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https://www.readbyqxmd.com/read/29679692/impact-of-fellowship-training-level-on-colonoscopy-quality-and-efficiency-metrics
#1
Hussein Bitar, Hassaan Zia, Muhammad Bashir, Pratyusha Parava, Muhammad Hanafi, William Tierney, Mohammad Madhoun
BACKGROUND & AIMS: Previous studies have described variable effects of fellow involvement on the adenoma detection rate (ADR), but few have stratified this effect by level of training. We aimed to evaluate the "fellow effect" on multiple procedural metrics including a newly defined adenoma management efficiency index, which may have a role in documenting colonoscopy proficiency for trainees. We also describe the impact of level of training on moderate sedation use. METHODS: We performed a retrospective review of 2024 patients (mean age 60...
April 18, 2018: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/29679681/inhibition-of-protein-kinase-a-and-girk-channel-reverses-fentanyl-induced-respiratory-depression
#2
Xiaonan Liang, Zheng Yong, Ruibin Su
Opioid-induced respiratory depression is a major obstacle to improving the clinical management of moderate to severe chronic pain. Opioids inhibit neuronal activity via various pathways, including calcium channels, adenylyl cyclase, and potassium channels. Currently, the underlying molecular pathway of opioid-induced respiratory depression is only partially understood. This study aimed to investigate the mechanisms of opioid-induced respiratory depression in vivo by examining the effects of different pharmacological agents on fentanyl-induced respiratory depression...
April 18, 2018: Neuroscience Letters
https://www.readbyqxmd.com/read/29679387/the-pharmacokinetics-and-pharmacodynamics-of-carfentanil-after-recreational-exposure-a-case-report
#3
Uvaraj Uddayasankar, Colin Lee, Curtis Oleschuk, Gregg Eschun, Robert E Ariano
Carfentanil and related fentanyl analogues have been linked to a number of overdose deaths from drug users in several cities across North America. Diagnosis of carfentanil exposure requires a very high index of clinical suspicion, especially because available laboratory narcotic screens do not detect this agent. We describe a 34-year-old male admitted with depressed level of consciousness and in respiratory failure after recreational exposure to a white powder later inferred to contain carfentanil. Urine and whole blood samples were obtained for conventional preliminary drug screen immunoassays for unknown exposures; in addition to utilizing high pressure liquid chromatography tandem mass spectrometry assay for quantification of carfentanil and its metabolite...
April 20, 2018: Pharmacotherapy
https://www.readbyqxmd.com/read/29678561/distribution-of-take-home-opioid-antagonist-kits-during-a-synthetic-opioid-epidemic-in-british-columbia-canada-a-modelling-study
#4
Michael A Irvine, Jane A Buxton, Michael Otterstatter, Robert Balshaw, Reka Gustafson, Mark Tyndall, Perry Kendall, Thomas Kerr, Mark Gilbert, Daniel Coombs
BACKGROUND: Illicit use of high-potency synthetic opioids has become a global issue over the past decade. This misuse is particularly pronounced in British Columbia, Canada, where a rapid increase in availability of fentanyl and other synthetic opioids in the local illicit drug supply during 2016 led to a substantial increase in overdoses and deaths. In response, distribution of take-home naloxone (THN) overdose prevention kits was scaled up (6·4-fold increase) throughout the province...
April 17, 2018: Lancet. Public Health
https://www.readbyqxmd.com/read/29678487/effective-postoperative-analgesia-using-intravenous-flurbiprofen-and-acetaminophen
#5
Mitsuhiro Yoshida, Yoshitaka Shimizu, Keita Yoshida, Akari Mukai, Mitsuru Doi, Masahiro Irifune
PURPOSE: Management of postoperative pain is one of the most important components in postoperative care, because most patients have pain after dental surgery. The aim of this study was to evaluate whether acetaminophen could be an alternative to fentanyl in combination with a nonsteroidal anti-inflammatory drug (NSAID) as an analgesic after dental surgery in cases in which narcotic drugs were contraindicated. MATERIALS AND METHODS: Patients were 24- to 54-year-old men who underwent enucleation of a mandibular cyst under general anesthesia...
March 28, 2018: Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/29678158/dexmedetomidine-infusion-as-an-analgesic-adjuvant-during-laparoscopic-%C3%B1-holecystectomy-a-randomized-controlled-study
#6
Kateryna Bielka, Iurii Kuchyn, Volodymyr Babych, Kseniia Martycshenko, Oleksii Inozemtsev
BACKGROUND: Dexmedetomidine (DEX) has sedative, sympatholytic and analgesic effects and might be beneficial if used as an adjuvant to: improve analgesia; modulate haemodynamic responses to intubation and pneumoperitoneum and; reduce the number of opioid-associated adverse events. The aim of this study was to evaluate the efficacy and safety of DEX infusion during elective laparoscopic cholecystectomy (LC). METHODS: A randomized, single-centre, parallel-group, placebo-controlled study was carried out between May 2016 and June 2017...
April 20, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29675893/characteristics-of-opioid-maintained-clients-smoking-fentanyl-patches-the-importance-of-confirmatory-drug-analysis-illustrated-by-a-case-series-and-mini-review
#7
Andreas Kimergård, Jacklyn Dunne, Anette Bøgen, Peter Hindersson, Torben Breindahl
The increase in opioid prescribing in many European countries over the last decade has raised concerns about associated diversion, overdose and mortality. Fentanyl is one of these synthetic opioids that is typically prescribed as a transdermal patch for pain that requires continuous pain relief and has been the focus of investigations due to reports of overdose and death. We report a case series of 14 drug addiction treatment entrants who entered treatment in one service located in the region of Southern Denmark from August 2015 to December 2015 for smoking fentanyl patches...
April 19, 2018: Drug Testing and Analysis
https://www.readbyqxmd.com/read/29669042/p-glycoprotein-on-blood-brain-barrier-plays-a-vital-role-in-fentanyl-brain-exposure-and-respiratory-toxicity-in-rats
#8
ChenChen Yu, Mei Yuan, HaiYing Yang, XiaoMei Zhuang, Hua Li
Fentanyl is a rapid-acting, short duration opioid analgesic agent. In recent years, increased prescription and illicit use of fentanyl drugs have led to major safety concerns and a growing death toll. However, the causes of fentanyl induced fatal adverse effects have not been thoroughly researched. The current study investigated P-glycoprotein (P-gp) modulated brain blood barrier (BBB) penetration of fentanyl and its resulting toxicity in vitro and in vivo. ATPase assays were performed together with bi-directional transport assays using Caco-2 cells in the presence and absence of tariquidar, a P-gp inhibitor, to confirm the P-gp substrate property of fentanyl...
April 14, 2018: Toxicological Sciences: An Official Journal of the Society of Toxicology
https://www.readbyqxmd.com/read/29668546/induction-dosage-of-propofol-for-repeated-sedations-in-children-with-hematological-disorders
#9
Alessandra Moretto, Alberto Zanella, Valentina Ciceri, Matteo Rota, Vittorio Scaravilli, Virginia Beltrama, Mariagrazia Bosatra, Antonio Pesenti
Pediatric patients with hematologic malignancies require several procedural sedations by means of propofol infusion. We retrospectively analyzed the medical records of leukemic pediatric patients who had undergone procedural sedations at an Italian tertiary referral center (San Gerardo Hospital, Monza) from January 2011 to November 2013. We retrieved the following: demographics; diagnosis; chemotherapy phase; use of corticosteroids; induction dosage of propofol, fentanyl and/or ketamine; and the type of procedure...
April 17, 2018: Journal of Pediatric Hematology/oncology
https://www.readbyqxmd.com/read/29659874/carfentanil-in-impaired-driving-cases-and-the-importance-of-drug-seizure-data
#10
Nicholas B Tiscione, Ilene Alford
Drug seizures containing carfentanil continue to increase in Palm Beach County, FL, USA despite international efforts to control the distribution of the drug. The analysis of drug seizures from the county in 2016 and 2017 demonstrated that carfentanil was the most commonly identified fentanyl analog and was most often detected in combination with heroin, fentanyl, furanyl fentanyl and/or other fentanyl analogs. Carfentanil is an ultra-potent opioid requiring a method with adequate sensitivity for detection in blood specimens from impairment cases...
April 12, 2018: Journal of Analytical Toxicology
https://www.readbyqxmd.com/read/29657246/effects-of-three-forms-of-local-anesthesia-on-perioperative-fentanyl-induced-hyperalgesia
#11
Lu Chang, Fang Ye, Quehua Luo, Zewen Wang, Yimin Wang, Zhengyuan Xia, Haihua Shu
Both local infiltration analgesia (LIA) and nerve block are common analgesic modalities for pain relief after surgery. The aim of the current study was to investigate the effects of those two modalities on pain behavior and the expression of pro-inflammatory cytokines such as interleukin (IL)-1β and IL-6 and tumor necrosis factor-α (TNF-α) in the spinal cord and dorsal root ganglion (DRG) in a rat model of perioperative fentanyl induced hyperalgesia. Rats were injected with fentanyl (60 μg/kg) 4 times and received a plantar incision after the second injection or they received pre-incision LIA and sciatic nerve block (SNB) or post-incision LIA with levobupivacaine (0...
April 15, 2018: Bioscience Trends
https://www.readbyqxmd.com/read/29655977/dexmedetomidine-or-fentanyl-cardiovascular-stability-and-analgesia-during-propofol-ketamine-total-intravenous-anaesthesia-in-experimental-pigs
#12
Andreas Lervik, Joanna Raszplewicz, Birgit Ranheim, Susanna Solbak, Simen F Toverud, Henning A Haga
OBJECTIVE: To compare cardiovascular function and response to nociception during total intravenous anaesthesia in pigs with propofol, ketamine and either dexmedetomidine or fentanyl administered as a continuous infusion. STUDY DESIGN: Blinded, randomized, balanced, crossover study ANIMALS: Eight immunocastrated male, mixed breed pigs with a mean ± standard deviation body weight of 26.4 ± 1.9 kg for dexmedetomidine and 27.5 ± 3.8 kg for fentanyl treatment...
December 5, 2017: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/29652752/practice-change-from-intermittent-medication-boluses-to-bolusing-from-a-continuous-infusion-in-pediatric-critical-care-a-quality-improvement-project
#13
Jessica L Hochstetler, A Jill Thompson, Natalie M Ball, Melissa C Evans, Shaun C Frame, A Lauren Haney, Amelia K Little, Jaime L O'Donnell, Bryna M Rickett, Elizabeth H Mack
OBJECTIVES: To determine whether implementing a guideline to bolus medications from continuous infusions in PICUs affects nursing satisfaction, patient safety, central line entries, medication utilization, or cost. DESIGN: This is a pre- and postimplementation quality improvement study. SETTING: An 11-bed ICU and 14-bed cardiac ICU in a university-affiliated children's hospital. PATIENTS: Patients less than 18 years old admitted to the PICU or pediatric cardiac ICU receiving a continuous infusion of dexmedetomidine, midazolam, fentanyl, morphine, vecuronium, or cisatracurium from May 2015 to May 2016, excluding November 2015 (washout period), were eligible for inclusion...
April 12, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29650885/-fentanyl-citrate-sublingual-tablets-were-effective-in-relieving-symptoms-of-akathisia-a-case-report
#14
Takaomi Kessoku, Akihiko Kusakabe, Tetsuya Matsuura, Yasushi Honda, Asuka Yoshimi, Ayumu Goto, Haruhisa Yoshida, Akiko Sukegawa, Chiaki Hata, Yukie Saito, Yoko Miyashita, Ryoko Yashiro, Tomoya Komori, Sachiko Arai, Atsushi Nakajima, Yasushi Ichikawa
Akathisia is a condition wherein sitting calmly and quietly is impossible, with a representative complaint of restless legs. It is generally assumed to be caused by anti-dopamine activity. In severe cases, it has been known to result in suicide attempt. We reported a case of drug-induced akathisia with difficulty in oral intake, in which fentanyl citrate sublingual tablets were found to be effective in relieving symptoms. The patient was a female aged 50's who had a gastric cancer with peritoneal dissemination causing pain and vomiting...
March 2018: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/29650881/-combination-therapy-of-oxycodone-and-tapentadol-was-effective-for-intractable-pain-caused-by-breast-cancer-bone-metastasis-a-case-report
#15
Tetsuya Matsuura, Akihiko Kusakabe, Takaomi Kessoku, Yasushi Honda, Asuka Yoshimi, Ayumu Goto, Haruhisa Yoshida, Akiko Sukegawa, Atsushi Nakajima, Yasushi Ichikawa
A 52-year-old woman had been prescribed oral medication of acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and oxycodone for intractable pain associated with thoracic metastasis of breast cancer. However, the pain control was poor. Although pregabalin and gabapentin were used as supplementary analgesics, they could not be continued because of their side effects. Based on the noradrenalin reincorporation-inhibiting action of tapentadol, a combination therapy of tapentadol and oxycodone was introduced and satisfactory pain control was achieved...
March 2018: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/29650821/-continuation-of-axitinib-for-advanced-renal-cell-carcinoma-by-the-application-of-homecare-urology-a-case-report-and-literature-review
#16
Satoshi Yazawa, Yuji Kato, Jin Nakahara, Toshio Miyata, Mototsugu Oya
A 56-year-old man with advanced RCC and a past medical history of type 2 diabetes underwent a radical left nephrectomy following a histological diagnosis of papillary RCC, G2, INF b, pT3, V1 in 1999. In 2008, sorafenib was started to treat multiple pulmonary metastases of RCC. In 2011, sorafenib was switched to sunitinib when radiologic progression was observed. In 2014, sunitinib was switched to axitinib when further radiologic progression was observed. In 2015, the patient was referred to Yazawa clinic for homecare urology when hospital visits became difficult due to cancer pain and bilateral lower-extremity muscle weakness...
April 2018: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/29649890/what-parenteral-opioids-to-use-in-face-of-shortages-of-morphine-hydromorphone-and-fentanyl
#17
Mellar P Davis, Mary Lynn McPherson, Zankhana Mehta, Bertrand Behm, Carlos Fernandez
Parenteral potent opioid availability is becoming an issue in acute pain management. Two opioids, nalbuphine and buprenorphine, are available which can be substituted for hydromorphone, fentanyl, and morphine. There are advantages and disadvantages in using these 2 opioids which are discussed, and potential dosing strategies are outlined.
January 1, 2018: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29649695/doctor-shopping-of-opioid-analgesics-relative-to-benzodiazepines-a-pharmacoepidemiological-study-among-11-7-million-inhabitants-in-the-french-countries
#18
Camille Ponté, Marion Lepelley, Quentin Boucherie, Michel Mallaret, Maryse Lapeyre Mestre, Vincent Pradel, Joëlle Micallef
BACKGROUND: The abuse of prescription opioids and its subsequent consequences is an important public concern particularly in the USA. The literature on opioid analgesic abuse is scarce. OBJECTIVE: We assess the extent and risk of opioid analgesics abuse relative to benzodiazepines (BZD) using the doctor shopping method, taken into account the pharmacological characteristics (dosage, route of administration, extended or immediate release). METHODS: We used SNIIRAM database covering 11...
April 4, 2018: Drug and Alcohol Dependence
https://www.readbyqxmd.com/read/29649029/dexmedetomidine-sedation-for-paroxysmal-supraventricular-tachycardia-ablation-is-not-associated-with-alteration-of-arrhythmia-inducibility
#19
Andrew M Slupe, Jessica Minnier, Merritt H Raitt, Ignatius Gerardo E Zarraga, Karen S MacMurdy, Peter M Jessel
BACKGROUND: Dexmedetomidine (Dex) is an attractive agent for procedural sedation due to its unique pharmacodynamic profile, specifically affording predictable sedation without concurrent respiratory depression. However, Dex has previously been reported to prevent or terminate arrhythmias. The purpose of this study was to investigate paroxysmal supraventricular tachycardia (PSVT) inducibility and homeostatic stability during electrophysiology studies (EPSs) and ablation when a standardized Dex protocol was used as the primary sedation agent...
April 11, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29644702/influence-of-group-iii-iv-muscle-afferents-on-small-muscle-mass-exercise-performance-a-bioenergetics-perspective
#20
Ryan M Broxterman, Thomas J Hureau, Gwenael Layec, David E Morgan, Amber D Bledsoe, Jacob E Jessop, Markus Amann, Russell S Richardson
The direct influence of group III/IV muscle afferents on exercise performance remains equivocal. Therefore, all-out intermittent isometric single-leg knee-extensor exercise and phosphorous magnetic resonance spectroscopy (31 P-MRS) were utilized to provide a high time resolution assessment of exercise performance and skeletal muscle bioenergetics in control conditions (CTRL) and with the attenuation of group III/IV muscle afferent feedback via lumbar intrathecal fentanyl (FENT). In both conditions, seven recreationally active men performed 60 maximal voluntary quadriceps contractions (MVC; 3 s contraction, 2 s relaxation), while knee-extensor force and 31 P-MRS were assessed during each MVC...
April 12, 2018: Journal of Physiology
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