[Pain therapy in palliative ENT patients]

Alleviation of physical complaints through pain management and symptom control represents an essential part of a palliative treatment concept. Persistent cancer pain in palliative care leads to a significant reduction in quality of life. Evaluation of pain on the basis of a detailed pain history allows recognition of the types of pain and initiation of a corresponding effective pain therapy. The basis of cancer pain therapy in palliative patients is transdermal and oral administration of long-acting analgesics according to a fixed time schedule. Especially important is the detection and treatment of breakthrough pain. For this form of pain, sufficiently effective analgesics with a fast effect are available. Palliative otorhinologic (ENT) patients often pose a major challenge to their treating physicians, as advanced oropharyngeal tumors are often associated with dysphagia. The following article presents an overview of the possibilities of drug-based cancer pain therapy in palliative ENT patients.

Best practice for perioperative management of patients with cytoreductive surgery and HIPEC

Due to the significantly improved outcome and quality of life of patients with different tumor entities after cytoreductive surgery (CRS) and HIPEC, there is an increasing number of centers performing CRS and HIPEC procedures. As this procedure is technically challenging with potential high morbidity and mortality, respectively, institutional experience also in the anesthetic and intensive care departments is essential for optimal treatment and prevention of adverse events. Clinical pathways have to be developed to achieve also good results in more comorbid patients with border line indications and extensive surgical procedures. The anesthesiologist has deal with relevant fluid, blood and protein losses, increased intraabdominal pressure, systemic hypo-/hyperthermia, and increased metabolic rate in patients undergoing cytoreductive surgery with HIPEC. It is of utmost importance to maintain or restore an adequate volume by aggressive substitution of intravenous fluids, which counteracts the increased fluid loss and venous capacitance during this procedure. Supplementary thoracic epidural analgesia, non-invasive ventilation, and physiotherapy are recommended to guarantee adequate pain therapy and postoperative extubation as well as fast-track concepts. Advanced hemodynamic monitoring is essential to help the anesthesiologist picking up information about the real-time fluid status of the patient. Preoperative preconditioning is mandatory in patients scheduled for HIPEC surgery and will result in improved outcome. Postoperatively, volume status optimization, early nutritional support, sufficient anticoagulation, and point of care coagulation management are essential. This is an extensive update on all relevant topics for anesthetists and intensivists dealing with CRS and HIPEC.

Comparison of forced-air warming and resistive heating

BACKGROUND

Perioperative hypothermia is common during anesthesia and surgery and is accompanied by several complications. Forced-air warming is recognized as an effective procedure to prevent hypothermia. The aim of this study was to compare a resistive heating device with a forced-air warming device.

METHODS

Prospective randomized trial.

SETTING

heat transfer laboratory of a University hospital.

PARTICIPANTS

six healthy volunteers.

INTERVENTIONS

warming with a forced-air warming device (BairHugger 505 and Upper Body Blanket 522; Arizant Healthcare Inc., Eden Prairie, MN, USA) or a resistive heating device (Geratherm Adult system; Geratherm Medical AG, Geschwenda, Germany).

MEASURES

heat transfer was measured with 11 calibrated heat flux transducers on the upper body. Additionally, blanket and skin temperatures were measured. The t-test for matched pairs was used for statistical evaluation.

RESULTS

Skin temperature under the covered surface was not statistically different between the two groups (37.3+/-0.2 degrees C in the forced-air warming group and 37.8+/-0.2 degrees C in the resistive heating group). In contrast, blanket temperature (40.3+/-0.6 degrees C vs 38.1+/-0.4 degrees C, P=0.002) and heat transfer (13.2+/-3.6 W vs 7.8+/-1.9 W, P=0.048) were significantly higher in the resistive heating group.

CONCLUSION

Heat transfer in the resistive heating system was significantly greater than that of the forced-air warming system.