A. Management of Postoperative Pain:
Postoperative care encompasses a majority of the time spent during hospitalizations following prolonged operations. One of the main goals of postoperative care includes pain management as improved pain control may shorten the hospital course125-129. Optimum postoperative analgesia results in earlier ambulation and rehabilitation postoperatively.130-132 Additionally, patient satisfaction greatly improves. Optimal control of pain occurs through the use of multiple analgesics that act on different receptors within the nervous system, a term deemed multimodal analgesia133. Various neurotransmitters exist and the ability to target each aims to minimize the effects of individual agents133. In addition to different classes of drug therapy, the anesthesiologist employs regional anesthetic techniques to help reduce pain via neuropathic transmission.
Although the mainstay of postoperative pain control requires opiate therapy, other classes of drugs help to reduce opioid consumption and their side effects when utilized. Non steroidal anti-inflammatory drugs (NSAIDs) inhibit the synthesis of prostaglandins at periphery, one of the main causes of the heightened pain state. Acetaminophen also inhibits cyclooxygenase and possesses mild if any anti-inflammatory properties. Furthermore, gabapentin and pregabalin target a neuropathic component through GABA and voltage gated calcium channels. Lastly, ketamine acts on multiple pain receptors, the most important being the NMDA receptor. Each of these drugs decrease opioid consumption and improve analgesia by targeting differing pain receptors134-143.
Within the opioid related side effects, preventing postoperative nausea and vomiting, avoiding excessive sedation...
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...nitial preoperative evaluation, intraoperative management to postoperative pain management, aspires to improve surgical outcomes through reduced morbidity and mortality. Communication between the surgeons and anesthesiologists about preoperative risks and perioperative management plans is extremely important in reoperative surgery. Vigilance of the anesthesiologist, via meticulous attention to perioperative details, helps to improve surgical outcomes and further decrease perioperative morbidity such as surgical site infections, cardiac complications, and fluid overload. The issues highlighted within this chapter are not all inclusive. The importance of perioperative optimization and communication concerning care plans to achieve the best outcomes for patients cannot be emphasized enough and requires daily cooperation amongst all parties involved with patient care.
This essay will discuss the risks for patients during the preoperative, intraoperative and postoperative stages of the perioperative journey and how both patients and healthcare professionals involved in the perioperative stages can work together to prevent perioperative hypothermia.
Prior to intubation for a surgical procedure, the anesthesiologist administered a single dose of the neuromuscular blocking agent, succinylcholine, to a 23-year-old female to provide muscular relaxation during surgery and to facilitate the insertion of the endotracheal tube. Following this, the inhalation anesthetic was administered and the surgical procedure completed.
It has been shown that intrathecal administriton of GABA receptor antagonists cause hyperalgesia and allodynia. Constitutive, the increase in the endogenous GABA activity in the spinal cord alleviate pain resulting from noxious and innoxious mechanical and thermal stimuli. Different GABA receptors have different roles in alleviating thermal and mechanical pain in different animal pain models. There is no study to date that has examined the involvement of GABA A and GABA B in sensory dimension of neuropathic pain resulting from compression of spinal cord. The current study tests the hypothesis that GABA A or GABA B receptors contributes to the allodynia and hyperalgesia observed after spinal cord injury. The results showed that the effect of GABA A and GABA B receptors on mechanical hyperalgesia is similar but these receptors have different effects on thermal hyperalgesia. While using baclofen as GABA B receptor agonist does not affect the thermal pain, thermal hyperalgesia resulting from spinal cord injury was greatly alleviated by different doses of GABA A agonist, muscimol. Both Baclofen and muscimol are able to reduce the mechanical and cold allodynia has been seen after spinal cord injury but the effect of baclofen is dose dependent with no effect in higher doses used in this study. While almost all doses of muscimol were used in this study reduce the amount of cold and mechanical allodynia. The other result obtained in this study is the short term effect of GABA agonist. The anitinociceptive effect of Baclofen and muscimol appear to be maxium at 15 min after injection and gradually diminished by time and their analgesic effect disappeared 3 hours after injection.
Winfield, H., Katsikitis, M., Hart, L. and Rounsefell, B. (1989). Postoperative pain experiences: Relevant patient and staff attitudes. [online] 34(5): pp.543-552. Available at: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T8V-45WYV7R-7G&_user=10&_coverDate=12%2F31%2F1990&_rdoc=1&_fmt=high&_orig=gateway&_origin=gateway&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=35e6b5e8c8f803b487b35d4ae3b06cef&searchtype=a[ [accessed 8/5/2013]
" Chronic Pain (CP) statistics astounding according to The Institute of medicine approximately 100 million adults suffer from chronic pain which is more than heart disease, diabetes, and cancer combined."(IOM Relieving Pain in America 2011, p. 1)
Ignatavicius, D. D., & Workman, M. L. (2013). Care of Intraoperative Patients. Medical-surgical nursing: patient-centered collaborative care (7th ed.). St. Louis: Elsevier.
According to Career Cruising, “anesthesiologists are doctors who administer drugs or gases that prevent patients from feeling any pain or sensation during surgery.” They monitor the patient before, during, and after the operation. Career Cruising also noted that before surgery, anesthesiologists consult with patients and make decisions
Brody, Michael, and Donald Martin. “The Role of Anesthesiologists.” Physicians Protecting Patients. N.p. N.d. Web. October 21, 2015. An anesthesiologist is a physician who has received at least 8 years of schooling and has completed a residency program dealing with anesthesiology. Now, a licensed physician, an anesthesiologist deals with the administration of anesthesia during many medical procedures, including surgical or obstetric procedures, and pain management for acute and chronic illnesses, or cancer related pain. Anesthesiologists are also in charge of “anesthesia care teams” that include the anesthesiologist, an anesthesia assistant, certified registered nurse anesthetist, and an anesthesia technician. As the leader of the care team, the anesthesiologist is responsible for assessing the patient before, during, and after medical procedures, as well as developing and monitoring performance and quality of practices and standards in regards to administering anesthesia. The entirety of
Lindley, P., Pestano, C. R., & Gargiulo, K. (2009). Comparison of postoperative pain management using two patient-controlled analgesia methods: Nursing perspective. Journal of Advanced Nursing, 65(7), 1370-1380. doi: 10.1111/j.1365-2648.2009.04991.x
Stomberg, M., Sjöström, B., & Haljamäe, H. (2003). The Role of the Nurse Anesthetist in the Planning of Postoperative Pain Management. AANA Journal, 71(3), 197.
The major concepts deduced from the hypothesis fall under three categories: (1) multimodal intervention, (2) attentive care, and (3) patient participation. Multimodal intervention includes the concepts of potent pain medication, pharmacological adjuvants, and non-pharmacological adjuvants. Attentive care relates to the assessment of pain and side effects and intervention along with reassessments. Patient participation includes goal setting and patient education. The resulting outcome of these three categories working together is the balance between analgesia and side effects.
Anesthesia is used in almost every single surgery. It is a numbing medicine that numbs the nerves and makes the body go unconscious. You can’t feel anything or move while under the sedative and are often delusional after being taken off of the anesthetic. Believe it or not, about roughly two hundred years ago doctors didn’t use anesthesia during surgery. It was rarely ever practiced. Patients could feel everything and were physically held down while being operated on. 2It wasn’t until 1846 that a dentist first used an anesthetic on a patient going into surgery and the practice spread and became popular (Anesthesia). To this day, advancements are still being made in anesthesiology. 7The more scientists learn about molecules and anesthetic side effects, the better ability to design agents that are more targeted, more effective and safer, with fewer side effects for the patients (Anesthesia). Technological advancements will make it easier to read vital life signs in a person and help better decide the specific dosages a person needs.
Everyday, people go through surgery and require a specialist that will monitor their surgery as well as give them what they need to be able to persevere the pain, which is exactly what anesthesiologists do. In order for the patients to be able to get into surgery and deal with the agonizing aches after the abscission, anesthesiologists have to give the sufferer the proper treatment before and after the surgery. Overall, anesthesiologists must be highly educated in both medicine and communication, they need to be able to give the patient the right amount of medicine as well as speak with the family of patients and other doctors to inform them all with what will be done during the surgery, and they need to be able to properly assist the surgeons during operations.
The role of the nurse in the preoperative area is to determine the patient’s psychological status to help with the use of coping during the surgery process. Determine physiologic factors directly or indirectly related to the surgical procedure that may cause operative risk factors. Establish baseline data for comparison in the intraoperative and postoperative period. Participate in the identification and documentation of the surgical site and or side of body on which the procedure is to be performed. Identify prescription drugs, over the counter, and herbal supplements that are taken by the patient that may interact and affect the surgical outcome. Document the results of all preoperative laboratory and diagnostic tests in the patient’s record
Pharmacology is a vital component in the perioperative practice. Medication use is monitored closely during the perioperative period. Preoperatively, there are certain drugs that must be discontinued prior to a surgery as they increase surgical risk, including anticoagulants, tranquillisers, corticosteroids and diuretics (Laws, 2010b). In fact, these drugs can increase the risk of respiratory depression, infection, fluid and electrolyte imbalance and increased risk of bleeding (Hamlin, 2010). Open communication is important in obtaining a medication history, and in identifying the drugs taken prior to the surgery. If any of these medications has be...