ACOEM practice guidelines: opioids for treatment of acute, subacute, chronic, and postoperative pain.

Description: The American College of Occupational and Environmental Medicine's guidelines have been updated to develop more detailed guidance for treatment of acute, subacute, chronic, and postoperative pain with opioids.

Methods: Literature searches were performed using PubMed, EBSCO, Cochrane Review, and Google Scholar without publication date limits. Of 264,617 articles' titles screened and abstracts reviewed, 263 articles met inclusion criteria.

ACOEM practice guidelines: opioids and safety-sensitive work.

Objective: ACOEM has updated the treatment guidelines concerning opioids. This report highlights the safety-sensitive work recommendation that has been developed.

Methods: Comprehensive literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel to develop evidence-based guidance.

The effect of addition of nitrous oxide to a sevoflurane anesthetic on BIS, PSI, and entropy.

Objective: N(2)O is a commonly used anesthetic that has amnestic and analgesic properties. Recently, devices that estimate depth of consciousness have been introduced in an attempt to better titrate anesthesia, however the effect of N(2)O on these monitors is unclear.

Methods: General anesthesia was induced and titrated to maintain normal blood pressure and pulse in healthy adults.

The efficacy and safety of pain management before and after implementation of hospital-wide pain management standards: is patient safety compromised by treatment based solely on numerical pain ratings?

Unlabelled: Inadequate analgesia in hospitalized patients prompted the Joint Commission on Accreditation of Healthcare Organizations in 2001 to introduce standards that require pain assessment and treatment. In response, many institutions implemented treatment guided by patient reports of pain intensity indexed with a numerical scale. Patient safety associated with treatment of pain guided by a numerical pain treatment algorithm (NPTA) has not been examined.

Constant positive airway pressure reduces hypoventilation induced by inhalation anesthesia.

Study Objective: To discover if reducing respiratory system impedance would increase tidal volume and improve ventilation during inhalation anesthesia.

Design: Prospective, randomized cross-over study.

Subjects: Nine ASA physical status I and II adult female oncology patients undergoing breast operations with or without lymph node dissection and general anesthesia while breathing spontaneously.

Supplemental oxygen impairs detection of hypoventilation by pulse oximetry.

Study Objective: This two-part study was designed to determine the effect of supplemental oxygen on the detection of hypoventilation, evidenced by a decline in oxygen saturation (Spo(2)) with pulse oximetry.

Design: Phase 1 was a prospective, patient-controlled, clinical trial. Phase 2 was a prospective, randomized, clinical trial.

Capnography accurately detects apnea during monitored anesthesia care.

Apnea and airway obstruction are common during monitored anesthesia care (MAC). Because their early detection is essential, we sought to measure the efficacy of capnography as an indicator of apnea during MAC at a variety of oxygen flow rates compared with thoracic impedance. Anesthesia care providers using standard American Society of Anesthesiologists monitors were blinded to capnography and thoracic impedance monitoring.

Treatment of cervicothoracic pain and cervicogenic headaches with regenerative injection therapy.

Significant progress has been made in interventional pain management. Despite this progress, patients continue to present a diagnostic and therapeutic challenge. Steroidal and nonsteroidal anti-inflammatory medications have limited use in degenerative painful conditions of connective tissue.

Epidural clonidine analgesia for intractable cancer pain. The Epidural Clonidine Study Group.

Although the vast majority of patients with cancer pain receive effective analgesia from standard therapy, a few patients, particularly those with neuropathic pain, continue to experience severe pain despite large doses of systemic or intraspinal opioids. Animal studies suggest intraspinal alpha 2-adrenergic agonists may be effective in such cases. Eighty-five patients with severe cancer pain despite large doses of opioids or with therapy-limiting side effects from opioids were randomized to receive, in a double-blind manner, 30 micrograms/h epidural clonidine or placebo for 14 days, together with rescue epidural morphine.