An analysis of renal dysfunction in 1511 patients with fractured neck of femur: the implications for peri‐operative analgesia

White, Stuart; Rashid, Nadeem; Chakladar, Abhijoy

doi:10.1111/j.1365-2044.2009.06012.x

Cited by 57 publications

(46 citation statements)

References 20 publications

(30 reference statements)

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“…All patients should have prescribed regular paracetamol [13] and, cautiously, short courses of non-steroidal antiinflammatory drugs [91]. It should be noted, however, that~36% of hip fracture patients present with at least moderate renal dysfunction, which can potentiate the adverse effects of both opioid and non-steroidal analgesia [92].…”

Section: Postoperative Carementioning

confidence: 99%

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

2013

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SummaryNational reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely to rise as the population ages, this review summarises the evidence on which such guidance is based, and provides information about how anaesthetists might participate in audit and research aimed at improving local and national outcomes for these most vulnerable of patients. More recently, national audits have reported several-fold variations in the care of elderly emergency surgical patients in the UK [4][5][6], and importantly, these data are beginning to be used to drive quality improvement [11] through professional guidance [12][13][14] that advocates early, focused, multidisciplinary 70

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Section: Postoperative Carementioning

confidence: 99%

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

2013

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“…There is a degree of variability in effectiveness, with up to 30% of patients being poor debrisoquine hydroxylators/O-demethylators of codeine to form morphine, such that analgesia is limited or not achieved [56]. Conversely, 1-3% of British patients are ultrafast metabolisers of codeine and tramadol (UM CYP2D6 genotype), converting these prodrugs to their active forms rapidly, leading to their accumulation in renal failure, and resulting in respiratory depression or apnoea [57]. Conversion to active metabolites is inhibited by common medications, including cimetidine, haloperidol, amitriptylline and many selective serotonin re-uptake inhibitors (e.g.…”

Section: Codeinementioning

confidence: 99%

The assessment and management of peri‐operative pain in older adults

Schofield

2013

Anaesthesia

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SummaryA number of recent reports have highlighted the inadequate provision of pain relief for older inpatients. Despite the availability of numerous validated pain measures, pain remains poorly assessed in some cases and, particularly, in the cognitively impaired. Without proper assessment, patients may receive inadequate or inappropriate analgesia, both of which can worsen outcome. Most drugs and techniques that are used for analgesia in younger patients are also suitable for older patients, although dosages may have to be adjusted to avoid the side‐effects that are consequent upon age‐related changes in drug pharmacokinetics and pharmacodynamics, co‐morbidity, frailty, cognitive impairment and polypharmacy. This paper reviews current guidelines and methods of assessing pain in the older adult, and describes the use of, and problems with, mild, moderate, strong, adjuvant and local anaesthetic drugs in the older population for analgesia, advocating multimodal intervention to reduce dose‐related side‐effects, particularly of opioids.

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“…The Brighton Hip Fracture Database [1] contains data that supports Tighe's assertion that low-dose spinal anaesthesia is perfectly safe to use, even for longer procedures. Over the last 4 [2].…”

mentioning

confidence: 78%

Duration of low‐dose spinal anaesthesia for hip fracture surgery

White

2016

Anaesthesia

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An analysis of renal dysfunction in 1511 patients with fractured neck of femur: the implications for peri‐operative analgesia

Cited by 57 publications

References 20 publications

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

The assessment and management of peri‐operative pain in older adults

Duration of low‐dose spinal anaesthesia for hip fracture surgery

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