PREFACE

Abstract

This issue presents an update on acute pain management in the critically ill patient. Authors were selected based on their individual areas of expertise, and have presented fundamental principles of pain management in their respective fields, together with new developments and information that have become available over recent years. Sometimes this involves presentation of topics little discussed, such as opioid pharmacokinetics in the liver transplant population, or the influence of opioids on ventilatory control in the postoperative period. More often, however, existing techniques are re-evaluated based on new information that has come to light regarding risk-benefit ratios. Thus the risks of acute renal dysfunction and upper gastrointestinal hemorrhage following short-term administration of ketorolac are revisited; multicenter data clarifying the cost-effective use of nonsteroidal anti-inflammatory agents are presented; and updates on the efficacy of a well-established analgesic, ketamine, in the management of status epilepticus and status asthmaticus are discussed.Although its exact contribution to outcome remains ill defined, the stress response to acute injury is discussed in detail, as investigation continues into its control, particularly through the use of analgesic agents. Efficacy data of local as compared to intravenous analgesics in altering morbidity and mortality following thoracoabdominal injury are presented, and the use of local anesthetic techniques is discussed for both the pediatric and adult populations.This issue is designed for use by clinicians. Although some of the authors have researched and published extensively in those subjects covered by their articles, all authors were chosen based on their extensive clinical experience in their appointed topics. Our aim was to design a text that would provide both revision and updating of the basic subject matter, while at the same time direct the practitioner towards using a drug or technique with confidence. Therefore, drug dosages and infusion rates are frequently supplied and local anesthetic techniques described in detail. We have personally found enriching the revision and editing of the individual manuscripts rewarding, and believe that the contributors have successfully provided subject matter that is well-balanced between theoretical understanding and practical clinical implementation, a balance which so often seems to define a good clinician.ACKNOWLEDGMENTWe would like to acknowledge Mrs. Lisa Kimbrough for the excellent administrative support she provided while preparing this issue for publication. This issue presents an update on acute pain management in the critically ill patient. Authors were selected based on their individual areas of expertise, and have presented fundamental principles of pain management in their respective fields, together with new developments and information that have become available over recent years. Sometimes this involves presentation of topics little discussed, such as opioid pharmacokinetics in the liver transplant population, or the influence of opioids on ventilatory control in the postoperative period. More often, however, existing techniques are re-evaluated based on new information that has come to light regarding risk-benefit ratios. Thus the risks of acute renal dysfunction and upper gastrointestinal hemorrhage following short-term administration of ketorolac are revisited; multicenter data clarifying the cost-effective use of nonsteroidal anti-inflammatory agents are presented; and updates on the efficacy of a well-established analgesic, ketamine, in the management of status epilepticus and status asthmaticus are discussed. Although its exact contribution to outcome remains ill defined, the stress response to acute injury is discussed in detail, as investigation continues into its control, particularly through the use of analgesic agents. Efficacy data of local as compared to intravenous analgesics in altering morbidity and mortality following thoracoabdominal injury are presented, and the use of local anesthetic techniques is discussed for both the pediatric and adult populations. This issue is designed for use by clinicians. Although some of the authors have researched and published extensively in those subjects covered by their articles, all authors were chosen based on their extensive clinical experience in their appointed topics. Our aim was to design a text that would provide both revision and updating of the basic subject matter, while at the same time direct the practitioner towards using a drug or technique with confidence. Therefore, drug dosages and infusion rates are frequently supplied and local anesthetic techniques described in detail. We have personally found enriching the revision and editing of the individual manuscripts rewarding, and believe that the contributors have successfully provided subject matter that is well-balanced between theoretical understanding and practical clinical implementation, a balance which so often seems to define a good clinician. ACKNOWLEDGMENT We would like to acknowledge Mrs. Lisa Kimbrough for the excellent administrative support she provided while preparing this issue for publication.