I Disturbi della Deglutizione

Many of the benefits of effective epidural analgesia for open abdominal surgery are soundly established. A well-managed epidural can provide excellent analgesia in the postoperative period allowing the patient to be pain free at rest and when mobilizing. In addition, epidural block will obtund the acute stress response to surgery. Consequently along with the analgesic benefits, patients are less likely to suffer cardiac, respiratory, or gastrointestinal side-effects. However, the increasing application of laparoscopic techniques for many major intra-abdominal procedures results in less pain and shorter recovery times than open surgery. We now have a clearer appreciation of the potential risks of epidural analgesia. A number of alternative local anaesthetic-based analgesic techniques have been described. In the context of these advances, we discuss whether in fact in abdominal surgery, there is still a time and a place for the thoracic epidural?
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The American Geriatrics Society (AGS) has released a new practice guideline for preventing and treating postoperative delirium in patients aged 65 years or older. The guideline was published online November 4 on the AGS website. An additional best practices document containing almost all guideline recommendations plus additional clinical recommendations was published online November 14 in the Journal of the American College of Surgeons.

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Montreal—A review of the records of more than 20,000 women in labor has found that even those with platelet counts as low as 50×109/L can safely receive regional anesthesia (RA), under the right circumstances. Although RA is now the standard of care in laboring women, turning to epidurals and spinals in high-risk parturients—especially those with low platelet counts—can be discomfiting.

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