29049104 [PubMed - in process] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - October 20, 2017 Category: Anesthesiology Authors: Brown RE, Sloan PA Tags: Anesth Analg Source Type: research

Themed Issue on the Opioid Epidemic: What Have We Learned? Where Do We Go From Here?
PMID: 29049105 [PubMed - in process] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - October 20, 2017 Category: Anesthesiology Authors: Benzon HT, Anderson TA Tags: Anesth Analg Source Type: research

Do Not Resuscitate and the Surgical Patient: Not a Contradiction in Terms.
PMID: 29049106 [PubMed - in process] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - October 20, 2017 Category: Anesthesiology Authors: Whitlock EL, Lane RK Tags: Anesth Analg Source Type: research

Venovenous Bypass Associated With Acute Kidney Injury Prevention in Liver Transplantation: An Ode to the Retrospective Data Researcher.
PMID: 29049107 [PubMed - in process] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - October 20, 2017 Category: Anesthesiology Authors: Kappen TH, McCluskey SA Tags: Anesth Analg Source Type: research

The Perioperative Surgical Home Is Not Just a Name.
PMID: 29049108 [PubMed - in process] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - October 20, 2017 Category: Anesthesiology Authors: Mariano ER, Vetter TR, Kain ZN Tags: Anesth Analg Source Type: research

Tracking Speckles: Overcoming Conventions to Evaluate Right Ventricular Function.
PMID: 29049109 [PubMed - in process] (Source: Anesthesia and Analgesia)
Source: Anesthesia and Analgesia - October 20, 2017 Category: Anesthesiology Authors: Tousignant CP, Howard-Quijano K, Skubas NJ Tags: Anesth Analg Source Type: research

Evidence for the Efficacy of Systemic Opioid-Sparing Analgesics in Pediatric Surgical Populations: A Systematic Review.
Abstract While a large number of studies has examined the efficacy of opioid-sparing analgesics in adult surgical populations, fewer studies are available to guide postoperative pain treatment in pediatric patients. We systematically reviewed available publications on the use of systemic nonopioid agents for postoperative analgesia in pediatric surgical populations. A comprehensive literature search identified meta-analyses and randomized controlled trials (RCTs) assessing the effects of systemic, nonopioid agents on postoperative narcotic requirements or pain scores in pediatric surgical populations. If a meta-an...
Source: Anesthesia and Analgesia - October 20, 2017 Category: Anesthesiology Authors: Zhu A, Benzon HA, Anderson TA Tags: Anesth Analg Source Type: research

Risk Management for Opioid Prescribing in the Treatment of Patients With Pain From Cancer or Terminal Illness: Inadvertent Oversight or Taboo?
Abstract As the United States experiences an epidemic of prescription drug abuse, and guidelines on safe practices in prescribing opioids in chronic pain have subsequently emerged from professional organizations and governmental agencies, limited guidance exists for prescribers of opioids to treat pain in patients with cancer or terminal illness. Patients with active cancer or terminal illness often have pain and are frequently prescribed opioids and other controlled substances. Current studies suggest that patients with cancer have similar rates of risk for misuse, abuse, and addiction as the general public. More...
Source: Anesthesia and Analgesia - October 20, 2017 Category: Anesthesiology Authors: Copenhaver DJ, Karvelas NB, Fishman SM Tags: Anesth Analg Source Type: research

America's Opioid Epidemic: Supply and Demand Considerations.
Abstract America is in the midst of an opioid epidemic characterized by aggressive prescribing practices, highly prevalent opioid misuse, and rising rates of prescription and illicit opioid overdose-related deaths. Medical and lay public sentiment have become more cautious with respect to prescription opioid use in the past few years, but a comprehensive strategy to reduce our reliance on prescription opioids is lacking. Addressing this epidemic through reductions in unnecessary access to these drugs while implementing measures to reduce demand will be important components of any comprehensive solution. Key supply...
Source: Anesthesia and Analgesia - October 20, 2017 Category: Anesthesiology Authors: Clark DJ, Schumacher MA Tags: Anesth Analg Source Type: research

The US Opioid Crisis: Current Federal and State Legal Issues.
Abstract The United States is in the midst of a devastating opioid misuse epidemic leading to over 33,000 deaths per year from both prescription and illegal opioids. Roughly half of these deaths are attributable to prescription opioids. Federal and state governments have only recently begun to grasp the magnitude of this public health crisis. In 2016, the Centers for Disease Control and Prevention released their Guidelines for Prescribing Opioids for Chronic Pain. While not comprehensive in scope, these guidelines attempt to control and regulate opioid prescribing. Other federal agencies involved with the federal ...
Source: Anesthesia and Analgesia - October 20, 2017 Category: Anesthesiology Authors: Soelberg CD, Brown RE, Du Vivier D, Meyer JE, Ramachandran BK Tags: Anesth Analg Source Type: research

Alternatives to Opioids in the Pharmacologic Management of Chronic Pain Syndromes: A Narrative Review of Randomized, Controlled, and Blinded Clinical Trials.
Abstract Chronic pain exerts a tremendous burden on individuals and societies. If one views chronic pain as a single disease entity, then it is the most common and costly medical condition. At present, medical professionals who treat patients in chronic pain are recommended to provide comprehensive and multidisciplinary treatments, which may include pharmacotherapy. Many providers use nonopioid medications to treat chronic pain; however, for some patients, opioid analgesics are the exclusive treatment of chronic pain. However, there is currently an epidemic of opioid use in the United States, and recent guidelines...
Source: Anesthesia and Analgesia - October 20, 2017 Category: Anesthesiology Authors: Nicol AL, Hurley RW, Benzon HT Tags: Anesth Analg Source Type: research

An Evidence-Based Approach to the Prescription Opioid Epidemic in Orthopedic Surgery.
Abstract Orthopedic surgery is associated with significant perioperative pain. Providing adequate analgesia is a critical component of patient care and opioids play a vital role in the acute postoperative setting. However, opioid prescribing for patients undergoing orthopedic procedures has recently been identified as a major contributor to the current opioid epidemic. As opioid usage and related morbidity and mortality continue to rise nationwide, opioid-prescribing practices are under increased scrutiny. Here, we update the evidence base and recommendations behind a set of interventions developed at the Hospital...
Source: Anesthesia and Analgesia - October 20, 2017 Category: Anesthesiology Authors: Soffin EM, Waldman SA, Stack RJ, Liguori GA Tags: Anesth Analg Source Type: research