Patients on Buprenorphine Formulations Undergoing Surgery.

PURPOSE OF REVIEW: To review the pharmacology of buprenorphine, the evolution of buprenorphine dosing recommendations, and the current literature regarding its recommendations for the perioperative period. RECENT FINDINGS: There is a consensus that for all surgeries, buprenorphine should be continued throughout the perioperative period. If the surgery is a minimal to mild pain surgery, no dose adjustment is needed. There is no clear consensus regarding moderate to severe pain. With all surgeries, multimodal analgesia should be utilized, with regional anesthesia when possible. Patients taking buprenorphine should continue their buprenorphine perioperatively; whether to decrease or maintain dosing is up for debate. Multimodal analgesia should also be used throughout the perioperative period, and communication between the patient and all provider teams is of the utmost importance to provide adequate analgesia during the perioperative period, as well as to arrange safe analgesia upon discharge.

Development of Overgeneral Autobiographical Memory in Offspring of Depressed Mothers.

Maternal depression increases the risk for offspring cognitive vulnerabilities, which may be a mechanism underlying the intergenerational transmission of depression. Little is known about how cognitive vulnerabilities, particularly memory biases, develop in the offspring of depressed mothers. Understanding the etiology of memory biases may lead to novel intervention targets. Therefore, the current study examined the prospective impact of maternal depression on the development of offspring overgeneral autobiographical memory (OGM; i.e., the tendency to recall less specific memories), a cognitive vulnerability implicated in the intergenerational transmission of depression. Participants were offspring (ages 8-14; 51% daughters, 81% Caucasian) of mothers with (n= 129) or without (n= 122) a history of major depressive disorder (MDD) during the offspring's life. Mothers and offspring completed assessments every 6 months for 2 years. Compared to offspring of never-depressed mothers, offspring of mothers with a history of MDD recalled less specific memories in response to negative, but not positive, cue words at the initial assessment, and this bias was maintained across the 2-year follow-up. For offspring of depressed, but not never-depressed, mothers, higher levels of maternal depressive symptoms at a given assessment predicted prospective decreases in the children's autobiographical memory specificity. Again, this finding was specific to negative, but not positive, cue words. These results suggest that maternal depression has both short- and long-term effects on the development of offspring OGM to negative cues, which may represent a malleable cognitive vulnerability for the intergenerational transmission of MDD that could be targeted for intervention.

What is new in the battle against postoperative nausea and vomiting?

The issue of postoperative nausea and vomiting (PONV) still poses a significant burden on our patients. Although rarely associated with a life-threatening condition, it is consistently considered as one of the most undesirable side effects of surgery and anesthesia. There are well-established risk factors for the development of PONV that include patient-related factors, anesthetic technique, use of volatile anesthetics, use of nitrous oxide, duration of anesthesia, opioid administration, and type of surgery. Because pharmacologic interventions for PONV are not without risks, practitioners must assess patient's risk status from low to high and consider the benefits of treatment. This review summarizes the current state of knowledge related to PONV and provides a practical approach toward risk assessment, prevention, and numerous treatment strategies.

Episodic Life Stress and the Development of Overgeneral Autobiographical Memory to Positive Cues in Youth.

Overgeneral autobiographical memory (OGM) has been established as a risk factor for depression in both youth and adults, but questions remain as to how OGM develops. Although theorists have proposed that the experience of stressful life events may contribute to the development of OGM, no studies have examined the impact of negative life events on prospective changes in OGM. The goal of the current study was to address this gap in the literature. Participants included 251 mothers and their biological children (aged 8-14 years old at the initial assessment). Using a multi-wave prospective design with assessments every 6 months for 2 years, we found that episodic life stress predicted prospective decreases in youths' autobiographical memory specificity to positive, but not negative, cues. This study supports theories proposing that negative life events may contribute to the development of OGM, but suggest that, in youth, the impact of life stress on OGM may be specific to positive rather than negative memories.

Brief report: Overgeneral autobiographical memory in adolescent major depressive disorder.

The current study examined whether overgeneral autobiographical memory (OGM) bias serves as a state-like marker of major depressive disorder (MDD) in adolescence or whether it would also be observed in currently nondepressed adolescents with a history of MDD. We examined differences in OGM to positive and negative cue words between adolescents (aged 11-18 years) with current MDD (n = 15), remitted MDD (n = 25), and no history of any depressive disorder (n = 25). Youth and their parents were administered a structured diagnostic interview and adolescents completed the autobiographical memory test. Compared to never depressed adolescents, adolescents with current or remitted MDD recalled less specific memories in response to positive and negative cue words. The difference between the two MDD groups was small and nonsignificant. These findings suggest that OGM is not simply a state-like marker in currently depressed adolescents, but is also evident in adolescents with remitted MDD, indicating that it may represent a trait-like vulnerability that increases risk for relapse.