影响疼痛管理和术后麻醉剂在头骨改造中的术内因素:回顾性审查
Elizabeth Dominguez1, Carly M O'Donnell, Jonathan T Bacos
1Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, WI.
The Journal of craniofacial surgery
|December 27, 2024
概括
在开放的头骨重建中,优化手术内流体量,手术持续时间和排水使用可以显著减少术后麻醉剂的需求. 早期使用非类固醇抗炎药物也降低了阿片类药物需求,改善了患者的治疗结果.
科学领域:
- 儿科手术 儿科手术
- 麻醉学 麻醉学
- 神经外科 神经外科
背景情况:
- 在开放的头骨重建 (CVR) 中,术后疼痛管理存在挑战,因为麻醉剂的使用可以掩盖神经系统的变化并引起并发症.
- 在CVR中减少麻醉剂的使用与改善患者健康结果有关.
研究的目的:
- 为了检查可修改的手术内因子和术后麻醉剂消费在接受开放CVR的儿科患者之间的关联.
主要方法:
- 一项回顾性队列研究分析了237名患有骨突症的儿科患者,他们在10年内接受了开放式CVR.
- 收集的数据包括手术内流体量,手术时间,排水位置,输血产品和术后药物使用.
主要成果:
- 增加的手术内流体体积 (mL/kg),更长的手术时间和排水位置与更高的术后总吗啡等价物 (MEs,mL/kg) 有显著的关联.
- 术后非类固醇抗炎药物 (NSAID) 的使用与明显较低的总ME需求相关联.
- 在手术期间使用胺酸与手术后输血需求的减少有关.
结论:
- 可修改的手术内因素,包括流体管理,手术持续时间和排水使用,在开放的CVR中显著影响术后麻醉剂的要求.
- 术后使用NSAID有效降低阿片类药物需求.
- 针对这些手术内变量可能会减轻疼痛,限制麻醉药物依赖,并提高患者在CVR后的整体康复.
相关概念视频
Local Anesthetics: Clinical Application as Epidural Anesthesia
409
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
409
Analgesia and Pain Management
496
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
496
Opioid Analgesics: Synthetic and Semisynthetic Opioids
219
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
219
General Anesthesia: Overview
191
Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
191
Opioid Analgesics: Morphine and Other Natural Cogeners
179
Opioids are a class of drugs that mimic endogenous opioid peptides and act on opioid receptors, and help in pain relief. These compounds are classified as natural, synthetic, or semi-synthetic. Natural opioids, like morphine, codeine, and thebaine, are derived from the opium poppy plant (Papaver somniferum or Papaver album) and are termed opiates. Synthetic opioids are artificial, while semi-synthetic opioids combine natural and synthetic compounds. Morphine, a prototypical opioid, possesses a...
179


