Pharmacologic rationale for anesthetic agents in ambulatory practice

Meta-analysis of the efficacy of non-steroidal anti-inflammatory drugs vs. opioids for SWL using modern electromagnetic lithotripters

PURPOSE

Clinical studies produce conflicting results on pain relief for shock wave lithotripsy (SWL). We performed a systematic review and meta-analysis to compare non-steroidal anti-inflammatory drugs (NSAIDs) and opioids in pain relief for SWL powered by an electromagnetic generator.

MATERIAL AND METHODS

A search of MEDLINE and EMBASE was performed and all randomized controlled trials comparing NSAIDs and opioids in pain relief for SWL using modern electromagnetic lithotripters were included in the analysis. Data from 3 trials (244 patients) were pooled. The primary outcome measure was adequate analgesia, defined as "if no additional pain relief was used". The difference in the proportion of patients with adequate anesthesia was compared between the NSAIDs and opioids groups as an odds ratio and odds ratio were pooled across the 3 trials with a fixed effects model.

RESULTS

There was no statistically significant difference between using NSAIDs and opioids for pain relief during SWL using modern electromagnetic lithotripters (odds ratio 0.886, 95% CI 0.446-1,760, p = 0.730).

CONCLUSIONS

Our analysis shows that in relieving pain during SWL using modern electromagnetic lithotripters NSAIDs are as effective as opioids.

Perianesthesia care of the patient with gastroesophageal reflux disease

Every day millions of people suffer heartburn and other related symptoms of gastroesophageal reflux disease (GERD). Because symptoms can lead to a reduced quality of life, GERD sufferers are desperate for relief. This article explores the definition and pathophysiology, clinical manifestations, diagnostic procedures, and treatment options for GERD, including lifestyle modifications, medications, surgery, and alternative procedures. It also discusses preoperative, anesthesia/intraoperative, and postoperative special care considerations for the surgical patient with GERD.