- Bupivacaine vs. Pethidine in Spinal Anesthesia of Old Patients: Haemodynamic Changes and Complications. [Journal Article]
- AJAsian J Anesthesiol 2019; 2019(2019):1-9
- CONCLUSIONS: By regarding different aspects of opioids use, it seems pethidine is more efficient due to longer analgesic time, similar hemodynamic changes, fewer headache, and shivering occurrence in comparison to bupivacaine in old patients.
- Risk factors for postoperative delirium in patients undergoing lower extremity joint arthroplasty: a retrospective population-based cohort study. [Journal Article]
- RAReg Anesth Pain Med 2019 Jul 12
- CONCLUSIONS: In this large national cohort, we identified various modifiable risk factors (including anesthesia type and pharmaceutical agents) for postoperative delirium, demonstrating possible prevention pathways.
- Opioid Management in Older Adults with Chronic Kidney Disease: A Review. [Review]
- AJAm J Med 2019 Jul 08
- Chronic pain, a common comorbidity of chronic kidney disease, is consistently under-recognized and difficult to treat in older adults with non-dialysis chronic kidney disease. Given the decreased kid…
Chronic pain, a common comorbidity of chronic kidney disease, is consistently under-recognized and difficult to treat in older adults with non-dialysis chronic kidney disease. Given the decreased kidney function associated with aging and chronic kidney disease, these patients are at increased risk for drug accumulation and adverse events. Emerging research has demonstrated the efficacy of opioids in chronic kidney disease patients, but research specifically focusing on older, non-dialysis chronic kidney disease patients is scarce. The primary objective of this review is to determine which oral and transdermal opioids are the safest for older, non-dialysis chronic kidney disease patients. We discuss the limited existing evidence on opioid prescription in older, non-dialysis chronic kidney disease patients and provide recommendations for the management of oral and transdermal opioids in this patient population. Specifically, transdermal buprenorphine, transdermal fentanyl, and oral hydromorphone are the most tolerable opioids in these patients; hydrocodone, oxycodone, and methadone are useful but require careful monitoring; and tramadol, codeine, morphine, and meperidine should be avoided due to risk of accumulation and adverse events. Since older adults with non-dialysis chronic kidney disease are at increased risk for adverse events, vigilant monitoring of opioid prescription is critical. Lastly, collaboration among an interprofessional clinical team can ensure safe prescription of opioids in older adults with non-dialysis chronic kidney disease.
- Comparison of Electric Resistive Heating Pads and Forced-Air Warming for Pre-hospital Warming of Non-shivering Hypothermic Subjects. [Journal Article]
- MMMil Med 2019 Jul 11
- CONCLUSIONS: Total heat gain was greater in FAW than both EHP, and spontaneous rewarming conditions, however, there were no observed differences found in rewarming rates, post-cooling afterdrop or metabolic heat production. The electric heat pad system provided similar rewarming performance to a forced-air warming system commonly used in US military field hospitals for hypothermic patients. A battery-powered version of this system would not only relieve pressure on the field hospital power supply but could also potentially allow extending use to locations closer to the field of operations and during transport. Such a system could be studied in larger groups in prospective trials on colder patients.
- Deep Learning-Assisted Three-Dimensional Fluorescence Difference Spectroscopy for Identification and Semiquantification of Illicit Drugs in Biofluids. [Journal Article]
- ACAnal Chem 2019 Jun 13
- The fast identification and quantification of illicit drugs in biofluids are of great significance in clinical detection. However, existing drug detection strategies cannot fully meet clinical needs,…
The fast identification and quantification of illicit drugs in biofluids are of great significance in clinical detection. However, existing drug detection strategies cannot fully meet clinical needs, and the on-site identification and quantification of various illicit drugs in biofluids remain a great challenge. Here, we report the development of a deep learning-assisted three-dimensional (3D) fluorescence difference spectroscopy for rapid identification and semiquantification of illicit drugs in biofluids. This strategy introduces highly fluorescent silver nanoclusters into the biofluids with illicit drugs as signal sources. The interaction between silver nanoclusters and drug molecules changed the fluorescence performance of the mixture. Deep learning methods were applied to grasp the subtle fingerprint information from the 3D fluorescence difference spectra to identify and semiquantify various illicit drugs in biofluids, including codeine, 4,5-methylene-dioxy amphetamine, 3,4-methylene dioxy methamphetamine, meperidine, and methcathinone. This approach can achieve a high prediction accuracy rate of 88.07% and a broad detection range from 2 μg/mL to 100 mg/mL. It opens up a new way for the detection of small molecules with or without fluorescence in complicated matrixes.
- Comparison of Effects of Hemostatic Gelatin Sponge Impregnated with Ropivacaine versus Normal Saline Applied on the Transverse Process of the Operated Vertebrae on Postoperative Pain in Patients Undergoing Spinal Instrumentation Surgery: A Randomized Clinical Trial. [Journal Article]
- WNWorld Neurosurg 2019 May 20
- CONCLUSIONS: Use of intraoperative hemostatic gelatin sponge impregnated with ropivacaine applied on the transverse process of the operated vertebrae intraoperatively resulted in decreasing the postoperative pain in patients undergoing lumbar instrumentation surgery as manifested by the decrease in the VAS score and the total dose of opioids.
- MMP-9 and MMP-2 regulation in patients undergoing non-oncological and non-vascular elective surgery independent of the use of propofol or sevoflurane. [Journal Article]
- PRPharmacol Rep 2019; 71(3):528-534
- CONCLUSIONS: Concluding, neither sevoflurane nor propofol used as anesthetics modulate MMP-2 and MMP-9 concentrations and activities during non-oncological, non-vascular elective surgery. Meperidine seems to decrease MMP-9 activity.
- Opioids: A Review of Pharmacokinetics and Pharmacodynamics in Neonates, Infants, and Children. [Review]
- EJEur J Drug Metab Pharmacokinet 2019 Apr 22
- Pain management in the pediatric population is complex for many reasons. Mild pain is usually managed quite well with oral acetaminophen or ibuprofen. Situations involving more severe pain often requ…
Pain management in the pediatric population is complex for many reasons. Mild pain is usually managed quite well with oral acetaminophen or ibuprofen. Situations involving more severe pain often require the use of an opioid, which may be administered by many different routes, depending on clinical necessity. Acute and chronic disease states, as well as the constantly changing maturational process, produce unique challenges at every level of pediatrics in dosing and management of all medications, especially with regard to high-risk opioids. Although there has been significant progress in the understanding of opioid pharmacokinetics and pharmacodynamics in neonates, infants, children, and adolescents, somewhat limited data exist from which necessary information, concerning the safe and effective use of these agents, may be drawn. The evidence here provided is intended to be helpful in directing the practitioner to patient-specific reasons for preferring one opioid over another. As our knowledge of opioids and their effects has grown, it has become clear that older medications like codeine and meperidine (pethidine) have very limited use in pediatrics. This review provides pharmacokinetic and pharmacodynamic evidence on the currently available opioids: morphine, fentanyl (and derivatives), codeine, meperidine, oxycodone, hydrocodone, hydromorphone, methadone, buprenorphine, butorphanol, nalbuphine, pentazocin, ketobemidone, tramadol, piritramide, naloxone and naltrexone. Morphine, being the most studied opioid analgesic, is the standard against which all others are compared. Pharmacokinetic parameters of morphine that have been found in neonates, i.e., higher volume of distribution, immature metabolic processes that develop at various rates, elimination that is variable based on age and weight, as well as treated and untreated disease processes, are an example of all opioids in the population discussed in this review. Outside the premature and neonatal population, the use of opioids in infants, children, and adolescents quickly begins to resemble the established values found in adults. As such, the concerns (risks) of these medications become comparable to those seen in adults.
- Reductions in length of stay, narcotics use, and pain following implementation of an enhanced recovery after surgery program for 1- to 3-level lumbar fusion surgery. [Journal Article]
- NFNeurosurg Focus 2019 Apr 01; 46(4):E4
- CONCLUSIONS: In this very initial implementation of the first phase of an ERAS program for short-segment lumbar fusion, the authors were able to demonstrate substantial positive effects on the early recovery process. Importantly, these effects were not surgeon-specific and could be generalized across surgeons with disparate technical predilections. The authors plan additional iterations to their ERAS protocols for continued quality improvements.
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- Usage of Intravenous Lidocaine Infusion with Enhanced Recovery Pathway in Patients Scheduled for Open Radical Cystectomy: A Randomized Trial. [Randomized Controlled Trial]
- PPPain Physician 2019; 22(2):E71-E80
- CONCLUSIONS: Adding IVLI to ERP improved postoperative analgesia and bowel function after open RC with urinary diversion.