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1.
J Clin Anesth ; 75: 110500, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34517291
2.
Postgrad Med ; : 1-14, 2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34551662

RESUMO

Background: This review article discusses the pharmacology of the most commonly used chronic medications in patients undergoing elective surgical procedures. The mechanism of action and adverse side effects of cardiovascular medications (e.g., beta blockers, alpha-2 agonist, calcium channel blockers, ACE inhibitors, diuretics), lipid-lowering drugs, gastrointestinal medications (H2-blockers, proton pump inhibitors), pulmonary medications (inhaled ß-agonists, anticholinergics,), antibiotics (tetracyclines, clindamycin and macrolide, linezolid), opioids and non-opioids analgesics (NSAIDs, COX-2 inhibitors, acetaminophen), gabapentanoids, erectile dysfunction (ED) drugs, and psychotropic drugs (tricyclic antidepressants [TCAs], monoamine oxidase inhibitors [MAOI], selective serotonin reuptake inhibitors [SSRIs], serotonin norepinephrine reuptake inhibitors [SNRIs], and cannabinol-containing drugs) will be reviewed.Materials and Methods: An online search was conducted from January 2000 through February 2021 with the Medline database through PubMed and Google Scholar using the following search terms/keywords: "chronic medications in the perioperative period", and "chronic medications and anesthetic implications." In addition, we searched for anesthetic side effects associated with the major drug groups.Results and Conclusions: An understanding of the pharmacology and pharmacokinetics of most used chronic medications is important to avoid untoward outcomes in the perioperative period. These drug interactions may result in altered efficacy and toxicity of the anesthetic medications administered during surgery. These drug-drug interactions can also effect the morbidity, mortality, and recovery time of surgical patients. Part I of this two-part review article focuses on the mechanisms of action and adverse side effects of the chronic medications most commonly taken by surgical patients in the preoperative period.

3.
Postgrad Med ; : 1-19, 2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34551658

RESUMO

Background: This review article discusses the pharmacodynamic effects of the most commonly used chronic medications by patients undergoing elective surgical procedures, namely cardiovascular drugs (e.g., beta blockers, alpha-2 agonist, calcium channel blockers, ACE inhibitors, diuretics, etc.), lipid-lowering drugs, gastrointestinal medications (H2-blockers, proton pump inhibitors), pulmonary medications (inhaled ß-agonists, anticholinergics,), antibiotics (tetracyclines, clindamycin and macrolide, linezolid.), opioids and non-opioids analgesics (NSAIDs, COX-2 inhibitors, acetaminophen), gabapentanoids, erectile dysfunction (ED) drugs, psychotropic drugs (tricyclic antidepressants [TCAs], monoamine oxidase inhibitors [MAOI], selective serotonin reuptake inhibitors [SSRIs], serotonin norepinephrine reuptake inhibitors [SNRIs], and cannabinol-containing drugs).  In addition, the potential adverse drug-interactions between these chronic medications and commonly used anesthetic drugs during the perioperative period will be reviewed. Finally, recommendations regarding the management of chronic medications during the preoperative period will be provided.Materials and Methods: An online search was conducted from January 2000 through February 2021 with the Medline database through PubMed and Google Scholar using the following search terms/keywords: "chronic medications in the perioperative period", and "chronic medications and anesthetic implications." In addition, we searched for anesthetic side effects associated with the major drug groups.Results and Conclusions: An understanding of the pharmacodynamic effects of most used chronic medications is important to avoid untoward outcomes in the perioperative period. These drug interactions may result in altered efficacy and toxicity of the anesthetic medications administered during surgery. These drug-drug interactions can also affect the morbidity, mortality, recovery time of surgical patients and acute relapse of chronic illnesses which could lead to last minute cancellation of surgical procedures. Part II of this two-part review article focuses on the reported interactions between most commonly taken chronic medications by surgical patients and anesthetic and analgesic drugs, as well as recommendations regarding the handling these chronic medications during the perioperative period.

7.
F1000Res ; 92020.
Artigo em Inglês | MEDLINE | ID: mdl-32913634

RESUMO

Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) remain common and distressing complications following surgery. The routine use of opioid analgesics for perioperative pain management is a major contributing factor to both PONV and PDNV after surgery. PONV and PDNV can delay discharge from the hospital or surgicenter, delay the return to normal activities of daily living after discharge home, and increase medical costs. The high incidence of PONV and PDNV has persisted despite the introduction of many new antiemetic drugs (and more aggressive use of antiemetic prophylaxis) over the last two decades as a result of growth in minimally invasive ambulatory surgery and the increased emphasis on earlier mobilization and discharge after both minor and major surgical procedures (e.g. enhanced recovery protocols). Pharmacologic management of PONV should be tailored to the patient's risk level using the validated PONV and PDNV risk-scoring systems to encourage cost-effective practices and minimize the potential for adverse side effects due to drug interactions in the perioperative period. A combination of prophylactic antiemetic drugs with different mechanisms of action should be administered to patients with moderate to high risk of developing PONV. In addition to utilizing prophylactic antiemetic drugs, the management of perioperative pain using opioid-sparing multimodal analgesic techniques is critically important for achieving an enhanced recovery after surgery. In conclusion, the utilization of strategies to reduce the baseline risk of PONV (e.g. adequate hydration and the use of nonpharmacologic antiemetic and opioid-sparing analgesic techniques) and implementing multimodal antiemetic and analgesic regimens will reduce the likelihood of patients developing PONV and PDNV after surgery.


Assuntos
Náusea e Vômito Pós-Operatórios , Atividades Cotidianas , Assistência ao Convalescente , Antieméticos , Humanos , Alta do Paciente
10.
Brain Res ; 1706: 116-124, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30408479

RESUMO

Recent studies indicate that glucagon-like peptide 1 (GLP-1) receptor (GLP-1R) agonists exhibit neurotrophic and neuroprotective effects. The aim of this study was to explore whether the GLP-1R agonist exendin-4 can alter surgery-induced behavioral deficits and exert neuroprotective effects via the activation of the hippocampal GLP-1/GLP-1R pathway. 120 male Sprague-Dawley rats (aged 18-20 months old) were randomly divided into four groups: control group, exendin-4 group, surgery group, and surgery + exendin-4 group. The animals received either exendin-4 (5 µg/kg/day) or saline intra-peritoneally for 14 days, and then were subjected to partial hepatectomy 24 h after the last injection. Behavioral changes were evaluated with Morris Water Maze and Open field testing on postoperative days 7 and 14. The levels of IL-1ß, NF-κB, Iba-1, Synaptophysin, GLP-1/GLP-1R, GSK-3ß, p-GSK-3ß (Ser9), p-Tau (Ser396), and p-Tau (Ser202/199) in the hippocampus were measured at the same time point. Surgical trauma induced an exacerbated spatial learning and memory impairment, increased the levels of depressive performance, and enhanced hippocampal NF-κB and IL-1ß expression in the aged rats on postoperative day 7. A corresponding decline in GLP-1R was also found following surgical challenge on postoperative day 7. Exendin-4 treatment partly reversed surgery-induced postoperative behavioral impairment, downregulated the levels of NF-κB and IL-1ß, ameliorated tau hyperphosphorylation and enhanced the activity of p-GSK-3ß (Ser9). Together, the downregulation of GLP-1R exacerbated surgery-induced behavior deficits. Exendin-4 treatment attenuated these effects by inhibiting neuroinflammation and tau hyperphosphorylation. These findings suggest that pretreatment with exendin-4 is a potential adjuvant for preventing surgery-induced behavioral deficits.


Assuntos
Comportamento Animal/efeitos dos fármacos , Disfunção Cognitiva/tratamento farmacológico , Exenatida/farmacologia , Peptídeo 1 Semelhante ao Glucagon/metabolismo , Receptor do Peptídeo Semelhante ao Glucagon 1/metabolismo , Animais , Disfunção Cognitiva/metabolismo , Disfunção Cognitiva/patologia , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Glicogênio Sintase Quinase 3 beta/metabolismo , Hepatectomia/métodos , Hipocampo/efeitos dos fármacos , Hipocampo/metabolismo , Hipocampo/patologia , Masculino , NF-kappa B/metabolismo , Fármacos Neuroprotetores/farmacologia , Complicações Cognitivas Pós-Operatórias/metabolismo , Complicações Cognitivas Pós-Operatórias/terapia , Ratos , Ratos Sprague-Dawley , Transdução de Sinais/efeitos dos fármacos
12.
Minerva Anestesiol ; 84(5): 590-598, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29405668

RESUMO

BACKGROUND: Low back pain (LBP) is a common and costly illness. This randomized, double-blind, placebo-controlled, cross-over study tested the hypothesis that periradicular injections of meloxicam would reduce LBP and improve physical activity compared to a saline injection at 3 months follow-up. METHODS: After IRB approval, 80 consenting patients suffering LBP of <6 months duration were randomly assigned to the control (C-group, N.=40, receiving 10 mL of saline) or the meloxicam (M-group, N.=40, receiving 10 mg in 10 mL saline). If the pain Numeric Rating Score (NRS) at 24 hours remained >50% of the pretreatment score, the patient was crossed-over to the other group. A successful treatment was NRS<3 at 3 months follow-up. Secondary outcome measures which were assessed included work-absence, physical-assistance, physical-activities limitations and pain-related insomnia. RESULTS: The baseline NRS was 9.3 (95% CI: 8.9-9.7) in the C-group and 9.2 (95% CI: 8.8-9.6) in the M-group. At the 24 hours follow-up after the initial treatment, the mean NRS was 6.3 (95% CI: 5.4-7.2) in the C-group vs. 3.5 (95% CI: 2.6-4.4) in the M-group (P<0.05). The number of cross-over cases was significantly higher in the C-group (N.=31, 77.5% vs. N.=5, 12.5%, P<0.001). At the 3 months follow-up, 66 patients (35+31) were allocated in the M-group and 54 (82%) reported NRS Score <3, while only 14 (9+5) patients remained in the C-group and eight patients had NRS<3. CONCLUSIONS: Periradicular injection of meloxicam is an effective analgesic treatment for acute/subacute LBP. This novel use of meloxicam also leads to an improvement in the level of physical activity at the 3-month follow-up.


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Dor Lombar/tratamento farmacológico , Meloxicam/administração & dosagem , Estudos Cross-Over , Método Duplo-Cego , Exercício Físico , Feminino , Seguimentos , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Raízes Nervosas Espinhais , Fatores de Tempo
13.
Rheumatol Int ; 38(3): 517-523, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29080932

RESUMO

Fibromyalgia is a chronic musculoskeletal condition characterized by widespread pain in the body and is associated with tender points at the shoulder, back and hip regions. A wide variety of pharmacologic drugs and dietary supplements have been used with limited success in treating the musculoskeletal pain. Early clinical studies with low level laser therapy (LLLT) alone or in combination with drugs commonly used to treat fibromyalgia suggested that LLLT may be effective in reducing musculoskeletal pain and stiffness, as well as the number of tender locations. However, a sham-controlled study reported that LLLT was not significantly better than the sham treatment and kinesiotape. Preliminary studies with high-intensity laser therapy (HILT) suggest that it may be more effective than LLLT for treating chronic pain syndromes. Therefore, we evaluated low (1 W), intermediate (42 W) and high level (75 W) HILT in a woman with long-standing fibromyalgia syndrome which was resistant to both standard pharmacotherapy and treatment in an interdisciplinary pain management program. The patient received a series of treatments with a HILT device (Phoenix Thera-lase) at a wavelength of 1275 nm administered at both the paraspinous region and tender points in the shoulder and hip regions. Although the 1 W treatment produced minimal symptom relief, both the 42 and the 75 W treatments produced a dramatic reduction in her overall pain, improved quality of sleep, and increased her level of physical activity for 4-10 days after these treatment sessions. This case illustrates the potential beneficial effects of using higher power levels of HILT for patients with fibromyalgia syndrome who have failed to respond to conventional interdisciplinary treatment regimens.


Assuntos
Analgésicos/uso terapêutico , Resistência a Medicamentos , Fibromialgia/terapia , Terapia a Laser/métodos , Dor Musculoesquelética/terapia , Manejo da Dor/métodos , Idoso , Feminino , Fibromialgia/diagnóstico , Fibromialgia/fisiopatologia , Fibromialgia/psicologia , Humanos , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/fisiopatologia , Dor Musculoesquelética/psicologia , Medição da Dor , Qualidade de Vida , Recuperação de Função Fisiológica , Resultado do Tratamento
15.
Drugs Aging ; 34(9): 673-689, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28808946

RESUMO

The ambulatory setting offers potential advantages for elderly patients undergoing elective surgery due to the advancement in both surgical and anesthetic techniques resulting in quicker recovery times, fewer complications, higher patient satisfaction, and reduced costs of care. This review article aims to provide a practical guide to anesthetic management of elderly outpatients. Important considerations in the preoperative evaluation of elderly outpatients with co-existing diseases, as well as the advantages and disadvantages of different anesthetic techniques on a procedural-specific basis, and recommendations regarding the management of common postoperative complications (e.g., pain, postoperative nausea and vomiting [PONV], delirium and cognitive dysfunction, and gastrointestinal dysfunction) are discussed. The role of anesthesiologists as perioperative physicians is important for optimizing surgical outcomes for elderly patients undergoing ambulatory surgery. The implementation of high-quality, evidence-based perioperative care programs for the elderly on an ambulatory basis has assumed increased importance. Optimal management of perioperative pain using opioid-sparing multimodal analgesic techniques and preventing PONV using prophylactic antiemetics are key elements for achieving enhanced recovery after surgery.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Anestesia/métodos , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Idoso , Analgésicos/administração & dosagem , Analgésicos/uso terapêutico , Antieméticos/administração & dosagem , Antieméticos/uso terapêutico , Humanos , Pacientes Ambulatoriais , Satisfação do Paciente , Medição de Risco
16.
J Clin Anesth ; 40: 51-53, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28625446

RESUMO

In a recent article from the Center for Disease Control, the authors addressed the current opioid epidemic in America and emphasized the importance of utilizing non-opioid analgesic alternatives to opioid medication for treating chronic pain. In cases where non-opioid analgesic drugs alone have failed to produce adequate pain relief, these authors suggested that non-pharmacologic therapies should also be considered. This Case Series describes a pilot study designed to evaluate a novel non-pharmacologic approach to treating long-standing (>1year) opioid dependency. The therapy involved the use of a high intensity cold laser device to treat three patients who had become addicted to prescription opioid-containing analgesic medication for treating chronic (residual) pain after a major operation. After receiving a series of 8-12 treatment sessions lasting 20-40min to the painful surgical area over a 3-4week period of time with the high intensity (42W) Phoenix Thera-lase laser device, an FDA-approved Class IV cold laser, these patients were able to discontinue their use of all oral opioid-containing analgesic medications and resume their normal activities of daily living. At a follow-up evaluation 1-2months after their last laser treatment, these patients reported that they have been able to control their pain with over-the-counter non-opioid analgesics and they have remained largely opioid-free. Further larger-scale studies are needed to verify these preliminary findings with this powerful cold laser in treating opioid-dependent patients.


Assuntos
Dor Crônica/cirurgia , Terapia a Laser/métodos , Transtornos Relacionados ao Uso de Opioides/reabilitação , Dor Pós-Operatória/cirurgia , Atividades Cotidianas , Adulto , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Dor Crônica/tratamento farmacológico , Dor Crônica/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/reabilitação , Projetos Piloto
18.
Brain Res ; 1665: 65-73, 2017 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-28414034

RESUMO

Age is the most prominent risk factor for the development of postoperative cognitive dysfunction. This study investigated the potential role of anti-inflammatory interleukin (IL)-4 in age-related differences of surgery-induced cognitive deficits and neuroinflammatory responses. Both adult and aged Sprague-Dawley male rats were subjected to partial hepatectomy or partial hepatectomy with a cisterna magna infusion of IL-4. On postoperative days 1, 3, and 7, the rats were subjected to a reversed Morris water maze test. Hippocampal IL-1ß, IL-6, IL-4, and IL-4 receptor (IL-4R) were measured at each time point. Brain derived neurotrophic factor (BDNF), synaptophysin, Ionized calcium-binding adapter molecule 1 (Iba-1), microglial M2 phenotype marker Arg1, and CD200 were also examined in the hippocampus. Age induced an exacerbated cognitive impairment and an amplified neuroinflammatory response triggered by surgical stress on postoperative days 1 and 3. A corresponding decline in the anti-inflammatory cytokine IL-4 and BDNF were also found in the aged rats at the same time point. Treatment with IL-4 downregulated the expression of proinflammatory cytokines (e.g., IL-1ß and IL-6), increased the levels of BDNF and synaptophysin in the brain and improved the behavioral performance. An increased Arg1 expression and a high level of CD200 were also observed after a cisterna magna infusion of IL-4. An age-related decrease in IL-4 expression exacerbated surgery-induced cognitive deficits and exaggerated the neuroinflammatory responses. Treatment with IL-4 potentially attenuated these effects by enhancing BDNF and synaptophysin expression, inhibiting microglia activation and decreasing the associated production of proinflammatory cytokines.


Assuntos
Disfunção Cognitiva/fisiopatologia , Hipocampo/cirurgia , Inflamação/fisiopatologia , Interleucina-4/metabolismo , Envelhecimento , Animais , Disfunção Cognitiva/metabolismo , Modelos Animais de Doenças , Hipocampo/metabolismo , Microglia/metabolismo , Ratos Sprague-Dawley
19.
J Anesth ; 31(4): 617-626, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28455599

RESUMO

Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) remain common and distressing complications following surgery. PONV and PDNV can delay discharge and recovery and increase medical costs. The high incidence of PONV has persisted in part because of the tremendous growth in ambulatory surgery and the increased emphasis on earlier mobilization and discharge after both minor and major operations. Pharmacological management of PONV should be tailored to the patients' risk level using the PONV and PDNV scoring systems to minimize the potential for these adverse side effects in the postoperative period. A combination of prophylactic antiemetic drugs should be administered to patients with moderate-to-high risk of developing PONV in order to facilitate the recovery process. Optimal management of perioperative pain using opioid-sparing multimodal analgesic techniques and preventing PONV using prophylactic antiemetics are key elements for achieving an enhanced recovery after surgery. Strategies that include reductions of the baseline risk (e.g., adequate hydration, use of opioid-sparing analgesic techniques) as well as a multimodal antiemetic regimen will improve the likelihood of preventing both PONV and PDNV.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Antieméticos/uso terapêutico , Náusea e Vômito Pós-Operatórios/tratamento farmacológico , Anestesia/métodos , Humanos
20.
PLoS One ; 12(2): e0171233, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28196099

RESUMO

BACKGROUND: There is currently no widely accepted instrument for measuring preoperative anxiety. The objective of this study was to develop a simple visual facial anxiety scale (VFAS) for assessing acute preoperative anxiety. METHODS: The initial VFAS was comprised of 11 similarly styled stick-figure reflecting different types of facial expressions (Fig 1). After obtaining IRB approval, a total of 265 participant-healthcare providers (e.g., anesthesiologists, anesthesiology residents, and perioperative nurses) were recruited to participate in this study. The participants were asked to: (1) rank the 11 faces from 0-10 (0 = no anxiety, while 10 = highest anxiety) and then to (2) match one of the 11 facial expression with a numeric verbal rating scale (NVRS) (0 = no anxiety and 10 = highest level of anxiety) and a specific categorical level of anxiety, namely no anxiety, mild, mild-moderate, moderate, moderate-high or highest anxiety. Based on these data, the Spearman correlation and frequencies of the 11 faces in relation to the 11-point numerical anxiety scale and 6 categorical anxiety levels were calculated. The highest frequency of a face assigned to a level of the numerical anxiety scale resulted in a finalized order of faces corresponding to the 11-point numeric rating scale. RESULTS: The highest frequency for each of the NVRS anxiety scores were as follow: A0, A1, A2, A3, A4, A5, A7, A6, A8, A9 and A10 (Fig 2). For the six categorical anxiety levels, a total of 260 (98.1%) participants chose the face A0 as representing 'no' anxiety, 250 (94.3%) participants chose the face A10 as representing 'highest' anxiety and 147 (55.5%) participants chose the face A8 as representing 'moderate-high' anxiety. Spearman analysis showed a significant correlation between the faces A3 and A5 assigned to the mild-moderate anxiety category (r = 0.58), but A5 was ultimately chosen due to its higher frequency compared to the frequency of A3 (30.6% vs 24.9%)(Fig 3). Similarly, the correlation of the faces A7 and A6 was significantly correlated with moderate anxiety (r = 0.87), but A7 remained because of its higher frequency (35.9% vs 22.6%). Using frequency and Spearman correlations, the final order of the faces assigned to the categories none, mild, mild-moderate, moderate, moderate-high and highest anxiety levels was A0, A1, A5, A7, A8 and A10, respectively (Fig 4). CONCLUSION: The proposed VFAS was a valid tool for assessing the severity of acute [state] anxiety, and could be easy to administer in routine clinical practice.


Assuntos
Ansiedade/diagnóstico , Ansiedade/fisiopatologia , Expressão Facial , Escala de Ansiedade Manifesta , Período Pré-Operatório , Feminino , Humanos , Masculino
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