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https://www.readbyqxmd.com/read/29164294/a-novel-technique-of-paravertebral-thoracic-and-preperitoneal-analgesia-enhances-early-recovery-after-oesophagectomy
#1
Stephanie Phillips, Jasmina Dedic-Hagan, d'Arcy Ferris Baxter, H Van der Wall, G L Falk
BACKGROUND: Excellent analgesia following oesophagectomy facilitates patient comfort, early extubation, physiotherapy and mobilisation, reduces post-operative complications and should enhance recovery. Thoracic epidural analgesia (TEA), the gold standard analgesic regimen for this procedure, is often associated with systemic hypotension treated with inotropes or fluid. This may compromise enhanced recovery and be complicated by anastomotic ischaemia or tissue oedema. METHODS: We report a novel analgesic regimen to reduce post-operative inotrope usage...
November 21, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/29158691/project-for-the-introduction-of-prehospital-analgesia-with-fentanyl-and-morphine-administered-by-specially-trained-paramedics-in-a-rural-service-area-in-germany
#2
Maximilian Scharonow, Timo Alberding, Wolfgang Oltmanns, Christian Weilbach
Background: In patients with serious illness or trauma, reduction of severe pain is a key therapeutic goal of emergency medical service (EMS) teams. In Germany, only physicians are allowed to use opioid analgesics. In the rural EMS area studied, the mean arrival time for paramedics is 8 minutes, 23 seconds, and for the rescue physician between 10 minutes, 30 seconds and 16 minutes, 59 seconds, depending on EMS site. In cases of parallel callouts, rescue-physician arrival times may be considerably longer...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/29158248/pregnancy-increases-norbuprenorphine-clearance-in-mice-by-induction-of-hepatic-glucuronidation
#3
Michael Z Liao, Chunying Gao, Brian R Phillips, Naveen K Neradugomma, Lyrialle W Han, Deepak Kumar Bhatt, Bhagwat Prasad, Danny D Shen, Qingcheng Mao
Norbuprenorphine (NBUP) is the major active metabolite of buprenorphine (BUP) which is commonly used to treat opiate addiction during pregnancy; it possesses 25% of BUP's analgesic activity and 10 times BUP's respiratory depression effect. To optimize BUP's dosing regimen during pregnancy with better efficacy and safety, it is important to understand how pregnancy affects NBUP disposition. In this study, we examined the pharmacokinetics of NBUP in pregnant and non-pregnant mice by administering the same amount of NBUP through retro-orbital injection...
November 20, 2017: Drug Metabolism and Disposition: the Biological Fate of Chemicals
https://www.readbyqxmd.com/read/29154612/alexithymia-is-associated-with-a-multidomain-multidimensional-failure-of-interoception-evidence-from-novel-tests
#4
Jennifer Murphy, Caroline Catmur, Geoffrey Bird
Interoception, the perception of the body's internal state, contributes to numerous aspects of higher-order cognition. Several theories suggest a causal role for atypical interoception in specific psychiatric disorders, including a recent claim that atypical interoception represents a transdiagnostic impairment across disorders characterized by reduced perception of one's own emotion (alexithymia). Such theories are supported predominantly by evidence from only one interoceptive domain (cardiac); however, evidence of domain-specific interoceptive ability highlights the need to assess interoception in noncardiac domains...
November 20, 2017: Journal of Experimental Psychology. General
https://www.readbyqxmd.com/read/29149613/tuning-biased-gpcr-signaling-for-physiological-gain
#5
Skylar Spangler, Michael R Bruchas
Effective and safe doses of opiate painkillers, like morphine, can be limited by respiratory depression. Schmid et al. (2017) now present a quantitative method to design ligands and correlate GPCR signaling bias to the dose separation between therapeutic and adverse effects in animals.
November 16, 2017: Cell
https://www.readbyqxmd.com/read/29148881/ultrarapid-influence-of-buprenorphine-on-major-depression-in-opioid-dependent-patients-a-double-blind-randomized-clinical-trial
#6
Jamshid Ahmadi, Mina Sefidfard Jahromi
OBJECTIVE: To examine the impact of different doses of buprenorphine on depression symptoms in opioid dependent inpatient over a three-day interval, using a randomized clinical trial design (RCT). DESIGN: Patients were randomized and assigned to three groups. PARTICIPANTS: Forty males who were admitted to an inpatient psychiatric unit and who fulfilled the DSM-5 criteria for both opioid dependence and major depressive disorder. INTERVENTION: Patients randomly received 32 mg, 64 mg, or 96 mg of buprenorphine as a single high dose...
November 17, 2017: Substance Use & Misuse
https://www.readbyqxmd.com/read/29148295/is-naloxone-the-best-antidote-to-reverse-tramadol-induced-neuro-respiratory-toxicity-in-overdose-an-experimental-investigation-in-the-rat
#7
Camille Lagard, Isabelle Malissin, Wassila Indja, Patricia Risède, Lucie Chevillard, Bruno Mégarbane
CONTEXT: Since the banning of dextropropoxyphene from the market, overdoses, and fatalities attributed to tramadol, a WHO step-2 opioid analgesic, have increased markedly. Tramadol overdose results not only in central nervous system (CNS) depression attributed to its opioid properties but also in seizures, possibly related to non-opioidergic pathways, thus questioning the efficiency of naloxone to reverse tramadol-induced CNS toxicity. OBJECTIVE: To investigate the most efficient antidote to reverse tramadol-induced seizures and respiratory depression in overdose...
November 17, 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/29142147/accidental-afloqualone-intoxication-in-two-dogs
#8
Jin-Ok Ahn, Won-Joung Jaung, Sang-Heum Won, Min-Ok Ryu, Woo-Jin Song, Kee-Ok Jeon, Jin-Young Chung, Hwa-Young Youn
Two dogs presented to the emergency service after accidental ingestion of afloqualone tablets, a muscle relaxant used for back pain in humans. Toxic effects of the drug in these dogs included vomiting, respiratory depression, seizures, ataxia, bradycardia, and hematuria. Treatment consisted of fluid diuresis, furosemide, and propofol. Flumazenil, a gamma-amino butyric acid antagonist, was administered intravenously; however, it was not effective in stopping the seizures in these dogs. Both dogs recovered with supportive treatment...
November 14, 2017: Journal of Veterinary Medical Science
https://www.readbyqxmd.com/read/29142091/physiological-and-pathophysiological-firing-properties-of-single-postganglionic-sympathetic-neurons-in-humans
#9
Vaughan G Macefield, B Gunnar Wallin
It has long been known from microneurographic recordings in human subjects that activity of postganglionic sympathetic axons occurs as spontaneous bursts, with muscle sympathetic nerve activity (MSNA) exhibiting strong cardiac rhythmicity via the baroreflex and skin sympathetic nerve activity (SSNA) showing much weaker cardiac modulation. Here we review the firing properties of single sympathetic neurons, obtained using highly selective microelectrodes. Individual vasoconstrictor neurons supplying muscle or skin, or sudomotor neurones supplying sweat glands, always discharge with a low firing probability (~30%) and at very low frequencies (~0...
November 15, 2017: Journal of Neurophysiology
https://www.readbyqxmd.com/read/29132594/ketamine-sedation-for-patients-with-acute-behavioral-disturbance-during-aeromedical-retrieval-a-retrospective-chart-review
#10
Vinay Gangathimmaiah, Minh Le Cong, Mike Wilson, Kate Hooper, Andrew Perry, Luke Burman, Nathan Puckeridge, Brian J Maguire
OBJECTIVE: The aim of this study was to determine the prevalence, safety (as measured by the incidence of adverse events), and effectiveness (as measured by the incidence of intubations) of ketamine sedation in patients with acute behavioral disturbance (ABD) during air medical retrieval. METHODS: This was a retrospective observational study. Eligible patients were identified by searching the electronic databases of 2 air medical retrieval services in Queensland, Australia, for adult patients with ABD transported between January 1, 2015, and June 30, 2016...
November 2017: Air Medical Journal
https://www.readbyqxmd.com/read/29128544/experimental-poisoning-by-vernonia-rubricaulis-in-sheep
#11
Kelly C S Godoy, Paula V Leal, Marcelo A Araújo, Alda I Souza, Arnildo Pott, Stephen T Lee, Claudio S L Barros, Ricardo A A de Lemos
In order to evaluate the susceptibility of sheep to V. rubricaulis and to establish the clinical signs, serum biochemistry, and pathological findings, eight sheep were fed varying doses of V. rubricaulis. The onset of clinical signs occurred 6-48 h after the ingestion of V. rubricaulis. Clinical courses lasted 6-56 h after the ingestion of the plant. Serum activities of aspartate aminotransferase, gamma-glutamyl transferase, and alkaline phosphatase were highly elevated and glucose blood levels were low in affected sheep...
November 8, 2017: Toxicon: Official Journal of the International Society on Toxinology
https://www.readbyqxmd.com/read/29127594/morphine-double-faced-roles-in-the-regulation-of-tumor-development
#12
REVIEW
X Y Zhang, Y X Liang, Y Yan, Z Dai, H C Chu
Morphine, a highly potent analgesic, is one of the most effective drugs for the treatment of severe pain associated with cancer. It directly acts on the central nervous system to relieve pain, but also cause secondary complications, such as addiction, respiratory depression and constipation due to its activities on peripheral tissues. Besides pain relief, morphine is of great importance on cancer management with its effect on tumor development being the subject of debate for many years with some contradictory findings...
November 10, 2017: Clinical & Translational Oncology
https://www.readbyqxmd.com/read/29125380/breathing-pattern-recordings-using-respiratory-inductive-plethysmography-before-and-after-a-physiotherapy-breathing-retraining-program-for-asthma-a-case-report
#13
Rokhsaneh Tehrany, Ruth DeVos, Anne Bruton
Breathing retraining (BR) improves symptoms, psychological well-being and quality of life in adults with asthma; but there remains uncertainty as to mechanism of effect. One of the intuitively logical theories is that BR works through altering breathing pattern. There is currently no evidence, however, that BR does result in measurable changes in breathing pattern. In this case report we describe the effects of physiotherapy BR on a 57-year-old female with a 10-year history of asthma. Data were collected before and after a physiotherapy BR program comprising three sessions over 18 weeks: breathing pattern (respiratory inductive plethysmography (RIP); physiology (end tidal carbon dioxide (ETCO2), heart rate, oxygen saturations, spirometric lung function); questionnaires (Asthma Control Questionnaire (ACQ), Hospital Anxiety and Depression Score, Nijmegen Questionnaire); and medication usage...
November 10, 2017: Physiotherapy Theory and Practice
https://www.readbyqxmd.com/read/29124404/pediatric-patients-receiving-naloxone-within-48%C3%A2-h-of-anesthesia-a-case-control-study
#14
Vinay K Donempudi, Juraj Sprung, Toby N Weingarten
PURPOSE: Excessive narcotization in pediatric surgical patients has not been well characterized. This report describes the use of postoperative naloxone in pediatric patients. METHODS: Pediatric surgical patients from January 1, 2010, through June 30, 2016, who underwent general anesthesia and received naloxone within 48 h postoperatively were identified and matched 1:1 with controls by age, sex, and procedure. Cases and controls underwent retrospective chart review...
November 9, 2017: Pediatric Surgery International
https://www.readbyqxmd.com/read/29123970/physiological-markers-of-interpersonal-stress-generation-in-depression
#15
Jessica L Hamilton, Lauren B Alloy
Abnormalities in parasympathetic nervous system activity have been linked to depression, but less is known about processes underlying this relationship. The present study evaluated resting and stress-reactive respiratory sinus arrhythmia (RSA) to a laboratory stressor as predictors of daily interpersonal stress generation and depressive symptoms, whether stress generation mediated the relationship between RSA and depressive symptoms, and potential sex differences. A sample of formerly depressed 102 emerging adults (18-22 years; 78% female) completed a laboratory stressor and daily assessments of stressors and depressive symptoms over two weeks...
2017: Clinical Psychological Science
https://www.readbyqxmd.com/read/29123359/reversal-of-opioid-induced-toxicity
#16
Shrenik P Ostwal, Naveen Salins, Jayita Deodhar
Opioids are commonly used for pain control in palliative care setting. Accumulation of active metabolites of opioids can cause a well-recognized toxidrome including respiratory depression (RD), decreased conscious level, pinpoint pupils, and drop in blood pressure. Opioid toxicity is often associated with amount ingested and its speed of absorption in the body. This can have life-threatening effects on various body systems. Naloxone is an opioid antagonist that competitively binds to opioid receptors and reverses all their effects...
October 2017: Indian Journal of Palliative Care
https://www.readbyqxmd.com/read/29121531/decreased-pain-tolerance-before-surgery-and-increased-postoperative-narcotic-requirements-in-abstinent-tobacco-smokers
#17
Ling Shen, Kai Wei, Qianbo Chen, Haibo Qiu, Yong Tao, Qiang Yao, Jinchao Song, Chengjian Li, Liang Zhao, Yantao Liu, Zhijie Lu
INTRODUCTION: The clinical influence of smoking cessation on pain tolerance before surgery and postoperative pain perception is not fully understood. This clinical study investigated the effect of smoking cessation on pain threshold during the perioperative period in patients undergoing hepatic resection. METHODS: We enrolled 148 male patients (68 non-smokers and 80 abstinent smokers) who underwent hepatic resection and received postoperative patient-controlled intravenous analgesia...
October 28, 2017: Addictive Behaviors
https://www.readbyqxmd.com/read/29120929/risk-factors-for-opioid-induced-respiratory-depression-and-failure-to-rescue-a-review
#18
Kapil Gupta, Arun Prasad, Mahesh Nagappa, Jean Wong, Lusine Abrahamyan, Frances Chung
PURPOSE OF REVIEW: The primary objective of this review is to identify the risk factors for opioid-induced respiratory depression (OIRD) in the postoperative period. RECENT FINDINGS: In the postoperative period, OIRD has often been reported resulting in morbidity and mortality. The risk factors which predispose surgical patients to increased risk of OIRD are not clearly defined. A literature search was performed for adult surgical patients who were prescribed opioids during their hospital stay and any available reports on postoperative respiratory depression/respiratory events...
November 7, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29120894/advances-in-pharmacotherapies-for-movement-disorders-in-children-current-limitations-and-future-progress
#19
Jean-Pierre Lin
PURPOSE OF REVIEW: In childhood, movement disorders are generated by a very large number of disorders of the nervous system, and the very different developmental ages at which these occur make studies of pharmacotherapy efficacy extremely difficult. In most clinical practices, medication used in management is by trial and error, and limited by lack of efficacy and/or adverse drug reactions leading to drug intolerance. Nevertheless, symptom reduction using polypharmacy must be balanced against any accompanying comorbidities such as poor attention and concentration, constipation, ileus, urinary retention, blurred vision sedation and respiratory depression...
December 2017: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/29118840/too-many-pills-to-swallow-a-case-of-a-mixed-overdose
#20
Louise Emily Hopkins, Jonathan Sunkersing, Andrew Jacques
Propranolol is a highly lipid-soluble beta-receptor antagonist. We describe a case of mixed overdose, including propranolol, amlodipine and olanzapine, resulting in severe resistant hypotension which was successfully treated. A 21-year-old student ingested 6.4 g of propranolol, 280 mg of amlodipine and 560 mg of olanzapine. The patient was brought to the emergency department and exhibited signs of severe systemic toxicity - profound hypotension and circulatory collapse, respiratory depression and coma...
August 2017: J Intensive Care Soc
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