1) The document discusses the history and modern understanding of pain physiology and management of postoperative pain. It describes how pain was originally thought to be outside the body but is now understood as a physical sensation processed in the nervous system.
2) Postoperative pain has acute causes from incisions and procedures as well as referred pain, and poorly managed pain can impair recovery. A multimodal approach using combinations of analgesics like paracetamol, NSAIDs, and opioids along with local anesthetics and nerve blocks is recommended.
3) Patient-controlled analgesia allows patients to self-administer opioids within safe limits and provides effective pain relief. Preemptive analgesia aims to prevent central sensitization by treating pain before and
Post operative pain management has no specific criteria. Lots of methods and procedures are suggested with various types of drugs. It is just a guideline for management of pain after surgery.
Post operative pain management has no specific criteria. Lots of methods and procedures are suggested with various types of drugs. It is just a guideline for management of pain after surgery.
Preventive analgesia:
Broader definition of preemptive analgesia
Perioperative analgesic regimen that able to control pain-induced sensitization
Not the timing of the analgesic treatment but the duration and efficacy of an analgesic intervention are more important for an effective postoperative pain relief
Adequate preventive analgesia should include multimodal techniques and with a sufficient duration of tretment
Aggressive preemtive multimodal including epidural or nerve block not only produce optimal analgesia but also may prevent the occurrence of chronic pain after surgical
Paracetamol as a single analgesic is only for mild and moderate pain.
However it can be combined with many analgesics to provide strong effect.
So, it can be the basic regiment for Multimodal Analgesia.
The key to a successful Acute Pain Service is not so much the use of sophisticated drugs and high technology equipment, but an excellent organisational structure and well trained medical and nursing personnel.
To improving postoperative pain management, we need to;
- Always applies multi-modal analgesia. (get the advantages of multimodal analgesia)
- Implementation of the existing EB regarding the use of non-opioid + opioid on as needed basis.
- Use available specific evidence for optimizing multimodal pain management procedure (PROSPECT Web site).
Pain definition, Pain pathways, pain modulation, the endorphin system, Types of Pain, current trend of Drugs used for pain management. New Drugs for pain
CPSP is a new emerging disease but can be a silent epidemic.
Optimal perioperative management may reduce the incidence of CPSP.
Minimal invasive surgical techniques
Agressive perioperative multimodal analgesia, inluding epidural or nerve blocks.
Appropriate management of acute pain is therefore not only a humane obligation, but also may prevent of chronic pain!
Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain's widely used definition defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage"
Preventive analgesia:
Broader definition of preemptive analgesia
Perioperative analgesic regimen that able to control pain-induced sensitization
Not the timing of the analgesic treatment but the duration and efficacy of an analgesic intervention are more important for an effective postoperative pain relief
Adequate preventive analgesia should include multimodal techniques and with a sufficient duration of tretment
Aggressive preemtive multimodal including epidural or nerve block not only produce optimal analgesia but also may prevent the occurrence of chronic pain after surgical
Paracetamol as a single analgesic is only for mild and moderate pain.
However it can be combined with many analgesics to provide strong effect.
So, it can be the basic regiment for Multimodal Analgesia.
The key to a successful Acute Pain Service is not so much the use of sophisticated drugs and high technology equipment, but an excellent organisational structure and well trained medical and nursing personnel.
To improving postoperative pain management, we need to;
- Always applies multi-modal analgesia. (get the advantages of multimodal analgesia)
- Implementation of the existing EB regarding the use of non-opioid + opioid on as needed basis.
- Use available specific evidence for optimizing multimodal pain management procedure (PROSPECT Web site).
Pain definition, Pain pathways, pain modulation, the endorphin system, Types of Pain, current trend of Drugs used for pain management. New Drugs for pain
CPSP is a new emerging disease but can be a silent epidemic.
Optimal perioperative management may reduce the incidence of CPSP.
Minimal invasive surgical techniques
Agressive perioperative multimodal analgesia, inluding epidural or nerve blocks.
Appropriate management of acute pain is therefore not only a humane obligation, but also may prevent of chronic pain!
Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain's widely used definition defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage"
This slide comprise the idea of General anesthesia, The intravenous and Inhalation Anesthetics- their mechanism and uses and effects on the organ system. Also the drug distribution and redistribution, MAC and pre-anesthetic medication with proper pictorial demonstration.
Anesthesia
What are the risks and complications of anesthesia?
Stages of anesthesia
types of Anesthesia :
General ,local and Regional Anesthesia
Drugs for Anesthesia
anesthesia in surgery used in hospitals and various clinics for big and small surgical procedures. in this there are all types of anesthesia are described shortly.
Pain results from a variety of pathological processes and is considered as a vital sign.
It is expressed differently by each patient depending on cultural background, age, etc,etc.
IT IS A HIGHLY SUBJECTIVE EXPERIENCE MEANING THAT ONLY THE INDIVIDUAL IS ABLE TO ASSESS HIS/HER LEVEL OF PAIN.....
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. Content
◦ Definition of Pain
◦ Physiology
◦ Causes of PostOp Pain
◦ Effects of Pain
◦ Treatment Options
◦ Modalities of Treatment
◦ Related Thesis in BSMMU
4. DURING ANCIENT TIMES
Aristotle did not include a sense of pain
when he enumerated the five senses.
Hippocrates believed that pain was
caused by an imbalance in the vital
fluids of a human.
5. BEFORE THE RENAISSANCE
Even just prior to the scientific
Renaissance in Europe, pain was not
well understood and it was theorized
that pain existed outside of the body,
perhaps as a punishment from God,
with the only treatment being prayer.
6. DURING THE RENAISSANCE
In his 1664 Treatise of Man, René
Descartes theorized that the body was
more similar to a machine, and that pain
was a disturbance that passed down
along nerve fibers until the disturbance
reached the brain. This theory
transformed the perception of pain from a
spiritual, mystical experience to a
physical, mechanical sensation.
7. MODERN THEORY
In 1975, well after the time of Descartes,
the International Association for the Study
of Pain sought a consensus definition for
pain, finalizing “an unpleasant sensory and
emotional experience associated with
actual or potential tissue damage” as the
final definition.
13. Acute Pain
Acute pain typically
has a sudden onset
and recedes during
the healing process.
it can be regarded as
“good pain” as it
serves an important
protective
mechanism.
TYPES OF PAIN
Chronic Pain
It persists long after
recovery from an
injury and is often
refractory
to common
analgesic agents.
Results from nerve
injury (neuropathic
pain) and ischemia.
14. REFERRED PAIN
Irritation of a visceral organ frequently
produces pain that is felt not at that site
but in a somatic structure that may be
some distance away.
When pain is referred, it is usually to a
structure that developed from the same
embryonic segment or dermatome as the
structure in which the pain originates.
17. CAUSES OF POST OPERATIVE PAIN
Incisional
◦ Skin
◦ Subcutaneous
tissue
Deep
◦ cutting
◦ coagulation
I/V site
◦ Needle trauma
◦ Extravasation
◦ Irritation
Tube
◦ Drain
◦ Nasogastric
◦ Endotrachial
tube
Operative site
◦ Cast
◦ Tight dressing
Others
◦ Urinary retention
◦ Ambulation
18. CONSEQUENCES OF POORLY MANAGED POST OPERATIVE
PAIN
Respiratory effects
Surgery involving the upper abdomen or chest
reduces vital capacity, functional residual
capacity and the ability to cough and deep
breathe. This in turn can lead to retention of
secretions, atelectasis and pneumonia.
Cardiovascular effects
Pain causes an increase in sympathetic output
(tachycardia, hypertension and increasing blood
catecholamines), which leads to increasing
myocardial oxygen demand.
19. CONSEQUENCES OF POORLY MANAGED POST OPERATIVE
PAIN
Neuroendocrine effects
The stress response to surgery and pain includes
the secretion of catecholamines and catabolic
hormones. This increases metabolism and
oxygen consumption and promotes sodium and
water retention.
Effects on mobilization
Mobilization may be delayed if the patient is
experiencing pain. This may increase the risk of
deep vein thrombosis and also prolong hospital
stay.
23. Non Pharmacological
◦ PreOp Counselling
◦ TENS
◦ Acupuncture
◦ Massage
◦ Hypnosis
METHODS AVAILABLE TO TREAT PAIN
Parmacological
◦ Paracetamol
◦ NSAIDs
◦ Opoids
◦ Local Anaesthetics
◦ Spinal analgesia
◦ Epidural analgesia
24.
25. PARACETAMOL & NSAIDs
◦ Paracetamol & NSAIDs block the synthesis of
prostaglandins by inhibiting the enzyme cyclo-
oxygenase.
◦ They do not relieve severe pain when used
alone, but they are valuable in multimodal
analgesia because they decrease opioid
requirement and thus its side effects.
◦ Adverse effects include: Gastrointestinal
disturbance, impaired hemostasis,
nephrotoxicity, aggrevation of asthma etc.
26.
27.
28. OPIOIDS
◦ Opioids mimic endogenous opioid peptides at
3 opioid receptors, causing their activation
within the central nervous system. This
decreases the activity of the dorsal horn relay
neurons that transmit painful stimuli, thereby
reducing their transmission to higher centers
and producing analgesia.
◦ Side effects include itching, sedation,
respiratory depression, nausea and vomiting,
euphoria or dysphoria and bladder
dysfunction.
29. LOCAL ANAESTHETICS
◦ Local anaesthetic drugs (e.g. bupivacaine and
lidocaine) are sodium channel blockers and
prevent the propagation of nerve impulses when
applied to peripheral nerves or nerve roots.
Sensory and sympathetic nerve fibers are also
blocked as are motor nerves.
◦ In the treatment of postoperative pain, LA drugs
can be used in many ways: Local wound
infiltration (e.g. after an inguinal hernia repair),
Injection close to a peripheral nerve, Injection
close to a plexus of nerves, central neural
blockade (e.g. a spinal or epidural).
30.
31. LOCAL ANAESTHETICS
All local anaesthetic drugs can cause toxic
effects if given in large doses or if accidental
intravascular injection occurs. Central nervous
system and cardiovascular toxicity can result in
restlessness, hypotension, convulsions, cardiac
arrhythmias and even cardiorespiratory arrest.
Drug Safe Dose
Bupivacaine 2 mg/kg
Lignocaine 3 mg/kg
Lignocaine (with adrenaline) 7 mg/kg
32.
33. SPINAL ANALGESIA
◦ Local anaesthetic drugs with or without an
opioid may be administered intrathecally as a
'single shot' spinal injection.
◦ An opioid such as morphine or diamorphine
may provide useful postoperative analgesia for
up to 12-24 h.
◦ Side effects include: hypotension, reduced
cardiac output, respiratory depression,
postdural puncture headache, spinal
hematoma, infection.
34. EPIDURAL ANALGESIA
◦ The epidural space is a fat-filled space within
the spinal canal. Anaesthetists inject local
anaesthetics into this space, and, by doing so,
block nerve root transmission of pain. Epidural
opioids can also modulate pain pathways once
within the epidural space by diffusion through
the dura mater into the cerebrospinal fluid
(CSF) and so to the opioid receptors of the
spinal cord.
◦ Side effects are similar to spinal analgesia.
37. MULTIMODAL (BALANCED) ANALGESIA
◦ Using more than one drug for pain control
◦ Drugs : Opioids with Paracetamol / NSAIDs
/ LAs
◦ Each with a lower dose than if used alone
◦ Can provide additive or synergistic effects
◦ Provides better analgesia with less side
effects
38. THE WHO ANALGESIC LADDER
The basic principle of the WHO ladder
is that analgesia which is appropriate
for the degree of pain should be
prescribed. If pain is severe or remains
poorly controlled, strong opioids should
be prescribed and increased as
indicated by the patient’s need for
additional analgesia (opioid titration).
39.
40. PATIENT CONTROL ANALGESIA (PCA)
◦ Procedure where patient controls the
frequency of analgesic
administration but within safe limits.
◦ First PCA machine demonstrated in
1976 was “The Cardiff Palliator”.
41.
42. PATIENT CONTROL ANALGESIA (PCA)
Settings of PCA machine :
◦ A microprocessor controlled pump
◦ A button to trigger the pump
◦ Computer for controlling the strength,
frequency and total dose in a specific time
Routes :
◦ Usually intravenous
◦ Patient controlled epidural analgesia (PCEA)
43. PRE-EMPTIVE ANALGESIA
A hypothesis exists that surgery, which produces
a barrage of pain signals to the spinal cord, is a
'priming‘ mechanism which sensitizes the central
nervous system. This is said to lead to enhanced
postoperative pain. The rationale behind several
studies is that, by providing presurgery, or pre-
emptive, analgesia using parenteral opioids,
regional blocks or NSAIDs, either individually or
in combination, these sensitizing neuroplastic
changes can be prevented within the spinal cord,
leading to diminished postoperative analgesic
requirements.
44. SPECIAL CONSIDERATION FOR CHILDREN
◦ Psychological support may decrease anxiety
and fear of surgical procedure
◦ Presence of parent in the anesthetic room
decreases post operative pain and reduces
risk of psychological sequelae
◦ Dosage selection must be guided by
calculation based on patient weight
45. Good Analgesia
Results in:
◦ Improved patient satisfaction and
Doctor-Patient relationship
◦ Better rehabilitation
◦ Earlier discharge from hospital & return
to function
◦ Decrease likelihood of chronic pain
◦ Reduced health care costs
46. Honorable Mentions
Assessment of the effect of paracetamol as a
centrally acting adjunct with diclofenac in
preemptive analgesia of children.
Prof. M. Saiful Islam, Dr. Md. Nooruzzaman
Comparison of degree of pain centered between
protocol based and randomly administered
postoperative pain intervention in children.
Prof. M. Saiful Islam, Dr. Ramana Rajkarnikar
47. “
Patient has every right to remain pain
free during and after operation. This can
be achieved by appropriate counselling,
gentle tissue handling and proper
analgesia.
Chronic pain, which can persist for years, is defined as pain that persists for at least 1 month beyond the usual course of an acute disease or beyond a reasonable time in which an injury would be expected to heal.
The basis for referred pain may be convergence of somatic and visceral pain fibers on the same second-order neurons in the dorsal horn that project to the thalamus and then to the somatosensory cortex. This is called the convergence-projection theory. Somatic and visceral neurons converge in the ipsilateral dorsal horn. The somatic nociceptive fibers normally do not activate the second-order neurons, but when the visceral stimulus is prolonged, facilitation of the somatic fiber endings occurs. They now stimulate the second order neurons, and of course the brain cannot determine whether the stimulus came from the viscera or from the area of referral.