The present article reviews medical literature in the field of perioperative medicine in Greece and presents statistics about the Greek e-journal of Perioperative Medicine during from 2003 up to 1st issue of 2016.
Continue reading
Postoperative pain management has become pre-requisite for early recovery after laparoscopic chole-cystectomy and the ideal management of it is definitely multimodal due to the complexity of its na-ture. Many analgesic approaches have already been tested to relieve pain after laparoscopic cholecys-tectomy and anticonvulsants drugs, like pregabalin and gabapentin might be useful and effec-tive.Pregabalin is an antiepileptic drug that is often used to treat neuropathic pain. The use of pre-gabalin as part of multimodal analgesia is still under evaluation and may have a role in the postopera-tive management, as an adjunct. Several studies have evaluated the efficacy and adverse effects of pregabalin in reducing postoperative pain and opioid consumption.In this review, we discuss the role of pregabalin in acute postoperative management after laparoscopic cholecystectomy. Based on avail-able clinical trials it is difficult to draw solid conclusions. More studies and especially well designed clinical trials are required in order to clarify the optimal dose and the duration of therapy before adopt-ing pregabalin in routine clinical practice.
Continue readingPain is a disastrous manifestation of cancer that influences the patients’ quality of life, their families, and health care providers. It is a multidimensional symptom that includes the physical, psychosocial, emotional and spiritual character of the human organism. Despite the development of new analgesic drugs and updated guidelines, the pain management remains insufficient, and some patients with mild to severe pain do not received adequate pain treatment. This insufficient management can be attributed to barriers related to health professionals, to the patients, and the health care system. Common professional barriers include the bad pain evaluation, the lack of knowledge and skills, and the doctors’ reluctance to prescribe opioids. The barriers related to the patient include cognitive factors, emotional factors, and the compliance with analgesic regimens. Barriers related to the health system, like the limited access to opioids, and limited availability of pain and palliative care experts, consist additional challenges, especially in poor countries. Given the multidimensional nature of cancer pain, and the multilevelbarriers involved, the effective pain management demands multimodal interventions from interscientific groups. Educational interventions to the patients and health professionals it is possible to improve the successof pain management.
Continue readingThe objective of postoperative pain management after thoracotomy is the prevention of postoperative complications, the reduction of the length of hospital stay, the increase of the patient’s satisfaction and finally the resumption of the daily living’s normal activities.
Thoracic surgery affects postoperative respiratory function, along with a high risk of developing postoperative pulmonary complications. Pain is a subjective experience. Postoperative pain management in thoracic surgery patients should be individually applied, based on a well-organized health care system that emphasizes consistent nursing education regarding proper pain management techniques, with an effective communication between the patient and members of the existing multidisciplinary team, especially the nursing staff.
Continue readingFractures of the proximal femur are of the most frequent, especially in elderly patients. The increased frequency of these fractures highlights the need for effective management of those patients and the impact of these fractures regarding the cost to the national health system. The effects of pain in elderly patients is extremely aggravating, frequently leading to mental (confusion, delirium) and physical (cardiovascular) deterioration and complications.
The pain management of these patients in the emergency department (ED) with intravenous administered analgesics might complicate the status of these patients. The use of non-steroidal anti-inflammatory drugs (NSAID’s) might increase the risk of gastric ulceration, gastric haemorrhage and coronary syndromes, while the use of IV opioids–especially in elderly-incorporates the risk of respiratory depression, delirium, hypotension and constipation. The pain management of these patients with the use of fascia iliaca block applied in ED, or even in a prehospital setting from doctors of various specialties, paramedics or nurses seems to gain acceptance because of its steep learning curve, the simple technique, the high success rate and the low rate of significant complications.
Continue reading
Difficulties or failure in airway management are common factors leading to death and brain damage as a direct result of anesthesia. Prediction of the difficult airway enables the anesthetists to prepare for this challenging clinical scenario. Although the ability to predict accurately a difficult airway preoperatively would be of great value, it is evident from the literature that no single airway assessment can reliably predict a difficult airway. The purpose of this paper is to define the difficult airway and to review the current literature on methods used for prediction of difficult airway.
Continue readingThe incidence of pre-eclampsia in the western countries is estimated to range from 2% to 6% in healthy, nulliparous women. In developing nations, the incidence of the disease is reported to be 4- 18%,with hypertensive disorders being the second most common obstetric cause of stillbirths and early neonatal deaths in these countries Etiology of the disease is multifactorial, with risk factors like maternal age, oxidative stress, angiotensin T-235 homozygote having a different role in every case. Moreover, the disease its self is a multisystem expression of a complicated pathophysiology. Many attempts to explain the latter have been made with often controversial results. In the present article we explore the hypothesis of intra-abdominal pressure as possible causative factor of pre-eclampsia and the role ofthe maternal venous compartment and rennin-angiotensin-anldosterin system in this hypothesis.
Continue readingEffective postoperative analgesia in geriatric patients is both challenging and rewarding. Inadequate pain control after surgery is associated with adverse outcomes in the older patient. This review will attempt to describe the difficulty with assessment of pain and variations in pain experience of elderly patients. Physiological changes related to aging need to be also carefully considered, because aging is individualized and progressive. Pharmacokinetic and pharmacodynamic changes in geriatric patients, the higher incidence of comorbidities and concurrent use of other drugs, must be carefully adjusted to suit each geriatric patient, concerning postoperative pain management. Medication for postoperative pain will be discussed. Unfortunately, many medications have not been studied well in the older population.Non-pharmacological approaches to postoperative pain management will not be discussed, although this would be an interesting topic for further discussion.
Continue readingDelirium, a serious and common manifestation of brain dysfunction in critically ill patients gained great attention over the last decade. Important risk factors such as use of benzodiazepines, coma, preexisting cognitive impairment, alcoholism and high severity of illness at ICU admission were i-dentified. Screening tools like the CAM-ICU and the ICDSC were extensively validated in many different ICU patient populations and are recommended for routine monitoring in everyday practice. Sedation with novel sedatives such as dexmedetomidine, implementation of non pharma-ceutical, preventive interventions and early mobilization of patients may reduce the incidence of this syndrome. The role of haloperidol and atypical antipsychotics in the prevention and treatment of ICU delirium is still under investigation.
Continue readingThe application of statistical methods in order to extract safer conclusions from samples of medical data has become a key methodology for synthesis and evaluation in any medical research. This study makes a retrospective overview of statistical methods used for oral presentations in the summaries of Greek anesthesia conferences and tries to “capture” the change in the use of statistics in recent years. Nine hundred and twenty five oral presentations from seven Greek anesthesia conferences were included for further analysis.
Continue reading
