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Opioid Cardioprotection In The Perioperative Period
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Book Synopsis Opioid Cardioprotection in the Perioperative Period by : TIN-CHUN GORDON. WONG
Download or read book Opioid Cardioprotection in the Perioperative Period written by TIN-CHUN GORDON. WONG and published by . This book was released on 2017-01-26 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation, "Opioid Cardioprotection in the Perioperative Period" by Tin-chun, Gordon, Wong, 黃田鎮, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. Abstract: Many factors present during the perioperative period render patients susceptible in developing myocardial ischaemia reperfusion injury. Various mode of conditioning the heart against this type of injury has been discovered in animal models and involve powerful innate pathways that enhance cellular survival. These may be harnessed by applying a trigger either immediately before (preconditioning) or after (postconditioning) the lethal ischaemic injury, by physical or pharmacological means. Morphine was the first clinically used opioid shown to be cardioprotective but the intravenous dose required limited its use clinically. Remifentanil, an ultra-short acting opioid, was later also shown to be cardioprotective. A better understanding of how these opioids can protect the heart may enable the rational design of clinical regimens that best protect patients. The purpose of this thesis is to demonstrate and elucidate how these two agents provide cardiac protection. I first demonstrated the clinical efficacy of remifentanil preconditioning in reducing the release CKMB, cardiac troponin I, heart type fatty acid binding protein and ischaemia modified albumin following cardiopulmonary bypass. As opioids cannot be omitted completely from patients undergoing cardiac surgery due to ethical considerations, I then used a well-established animal model of ischaemia reperfusion injury to complete the remainder of the studies. I demonstrated that remifentanil postconditioning was also effective in reducing myocardial infarct size, an effect mediated through the activation of kappa and delta opioid receptor subtypes, and in part triggered at the level of the myocardium. I then confirmed previous findings showing the efficacy of intrathecal morphine preconditioning using clinically relevant doses. In addition, I demonstrated that all three opioid receptor subtypes were involved. This effect was comparable to that achievable by classical ischaemic or intravenous morphine preconditioning and is mediated by central but not peripheral opioid receptor activation. Intrathecal morphine reduces the degree of myocardial apoptosis, alters the phosphorylation of Akt and the expression of endothelial nitric oxide synthatase and opens the potassium ATP channels. It also involves spinal adenosine receptors, similar to spinal morphine mediated analgesia. Intrathecal morphine preconditioning can be abolished by the interruption of autonomic nervous system function and blockade of calcitonin gene related peptide (CGRP) and bradykinin receptors. Intrathecal morphine postconditioning also has an infarct sparing effect. It also involves the activation of central opioid receptors and peripheral adenosine and CGRP receptors. Finally I demonstrated a pivotal role of central opioid receptor in remote preconditioning by showing that selective blockade of these receptors abolished the protective effects of remote but not classical ischaemic preconditioning. Cumulatively, these results demonstrated the versatility of opioid mediated cardioprotection using morphine or remifentanil and the pivotal role of central opioid receptors in cardioprotection and revealed some of the mechanisms underlying these benefits. Not only does intrathecal morphine provide analgesia, it also generates signals that are transmitted through the autonomic nervous system resulting in changes in cellular function in the heart. This point to the pos
Book Synopsis Opioid Cardioprotection in the Perioperative Period by : 黃田鎮
Download or read book Opioid Cardioprotection in the Perioperative Period written by 黃田鎮 and published by . This book was released on 2011 with total page 153 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author :National Academies of Sciences, Engineering, and Medicine Publisher :National Academies Press ISBN 13 :0309459575 Total Pages :483 pages Book Rating :4.3/5 (94 download)
Book Synopsis Pain Management and the Opioid Epidemic by : National Academies of Sciences, Engineering, and Medicine
Download or read book Pain Management and the Opioid Epidemic written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2017-09-28 with total page 483 pages. Available in PDF, EPUB and Kindle. Book excerpt: Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA's development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.
Book Synopsis Anesthesia and Perioperative Care of the High-Risk Patient by : Ian McConachie
Download or read book Anesthesia and Perioperative Care of the High-Risk Patient written by Ian McConachie and published by Cambridge University Press. This book was released on 2014-09-04 with total page 501 pages. Available in PDF, EPUB and Kindle. Book excerpt: A concise summary of perioperative management of high-risk surgical patients, bridging the gap between the operating theatre and ICU.
Book Synopsis Perioperative Considerations in Cardiac Surgery by : Cuneyt Narin
Download or read book Perioperative Considerations in Cardiac Surgery written by Cuneyt Narin and published by BoD – Books on Demand. This book was released on 2012-02-29 with total page 394 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book considers mainly the current perioperative care, as well as progresses in new cardiac surgery technologies. Perioperative strategies and new technologies in the field of cardiac surgery will continue to contribute to improvements in postoperative outcomes and enable the cardiac surgical society to optimize surgical procedures. This book should prove to be a useful reference for trainees, senior surgeons and nurses in cardiac surgery, as well as anesthesiologists, perfusionists, and all the related health care workers who are involved in taking care of patients with heart disease which require surgical therapy. I hope these internationally cumulative and diligent efforts will provide patients undergoing cardiac surgery with meticulous perioperative care methods.
Book Synopsis Reducing Mortality in the Perioperative Period by : Giovanni Landoni
Download or read book Reducing Mortality in the Perioperative Period written by Giovanni Landoni and published by Springer. This book was released on 2016-12-26 with total page 156 pages. Available in PDF, EPUB and Kindle. Book excerpt: This second edition presents the first update on a consensus process during which all evidence from the literature with a survival benefit in the perioperative period was gathered, and in which 500 physicians from 61 countries worked to confirm the findings. Perioperative morbidity and mortality currently represent a public health problem, as mortality alone is 1-4% in Western countries. Surprisingly, randomized evidence of survival benefit in the perioperative period is available for only 12 topics, while two drugs have been demonstrated to increase mortality. This book offers a complete description of each topic with updated evidence from the literature. Each chapter deals with a specific drug or technique and is structured into the following: background knowledge, main evidence from the literature, and a practical how-to section. Lastly, the book describes in detail the consensus process used, which served to reinforce the systematic review and which is currently being used and improved in other settings with growing success. Written by respected international experts, Reducing Mortality in the Perioperative Period, 2nd ed. will be of interest to a wide variety of specialists, including anesthesiologists, intensivists, surgeons and cardiologists.
Book Synopsis Acute Pain Management by : Raymond S. Sinatra
Download or read book Acute Pain Management written by Raymond S. Sinatra and published by Cambridge University Press. This book was released on 2009-04-27 with total page 729 pages. Available in PDF, EPUB and Kindle. Book excerpt: This textbook provides an overview of pain management useful to specialists as well as non-specialists, surgeons, and nursing staff.
Book Synopsis Myocardial Protection by : Tomas A. Salerno
Download or read book Myocardial Protection written by Tomas A. Salerno and published by John Wiley & Sons. This book was released on 2008-04-15 with total page 344 pages. Available in PDF, EPUB and Kindle. Book excerpt: Myocardial protection is regarded as one of the most important, yet also most controversial aspects of cardiac surgery. There has been considerable improvement in myocardial protection strategies over recent years, utilising a variety of new approaches to treat cardiac diseases, and this text is intended to embrace the state of the art in this field. The book summarises the state of knowledge on all aspects of myocardial protection, including the latest in the treatment of cardiac diseases, robotics, pediatric surgery and the treatment of cardiac failure. Robotic surgery, valvular surgery, pediatric surgery and coronary surgery are all covered by renowned experts, producing a comprehensive, forward-looking view of the field of myocardial protection. This book should function to update physicians and surgeons interested in the field of cardiac surgery on the current state of knowledge on myocardial protection.
Download or read book Pain and Treatment written by Gabor Racz and published by BoD – Books on Demand. This book was released on 2014-07-10 with total page 346 pages. Available in PDF, EPUB and Kindle. Book excerpt: This new edition reflects the evolution of the field including new topics for historical relevance regarding the changing attitudes towards opioid prescription and use. The book points out that the realization of liberalizing use is almost uncontrollably linked to unnecessary patient death. Similarly, the evidence is increasingly confirming that interventional pain procedures work. New evidence presents, for example, that Percutaneous Lysis of Adhesions is an effective therapeutic modality that has advantages over other options due to its cost effective nature and long term outcomes reducing the need for additional procedures including surgeries and more and more expensive medications. Awareness about the consequences of bad outcomes leads to medicolegal complications. The inevitable trigger is bad outcome which is often related to knowledge, training, experience, as well as equipment design. Some of the examples and lessons learned from the medicolegal arena may soon prevent such occurrences.
Book Synopsis Core Topics in Cardiac Anesthesia by : Jonathan H. Mackay
Download or read book Core Topics in Cardiac Anesthesia written by Jonathan H. Mackay and published by Cambridge University Press. This book was released on 2012-03-15 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Since the publication of the first edition of Core Topics in Cardiac Anaesthesia, the clinical landscape has undergone significant change. Recent developments include the increased use of electrophysiology, the resurgence of primary percutaneous intervention in acute coronary syndromes, the use of percutaneous devices in patients previously considered inoperable, and the withdrawal of aprotinin. Against this landscape, this invaluable resource has been fully updated. New chapters are dedicated to right heart valves, pulmonary vascular disease, cardiac tumours and cardiac trauma. All other chapters have been updated according to the latest international guidelines. Written and edited by an international author team with a wealth of expertise in all aspects of the perioperative care of cardiac patients, topics are presented in an easy to digest and a readily accessible manner. Core Topics in Cardiac Anaesthesia, Second Edition is essential reading for residents and fellows in anaesthesia and cardiac surgery and clinical perfusionists.
Book Synopsis Anaesthetic and Perioperative Complications by : Kamen Valchanov
Download or read book Anaesthetic and Perioperative Complications written by Kamen Valchanov and published by Cambridge University Press. This book was released on 2011-09-22 with total page 273 pages. Available in PDF, EPUB and Kindle. Book excerpt: Anaesthetic and Perioperative Complications dissects the nature of complications and helps anaesthetists and anaesthetic practitioners understand, avoid and manage them efficiently. Leading experts combine the detailed clinical management of common and important anaesthetic and perioperative complications with discussion of the key philosophical, ethical and medico-legal issues that arise with assessing a medical complication. Initial chapters discuss how and why complications occur, the prevention of complications and risk management. The main body of the text reviews the clinical management of airway, respiratory, cardiovascular, neurological, psychological, endocrine, hepatic, renal and transfusion-related complications, as well as injury during anaesthesia, complications related to regional and obstetric anaesthesia, drug reactions, equipment malfunction and post-operative management of complications. Each chapter contains sample cases of complications and medical errors, giving clinical scenario, outcomes and recommendations for improved management. This is an important practical and clinical text for all anaesthetists and anaesthetic practitioners, both trained and trainees.
Book Synopsis Cardioprotection by : Derek Hausenloy
Download or read book Cardioprotection written by Derek Hausenloy and published by Oxford University Press. This book was released on 2009-08-20 with total page 138 pages. Available in PDF, EPUB and Kindle. Book excerpt: Coronary heart disease (CHD) is the leading cause of death worldwide. Cardioprotection refers to the prevention of CHD and the clinical improvement in patients suffering from cardiovascular problems.
Book Synopsis Deep Sternal Wound Infections by : Raymund E. Horch
Download or read book Deep Sternal Wound Infections written by Raymund E. Horch and published by Springer. This book was released on 2017-01-19 with total page 139 pages. Available in PDF, EPUB and Kindle. Book excerpt: This concise and practical handbook covers the basics of pathophysiology, diagnosis, interdisciplinary surgical management, prevention and rehabilitation of patients with deep sternal wound infections and sternal osteomyelitis. All relevant aspects and surgical procedures are explained in an easily understandable way. Additionally special approaches and preventive measures are highlighted with regard to the perioperative handling as well as the rehabilitation possibilities. Through concise texts with numerous illustrations, the book is ideal for the practice and as a supplement to further studies. This book is suitable for all specialists who are involved into the treatment and diagnosis of sternal wound infections, particularly cardio-thoracis, thoracic, plastic, vascular surgeons, cardiologists, radiologists, and rehabilitation physicians.
Book Synopsis Essential Clinical Anesthesia by : Charles Vacanti
Download or read book Essential Clinical Anesthesia written by Charles Vacanti and published by Cambridge University Press. This book was released on 2011-07-11 with total page 1191 pages. Available in PDF, EPUB and Kindle. Book excerpt: The clinical practice of anesthesia has undergone many advances in the past few years, making this the perfect time for a new state-of-the-art anesthesia textbook for practitioners and trainees. The goal of this book is to provide a modern, clinically focused textbook giving rapid access to comprehensive, succinct knowledge from experts in the field. All clinical topics of relevance to anesthesiology are organized into 29 sections consisting of more than 180 chapters. The print version contains 166 chapters that cover all of the essential clinical topics, while an additional 17 chapters on subjects of interest to the more advanced practitioner can be freely accessed at www.cambridge.org/vacanti. Newer techniques such as ultrasound nerve blocks, robotic surgery and transesophageal echocardiography are included, and numerous illustrations and tables assist the reader in rapidly assimilating key information. This authoritative text is edited by distinguished Harvard Medical School faculty, with contributors from many of the leading academic anesthesiology departments in the United States and an introduction from Dr S. R. Mallampati. This book is your essential companion when preparing for board review and recertification exams and in your daily clinical practice.
Book Synopsis Perioperative Medicine by : Steven L. Cohn
Download or read book Perioperative Medicine written by Steven L. Cohn and published by Springer Science & Business Media. This book was released on 2011-06-21 with total page 557 pages. Available in PDF, EPUB and Kindle. Book excerpt: Perioperative Medicine uses a concise, highly practical, bulleted format designed to ensure rapid comprehension of key concepts and reinforce the reader's understanding of complex topics in perioperative medicine. It contains authoritative, up-to-date coverage of the most essential concepts in perioperative care from preoperative risk assessment to postoperative follow-up. The Editor and his contributors use their expert insight and experience to provide an in-depth review of comorbid conditions, patient and surgery-specific risk assessment, and common postoperative complications. This new book reviews recent developments in the field, including published guidelines, and emphasizes an evidence-based, cost-effective approach designed to ensure quality, patient safety, and optimal outcomes. It is intended for use by hospitalists, general internists and subspecialists as well as anesthesiologists, surgeons, and residents in training who are caring for patients before and after surgery.
Book Synopsis Miller's Anesthesia by : Lars I. Eriksson
Download or read book Miller's Anesthesia written by Lars I. Eriksson and published by Elsevier Health Sciences. This book was released on 2009-01-01 with total page 3221 pages. Available in PDF, EPUB and Kindle. Book excerpt: From fundamental principles to advanced subspecialty procedures, this text is the go-to reference on the technical, scientific, and clinical challenges professionals face. Features new chapters, new authors, meticulous updates, an increased international presence, and a new full-color design.
Book Synopsis Statin-Associated Muscle Symptoms by : Paul D. Thompson
Download or read book Statin-Associated Muscle Symptoms written by Paul D. Thompson and published by Springer Nature. This book was released on 2020-01-25 with total page 191 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book provides an overview of statin-associated muscle symptoms (SAMS) from clinical presentation to treatment and possible metabolic causes. It examines the risk factors, presentations, diagnosis and differential diagnosis, clinical management, and financial costs of SAMS. The book also highlights patients’ perspectives on SAMS such as the psychosocial, emotional, and societal factors influencing their perceptions and experiences. Finally, the book presents the results of observational and clinical trials on the prevalence of SAMS, clinical trials for treatments, and potential future research approaches for improving the understanding and treatment of SAMS. A key addition to the Contemporary Cardiology series, Statin-Associated Muscle Symptoms is an essential resource for physicians, medical students, residents, fellows, and allied health professionals in cardiology, endocrinology, pharmacotherapy, primary care, and health promotion and disease prevention.
