Pain treatment in the perioperative period.
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Analgesia, Epidural↗
Biomedical subjects
R A Swarm
Publications and source records attributed to R A Swarm.
Current trends in perioperative pain management.
Wider use of optimized multimodal accelerated postoperative recovery programs require that anesthesiologists step out of traditional operating room anesthesia roles and even beyond current pain management consultant roles. Development of optimal postoperative recovery services requires close collaboration between anesthesiologists, surgeons, nurses, physical therapists, administrators, and others involved in the management of patients after surgery. Optimization of perioperative care is an ongoing process enhanced by clinical investigation; however, making significant improvements to clinical practice does not have to wait for additional research data, but should proceed now, with broader application of techniques known to enhance rehabilitation and recovery. Based on existing data, the challenges of developing perioperative recovery services seem likely to be rewarded with improved patient outcomes and reduced cost.
Analgesia, Epidural↗
Simultaneous bilateral percutaneous nephrolithotomy with subarachnoid spinal anesthesia.
We report our experience performing simultaneous bilateral percutaneous nephrolithotomy (SBPN) in four patients with large stone burdens in both kidneys. We modified the previously described approach by combining SBPN with subarachnoid Duramorph (preservative-free morphine sulfate) in an effort to decrease postoperative discomfort and shorten the duration of hospitalization. These patients (study group) were then compared with a contemporary group of four patients with similar bilateral stone burdens who underwent staged bilateral percutaneous nephrolithotomies (PCNs) (control group). The comparison showed a marked advantage in hospital stay (4.8 days for the study group v 11 days for the control group) and postoperative narcotic requirement (27.5 mg of meperidine for the study group v 533 mg for the control group). All four patients were rendered stone free. This method of treatment for large bilateral renal calculi with the addition of subarachnoid Duramorph resulted in less postoperative discomfort, less morbidity, and a more rapid recovery than staged PCN or sandwich PCN/SWL/PCN.
Adult↗
Protective effect of exogenous phospholipid on aspirin-induced gastric mucosal injury.
The protective effects of exogenous phospholipid on aspirin-induced gastric mucosal injury were examined in a canine chamber model which provided two separate segments of mucosa supplied by a single vascular pedicle. In each dog, one segment was treated with a suspension of surface-active phospholipid, similar in composition to that normally present in the gastric mucosa, whereas the other segment served as the control. Pretreatment of the test segments significantly prevented aspirin-induced disruption of the mucosal barrier as evidenced by an increase in potential difference and a decrease in acid back-diffusion and sodium ion and potassium ion flux. These findings were associated with a marked reduction in the degree of mucosal injury. Our results support the recent hypothesis that surface-active phospholipid plays an important role in gastric mucosal defense against the damaging effects to luminal acid.
Animals↗
Effects of luminal salt concentration on electrical pathways in Necturus antrum.
By use of microelectrode techniques the electrical resistances of the cell membranes and paracellular pathways of surface epithelium in Necturus antrum were determined under control conditions (Ringer solutions containing 106.6 mM Na+, 91.4 mM Cl-) and during exposure to mucosal solutions containing high Na+ and Cl- concentrations. Resistances were determined by briefly exposing tissues to mucosal solutions containing 10(-4) M amiloride, a reversible inhibitor of Na+ conductances. Under control conditions in eight tissues, measurements obtained by exposure to amiloride were not significantly different from those obtained by an independent method, intraepithelial cable analysis, thus indicating the validity of the measurements obtained by the amiloride method. In 10 tissues, high luminal NaCl concentrations (Ringer salts + 125 mM NaCl) increased the apical cell membrane resistance from 5,778 +/- 267 to 7,714 +/- 422 omega X cm2 (P less than 0.01) and the basolateral membrane resistance from 2,973 +/- 186 to 3,869 +/- 335 omega X cm2 (P less than 0.01). The resistance of the paracellular pathway decreased from 625 +/- 13 to 505 +/- 13 omega X cm2 (P less than 0.001). Similar alterations in these resistances were observed when Na+ or Cl- were increased individually, when added as salts of isethionate- and N-methyl-D-glucamine+, respectively. These effects were not attributable to increases in luminal osmolarity, since mucosal solutions made equally hyperosmotic with 250 mM sucrose elicited increases in paracellular pathway resistance and decreases in resistances of the cell membranes.(ABSTRACT TRUNCATED AT 250 WORDS)
Amiloride↗
Regional gastric mucosal blood flow after parietal cell vagotomy in dogs.
In this study we used the recently validated H2 clearance method to perform endoscopic measurements of gastric mucosal blood flow (MBF) in anesthetized dogs before and after parietal cell vagotomy (PCV). Under resting conditions, MBF in the gastric corpus before PCV was 72 +/- 5 ml/min/100 gm. This was not altered significantly at 4, 8, or 16 weeks after PCV, and there were not significant long-term changes in MBF on the greater or lesser curvatures of the corpus individually. Before PCV infusion of pentagastrin (8 micrograms/kg/hr) elicited increases in corpus MBF to 104 +/- 4 ml/min/100 gm, accompanied by increases in gastric acid output from resting levels of 2.1 +/- 0.9 to 38.6 +/- 2.4 mEq/hr (p less than 0.001). PCV significantly reduced pentagastrin-stimulated acid secretion by 50%, and secretory inhibition was accompanied by significant reductions in pentagastrin-stimulated MBF in the corpus. Pentagastrin did not alter antral MBFs before or after PCV. In summary PCV does not elicit significant long-term changes in resting MBF in different regions of the gastric corpus, and PCV significantly diminishes increases in acid output and corpus MBF that are normally stimulated by pentagastrin. These observations suggest that alterations in gastric MBF after PCV may be attributable to alterations in acid secretion.
Animals↗