Current State of Pain Treatment: Does Dexmedetomidine Have a Role to Play?

Opioids are a mainstay in the modern practice of anesthesia and perioperative pain management. However, due to the crisis surrounding opioid use and abuse, as well as the undesirable side effects that occur with normal use, anesthesia providers are searching for ways to curtail perioperative opioid use. The advent of various analgesic adjuncts such as dexmedetomidine has opened new avenues for multimodal analgesic approaches to perioperative pain management. A review of current research focused on these analgesic adjuncts and the drawbacks of opioid use reveals increased understanding and complexity of the physiology of pain, its treatment, and our understanding of pharmacologic mechanisms of action of analgesics. This course will examine the current limitations of opioids, provide a brief overview of the physiology of pain, and discuss the pharmacologic mechanism of action of dexmedetomidine and patient populations in which its use might be advantageous.

Difficulties in Emotion Regulation, Alexithymia, and Social Phobia Are Associated With Disordered Eating in Male and Female Undergraduate Athletes.

Investigations of disordered eating in the athlete population tend to focus on females and the influence of sport level. This leaves unanswered whether, and how, team interdependence (i.e., whether the competition is engaged with one person or as a team) may differentially impact male athletes. In the present study, we recruited a sample of non-athletes, individual athletes, and team athletes and examined the interaction of gender and teammate interdependence on established psychosocial risk factors for disordered eating, including social phobia, alexithymia, and emotion regulation. Although we identified a significant main effect of gender, there was no main effect of team type, nor was there a significant interaction of gender and team type. Using descriptive discriminant analysis, these variables significantly discriminated between genders. Women were defined by higher scores than men on drive for thinness, body dissatisfaction, and emotion recognition and men were defined by relatively higher scores on emotion dysregulation and binge eating. When we combined all athletes and compared them with non-athletes, a significant interaction of gender and athlete status emerged such that female athletes, compared to male athletes and women non-athletes, were defined by higher scores on drive for thinness, emotion dysregulation, and binge eating. Conversely, male athletes, compared to female athletes, were defined by greater difficulty identifying feelings and body dissatisfaction. Non-athletes were not well defined by the discriminant function. These results highlight that emotional processes convey risk of eating disorders in men and women, particularly in athletes, and these risk factors are not uniform.

AANA Journal Course-Residual Neuromuscular Blockade: Evidence-Based Recommendations to Improve Patient Outcomes.

Neuromuscular blocking drugs are administered to facilitate endotracheal intubation and induce paralysis to allow surgeons access to their anatomical target. Traditionally, qualitative measures; such as tactile observation of fade by a peripheral nerve stimulator, are used to assess the extent of the patient's recovery after receiving the neuromuscular blocking agent. Use of these qualitative measures; however, can contribute to high rates of residual neuromuscular blockade (RNMB), placing patients at risk of serious postoperative adverse events. Such adverse events include the need for tracheal reintubation, impaired oxygen and ventilation, increased risk of aspiration and pneumonia, pharyngeal dysfunction, and delayed discharge from the postanesthesia care unit. This problem of RNMB is exacerbated by the use of traditional drugs to reverse the neuromuscular blockade, such as the acetylcholinesterase inhibitor neostigmine. This course will examine the current limitations of qualitative neuromuscular monitoring, introduce the reader to acceleromyography, and outline the advantages of monitoring neuromuscular blockade during the perioperative period. In addition, this course will review the contemporary neuromuscular antagonists, including the newer neuromuscular antagonist sugammadex.

Analgosedation: Improving Patient Outcomes in ICU Sedation and Pain Management.

Sedation practices in the critical care unit have been trending toward lighter sedation since the start of the new millennium, but patients continue to experience inadequate pain management and excessive sedation. This paper includes a brief examination of the problem of pain management in the ICU; trends in sedation practices, including light sedation and the daily interruption of sedation; and a literature review of analgosedation. While the analgosedation literature is relatively sparse, it offers a promising, patient-centered method for managing the triad of pain, agitation, and delirium, while reducing common complications associated with long-term ventilation. This paper concludes with a recommended method for analgosedation, the nursing implications, and a discussion of limitations and recommendations.