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Opioid Analgesia After Discharge from Hospital
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
It may also be possible to address some of these risk factors prior to elective surgery (Levy et al, 2020). Development of transitional pain services, Acute Pain Service (APS) outpatient services, and the perioperative surgical home (Katz et al, 2015; Zaccagnino et al, 2017; Stamer et al, 2020) where selected patients can be seen prior to elective surgery and/or after discharge can reduce the risks of postdischarge chronic pain and excessive opioid use (Tiippana et al, 2016; Weinrib et al, 2017; Clarke et al, 2018; Clarke et al, 2020). In patients taking long-term opioids for chronic pain, there is evidence that tapering of the doses does not lead to an increase in pain (Fishbain & Pulikal, 2019).
Surgical Aspects Of Fever
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Jona Stadler, Hartley Stern, Jack M. Baron
Recommendations for elective surgery include use of combinations of barbiturates, narcotics, tranquilizers, or by ester type local anesthetics.15 However, the most effective preventative measure is screening of relatives of suspected patients.15
The UK Health Care System
Published in John Fry, Donald Light, Jonathan Rodnick, Peter Orton, Reviving Primary Care, 2018
John Fry, Donald Light, Jonathan Rodnick, Peter Orton
There is almost no private general practice in the UK, apart from a very few completely private practices in parts of London. The private insurance medical schemes do not cover general practice; rather, they provide supplementary coverage, largely of elective surgery, and other procedures, that allow policy holders to by-pass waiting lists and be seen promptly.
YKL-40 promotes proliferation and invasion of HTR-8/SVneo cells by activating akt/MMP9 signalling in placenta accreta spectrum disorders
Published in Journal of Obstetrics and Gynaecology, 2023
Weifang Liu, Runfang Wang, Suxin Liu, Xiaoqian Yin, Yan Huo, Ruiling Zhang, Jia Li
In the present study, 47 maternal cases were included, and the gestational age in the PAS group was lower and caesarean hysterectomy was higher than that in normal control group. The timing of delivery should be individualised. Hysterectomy has become the cornerstone of treatment in patients with PAS and postpartum haemorrhage. As for the termination time of PAS, when the mother and foetus are stable, the planned termination time varies according to different associations, and the American College of Obstetricians and Gynaecologists (ACOG) considered the best termination time to be 34–35+6 weeks (Allen et al. 2018). In addition, elective surgery under the condition of adequate preparation significantly reduced the risk of bleeding than emergency surgery, and also reduced the occurrence of many related complications (Miller et al. 2020). Therefore, the gestational age at termination of pregnancy in the PAS group was shorter than that in the control group, and no normal control pregnant women matched with the gestational age of PAS were obtained, which was also the limitation of this study. However, both groups were pregnant women in late pregnancy, which had limited impact on the study results. Among the 25 PAS cases, there was no significant difference in YKL-40 expression between 13 cases of placenta increta and 12 cases of placenta percreta (P > 0.05), which may be related to insufficient sample size and individual differences.
Impact of chronic medications in the perioperative period: mechanisms of action and adverse drug effects (Part I)
Published in Postgraduate Medicine, 2021
Ofelia Loani Elvir-Lazo, Paul F White, Hillenn Cruz Eng, Firuz Yumul, Raissa Chua, Roya Yumul
The vast majority of patients presenting for elective surgery are prescribed medications on a chronic basis. With populations throughout the world living longer, many more elderly patients are presenting for elective surgical procedures [1]. As more elderly patients, as well as patients with preexisting medical conditions, present for surgery, the management of chronic medications during the perioperative period has assumed increasing importance. Patients taking multiple chronic medications are at an increased risk of adverse drug interactions during the perioperative period [2–4]. In addition, some patients choose not to disclose their use of certain chronic medications (e.g. hormonal therapies, sleep aids, and erectile dysfunction [ED] drugs), phytopharmaceutical use, alcohol intake, and/or recreational drug use. Their compliancy or adherence with what they document in preoperative settings could not be accurate.
Impact of chronic medications in the perioperative period –anesthetic implications (Part II)
Published in Postgraduate Medicine, 2021
Ofelia Loani Elvir-Lazo, Paul F White, Hillenn Cruz Eng, Firuz Yumul, Raissa Chua, Roya Yumul
Since almost half of all patients presenting for elective surgery in the USA are taking prescription medications, over-the-counter medication, herbal (e.g. phytopharmaceuticals), alcohol, nicotine, undisclosed medications on a regular basis, the management of chronic medications during the perioperative period has assumed increasing importance, in particular when caring for high-risk and elderly surgical patients[1]. Physicians must decide whether to continue, reduce the dosage, or discontinue the patient’s chronic medication prior to elective surgery. Management guidelines in the perioperative period varies greatly due to the lack of high-quality outcome data regarding the impact of chronic medications during and after surgery[2]. Patients taking multiple chronic medications, in particular the elderly population (who are typically taking the largest number of chronic medications), and those with diminished organ function are at the highest risk of adverse drug interactions with anesthetics and analgesics during the perioperative period[3].