Page 42 - CASA Bulletin of Anesthesiology 2019 Issue 6

CASA Bulletin of Anesthesiology

DOI: 10.31480/2330-4871/104
many detrimental effects on health care outcomes erative dexmedetomidine in contemporary anesthesia practice?
and is currently precipitating an epidemic of prescrip- Translational Perioperative and Pain Medicine 2018;5(3) 55-62.
tion opioid addiction and overdose deaths through- 10. Davy A, Fessler J, Fischler M, LE Guen M. Dexmedetomidine and
out the United States. Many alternative non-opioid general anesthesia: a narrative literature review of its major in-
analgesic drugs with a lower addiction potential and dications for use in adults undergoing non-cardiac surgery. Min-
a better side effect profile are available but are cur- erva Anestesiol 2017 Dec;83(12):1294-1308.
rently underused. At present there is a campaign to 11. Arain SR, Ruehlow RM, Uhrich TD, Ebert TJ. The efficacy of
educate addicts and their families and friends about dexmedetomidine versus morphine for postoperative anal-
gesia after major inpatient surgery. Anesthesia and Analgesia
naloxone to curb opioid overdose deaths. To get the 2004;98(1):153-58.
current prescription opioid abuse epidemic under
control however primary prevention by limiting the 12. Jebaraj B, Ramachandran R, Rewari V, Trikha A, Chandralekha,
Kumar R, et al. Feasibility of dexmedetomidine as sole analgesic
administration of opioids during hospitalizations will agent during robotic urological surgery: a pilot study. J Anaes-
be necessary. Opioid free anesthesia can be achieved thesiol Clin Pharmacol 2017;33(2):187-92.
during most operations by employing alternative an- 13. Gunalan S, VenkatramanR, Sivarajan G,Sunder P. Comparative
algesics. The use of these non-opioid analgesic drugs evaluation of bolus administration and fentanyl for stress atten-
as the alternatives to opioids should be continued uation during laryngoscopy and endotracheal intubation. J Clin
after discharge from hospital. Opioid prescriptions Diagn Res 2015;9(9):06-9.
and refills will need to be limited and ongoing opioid 14. Peng K, Liu HY, Wu SR, Cheng H, Ji FH. Effects of combining dex-
requests by the patient will need to be assessed care- medetomidine and opioids for postoperative intravenous pa-
fully. Anesthesia care providers and surgeons need tient controlled analgesia: a systematic review and meta-analy-
sis. Clin J Pain 2015;31(12):1097-1104.
to understand that their perioperative pain manage-
ment has lasting effects that have the potential to 15. Peng K, Zhang J, Meng XW, Liu HY, Ji FH. Optimization of post-
operative intravenous patient controlled analgesia with opi-
negatively affect their patients for the rest of their oid-dexmedetomidine combinations: an updated meta-analysis
lives (Table 2). with trial sequential analysis of randomized controlled trials.
Pain Physician 2017;20(7):569-96.
Funding Sources
16. Groeben H, Mitzner W,Brown RH. Effects of the alpha 2 adreno-
This work was supported by the University of Cali- receptor agonist dexmedetomidine on bronchoconstriction I
fornia Davis Health Department of Anesthesiology and dogs. Anesthesiology 2004;100(2):359-63.
Pain Medicine, and NIH grant UL1 TR001860 of the Uni- 17. Xin J, Zhang Y, Zhou L, Liu F, Zhou X, Liu B, et al. Effect of dexme-
versity of California Davis Health. detomidine infusion for intravenous patient controlled analgesia
on the quality of recovery after laparotomy surgery. Oncotarget
References 2017;8(59):100371-83.
1. Mendelson J, Flower K, Pletcher MJ, Galloway, GP. Addiction to 18. Botting RM. Mechanism of action of acetaminophen: is there a
prescription opioids: characteristics of the emerging opioid ep- cyclooxygenase 3? Clinical Infectious Diseases 2000;31(5):202-
idemic and treatment with buprenorphine. Exp Clin Pharmacol 10.
2008;16(5):435-441. 19. O’Neal J. The utility of intravenous acetaminophen in the periop-
2. Peltz G, Südhof TC. The neurobiology of opioid addiction and the erative period. Front Public Health 2013;1:25.
potential for prevention strategies. JAMA 2018;319(20):2071-2. 20. Jaeschke H. Acetaminophen: dose dependent drug hepatotoxic-
3. Adans JM. Increasing naloxone awareness and use: the role of ity and acute liver failure in patients. Dig Dis 2015;33(4):464-71.
healthcare practitioners. JAMA 2018;319(20):2073-4. 21. Bunchorntavukul C, Reddy K. Acetaminphen-related hepatotox-
4. McEwen S, Prakken S. Reducing the oversupply of prescription icity. Clin Liver Dis 2013;17(4):587-607.
opioids. NC Med J 2018;79(3):175-80. 22. De Oliveira G, Agarwal D, Benzon HT. Perioperative single dose
5. Sultana A, Torres D, Schumann R. Indications for Opioid Free ketorolac to prevent postoperative pain: a meta-analysis of ran-
Anaesthesia and Analgesia, patient and procedure related: In- domized trials. Anesth Analg 2012;114(2):424-33.
cluding obesity, sleep apnoea, chronic obstructive pulmonary 23. Mikhaylov Y, Weinstein B, Schrank TP, Swartz JD, Ulm JP, Arm-
disease, complex regional pain syndromes, opioid addiction and strong MB, et al. Ketorolac and hematoma incidence in postmas-
cancer surgery. Best Pract Res Clin Anesthesiol 2017;31(4):547- tectomy implant-based breast reconstruction. Ann Plast Surg
60. 2018;80(5):472-4.
6. Alfonso J, Reis F. Dexmedetomidine: current role in anesthesia 24. Gao B, Remondini T, Dhaliwal N, Frusescu A, Patel P, Cook A, et al.
and intensive care. Rev Bras Anestesiol 2012;62(1):118-33. Incidence of bleeding in children undergoing circumcision with ke-
7. Kim R. Anesthesia technique and cancer recurrence in onco- torolac administration. Can Urol Assoc J 2018;12(1):E6-E9.
logic surgery: unravelling the puzzle. Cancer Metastasis Rev 25. P Forget, C Bentin, JP Machiels, M Berliere, PG Coulie, M De
2017;36(1):159-77. Kock. Intraoperative use of ketorolac or diclofenac is associated
8. Wang K, Qu X, Wang Y, Shen H, Liu Q, Du J. Effect of mu agonists with improved disease-free survival in conservative breast can-
on long-term survival and recurrence in nonsmall cell lung can- cer surgery. Br J Anaesth 2014;113(Suppl):i82-87.
cer patients. Medicine (Baltimore) 2015;94(33) 26. Li J, Ajiboye RM, Orden MH, Sharma A, Drysch A, Pourtaheri
9. Bohringer, C, Liu H. Is it time for an expanded role of intraop- S. The effect of ketorolac on thoracolumbar posterolateral fu-
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