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1.
Anesth Analg ; 137(1): 26-47, 2023 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-37326862

RESUMEN

Pain after cardiac surgery is of moderate to severe intensity, which increases postoperative distress and health care costs, and affects functional recovery. Opioids have been central agents in treating pain after cardiac surgery for decades. The use of multimodal analgesic strategies can promote effective postoperative pain control and help mitigate opioid exposure. This Practice Advisory is part of a series developed by the Society of Cardiovascular Anesthesiologists (SCA) Quality, Safety, and Leadership (QSL) Committee's Opioid Working Group. It is a systematic review of existing literature for various interventions related to the preoperative and intraoperative pain management of cardiac surgical patients. This Practice Advisory provides recommendations for providers caring for patients undergoing cardiac surgery. This entails developing customized pain management strategies for patients, including preoperative patient evaluation, pain management, and opioid use-focused education as well as perioperative use of multimodal analgesics and regional techniques for various cardiac surgical procedures. The literature related to this field is emerging, and future studies will provide additional guidance on ways to improve clinically meaningful patient outcomes.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Trastornos Relacionados con Opioides , Humanos , Manejo del Dolor/métodos , Analgésicos Opioides/efectos adversos , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/etiología , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Analgésicos/uso terapéutico
2.
Anesth Analg ; 137(1): 2-25, 2023 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-37079466

RESUMEN

Pain after thoracic surgery is of moderate-to-severe intensity and can cause increased postoperative distress and affect functional recovery. Opioids have been central agents in treating pain after thoracic surgery for decades. The use of multimodal analgesic strategies can promote effective postoperative pain control and help mitigate opioid exposure, thus preventing the risk of developing persistent postoperative pain. This practice advisory is part of a series developed by the Society of Cardiovascular Anesthesiologists (SCA) Quality, Safety, and Leadership (QSL) Committee's Opioid Working Group. It is a systematic review of existing literature for various interventions related to the preoperative and intraoperative pain management of thoracic surgical patients and provides recommendations for providers caring for patients undergoing thoracic surgery. This entails developing customized pain management strategies for patients, which include preoperative patient evaluation, pain management, and opioid use-focused education as well as perioperative use of multimodal analgesics and regional techniques for various thoracic surgical procedures. The literature related to this field is emerging and will hopefully provide more information on ways to improve clinically relevant patient outcomes and promote recovery in the future.


Asunto(s)
Trastornos Relacionados con Opioides , Procedimientos Quirúrgicos Torácicos , Humanos , Manejo del Dolor/métodos , Analgésicos Opioides/uso terapéutico , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control , Trastornos Relacionados con Opioides/prevención & control , Procedimientos Quirúrgicos Torácicos/efectos adversos , Analgésicos
3.
J Cardiothorac Vasc Anesth ; 36(10): 3887-3903, 2022 10.
Artículo en Inglés | MEDLINE | ID: mdl-35871885

RESUMEN

Significant mitral regurgitation (MR) is the most common valvular disease in the United States in patients older than 75. However, many patients with severe MR are at a high risk for surgical repair due to other significant comorbidities. Over the past decade, many transcatheter mitral valve devices have been studied that address the different mechanisms of MR, but only a few have received a Conformité Européene (CE) mark or United States Food and Drug Administration (FDA) approval. The Carillon, Cardioband, and Mitralign all received CE marking for percutaneous mitral annuloplasty, while the Tendyne and SAPIEN 3 received a CE mark and FDA approval, respectively, for transcatheter mitral valve replacement. Finally, the NeoChord DS 1000 received a CE mark for transcatheter chordal repair. Each of these devices is reviewed in detail, including device indications, performance in clinical trials, anesthetic management, intraprocedural imaging guidance, and postprocedural complications. Although percutaneous devices will appear and disappear from use, understanding the procedural considerations remains highly relevant, as these key principles will apply to the next generation of transcatheter valve interventions.


Asunto(s)
Implantación de Prótesis de Válvulas Cardíacas , Anuloplastia de la Válvula Mitral , Insuficiencia de la Válvula Mitral , Cateterismo Cardíaco/métodos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , Anuloplastia de la Válvula Mitral/métodos , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/cirugía , Resultado del Tratamiento
6.
J Pediatr Gastroenterol Nutr ; 58(3): 303-6, 2014 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-24126831

RESUMEN

OBJECTIVES: Toilet refusal syndrome (TRS) is a common, benign disorder in toddlers defined by the use of diapers and refusal of toilet for defaecation, but has not been described systematically in preschool children yet. The aim of the study was to analyse and identify possible subgroups of TRS. METHODS: Retrospective analysis of all of the consecutive children with TRS presented as outpatients in a clinic for elimination disorders. Patients had received a detailed paediatric and child psychiatric assessment, including the Child Behavior Checklist questionnaire. Three typical case vignettes are presented of TRS with constipation, oppositional defiant disorder, and sibling rivalry. RESULTS: Twenty-five children (10 boys) with a mean age of 5.2 (3.4-7.3) years were included-representing 2.5% of all of the children (n = 1001) presented. They had high rates of constipation (60%) and elimination disorders (24%-44%). Child psychiatric International Classification of Diseases-10th Edition disorders were common (40%) and heterogeneous, with significantly more boys affected, but no differences between children with and without constipation. CONCLUSIONS: This study shows that TRS occurs also in older preschool (and even school) children. At this later age, it is associated with constipation and behavioural disorders. The case vignettes show differences in therapy and may represent different subgroups of TRS. TRS is associated with constipation, elimination disorders, and psychiatric disorders. Owing to this variety of comorbid disorders, different therapeutic approaches are needed. A general screening for behavioural symptoms is recommended.


Asunto(s)
Trastornos de la Conducta Infantil/clasificación , Conducta Infantil , Estreñimiento/complicaciones , Defecación , Trastornos Mentales/complicaciones , Control de Esfínteres , Factores de Edad , Niño , Trastornos de la Conducta Infantil/complicaciones , Trastornos de la Conducta Infantil/terapia , Preescolar , Estreñimiento/epidemiología , Estreñimiento/psicología , Pañales Infantiles , Femenino , Humanos , Masculino , Prevalencia , Estudios Retrospectivos , Encuestas y Cuestionarios , Síndrome
7.
Acta Paediatr ; 103(8): 868-78, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24799133

RESUMEN

AIM: Nocturnal enuresis (NE) and attention-deficit/hyperactivity disorder (ADHD) are common in childhood. We analysed the central processing of emotions in children with NE, ADHD, NE + ADHD and controls. METHODS: We examined 13 children with NE, 13 with ADHD, 14 with NE + ADHD and 14 controls. Acoustic evoked potentials were recorded using standardised methodology. For the event-related potentials, positive, negative and neutral pictures were presented and time intervals of 250-450, 450-650 and 650-850 msec evaluated. Hypotheses were tested with repeated-measures analyses of variance. RESULTS: In the frontal region, children with NE showed more intense responses to positive and negative pictures than controls measured with event-related potentials. Viewing positive pictures, children with NE + ADHD differed from children with ADHD in the central and parietal and for all types of stimuli in the parietal region. Children with NE + ADHD elicited the strongest responses. Children with ADHD did not differ from controls. There was an unspecific interaction effect of the acoustic evoked potentials in children with NE compared to the controls. CONCLUSION: Children with NE processed emotions differently from children with ADHD and controls. Children with NE + ADHD processed emotions the most intense, displaying interaction effects of the central nervous system that cannot be explained by each disorder alone.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Sistema Nervioso Central/fisiopatología , Emociones/fisiología , Potenciales Evocados Auditivos , Enuresis Nocturna/fisiopatología , Trastorno por Déficit de Atención con Hiperactividad/psicología , Estudios de Casos y Controles , Niño , Femenino , Humanos , Masculino , Enuresis Nocturna/psicología
8.
BJA Open ; 11: 100288, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-39007154

RESUMEN

Background: Sternal pain after cardiac surgery results in considerable discomfort. Single-injection parasternal fascial plane blocks have been shown to reduce pain scores and opioid consumption during the first 24 h after surgery, but the efficacy of continuous infusion has not been evaluated. This retrospective cohort study examined the effect of a continuous infusion of local anaesthetic through parasternal catheters on the integrated Pain Intensity and Opioid Consumption (PIOC) score up to 72 h. Methods: We performed a retrospective analysis of patients undergoing cardiac surgery with median sternotomy at a single academic centre before and after the addition of parasternal nerve catheters to a standard multimodal analgesic protocol. Outcomes included PIOC score, total opioid consumption in oral morphine equivalents, and time-weighted area under the curve pain scores up to 72 h after surgery. Results: Continuous infusion of ropivacaine 0.1% through parasternal catheters resulted in a significant reduction in PIOC scores at 24 h (-62, 95% confidence interval -108 to -16; P<0.01) and 48 h (-50, 95% CI -97 to -2.2; P=0.04) compared with no block. A significant reduction in opioid consumption up to 72 h was the primary factor in reduction of PIOC. Conclusions: This study suggests that continuous infusion of local anaesthetic through parasternal catheters may be a useful addition to a multimodal analgesic protocol in patients undergoing cardiac surgery with sternotomy. Further prospective study is warranted to determine the full benefits of continuous infusion compared with single injection or no block.

10.
J Comp Eff Res ; 10(1): 39-54, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33438461

RESUMEN

Background: Low socioeconomic status predicts inferior clinical outcomes in many patient populations. The effects of patient insurance status and hospital safety-net status on readmission rates following acute myocardial infarction are unclear. Materials & methods: A retrospective review of State Inpatient Databases for New York, California, Florida and Maryland, 2007-2014. Results: A total of 1,055,162 patients were included. Medicaid status was associated with 37.7 and 44.0% increases in risk-adjusted readmission odds at 30 and 90 days (p < 0.0001). Uninsured status was associated with reduced odds of readmission at both time points. High-burden safety-net status was associated with 9.6 and 9.5% increased odds of readmission at 30 and 90 days (p < 0.0003). Conclusion: Insurance status and hospital safety-net burden affect readmission odds following acute myocardial infarction.


Asunto(s)
Infarto del Miocardio , Readmisión del Paciente , Florida/epidemiología , Humanos , Maryland , Infarto del Miocardio/epidemiología , Infarto del Miocardio/terapia , New York/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Determinantes Sociales de la Salud , Estados Unidos/epidemiología
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