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https://www.readbyqxmd.com/read/29335074/trends-in-narcotics-and-sedative-use-during-mechanical-ventilation-of-preterm-infants-in-canadian-neonatal-intensive-care-units
#1
(no author information available yet)
OBJECTIVE: Mechanical ventilation (MV) in preterm infants (PTI) causes discomfort. Whether it causes pain is controversial. Meta analysis reviews of published work on PTI during MV have shown no clinically significant impact of opioids on pain scales, and hence not recommended for routine use in neonatal intensive care units (NICUs). Similarly regular use of sedative midazolam is also not recommended. Therefore we hypothesized a downward trend in narcotics and sedatives used in MV of PTI in NICUs...
January 2018: Zhongguo Dang Dai Er Ke za Zhi, Chinese Journal of Contemporary Pediatrics
https://www.readbyqxmd.com/read/29329388/a-series-of-deaths-involving-carfentanil-in-the-uk-and-associated-post-mortem-blood-concentrations
#2
Simon P Elliott, Elena Hernandez Lopez
The potent opioid and veterinary drug, carfentanil has recently entered the illicit drug market, especially in relation to heroin and cocaine. Recent publications have reported carfentanil concentrations found in fatalities occurring in the USA. This article presents the toxicological findings in seven heroin/cocaine cases occurring in the UK within a short period of time where carfentanil was detected and measured. Carfentanil was detected along with other drugs in all cases with no alcohol detected in the post-mortem blood in any of the cases...
January 10, 2018: Journal of Analytical Toxicology
https://www.readbyqxmd.com/read/29229039/analgesia-in-patients-with-trauma-in-emergency-medicine
#3
David Häske, Bernd W Böttiger, Bertil Bouillon, Matthias Fischer, Gernot Gaier, Bernhard Gliwitzky, Matthias Helm, Peter Hilbert-Carius, Björn Hossfeld, Christoph Meisner, Benjamin Schempf, Arasch Wafaisade, Michael Bernhard
BACKGROUND: Suitable analgesic drugs and techniques are needed for the acute care of the approximately 18 200-18 400 seriously injured patients in Germany each year. METHODS: This systematic review and meta-analysis of analgesia in trauma patients was carried out on the basis of randomized, controlled trials and observational studies. A systematic search of the literature over the 10-year period ending in February 2016 was carried out in the PubMed, Google Scholar, and Springer Link Library databases...
November 17, 2017: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/29205946/surveillance-of-drug-abuse-in-hong-kong-by-hair-analysis-using-lc-ms-ms
#4
K Wing Leung, Zack C F Wong, Janet Y M Ho, Ada W S Yip, Jerry K H Cheung, Karen K L Ho, Ran Duan, Karl W K Tsim
The aim of this study is to reveal the habits of drug abusers in hair samples from drug rehabilitation units in Hong Kong. With the application of LC-MS/MS technology, a total of 1,771 hair samples were analyzed during the period (Jan 2012 to Mar 2016) of hair testing service provided to fourteen drug rehabilitation units including non-governmental organizations (NGOs), rehabilitation centers and medical clinics. Hair samples were analyzed for abused drugs and their metabolites simultaneously, including ketamine, norketamine, cocaine, benzoylecgonine, cocaethylene, norcocaine, codeine, MDMA, MDA, MDEA, amphetamine, methamphetamine, morphine, 6-acetylmorphine, phencyclidine and methadone...
December 4, 2017: Drug Testing and Analysis
https://www.readbyqxmd.com/read/29205811/prehospital-analgesic-choice-in-injured-patients-does-not-impact-on-rates-of-vomiting-experience-from-a-new-south-wales-primary-retrieval-service
#5
Michael Zhang, Timothy Cowan, John-Paul Smiles, Mary Morgan, Jessica Armstrong, Chinky Goswami, Claire Sewell
OBJECTIVE: This study aimed to explore the analgesic regimes adopted in our contemporary retrieval practice and the incidence of vomiting in ED after prehospital analgesic use. METHOD: A retrospective review was conducted on trauma patients retrieved by the Hunter Primary Retrieval Service in the Hunter New England Local Health District, New South Wales, Australia, during 2015. RESULTS: Of the 379 patients attended by the service in 2015, 196 of them (mean age 38...
December 4, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29197244/systematic-assessment-of-different-solvents-for-the-extraction-of-drugs-of-abuse-and-pharmaceuticals-from-an-authentic-hair-pool
#6
Milena M Madry, Thomas Kraemer, Markus R Baumgartner
Hair analysis has been established as a prevalent tool for retrospective drug monitoring. In this study, different extraction solvents for the determination of drugs of abuse and pharmaceuticals in hair were evaluated for their efficiency. A pool of authentic hair from drug users was used for extraction experiments. Hair was pulverized and extracted in triplicate with seven different solvents in a one- or two-step extraction. Three one- (methanol, acetonitrile, and acetonitrile/water) and four two-step extractions (methanol two-fold, methanol and methanol/acetonitrile/formate buffer, methanol and methanol/formate buffer, and methanol and methanol/hydrochloric acid) were tested under accurately equal experimental conditions...
November 23, 2017: Forensic Science International
https://www.readbyqxmd.com/read/29196879/the-feasibility-of-physiologically-based-pharmacokinetic-modeling-in-forensic-medicine-illustrated-by-the-example-of-morphine
#7
Nadine Schaefer, Daniel Moj, Thorsten Lehr, Peter H Schmidt, Frank Ramsthaler
In forensic medicine, expert opinion is often required concerning dose and time of intake of a substance, especially in the context of fatal intoxications. In the present case, a 98-year-old man died 4 days after admission to a hospital due to a femur neck fracture following a domestic fall in his retirement home. As he had obtained high morphine doses in the context of palliative therapy and a confusion of his supplemental magnesium tablets with a diuretic by the care retirement home was suspected by the relatives, a comprehensive postmortem examination was performed...
December 1, 2017: International Journal of Legal Medicine
https://www.readbyqxmd.com/read/29175573/the-cost-effectiveness-of-post-operative-ketamine-in-chiari-decompression
#8
Michael M McDowell, Ahmad Alhourani, Beverly A Pearce-Smith, Anna Mazurkiewicz, Robert M Friedlander
INTRODUCTION: In Chiari I patients, post-operative pain and discomfort frequently slow the transition back to the home setting. OBJECTIVE: We sought to determine the effect of standardized ketamine infusion protocols on hospital length of stay. METHODS: This retrospective cohort study reviewed 100 consecutive adult patients undergoing Chiari I decompression. Fifty-nine patients were placed on a 2-3mg/hr ketamine drip until post-operative day one...
November 22, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29171155/interactions-of-2s-6s-2r-6r-hydroxynorketamine-a-secondary-metabolite-of-r-s-ketamine-with-morphine
#9
Tuomas O Lilius, Hanna Viisanen, Viljami Jokinen, Mikko Niemi, Eija A Kalso, Pekka V Rauhala
Ketamine and its primary metabolite norketamine attenuate morphine tolerance by antagonising N-methyl-D-aspartate (NMDA) receptors. Ketamine is extensively metabolised to several other metabolites. The major secondary metabolite (2S,6S;2R,6R)-hydroxynorketamine (6-hydroxynorketamine) is not an NMDA antagonist. However, it may modulate nociception through negative allosteric modulation of α7 nicotinic acetylcholine receptors. We studied whether 6-hydroxynorketamine could affect nociception or the effects of morphine in acute or chronic administration settings...
November 24, 2017: Basic & Clinical Pharmacology & Toxicology
https://www.readbyqxmd.com/read/29170340/43%C3%A2-management-of-acute-low-back-pain-in-the-ed-a-systematic-review
#10
Jane Ashbrook, Nikos Rodgdakis, Peter Goodwin, Gill Yeowell, Michael Callaghan
STUDY OBJECTIVE: There is no consensus on the management of low back pain in the ED and evidence suggests that these patients are likely to receive unwarranted imaging and inappropriate opioid prescription.The purpose of this study is to review the available literature pertaining to the clinical management of acute low back pain in the ED. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidelines were observed during this review...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29045243/use-of-ketamine-in-a-multimodal-analgesia-setting-for-rapid-opioid-tapering-in-a-profoundly-opioid-tolerant-patient-a-case-report
#11
Elise M Strickler, Eric S Schwenk, Mitchell J Cohen, Eugene R Viscusi
Opioids are frequently used for the treatment of chronic pain, and patients taking high doses are at increased risk of complications and adverse opioid-related events. Ketamine is appealing as an opioid adjunct because of its lack of respiratory depression and potential prevention of hyperalgesia and central sensitization. We present a case in which a ketamine infusion was utilized over a 7-day period to provide rapid taper of a daily dose of 400 mg of morphine equivalents to less than one-third of that dose on discharge with unchanged pain levels and no symptoms of opioid withdrawal...
October 17, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/29043601/pupillary-reflex-dilation-in-response-to-incremental-nociceptive-stimuli-in-patients-receiving-intravenous-ketamine
#12
Nada Sabourdin, Thomas Giral, Risa Wolk, Nicolas Louvet, Isabelle Constant
Pupillometry is a non-invasive monitoring technique, which allows dynamic pupillary diameter measurement by an infrared camera. Pupillary diameter increases in response to nociceptive stimuli. In patients anesthetized with propofol or volatile agents, the magnitude of this pupillary dilation is related to the intensity of the stimulus. Pupillary response to nociceptive stimuli has never been studied under ketamine anesthesia. Our objective was to describe pupillary reflex dilation after calibrated tetanic stimulations in patients receiving intravenous ketamine...
October 17, 2017: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29043488/hair-analysis-does-not-allow-to-discriminate-between-acute-and-chronic-administrations-of-a-drug-in-young-children
#13
Jean Claude Alvarez, Laetitia Lasne, Isabelle Etting, Gérard Chéron, Véronique Abadie, Nicolas Fabresse, Islam Amine Larabi
There are many differences between the hair from children and that of adult subjects, the hair being thinner, more porous with a different growth rate from the usual 1 cm/month observed in adults. In order to determine whether hair analysis could discriminate between chronic use and acute administration of a drug in children like in adults, we analyzed hair from 18 children aged between 1 day and 15 years in whom the administration of different drugs was known (single therapeutic administration or acute intoxication)...
October 18, 2017: International Journal of Legal Medicine
https://www.readbyqxmd.com/read/29034250/the-modification-and-performance-of-a-large-animal-anesthesia-machine-tafonius-%C3%A2-in-order-to-deliver-xenon-to-a-horse
#14
Bruna Santangelo, Astrid Robin, Keith Simpson, Julie Potier, Michel Guichardant, Karine Portier
INTRODUCTION: Xenon, due to its interesting anesthetic properties, could improve the quality of anesthesia protocols in horses despite its high price. This study aimed to modify and test an anesthesia machine capable of delivering xenon to a horse. MATERIALS AND METHODS: An equine anesthesia machine (Tafonius, Vetronic Services Ltd., UK) was modified by including a T-connector in the valve block to introduce xenon, so that the xenon was pushed into the machine cylinder by the expired gases...
2017: Frontiers in Veterinary Science
https://www.readbyqxmd.com/read/29025089/oral-ketamine-for-acute-pain-management-after-amputation-surgery
#15
Asokumar Buvanendran, Jeffrey S Kroin, Arvind Rajagopal, Sherry J Robison, Mario Moric, Kenneth J Tuman
Objective: Intravenous ketamine has been shown to provide postoperative analgesia in many clinical trials, in particular to reduce opioid consumption. The primary objective of this pilot study is to determine if multiple dosing over a three-day perioperative period with oral ketamine is a safe treatment method for acute pain after amputation surgery. Methods: Three consented subjects (age 57-60 years) undergoing elective amputation of the lower extremity were included in the study (Institutional Review Board and Food and Drug Administration Investigational New Drug approved)...
September 14, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28985334/simultaneous-quantitation-of-methamphetamine-ketamine-opiates-and-their-metabolites-in-urine-by-spe-and-lc-ms-ms
#16
Chu-An Yang, Hsiu-Chuan Liu, Dong-Liang Lin, Ray H Liu, You-Zung Hsieh, Shu-Pao Wu
Heroin, methamphetamine and ketamine have been the most commonly abused drugs in Taiwan. The presence of these drugs and their metabolites in postmortem specimens has been routinely monitored in our laboratory mostly by gas chromatographic-mass spectrometric methods. This study aimed to evaluate a more effective approach to simultaneously quantify these analytes (i.e., amphetamine, methamphetamine, 3,4-methylenedioxyamphetamine, 3,4-methylenedioxymethamphetamine (MDMA), morphine, codeine, 6-acetylmorphine, 6-acetylcodeine, ketamine and norketamine) in postmortem urine and blood specimens by liquid chromatography-tandem mass spectrometry (LC-MS-MS)...
October 1, 2017: Journal of Analytical Toxicology
https://www.readbyqxmd.com/read/28971157/comparing-the-analgesic-effect-of-intranasal-with-intravenous-ketamine-in-isolated-orthopedic-trauma-a-randomized-clinical-trial
#17
Ramin Parvizrad, Abdolghader Pakniyat, Bita Malekianzadeh, Amir Almasi-Hashiani
OBJECTIVES: Ketamine is commonly used in anesthetic and sedation before surgical procedures and acts as an analgesic in smaller doses. The aim of this study was to assess the effects of intranasal (IN) ketamine in patients with moderate to severe limb trauma (visual analog scale (VAS) > 60 mm). METHODS: In a triple-blind randomized controlled clinical trial; 154 patients with isolated orthopedic trauma and visual analog scale (VAS) ≥60 mm were included on the basis of inclusion and exclusion criteria...
September 2017: Turkish Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28946059/pregabalin-as-adjunct-in-a-multimodal-pain-therapy-after-traumatic-foot-amputation-a-case-report-of-a-4-year-old-girl
#18
Stephanie Wössner, Kirsten Weber, Anna C Steinbeck, Markus Oberhauser, Matthias Feuerecker
BACKGROUND AND PURPOSE: The purpose of this case report is to describe a multimodal pain therapeutic concept including the adjunct use of pregabalin in a 4.5 year-old child after forefoot amputation. Phantom limb pain and sensation is a complex pain syndrome that is difficult to treat and prevent. 70-75% of all children develop such a pain syndrome after amputation. We describe here a paediatric patient who underwent forefoot amputation following traumatic foot injury and received multimodal pain therapy including pregabalin...
October 2017: Scandinavian Journal of Pain
https://www.readbyqxmd.com/read/28926159/randomized-controlled-feasibility-trial-of-intranasal-ketamine-compared-to-intranasal-fentanyl-for-analgesia-in-children-with-suspected-extremity-fractures
#19
Stacy L Reynolds, Kathleen K Bryant, Jonathan R Studnek, Melanie Hogg, Connell Dunn, Megan A Templin, Charity G Moore, James R Young, Katherine Rivera Walker, Michael S Runyon
OBJECTIVES: We compared the tolerability and efficacy of intranasal subdissociative ketamine to intranasal fentanyl for analgesia of children with acute traumatic pain and investigated the feasibility of a larger noninferiority trial that could investigate the potential opioid-sparing effects of intranasal ketamine. METHODS: This randomized controlled trial compared 1 mg/kg intranasal ketamine to 1.5 μg/kg intranasal fentanyl in children 4 to 17 years old with acute pain from suspected isolated extremity fractures presenting to an urban Level II pediatric trauma center from December 2015 to November 2016...
September 19, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28868303/adjuvants-to-local-anesthetics-current-understanding-and-future-trends
#20
EDITORIAL
Amlan Swain, Deb Sanjay Nag, Seelora Sahu, Devi Prasad Samaddar
Although beneficial in acute and chronic pain management, the use of local anaesthetics is limited by its duration of action and the dose dependent adverse effects on the cardiac and central nervous system. Adjuvants or additives are often used with local anaesthetics for its synergistic effect by prolonging the duration of sensory-motor block and limiting the cumulative dose requirement of local anaesthetics. The armamentarium of local anesthetic adjuvants have evolved over time from classical opioids to a wide array of drugs spanning several groups and varying mechanisms of action...
August 16, 2017: World Journal of Clinical Cases
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