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New Trends and Approaches in Perioperative Pharmacotherapy

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Anesthesia and surgery are related with significant shifts in physiological parameters requiring correction. Besides the general and local anesthetics, drugs from multiple pharmacological groups are frequently used to treat perioperative pain, arterial hypertension (AH), arrhythmias, postoperative and ...

Anesthesia and surgery are related with significant shifts in physiological parameters requiring correction. Besides the general and local anesthetics, drugs from multiple pharmacological groups are frequently used to treat perioperative pain, arterial hypertension (AH), arrhythmias, postoperative and post-discharge nausea and vomiting (PONV and PDNV), and other symptoms during the perioperative period.
With advances in medicine and increased lifespan of the population, more patients present to the operating room with coexisting diseases requiring chronic therapy. Among them are: arterial hypertension, diabetes mellitus, chronic congestive heart disease, cardiovascular and cerebrovascular pathology, epilepsy, psychiatric disorders, morbid obesity, which frequently require continuous treatment on the day of surgery and in the early postoperative period increasing the perioperative risks. Depending on specific situation, patients may be required to stop their medications, switch to alternative drugs or continue the prescribed drugs throughout the perioperative period increasing the chances of adverse drug interactions.
Thus, there are questions regarding perioperative drug management that require further clarification. These areas include but are not limited to:
1. Novel approaches to AH in the perioperative period. The clinical efficacy, safety, and main indications for perioperative use of the newly developed antihypertensive medications (e.g. clevidipine) require further clarification. It is important to determine the main indications and limitations for their application in various groups of surgical patients (neurosurgical, pediatric, obstetrical patients, etc.).
2. Treatment of arrhythmias during the perioperative period. The risk / benefit ratio of beta blockers and their effects on stroke incidence, risk of postoperative cardiac events requires further research.
3. Postoperative analgesia, side effects and alternatives to opioids. Opioid tolerance and opioid-induced hyperalgesia as a result of postoperative analgesia are important topics requiring attention.
4. Current methods and anesthetic modifications to prevent PONV and PDNV. Most of the currently available methods may result in serious adverse effects. In addition, a longer drug administration is required to treat the PDNV making the treatment more risky and less cost-effective.
5. Anticoagulants and anti-platelet drugs in the perioperative period. A coronary arterial stent is placed at the time of the percutaneous coronary intervention in 90% of adults, and approximately 5% of them undergo non-cardiac surgery within a year of stent placement.
6. Perioperative drug – drug interactions. The incidence is proportional to the number of perioperative drugs used.
7. Postoperative cognitive disorders. Postoperative delirium and cognitive decline are serious complications related with significant morbidity and increased mortality.
8. Neuroinflammation and modern anesthetics. The ability of general anesthetics to trigger neuroinflammation and their effects on neuro-glial interaction is an important area, where many processes and mechanisms have yet to be explained.
9. Optimizing the anesthesia during intraoperative neurophysiological monitoring. Continuous infusions of ketamine, dexmedetomidine, lidocaine, stable delivery of anesthetics help to improve reliability of intraoperative evoked potentials. Further research is required to validate various approaches.

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