RESUMEN
Perioperative pain management in neurosurgical patients has been inadequately recognized and treated. An increased awareness of pain management and advances in understanding of pain modulation and pathophysiology have led to improved perioperative care of patients. There is a need to assess neurologic function while providing superior analgesia with minimal side effects. Several classes of drugs are currently available or under investigation for use as adjuvants or alternative therapies. There remains a need to determine the best treatment of perioperative pain in this patient population. Improved awareness, assessment, and treatment of pain result in better care and overall patient outcome.
Asunto(s)
Analgesia/métodos , Procedimientos Neuroquirúrgicos/métodos , Manejo del Dolor/métodos , Atención Perioperativa/métodos , Analgésicos/administración & dosificación , Analgésicos/efectos adversos , Analgésicos/uso terapéutico , Analgésicos no Narcóticos/administración & dosificación , Analgésicos no Narcóticos/uso terapéutico , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Analgésicos Opioides/uso terapéutico , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/uso terapéutico , Craneotomía , Preparaciones de Acción Retardada , Antagonistas de Aminoácidos Excitadores/uso terapéutico , Humanos , Complicaciones Intraoperatorias/terapia , Procedimientos Neuroquirúrgicos/efectos adversos , Dolor/fisiopatología , Dimensión del Dolor , Dolor Postoperatorio/terapia , Columna Vertebral/cirugíaRESUMEN
Increasing evidence suggests that Mannan-binding lectin (MBL), the initial factor of the lectin pathway of complement, plays a role in cardiovascular diseases, i.e. inversely associated with risk of myocardial infarction (MI). In the present case, a patient with MBL deficiency underwent coronary artery bypass grafting (CABG) after an acute MI with underlining chronic lymphocytic leukemia (CLL). Post-operatively, the patient had a cerebral vascular accident and eventually expired. Analysis of his blood samples from pre-, intra-, and post-operative periods showed that MBL levels abruptly increased post-operatively. We hypothesize that the post-operative increase of MBL in the patient with pre-existing MBL deficiency may contribute to systemic inflammation, causing a detrimental effect after cardiac surgery.