Herziene richtlijn 'Postoperatieve pijn'

On the initiative of the Dutch Association of Anaesthesiologists, a multidisciplinary workgroup has revised the 2003 practice guideline on 'Postoperative pain treatment' for adults and children. The main reason for revision was the availability of new drugs and new methods of administration. The most important deviations from the previous edition are the following. The organisation of care has been amended according to the current themes of the Safety Management System in the Netherlands, and a prediction model for postoperative pain was added. The drugs oxycodone, S-ketamine, pregabalin, gabapentin and metamizole were added, as well as new methods of administration and techniques for preventing postoperative pain. This revised guideline is more conservative than the previous one in the choice of epidural analgesia. In patients with relative contraindications for epidural analgesia, peripheral and locoregional blocks or multimodal pain treatment are advised. In the case of postoperative nausea and vomiting, administration of dexamethasone, droperidol and 5-HT3-antagonists is recommended, preferably in combination. Non-medicinal treatment options are not recommende

Herziene richtlijn 'Delier volwassenen en ouderen'

A multidisciplinary workgroup has revised the 2004 practice guidelines on 'Delirium' on the initiative of the Dutch Geriatrics Society. In comparison with the previous version, the new guidelines place more emphasis on screening and non-pharmaceutical prevention and treatment. They recommend a degree of restraint when prescribing medication. Both the patient's and the caregiver's perspectives are discussed. The guidelines also focus on delirium in patients in a nursing home setting, and describe what the workgroup regards as optimal care for patients suffering from delirium. The revised guidelines consider the diagnosis and treatment of delirium as a part of basic medical care and primarily the responsibility of the attending physician. The workgroup advises consulting an expert in the field of delirium only in cases of lack of experience, and for complex cases. The guidelines also include recommendations for the organization of follow-up care for the delirium patien