Taking knee arthroplasty as an example , patients deemed at low risk of experiencing outcomes such as postoperative pain or chronic pain  may receive intra-articular local anaesthesia infiltration ;  patients at medium risk may obtain additional analgesia via a saphe-nous nerve catheter ; and patients at high risk may also receive nerve blocks and anti-hyperalgesics .
pain and function after fast-track hip and knee arthroplasty .
catastrophizing , response to experimental heat stimuli , and post-cesarean section pain .
In 1946 , Mendelson 1 showed that pulmonary complications and death could arise in pregnant women because of aspiration of gastric contents .
Since then , prevention of aspiration of gastric contents has contributed significantly to a decrease in maternal deaths .
Warner and colleagues 2 demonstrated in a large series from the Mayo Clinic that no aspiration occurred in pregnant or post-partum women ( probably because of the routine use of prophylactic measures ) , while both its occurrence and severity were significant in emergency procedures .
formation of large informatic data bases , or clinical quality registries , linking preoperative and intraoperative clinical data , imaging , genomics , and cancer and drug prescription data bases .
References 1 Fischer HB , Simanski CJ , Sharp C , et al. A procedure-specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty .
Postoperative pain management : number-needed-to-treat approach versus procedure-specific pain management approach .
Effect of Metoclopramide on Gastric Fluid Volumes in Diabetic Patients Who Have Fasted before Elective Surgery
Background : Diabetes-induced gastroparesis is believed to increase fasting gastric fluid volume before elective surgery . Metoclopramide is routinely administered preoperatively to reduce gastric fluid volume in these patients . This study compared nondiabetic controls to non – insulin-dependent and insulin-dependent diabetics to determine the effect of metoclopramide , administered before surgery , on gastric volumes in patients who fasted before surgery . Methods : Control and diabetic patients fasted preoperatively before receiving either placebo or 10 mg intravenous metoclopramide 20 min before induction of anesthesia . After intubation , a gastric tube was placed , and stomach contents were aspirated with volumes compared among the groups . Results : Both groups of diabetic patients were older than the control group , and insulin-dependent patients had a higher incidence of comorbidities compared with the non – insulin-dependent group .  Fasting blood sugar and hemoglobin A1C values were higher in both insulin-dependent and non – insulin-dependent patients . Gastric fluid volumes were similar in control , non – insulin-dependent , and insulin-dependent patients ( 8.0 ± 2.6 vs. 9.6 ± 4.1 vs. 17.7 ± 2.5 ml , respectively ) . In insulin-dependent diabetic patients , metoclopramide decreased gastric volume compared with placebo treatment ( 17.7 ± 2.5 vs. 7.8 ± 2.9 ml ; P = 0.027 ) . After stratification , a sub population of patients with poorly controlled diabetes , regardless of type , were identified to have increased gastric residual volumes . Conclusion : In elective surgical patients who have fasted before surgery  , gastric volumes are minimal , even in diabetics with severe neuropathic symptoms . Metoclopramide prophylaxis to reduce gastric volumes seems to be unnecessary unless the patient has a prolonged history of poor blood glucose control
Taking knee arthroplasty as an example , patients deemed at low risk of experiencing outcomes such as postoperative pain or chronic pain  may receive intra-articular local anaesthesia infiltration ;  patients at medium risk may obtain additional analgesia via a saphe-nous nerve catheter ; and patients at high risk may also receive nerve blocks and anti-hyperalgesics .
pain and function after fast-track hip and knee arthroplasty .
catastrophizing , response to experimental heat stimuli , and post-cesarean section pain .
In 1946 , Mendelson 1 showed that pulmonary complications and death could arise in pregnant women because of aspiration of gastric contents .
Since then , prevention of aspiration of gastric contents has contributed significantly to a decrease in maternal deaths .
Warner and colleagues 2 demonstrated in a large series from the Mayo Clinic that no aspiration occurred in pregnant or post-partum women ( probably because of the routine use of prophylactic measures ) , while both its occurrence and severity were significant in emergency procedures .
formation of large informatic data bases , or clinical quality registries , linking preoperative and intraoperative clinical data , imaging , genomics , and cancer and drug prescription data bases .
References 1 Fischer HB , Simanski CJ , Sharp C , et al. A procedure-specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty .
Postoperative pain management : number-needed-to-treat approach versus procedure-specific pain management approach .