Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2008
The effects of fentanyl-like opioids and hydromorphone on human 5-HT3A receptors.
5-HT(3) receptors are involved in various physiologic functions, including the modulation of emesis. 5-HT(3) antagonists are clinically widely used as potent antiemetics. Emesis is also a side effect of opioid analgesics. Intriguingly, the natural opioid morphine shows specific interactions with human 5-HT(3) receptors at clinically relevant concentrations. In the present study, we investigated whether this is a general effect of opioids, even when they are structurally diverse. Therefore, another morphine (phenanthrene-type) derivative, hydromorphone, and fentanyl including its (4-anilinopiperidine-type) derivatives were tested. ⋯ Only morphine and hydromorphone, but not the fentanyl derivatives, reduced 5-HT-induced current amplitudes and slowed current kinetics near clinically relevant concentrations. The high potencies of morphine and hydromorphone, when compared to their lipophilicities, suggest a specific interaction with 5-HT(3A) receptors. In contrast, the effects of fentanyl-type opioids appear to be of unspecific nature. Because the rank order of opioid potencies for human 5-HT(3A) receptors is opposite of that for opioid receptors, the site involved is structurally different from opioid receptor binding sites. In agreement with recent data on different phenols, a phenolic OH-group (which morphine and hydromorphone possess) may contribute to specific interactions of morphine and hydromorphone with the 5-HT(3A) receptor. Future clinical studies could test whether corresponding differences in emetogenicity between different classes of opioids will be found.
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Anesthesia and analgesia · Jul 2008
The prevalence of and risk factors for adverse events in children receiving patient-controlled analgesia by proxy or patient-controlled analgesia after surgery.
Recent reports emphasize the risks associated with patient-controlled analgesia by proxy (PCA-P), yet data regarding such risks in children remain sparse. We compared the prevalence of clinically significant adverse events in children receiving PCA-P versus PCA, and examined factors that place children at increased risk. ⋯ This study found that although a significant number of children receiving PCA and PCA-P experienced adverse events, there was no difference in the prevalence between groups. The PCA-P group was at greater risk for events requiring rescue interventions, perhaps due to the prevalence of underlying comorbidities. These findings emphasize the need for vigilant monitoring to facilitate early recognition and timely intervention of respiratory depression.
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Anesthesia and analgesia · Jul 2008
Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit.
Incomplete recovery of neuromuscular function may impair pulmonary and upper airway function and contribute to adverse respiratory events in the postanesthesia care unit (PACU). The aim of this investigation was to assess and quantify the severity of neuromuscular blockade in patients with signs or symptoms of critical respiratory events (CREs) in the PACU. ⋯ A high incidence of severe residual blockade was observed in patients with CREs, which was absent in control patients without CREs. These findings suggest that incomplete neuromuscular recovery is an important contributing factor in the development of adverse respiratory events in the PACU.
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Anesthesia and analgesia · Jul 2008
The onset time of atracurium is prolonged in patients with sickle cell disease.
Patients with sickle cell disease (SCD) frequently undergo surgery during their lifetime. Patients with SCD are considered at greater risk of perioperative complications than otherwise healthy patients and require meticulous anesthetic management. The pharmacodynamics of anesthetics may be altered in patients with SCD due to microcirculatory abnormalities or anemia. ⋯ Delayed onset time, together with unchanged duration of the neuromuscular blocking effect of atracurium, may be explained by an increased distribution volume of atracurium in patients with SCD. Our results suggest that monitoring of neuromuscular block may guide the time of tracheal intubation in patients with SCD.
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Anesthesia and analgesia · Jul 2008
An evaluation of a new combined Spo2/PtcCO2 sensor in very low birth weight infants.
Recently, a new sensor for combined assessment of pulse oximetry oxygen saturation (Spo(2)) and transcutaneous monitoring of carbon dioxide partial pressure (PtcCO(2)) has been introduced (TOSCA 500, Radiometer basel AG, Switzerland) [corrected] We designed this study to evaluate the usability and reliability of TOSCA in neonates with birth weight