Pharmacology

Post-op Opioid Consumption

It would appear that opioid prescription post operatively is still excessive after abdominal surgery. “Postoperative patients might consume less than half of the opioid pills they are prescribed. More research is needed to standardize opioid prescriptions for postoperative pain management while reducing opioid diversion”.  This study shows just how little opioid amounts are needed on average.

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SGLT2 Inhibitors and Peri-Op Ketoacidosis

SGLT2 Inhibitors are increasingly promoted for diabetes and this article again highlights the risks of euglycemic ketocacidosis. Fasting, hypovolemia, infection, surgery, bowel preparation, keto diets before bariatric procedures, excessive alcohol are some of the predisposing conditions. Treatment involve some aggressive rehydration and Potassium supplementation with Insulin infusion and sometimes bicarbonate. Prevention may necessitate withholding SGLT2 Inhibitors for up to three days, more than the recommended 24 hours.

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Cannabis and Chronic Non-Cancer Pain

 

A study on cannabis dispels the hype again, finding no evidence that it reduces pain, improves outcome or reduces opioid use. “People who used cannabis had greater pain and lower self-efficacy in managing pain” – this is increasingly the key to managing (not eliminating) pain, using education, quality of life and function improvement rather than focus on pain.

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Remifentanil with Desflurane for LMA GA

While Sevoflurane is the standard agent for a non-irritating inhalational and spontaneously breathing anesthetic, the irritating effects of Desflurane  may be mitigated by the use of a Remifentanil infusion. This study showed that in the presence of a continuous infusion of remifentanil, desflurane is superior in terms of faster emergence and is similar in terms of intra-operative cough to sevoflurane or propofol infusion. Recovery time differences were of marginal clinical significance (2 minutes) but more predictable and less variable than other agents.

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Ketamine for Chronic Pain

Another consensus statement, akin to the consensus in acute pain ( blog link ).

The statement discusses the varying evidence for different conditions as well as the types of dosing regimes in conditions such as CRPS, spinal cord injury, fibromyalgia, other neuropathic conditions, cancer, headache and low back pain. The overall impression is that enthusiastic use is perhaps ahead of the evidence.

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