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Advanced therapy in thoracic surgery - part 1

Nó là tự nhiên muốn giảm đau và đau khổ. Không được nhận thức rõ hơn về điều này hơn so với những chuyên gia, những người đã cống hiến cuộc sống của họ để cung cấp thuốc gây mê, nhưng chúng ta thường bị ngăn cản làm giảm đau | Copyrighted Material Advanced Therapy in THORACIC SURGERY Second Edition Franco Putnam Copyrighted Material Chapter 1 Postoperative Analgesia for Thoracotomy Patients a Current Review Peter H. Norman md frcpc M. Denise Daley md frcpc Alicia Kowalski md It is natural to want to relieve pain and suffering. None are more aware of this than those professionals who have devoted their lives to the provision of anesthesia yet we have often been prevented from alleviating pain by not understanding its pathogenesis or by a lack of appropriate tools to deal with it. intraoperative pain is now only of historic concern. it is our fervent hope that postoperative pain will follow intraoperative pain into the history books. Not so long ago certainly within the professional experience of some of us a minimalist approach was taken to the management of pain after thoracic surgery. Anesthesiology residents and faculty alike were admonished to keep total opioid dosage low so the patient would want to breathe after surgery. During this era the classic thoracotomy patient would be nearly apneic from pain in the postanesthesia care unit. Hypoxic and hypercarbic diaphoretic and hypertensive patients would gradually improve to the point at which they could actually breathe and complain of pain only after large doses of opioids. Frequent arterial blood gas analyses often demonstrated the unusual observation that the administration of opioids led to a decrease in carbon dioxide tension and an increase in oxygen tension in this setting. In 1973 Gibbons and colleagues suggested that thoracic epidural blockade was the treatment of choice for relief of pain after a chest injury.1 The major limitation was sympathetic blockade causing hypotension. To prevent this complication they advocated intercostal blockade for fractures at or above the fifth rib. The modern era of pain management after thoracic surgery began with the introduction of epidural narcotic tech niques for post-thoracotomy pain.2 3