Perioperative N-acetylcysteine: evidence and indications.

Nonopioid analgesics serve to improve analgesia and limit side effects and risks of perioperative opioids. N-acetylcysteine (NAC), the primary treatment of acetaminophen toxicity, may have perioperative indications, including analgesia. NAC impacts glutathione synthesis, oxidant scavenging, glutamate receptor modulation and neuroinflammation. Potential perioperative benefits include arrhythmia prevention after cardiac surgery, decreased contrast-induced nephropathy, improved post-transplant liver function and superior pulmonary outcomes with general anesthesia. NAC may improve perioperative analgesia, with some studies displaying a reduction in postoperative opioid use. NAC is generally well tolerated with an established safety profile. NAC administration may predispose to gastrointestinal effects, while parenteral administration may carry a risk of anaphylactoid reactions, including bronchospasm. Larger randomized trials may clarify the impact of NAC on perioperative analgesic outcomes.

Nonopioid mediations are important to help pain control after surgery and may decrease risks of opioids. N-acetylcysteine (NAC), the treatment of acetaminophen overdose, decreased inflammation and has other positive effects on the body that may help pain after surgery. Thus, NAC has been studied to prevent abnormal heart rhythms with heart surgery, help kidneys after surgery, improve the liver after liver transplant or other live surgeries and improve breathing after anesthesia. NAC may also decrease pain and the amount of pain medications needed after surgery. While NAC is generally well tolerated and considered safe, stomach upset can occur as can itching or asthma like reactions in certain patients. This review describes how NAC may improve pain, summarizes the other ways NAC may help a patient undergoing surgery, and describes potential side effects when NAC is given.

Particulate Gastric Contents in Patients Prescribed Glucagon-Like Peptide 1 Receptor Agonists After Appropriate Perioperative Fasting: A Report of 2 Cases.

Glucagon-like peptide 1 (GLP-1) receptor agonists have surged in popularity for the treatment of both diabetes mellitus and obesity. While GLP-1 reduces proximal gastrointestinal motility and delays gastric emptying, the impact of these medications on adequate fasting before surgery is not clear. We present 2 cases of particulate gastric contents after following appropriate presurgical fasting in diabetic patients taking GLP-1 receptor agonists and review current literature regarding perioperative implications of these drugs.

To Infinity and Beyond: The Past, Present, and Future of Tele-Anesthesia.

Because the scope of anesthesia practice continues to expand, especially within the perioperative domain, our specialty must continually examine technological services that allow us to provide care in innovative ways. Telemedicine has facilitated the remote provision of medical services across many different specialties, but it remains somewhat unclear whether the use of telemedicine would fit within the practice of anesthesiology on a consistent basis. There have been several reports on the successful use of telemedicine within the preoperative and intraoperative realm. However, patient selection, patient and provider satisfaction, case cancellation rates, equipment reliability, and security of protected health information are just some of the issues that require further examination. This article seeks to review comprehensively the available literature related to the use of telemedicine within the preoperative, intraoperative, and postoperative phases of anesthetic care as well as analyze the major hurdles often encountered when implementing a teleconsultation service. Security of connection, data storage and encryption, federal and state medical licensure compliance, as well as overall cost/savings analysis are a few of the issues that warrant further exploration and research. As telemedicine programs develop within the perioperative arena, it is imperative for institutions to share knowledge, successes, and pitfalls to improve the delivery of care in today's technology-driven medical landscape.