scholarly journals Multimodal analgesia in bariatric surgery

2016 ◽  
Vol 10 (4) ◽  
pp. 254-261
Author(s):  
M. I Neimark ◽  
Roman V. Kiselev

This review is devoted to the treatment of postoperative pain in bariatric surgery. At present, the prevalence of patients with a high degree of obesity is an epidemic that leads steadily growing number of bariatric operations. Showing the risk factors in the traditional approach to the use of opioids in these patients, as well as the consequences of inadequate analgesia in these patients. Details are presented modern pharmacological agents acting on different levels nociceptive system. Substantiates the role of a multi-modal approach to perioperative analgesia, mandatory use of regional anesthesia. The attention to the visualization neuroaxial structures using ultrasound in the context of the implementation of the efficacy and safety of regional anesthesia in patients with morbid obesity. Possible prospects for pain control in bariatric surgery.

2021 ◽  
Vol 12 ◽  
Author(s):  
Shih-Yuan Liu ◽  
Yi-Hong Ho ◽  
Chih-Shung Wong

Laparoscopic bariatric surgery is increasingly performed in morbidly obese patients. However, post-surgical pain is common and is usually managed with classical opioids such as morphine and fentanyl. Further, morbidly obese patients are predisposed to opioid-related side effects, especially post-operative nausea and vomiting (PONV), and respiratory depression. Obstructive sleep apnea in morbidly obese patients even predisposes them to respiratory depression. Thus, reducing opioid consumption is important. Multimodal analgesia (MMA) provides optimal perioperative analgesia while minimizing opioid consumption. Studies have shown that MMA strategy can provide sufficient pain relief in bariatric surgery with enhanced recovery. There are very few reports on the use of dinalbuphine sebacate (DS), a newly introduced non-controlled opioid medication with long-lasting analgesic effects. DS has a different mechanism of action from that of morphine or fentanyl and is non-addictive, with minimal side effects. It has been successfully used in laparoscopic cholecystectomy in our previous study. We present a case of a new MMA protocol with DS on a 46-year-old morbidly obese female patient who underwent laparoscopic sleeve gastrectomy. The MMA protocol included ultrasound-guided intramuscular DS injection plus transversus abdominis plane (TAP) block and other analgesics; it achieved good perioperative analgesia with opioid-sparing effect and enhanced patient’s recovery with no pain in the following 4 months.


1980 ◽  
Vol 44 (01) ◽  
pp. 006-008 ◽  
Author(s):  
D Bergqvist ◽  
K-E Arfors

SummaryIn a model using an isolated rabbit mesenteric preparation microvessels were transected and the time until haemostatic plugs formed was registered. Perfusion of platelet rich plasma gave no haemostasis whereas whole blood did. Addition of chlorpromazine or adenosine to the whole blood significantly prolonged the time for haemostasis, and addition of ADP to the platelet rich plasma significantly shortened it. It is concluded that red cells are necessary for a normal haemostasis in this model, probably by a combination of a haemodynamic and ADP releasing effect.The fundamental role of platelets in haemostatic plug formation is unquestionable but there are still problems concerning the stimulus for this process to start. Three platelet aggregating substances have been discussed – thrombin, adenosine diphosphate (ADP) and collagen. Evidence speaking in favour of thrombin is, however, very minimal, and the discussion has to be focused on collagen and ADP. In an in vitro system using polyethylene tubings we have shown that "haemostasis" can be obtained without the presence of collagen but against these results can be argued that it is only another in vitro test for platelet aggregation (1).To be able to induce haemostasis in this model, however, the presence of red blood cells is necessary. To further study this problem we have developed a model where haemostatic plug formation can be studied in the isolated rabbit mesentery and we have briefly reported on this (2).Thus, it is possible to perfuse the vessels with whole blood as well as with platelet rich plasma (PRP) and different pharmacological agents of importance.


Author(s):  
Gulbarshyn Chepurko ◽  
Valerii Pylypenko

The paper examines and compares how the major sociological theories treat axiological issues. Value-driven topics are analysed in view of their relevance to society in times of crisis, when both societal life and the very structure of society undergo dramatic change. Nowadays, social scientists around the world are also witnessing such a change due to the emergence of alternative schools of sociological thought (non-classical, interpretive, postmodern, etc.) and, subsequently, the necessity to revise the paradigms that have been existed in sociology so far. Since the above-mentioned approaches are often used to address value-related issues, building a solid theoretical framework for these studies takes on considerable significance. Furthermore, the paradigm revision has been prompted by technological advances changing all areas of people’s lives, especially social interactions. The global human community, integral in nature, is being formed, and production of human values now matters more than production of things; hence the “expansion” of value-focused perspectives in contemporary sociology. The authors give special attention to collectivities which are higher-order units of the social system. These units are described as well-organised action systems where each individual performs his/her specific role. Just as the role of an individual is distinct from that of the collectivity (because the individual and the collectivity are different as units), so too a distinction is drawn between the value and the norm — because they represent different levels of social relationships. Values are the main connecting element between the society’s cultural system and the social sphere while norms, for the most part, belong to the social system. Values serve primarily to maintain the pattern according to which the society is functioning at a given time; norms are essential to social integration. Apart from being the means of regulating social processes and relationships, norms embody the “principles” that can be applied beyond a particular social system. The authors underline that it is important for Ukrainian sociology to keep abreast of the latest developments in the field of axiology and make good use of those ideas because this is a prerequisite for its successful integration into the global sociological community.


2016 ◽  
pp. 64-66
Author(s):  
S.Yu. Vdovichenko ◽  

The objective: to show a role of the family focused technologies in depression of frequency of pathology of pregnancy at women of high obstetric risk. Patients and methods. For determination of efficiency of prophylaxis of pathology of pregnancy on the basis of use of the family focused technologies complex clinical-psychological and laboratory and tool examination of 300 women with factors of obstetric risk which were divided into two groups was conducted. In the main group – 182 women with motivation on partner labors to which provided training on system of individual preparation of married couple to labors. The comparison group consisted of 118 women who were not in prenatal training and had individual support in childbirth, with the traditional approach to pain management. Results. Use of the family focused technologies during pregnancy allows to reduce significantly the frequency of the main complications of pregnancy, especially not incubation and premature births. Conclusion. In our opinion, the technique is simple, available and can widely be used in practical health care at women with high obstetric risk. Key words: obstetric risk, the family focused technologies, prophylaxis.


Author(s):  
Admink Admink ◽  
Сергій Виткалов ◽  
Валентина Вігула

Розглядається організаційно-культурна діяльність одного з помітних у регіональному просторі Західного Полісся фотомитця – Олександра Купчинського, а саме виставковий її вектор, втілений в презентації артефактів світового фотомистецтва; видавничий, розглянутий у  контексті  друку  різноманітних  фотоальбомів  із  творів експонентів, організація творчих зустрічей художньої інтелігенції міста з питань обговорення актуальних питань культурного розвитку, заснування фотоклубу тощо. Доводиться, що втрата зв’язку з Батьківщиною, у якій би формі це не відбувалося, не дозволяє митцю творчо самореалізуватися повною мірою. The importance and problematic range of local government reform in the regions of the country and ways of its solution in the field of culture are analyzed. The most effective steps are proposed for management structures at different levels to change attitudes of both the management and the local population regarding different cultural practices. Emphasis is placed on the role of sectoral methodological services in the implementation of this reform. The experience of other countries in activating the local population in this process is emphasized. An attempt has been made to offer effective, in the authors' opinion, solutions to the reform. Emphasis is placed on the educational factor.


Author(s):  
Shaun Blanchard

This book sheds further light on the nature of church reform and the roots of the Second Vatican Council (1962–65) through a study of eighteenth-century Catholic reformers who anticipated the Council. The most striking of these examples is the Synod of Pistoia (1786), the high-water mark of late Jansenism. Most of the reforms of the Synod were harshly condemned by Pope Pius VI in the bull Auctorem fidei (1794), and late Jansenism was totally discredited in the ultramontane nineteenth-century Church. Nevertheless, much of the Pistoian agenda—such as an exaltation of the role of bishops, an emphasis on infallibility as a gift to the entire Church, religious liberty, a simpler and more comprehensible liturgy that incorporates the vernacular, and the encouragement of lay Bible reading and Christocentric devotions—was officially promulgated at Vatican II. The career of Bishop Scipione de’ Ricci (1741–1810) and the famous Synod he convened are investigated in detail. The international reception (and rejection) of the Synod sheds light on why these reforms failed, and the criteria of Yves Congar are used to judge the Pistoian Synod as “true or false reform.” This book proves that the Synod was a “ghost” present at Vatican II. The council fathers struggled with, and ultimately enacted, many of the same ideas. This study complexifies the story of the roots of the Council and Pope Benedict XVI’s “hermeneutic of reform,” which seeks to interpret Vatican II as in “continuity and discontinuity on different levels” with past teaching and practice.


Author(s):  
Mohammad Paydar ◽  
Asal Kamani Fard

More than 150 cities around the world have expanded emergency cycling and walking infrastructure to increase their resilience in the face of the COVID 19 pandemic. This tendency toward walking has led it to becoming the predominant daily mode of transport that also contributes to significant changes in the relationships between the hierarchy of walking needs and walking behaviour. These changes need to be addressed in order to increase the resilience of walking environments in the face of such a pandemic. This study was designed as a theoretical and empirical literature review seeking to improve the walking behaviour in relation to the hierarchy of walking needs within the current context of COVID-19. Accordingly, the interrelationship between the main aspects relating to walking-in the context of the pandemic- and the different levels in the hierarchy of walking needs were discussed. Results are presented in five sections of “density, crowding and stress during walking”, “sense of comfort/discomfort and stress in regard to crowded spaces during walking experiences”, “crowded spaces as insecure public spaces and the contribution of the type of urban configuration”, “role of motivational/restorative factors during walking trips to reduce the overload of stress and improve mental health”, and “urban design interventions on arrangement of visual sequences during walking”.


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