Pharmacology of systemic analgesics.

Systemic administration of analgesic drugs is still the most widely used method for providing pain relief in acute painful situations. Opioids may be selected on the basis of their physicochemical characteristics and their diffusion index to the brain. But in clinical practice, their very steep concentration-analgesic effect relationship remains a critical aspect of opioid therapy.

Why should I change my practice of anesthesia? Opioids.

The selection of opioid drugs for anesthesia is often based on empirical judgment such as the selection of opioids with rapid elimination half-life for short surgical procedures (e.g. alfentanil), while opioids with longer elimination half-life (e.

The safety and effectiveness of remifentanil as an adjunct sedative for regional anesthesia.

Unlabelled: We assessed the sedative potential of continuous infusions of remifentanil with a validated composite alertness scale in 160 patients (ASA physical status I or II) undergoing hip replacement surgery with spinal block (n = 61) or hand surgery using brachial plexus block (n = 93). They were randomized to receive one of the following initial dose regimens in double-blinded fashion: placebo or 0.04, 0.

99mTechnetium-stannous oxinate as marker of liposome formulations.

Liposomes associated with tin(II) dioxinate were prepared from egg yolk phosphatidylcholine and cholesterol as sterile and pyrogen-free multilamellar or unilamellar vesicles. Complexing of liposomal tin(II) dioxinate with 99mTc attained 98% of the added radioactivity. Thirty percent 99mTc were released during 24-h incubation in biological fluids.

Continuous cervical intrathecal administration of morphine with a new infusion pump, the Anschütz IP 35.1: a case report.

The continuous intrathecal administration of low-dose morphine is an effective treatment for chronic neuropathic pain. Several implantable devices can be used for such treatments but they all have limitations. In this case report we opted for a new type of implantable pump, the Anschütz, for the combined cervical intrathecal administration of morphine and clonidine in a patient with severe cervicobrachialgia.

Influence of sufentanil on propofol anesthesia using a target controlled infusion system.

We assessed the effect of three different dosings of sufentanil on induction, maintenance and recovery characteristics of a propofol target controlled infusion anesthesia in twenty-four patients scheduled for laparoscopic cholecystectomy. The patients were allocated randomly to receive a sufentanil bolus of 15, 30 or 45 micrograms followed by a continuous infusion of sufentanil of 15, 30 or 45 micrograms/h respectively. The maintenance propofol anesthesia was titrated to achieve hemodynamic stability.

Evaluation of methylnaltrexone for the reduction of postoperative vomiting and nausea incidences.

We examined the effect of methylnaltrexone on the incidence of postoperative nausea and vomiting in a prospective double-blind placebo controlled study. One hundred and twenty female patients undergoing laparoscopic major gynecological surgery were allocated randomly to receive either 20 mg methylnaltrexone or placebo IV at the end of surgery. Postoperative nausea and vomiting was evaluated for 6 h after admission to the PACU and assessed by number of episodes and degree of severity.

Human albumin and colloid fluid replacement: their use in general surgery.

This review considers the pharmacology and indications for use of human albumin and synthetic colloids in general and transplantation surgery. The selection of a particular agent should be based on sound knowledge of their pharmacokinetic and pharmadynamic properties together with some consideration of cost. For correction of hypovolemia, human serum albumin solutions can adequately be replaced by present day colloids such as hydroxyethyl starch solutions.

Propofol and methohexitone anaesthesia: effects on the profile of mood state.

The influence on mood of anaesthesia by infusion with propofol or methohexitone was evaluated in 80 female patients assessed with the Profile of Mood State preoperatively and at 30 min, 1, 2 and 4 h after anaesthesia. Patients given propofol were more elated and continuously less anxious than those given methohexitone from 1 to 4 h after anaesthesia (54.3, SEM 1.

Does ranitidine provide protection against acid gastroesophageal reflux?

Continuous gastroesophageal pH monitoring was used to evaluate the effect of ranitidine on gastroesophageal reflux (GOR) in 60 patients scheduled for elective non-gastrointestinal abdominal or gynaecological surgery. The patients were randomly assigned to receive a single dose of ranitidine 50 mg either iv (RANIV group) or im (RANIM group) or a placebo iv (PLAC group) 90 min before surgery. The pH was measured continuously for six hours in the lower oesophagus using a flexible calibrated glass electrode.

Influence of propofol and methohexitone anesthesia on the cortisol response to surgery.

The effect of two intravenous hypnotics, propofol and methohexitone, on cortisol secretion was evaluated in two groups of 40 women during minor fertility surgery. Both hypnotics were administered as constant rate infusions for 45 min in the presence of nitrous oxide. Blood samples for cortisol measurement were taken before induction and 30 minutes after the surgery.

Thoracic epidural bupivacaine-fentanyl anesthesia for percutaneous cholecystolithotomy in high-risk patients.

Background And Objectives: The efficacy of a thoracic epidural block was assessed in 12 high-risk patients scheduled for elective percutaneous cholecystolithotomy.

Methods: A thoracic epidural catheter was inserted at level T8-9. The amount of 0.

Prostaglandin synthetase inhibitor treatment and the regulatory role of prostaglandins on organ perfusion.

Prostaglandin synthetase inhibitors (PGIs) are increasingly used in anesthetic practice and postoperative care. The influence of these agents on the hemodynamics and organ perfusion control remains largely unknown. This review attempts to assess the role of endogenous prostaglandins on the regulation of the microcirculation in different organs and to identify disease states in which PGIs may have deleterious effects.

The use of midazolam and flumazenil in locoregional anaesthesia: an overview.

Midazolam is useful as an intravenous supplement to local anaesthesia techniques in producing sedation, amnesia and anxiolysis, and has about five times the sedative potency of diazepam. Considerable interpatient variability exists in dose requirements, especially in elderly patients. The combined effects of local anaesthetics and midazolam may contribute to enhanced haemodynamic effects and changes in the respiratory pattern, impairing ventilation and oxygenation.