Perioperative ingestion of caffeine and postoperative headache

The interruption of daily consumption of caffeine-containing beverages can cause headache and other symptoms within 8 hours. Resumption of caffeine alleviates these symptoms. Surgical patients routinely fast preoperatively and may have postoperative symptoms from caffeine withdrawal. In the current study, we determined whether perioperative caffeine consumption altered the incidence of postoperative headache. After institutional approval of the study design, 233 surgical outpatients were surveyed about history of headaches, caffeine consumption, and the presence and severity of headaches postoperatively. Of the 233 patients, 190 (82%) drank caffeinated beverages daily (mean daily consumption, 290 mg of caffeine). Postoperative headaches occurred in 22% of patients who routinely drank caffeinated beverages but in only 7% of those who did not (P < 0.03). Other factors associated with postoperative headaches included a history of frequent headaches (P < 0.0001), age of 50 years or younger (P < 0.002), and amount of daily caffeine ingested (P < 0.01). Among daily caffeine drinkers, those who drank caffeinated beverages on the day of the surgical procedure had a lower incidence of postoperative headaches than did those who abstained (17% versus 28%; P < 0.04). Postoperative headaches may be related to several factors. Perioperative intake of caffeine altered postoperative well-being. Caffeine given preoperatively may limit postoperative withdrawal headaches among the millions of daily drinkers of caffeinated beverages. A randomized, prospective, and blinded trial to test this hypothesis is warranted.     

Retrospective study of postcraniotomy headaches in suboccipital approach: diagnosis and management

PURPOSE: The suboccipital approach used for cerebellopontine angle tumors, microvascular decompression, vestibular nerve section, and other procedures has been associated with significant postoperative headache. This study was undertaken to evaluate retrospectively the incidence and management of headaches in these patients. METHODS: Operation logs from 1988 through 1993 were reviewed to identify patients who underwent lateral suboccipital craniotomy or craniectomy. The nature of the operation, preoperative and postoperative complaints of headache, treatment for postoperative headache, and the use of primary cranioplasty were recorded from the medical records. RESULTS: Fifty-six suboccipital approaches were performed by the senior authors between 1988 and 1990. Seven patients had debilitating postoperative headaches. None responded to conservative management, and all underwent secondary cranioplasty. All seven patients showed significant improvement in their pain, with four of seven requiring no other treatment (follow-up from 15 to 38 months). Fifty patients underwent cranioplasty at the time of their initial operation, from 1991 to 1993. No case of debilitating headache was identified post-operatively in these patients. CONCLUSIONS: Cranioplasty at the time of lateral craniectomy appears to reduce the incidence of debilitating postoperative headache.     

Characterization of a de novo 48,XX,+r(X),+r(17) by in situ hybridization in a patient with neurofibromatosis (NF1)

The authors analyze the errors in the treatment of detachment of the retina in children. The errors were found not only in the surgical policy, but in the management of the pre- and postoperative period as well. They suggest rational methods for the pre- and postoperative management of patients with detachment of the retina and adequate schemes of surgical treatment.     

Effect of minimally invasive thoracic surgical approaches on acute and chronic postoperative pain

Acute postthoracotomy pain and chronic postthoracotomy pain are significant problems leading to increased length of hospital stay and medical costs, reduction in patient quality of life and patient productivity, and potential immunologic derangement that may compromise oncologic surgical results. Minimally invasive surgical approaches can potentially benefit the patient by reducing postoperative pain-related morbidity. Objective data supporting our inclination that these VATS approaches are superior to open thoracic surgical techniques is accumulating. Further study of the relative costs, risks, and benefits of standard postoperative analgesic management (e.g., epidural analgesia) combined with limited thoracotomy compared to VATS techniques is warranted as we try to define the most effective perioperative management of the patient requiring pulmonary resection.     

Headaches associated with nasal obstruction due to deviated nasal septum

A deviated nasal septum not only can cause a blocked nose, but may also be associated with headaches. This study evaluates the nature of these headaches, the effect of submucous resection of the nasal septum, and the factors associated with postoperative headache relief. Deviated nasal septa were corrected by submucous resection in 99 men and 17 women. Patients were studied at 4 to 48 months (mean 18 months) postoperatively. Fifty-five of the 116 patients studied (47.4%) had preoperative recurring headaches. Thirty-five of the 55 patients with headaches (63.6%) experienced relief (complete or partial) of their headaches at a mean follow-up period of 18 months. Patients were more likely to be relieved of their headaches following submucous resection if the headaches were most intense over the frontal region, pressurelike in nature, and if the submucous resection resulted in relief of nasal obstruction. It is possible that headaches recur in the long term, and it is postulated that central mechanisms play a role.     

Lives on hold: evaluation of a caregiver''s support program

BACKGROUND: With the increasing number of surgeons using phacoemulsification techniques combined with sutureless scleral tunnel and clear corneal incisions for cataract surgery, the majority of patients will undergo an uncomplicated course of visual rehabilitation requiring no more than standard topical antibiotic and steroid regimen. Occasionally--even with an uneventful surgical course--postoperative complications arise. Many of these postoperative complications can be managed medically, without surgical intervention. Topical and oral glaucoma and nonsteroidal anti-inflammatory agents play an important role in the management of postoperative cataract complications. METHODS: A review of the common postoperative complications and their medical management using topical and oral pharmaceutical agents are presented. Emphasis is placed on current trends in treatment following contemporary cataract surgery. CONCLUSION: Although the complication rate is reduced with modern cataract surgery techniques, the primary care clinician should be prepared to identify and manage the most common clinical conditions. Armed with the proper knowledge of ophthalmic medications and their possible ocular and systemic interactions, optometrists can successfully manage and co-manage many postoperative cataract complications. Common postoperative complications are reviewed, along with current treatment regiments and dosage forms.     

Anesthesia in laparoscopic surgery

The use of laparoscopic techniques in general surgery is increasing in popularity. The anesthesiologist's goals during laparoscopic surgery are hemodynamic and respiratory stability, appropriate muscle relaxation, control of diaphragmatic excursion, intraoperative and postoperative patient analgesia. The implications are that the anesthesiologist must use a technique that not only allows for optimal surgical conditions but also provides intraoperative patient comfort and safety and a rapid postoperative anesthetic recovery. Laparoscopy is not a benign procedure. It is associated with major and minor surgical and non surgical complications, including death. Therefore, it is imperative that the anesthesiologist and surgeon thoroughly understand the physiopathology and immediate treatment of these potential complications and communicate effectively about their management.     

Understanding shoulder arthroplasty

This article discusses the vital role of the professional nurse when caring for patients who have shoulder replacement surgery. The indications for surgery, recent advances in the surgical procedure, postoperative management, and potential complications are reviewed.     

Occipitocervical fusion by Luque loop rod instrumentation in Down syndrome

Four children with Down syndrome who had developed atlantoaxial dislocation and myelopathy underwent occipitocervical fusion with Luque loop rod instrumentation and decompressive laminectomy of C1. The postoperative results are presented and the indications discussed. This procedure provides many advantages in the surgical treatment of Down syndrome compared with the conventional procedures, because of the associated mental retardation that makes the postoperative management very complicated.     

Management of primary headache in emergency services of Santos and surrounding towns

OBJECTIVES: Primary headaches are often seen by Clinicians on duty at Emergency Services. We have investigated the treatment of such patients by 43 medical doctors who have been working at Emergency Services in the city of Santos and surrounding towns for many years. RESULTS: We confirmed the high prevalence of primary headaches in Emergency Services. There seem to be diagnosis difficulties concerning differentiating attacks of migraine and tension type headache. We also observed that IV dipirone was the most frequently prescribed treatment for patients with primary headaches in this study. There is no protocol in the literature which recommends IV dipirone for the treatment of migraine attacks or other primary headaches. CONCLUSION: It would be advisable to perform controlled double blind studies in order to verify the advantages of IV dipirone in the treatment of intense attacks primary headaches. We concluded that headache management recycling programs could be of interest for doctors who regularly work at Emergency Services.     

The efficacy of RS-25259, a long-acting selective 5-HT3 receptor antagonist, for preventing postoperative nausea and vomiting after hysterectomy procedures

We evaluated the safety and efficacy of RS-25259, a potent and long-acting selective 5-HT3 receptor antagonist, for the prevention of postoperative nausea and vomiting (PONV) in women undergoing hysterectomy procedures. In this randomized, double-blind, placebo controlled, dose-ranging study, 218 healthy, consenting women were assigned to one of the six treatment groups: placebo or RS-25259 0.1, 0.3, 1.0, 3.0, or 30 microg/kg. All patients underwent a standardized general anesthetic technique. The study medication was administered i.v. 20-30 min before the end of surgery. During the initial 24-h period after surgery, the incidence of vomiting, the need for rescue antiemetics, the time to the first episode of emesis, and administration of rescue antiemetic medication, as well as a nausea visual analog scale and verbal categorical scale scores were recorded. In addition, recovery times from the end of anesthesia and the incidences of perioperative side effects were noted. Only 30 microg/kg RS-25259 significantly decreased the incidence of vomiting and the requirement for rescue antiemetics. The largest dose of RS-25259 also delayed the time to the first emetic episode and reduced the number of treatment failures. However, no differences were found in the severity of postoperative nausea (versus saline), and postoperative headaches were more common after the administration of RS-25259 0.3-30 microg/kg i.v. In conclusion, RS-25259 30 microg/kg i.v. was effective in reducing the incidence of PONV after major gynecologic surgery, but the occurrence of headaches with the larger doses of RS-25259 is a concern. Implications: RS-25259, a long-acting 5-HT3 antagonist, was effective in reducing postoperative vomiting only at the largest dose studied (30 microg/kg). However, RS-25259 had no antinausea activity, and the larger doses were associated with an increased incidence of headaches in the postoperative period.     

Transformed migraine, analgesic rebound, and other chronic daily headaches

Although the International Headache Society's classification of headache has greatly enhanced the diagnosis of migraine and cluster headache, its application in chronic headache has been less than satisfactory. Based on a review of the literature and the author's experience, this article demonstrates the need for an expanded and modified classification and broader understanding of chronic headaches. The author proposes new categories, including transformed migraine. Analgesic rebound is described as a major cause of chronic headaches. The comorbidity of chronic headache disorders is also discussed. The article concludes with a suggestion for management of chronic headaches.     

Methylergonovine maleate as a cluster headache prophylactic: a study and review

Methylergonovine maleate (Methergine), an ergot derivative with vasoconstrictive properties, has been cited as an effective treatment for vascular headaches. Few studies are available to support its use in headache management. An uncontrolled pilot study of 20 episodic cluster headache patients confirmed its effectiveness and tolerability as an adjunct cluster headache prophylactic. Decreased headache frequency was reported by 19 of 20 patients (95%), and 15 of 20 patients (75%) reported decreased intensity of headaches within 1 week of initiating therapy. A review of methylergonovine's pharmacokinetic, molecular, and tolerability profile clarifies its mechanisms and clinical role in headache management.     

Anesthesiological support, postoperative care and the results of the surgical treatment of patients with tumors of the base of the posterior cranial fossa

Problems of anesthesiological maintenance, measures of the postoperative management and results of surgical treatment of 76 patients with an oncological process on the base of the posterior cranial fossa are discussed. An analysis of informative-regulatory and adaptational reactions of organism is made on the basis of the intervalogram in the course of operative interventions near by the cerebral trunk. The results are estimated.     

Management of the patient with rheumatic diseases going to surgery

This article reviews the perioperative management of rheumatoid arthritis, gout, systemic lupus erythematosus, scleroderma, and ankylosing spondylitis. It discusses the unique interactions between each rheumatologic disease and a surgical challenge and provides guidelines for the assessment of patients preoperatively. The available literature on surgical risks is analyzed, and approaches are suggested to both reduce postoperative complications and control the rheumatic disease. It is hoped that this will aid the internist in evaluating and treating the rheumatic patient undergoing surgery.     

Immobilisation of levansucrase on calcium phosphate gel strongly increases its polymerase activity

The goal of podiatric surgery in the older patient should be pain management with the highest degree of functional restoration. Thorough preoperative analysis, meticulous surgical technique, and careful postoperative planning are necessary to ensure a favorable surgical result. Each planned procedure must coincide with the specific needs of the individual patient while conforming to the body's physical limitations. A complete medical examination with laboratory studies is indicated due to the elderly patient's inherent diminished physical status. When the patient is deemed a proper candidate for surgery, the medical team, family, and friends should be consulted regarding immediate and long-term postoperative care. Strict adherence to these principles is in the best interest of both the practitioner and the older patient.     

Modified condylotomy for chronic nonreducing disk dislocations

OBJECTIVES: To retrospectively evaluate the modified condylotomy procedure for patients with chronic nonreducing disk dislocations of the temporomandibular joint. STUDY DESIGNS: Sixty-three patients underwent 78 modified condylotomies on temporomandibular joints that had chronic nonreducing disk dislocations and that were previously treated unsuccessfully with nonsurgical modalities. Patients were asked to evaluate their pain, headaches, bite, and success rate postoperatively. Comparisons of patients' preoperative and postoperative maximum incisal opening were also made. Transpharyngeal and transcranial radiographs were compared to determine condylar changes. RESULTS: Ninety-four percent felt that their pain was better, one patient (2%) said that his pain was the same, and two patients (4%) felt that their pain was worse. Eighty percent considered their headaches were better, and one patient (2%) considered them worse. Seventy-eight percent said that their bite was the same or better, and 22% said it was worse. Three patients underwent a second surgery. Progressive condylar remodeling occurred in 81%, and regressive condylar remodeling occurred in 6%. The maximum incisal opening change was overall a positive change; 35% had a significant positive change, and 10% had a significant negative change. CONCLUSION: This retrospective study shows that the modified condylotomy should be considered as a surgical alternative in treating patients with chronic nonreducing disk dislocations that have been unsuccessfully treated nonsurgically.     

Comparison of ketorolac and opioid analgesics in postoperative ACL reconstruction outpatient pain control

Pain control is an important postoperative consideration with any surgical procedure. Technological and procedural improvements have contributed to the reduction in both the degree of surgical difficulty and the postsurgical complications associated with intricate surgeries. As a result, certain surgeries have potential for being performed on an outpatient basis, dependent upon appropriate pain-management regimens and the degree of potential for postoperative complications. Arthroscopic anterior cruciate ligament (ACL) reconstruction is a common procedure. Because of the reduction in invasiveness that arthroscopy provides, outpatient surgery is now routinely employed for ACL patients. The arguments against ACL outpatient surgery have included the reluctance to use ambulatory, indwelling, intravenous pain-pump delivery systems for opioid pain medication. The purpose of this study was to determine the efficacy of a ketorolac tromethamine used for the management of the postoperative pain produced as a result of outpatient ACL reconstruction. When the ketorolac pain management regimen is compared in this setting with meperidine or morphine, pain control is as good as, or in some cases better than, either of the opioid drugs. Additionally, the adverse side effects associated with opioid drugs are significantly reduced at a substantially lower direct cost to the patient.     

The individualized choice of the method of operation in the planned surgery of gastric and duodenal peptic ulcers

A working classification of gastroduodenal ulcers was developed by the authors on the basis of surgical treatment of 1838 patients with ulcer disease of the stomach and duodenum. When used in combination with the complex examination of the patients it allows to individually choose the operative method. The indications and contraindications for different kinds of surgery are given. Specific features of the postoperative management are described.     

Resection of a large temporooccipital parenchymal arteriovenous fistula by using deep hypothermic circulatory bypass. Case report

The authors believe this to be the first published case in which a deep hypothermic cardiopulmonary bypass was used to facilitate resection of a large parenchymal arteriovenous fistula. The use of this procedure facilitated resection of the lesion by allowing compression and manipulation of large venous varices that were overlying the deeper arterial feeding vessels. The surgical rationale, technique, and intra- and postoperative management are discussed.