Buprenorphine: An anesthesia-centric review.

Buprenorphine was synthesized in the 1960s as a result of a search for a safe and effective opioid analgesic. Present formulations of buprenorphine are approved for the treatment of both acute and chronic pain. Its long duration of action, high affinity, and partial agonism at the µ-opioid receptor have established it as a mainstay treatment for opioid use disorder (OUD).

Chronic opioid pain treatment converted to buprenorphine: A case series using a 3-step low-dose incremental dosing guideline.

We report a 30-case series from the Pain Management Center at the Massachusetts General Hospital where we have applied a guideline to convert chronic treatment for pain from full agonist opioids (FAO) to buprenorphine (BUP). Of the patients, 24 (80 percent) elected to continue BUP over FAO. Five conversions were stopped for side effects (fatigue) and/or lack of sufficient pain reduction.

Substance Use Disorders: Basic Overview for the Anesthesiologist.

Substance use disorders (SUDs) represent a current major public health concern in the United States and around the world. Social and economic stressors secondary to the coronavirus disease 2019 (COVID-19) pandemic have likely led to an increase in SUDs around the world. This chronic, debilitating disease is a prevalent health problem, and yet many clinicians do not have adequate training or clinical experience diagnosing and treating SUDs.

Perioperative Management of Extended-Release Buprenorphine: A Narrative Review and Case Series.

Background: Perioperative management of formulations of buprenorphine used for the treatment of opioid use disorder and/or pain are common clinical challenges. Care strategies are increasingly recommending continuation of buprenorphine while administering multimodal analgesia including full agonist opioids. While this "simultaneous strategy" is relatively simple for the shorter-acting sublingual buprenorphine formulation, best practices are needed for the increasingly prescribed extended-release buprenorphine (ER-buprenorphine).

Perioperative Management of Extended-release Buprenorphine.

Perioperative management of buprenorphine is increasingly characterized by continuation of buprenorphine throughout the perioperative period while coadministering full agonist opioids for analgesia. Although this "simultaneous strategy" is commonly used for the shorter-acting sublingual buprenorphine formulations, there is little to guide management of the extended-release formulations of buprenorphine. Here we report the perioperative experience of an individual maintained on extended-release buprenorphine who successfully underwent major surgeries utilizing a strategy of performing the surgeries at the time of the next scheduled dose.

Perioperative Buprenorphine Management: A Multidisciplinary Approach.

Buprenorphine formulations (including buprenorphine/naloxone) are effective treatments of pain and opioid use disorder (OUD). Historically, perioperative management of patients prescribed buprenorphine involved abstinence from buprenorphine sufficient to allow for unrestricted mu-opioid receptor availability to full agonist opioid (FAO) treatment. Evidence is mounting that a multimodal analgesic strategy, including simultaneous administration of buprenorphine and FAO, nonopioid adjuncts such as acetaminophen and nonsteroidal anti-inflammatory drugs, and regional anesthesia, is a safe and effective perioperative strategy for the patient prescribed long-term buprenorphine treatment of OUD.

A dataset for quantum circuit mapping.

Quantum computing is rapidly establishing itself as a new computing paradigm capable of obtaining advantages over its classical counterpart. However, a major limitation in the design of a quantum algorithm is related to the proper mapping of the corresponding circuit to a specific quantum processor so that the underlying physical constraints are satisfied. Moreover, current deterministic mapping algorithms suffer from high run times as the number of qubits to map increases.

An Internet of Things and Fuzzy Markup Language Based Approach to Prevent the Risk of Falling Object Accidents in the Execution Phase of Construction Projects.

The Internet of Things (IoT) paradigm is establishing itself as a technology to improve data acquisition and information management in the construction field. It is consolidating as an emerging technology in all phases of the life cycle of projects and specifically in the execution phase of a construction project. One of the fundamental tasks in this phase is related to Health and Safety Management since the accident rate in this sector is very high compared to other phases or even sectors.

Facilitating discontinuation of intravenous opioids by -concurrent use of sublingual buprenorphine with rapid microdosing -induction: A pain management case study.

We report a case in which sublingual buprenorphine was used to help transition a patient off intravenous (IV) opioid analgesics medications post-multiple abdominal procedures. Intravenous opioids are commonly used in inpatient surgical pain management for patients with severe pain who are unable to take oral medications. Typically, a short course of IV analgesics is used, followed by transition to oral analgesic regimen.

A deep learning classifier for digital breast tomosynthesis.

Purpose: To develop a computerized detection system for the automatic classification of the presence/absence of mass lesions in digital breast tomosynthesis (DBT) annotated exams, based on a deep convolutional neural network (DCNN).

Materials And Methods: Three DCNN architectures working at image-level (DBT slice) were compared: two state-of-the-art pre-trained DCNN architectures (AlexNet and VGG19) customized through transfer learning, and one developed from scratch (DBT-DCNN). To evaluate these DCNN-based architectures we analysed their classification performance on two different datasets provided by two hospital radiology departments.

A dataset of EEG signals from a single-channel SSVEP-based brain computer interface.

The paper presents a collection of electroencephalography (EEG) data from a portable Steady State Visual Evoked Potentials (SSVEP)-based Brain Computer Interface (BCI). The collection of data was acquired by means of experiments based on repetitive visual stimuli with four different flickering frequencies. The main novelty of the proposed data set is related to the usage of a single-channel dry-sensor acquisition device.

Thiopental Does Not Produce Hyperalgesia: A Laboratory Study Using Two Human Experimental Pain Models.

Objective: Past investigations assessing the effects of thiopental on pain are conflicting. Although several studies demonstrate hyperalgesia as a result of barbiturate administration, others show analgesia. Our objective was to assess the effects of an infusion of the GABAA agonist thiopental, compared with placebo, in healthy participants on two subjective experimental pain paradigms: noxious electrical stimulation and intradermal capsaicin.

Perioperative Continuation of Buprenorphine at Low-Moderate Doses Was Associated with Lower Postoperative Pain Scores and Decreased Outpatient Opioid Dispensing Compared with Buprenorphine Discontinuation.

Objective: An increasing number of individuals are prescribed buprenorphine as medication-assisted treatment for opioid use disorder. Our institution developed guidelines for perioperative buprenorphine continuation with an algorithm for dose reduction based upon the surgical procedure and patient's maintenance dose. The objective of this study was to compare the effects of buprenorphine continuation with those of discontinuation on postoperative pain scores and outpatient opioid dispensing.

Perioperative Buprenorphine Continuous Maintenance and Administration Simultaneous With Full Opioid Agonist: Patient Priority at the Interface Between Medical Disciplines.

Buprenorphine is a partial-agonist opioid that is prescribed as a medication-assisted treatment (MAT) for opioid use disorder (OUD). Buprenorphine is also a potent analgesic with high opioid-receptor affinity and binding coefficient; when buprenorphine is administered simultaneously with a μ-opioid receptor full agonist ("full agonist opioid" [FAO]), the combination can yield unexpected outcomes depending on dosing and timing. Buprenorphine is sometimes perceived as a powerful competitive opioid blocker that will hamper pharmacologic management that necessitates the use of FAO.

Bloodstain pattern analysis as optimisation problem.

Bloodstain pattern analysis (BPA) is an approach to support forensic investigators in reconstructing the dynamics of bloody crimes. This forensic technique has been successfully applied in solving heinous and complex murder cases around the world and, recently, computer-based BPA approaches have been designed to better support investigators both in terms of speed and quality of analysis. However, despite its widespread use, current automatic techniques for BPA try to define some algorithmic steps to replicate a sequence of subjective investigators' tasks without relying on any mathematical formalism to compute an objective reconstruction of the crime.

Prediction of Pathological Stage in Patients with Prostate Cancer: A Neuro-Fuzzy Model.

The prediction of cancer staging in prostate cancer is a process for estimating the likelihood that the cancer has spread before treatment is given to the patient. Although important for determining the most suitable treatment and optimal management strategy for patients, staging continues to present significant challenges to clinicians. Clinical test results such as the pre-treatment Prostate-Specific Antigen (PSA) level, the biopsy most common tumor pattern (Primary Gleason pattern) and the second most common tumor pattern (Secondary Gleason pattern) in tissue biopsies, and the clinical T stage can be used by clinicians to predict the pathological stage of cancer.

Effect of Intravenous Ethanol on Capsaicin-Induced Hyperalgesia in Human Subjects.

Background: The objective of this study was to assess ethanol's (EtOH's) effects on capsaicin-induced hyperalgesia in healthy participants. Specifically, we investigated the change in area of capsaicin-induced hyperalgesia following 3 interventions: intravenous EtOH at 2 targeted breath alcohol concentrations (BrAC), or placebo.

Methods: Eighteen participants participated in 3 test days in a randomized order.

Cancer prevalence in the city of Naples: Contribution of the GP database analyses to the cancer registries network.

The Italian cancer registries network has not been sufficiently developed in the Southern regions. General practitioners (GPs) are knowledgeable about the prevalence, incidence and mortality for different types of cancer in their patient populations. The aim of this pilot study was to verify the feasibility and reliability of the characterization of cancer populations using GP databases in order to evaluate the impact of cancer in the general population of Naples.

A Survey on Ambient Intelligence in Health Care.

Ambient Intelligence (AmI) is a new paradigm in information technology aimed at empowering people's capabilities by the means of digital environments that are sensitive, adaptive, and responsive to human needs, habits, gestures, and emotions. This futuristic vision of daily environment will enable innovative human-machine interactions characterized by pervasive, unobtrusive and anticipatory communications. Such innovative interaction paradigms make ambient intelligence technology a suitable candidate for developing various real life solutions, including in the health care domain.

Subjective Effects of Thiopental in Young Adults with and without a Family History of Alcoholism.

Background: The development of alcohol use disorders is genetically influenced, and may be mediated through differences in the subjective response to alcohol. There is some evidence to suggest that response differences to alcohol could be conveyed by heritable differences in GABA receptors. The purpose of this study was to investigate whether individuals with a family history positive (FHP) for alcohol dependence would experience alterations in response to the GABA receptor agonist thiopental, in comparison to family history negative (FHN) subjects.

A pervasive visual-haptic framework for virtual delivery training.

Thanks to the advances of voltage regulator (VR) technologies and haptic systems, virtual simulators are increasingly becoming a viable alternative to physical simulators in medicine and surgery, though many challenges still remain. In this study, a pervasive visual-haptic framework aimed to the training of obstetricians and midwives to vaginal delivery is described. The haptic feedback is provided by means of two hand-based haptic devices able to reproduce force-feedbacks on fingers and arms, thus enabling a much more realistic manipulation respect to stylus-based solutions.

Analgesic effects of ethanol are influenced by family history of alcoholism and neuroticism.

Background: Although personality factors and family history of substance abuse influence how individuals experience pain and respond to analgesics, the combined effects of those factors have not been extensively studied. The objective of this study was to consider the possible role of personality trait of neuroticism and family history of alcoholism on the experience of pain and their role in the analgesic response to an ethanol challenge.

Methods: Forty-eight healthy subjects participated in this study; thirty-one had a positive family history of alcoholism (FHP), seventeen had a negative family history of alcoholism (FHN).

Ethanol-like effects of thiopental and ketamine in healthy humans.

The gamma-aminobutyric acid-A (GABA(A)) and N-methyl-D-aspartate (NMDA) receptors mediate aspects of the behavioural effects of alcohol. Prior studies reported drugs that block NMDA receptors or facilitate GABA(A) receptor function produce ethanol-like effects in humans. The purpose of this study was to compare the ethanol-related effects of two pharmacological agents with known NMDA and GABA(A) receptor activity.

Ethanol and pain sensitivity: effects in healthy subjects using an acute pain paradigm.

Background: The primary objective of this study was to determine whether healthy subjects without a history of heavy alcohol use or a family history of alcoholism exhibit a concentration-dependent analgesic effect of ethanol. In a preliminary fashion, we also compared this sample to a group of subjects with a strong positive family history for alcoholism (FHP) to test the secondary hypothesis that FHP individuals will be more sensitive to the analgesic effects of alcohol compared to healthy subjects who are negative for a family history of alcoholism (FHN).

Methods: Forty-one healthy FHN subjects and 19 FHP subjects participated.

Esmolol infusion during nitroprusside-induced hypotension: impact on hemodynamics, ventricular performance, and venous admixture.

The impact of esmolol infusion on hemodynamics, ventricular performance, venous admixture, sympathoadrenal, and renin-angiotensin system responses during sodium nitroprusside (SNP)-induced hypotension was studied in 11 patients undergoing lymph node dissection during general anesthesia with 60% nitrous oxide and fentanyl. Radial arterial and thermistor-tipped pulmonary catheters were employed for hemodynamic monitoring. Arterial and mixed venous blood gas tensions, arterial plasma renin activity (PRA), and plasma catecholamine levels were measured.