Acta anaesthesiologica Scandinavica
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Cancer pain generally responds in a predictable way to analgesic drugs and drug therapy is the mainstay of treatment. A small proportion of patients, of the order of 20%, have pain that does not respond well to conventional analgesic management. Because opioid analgesics are the most important part of this pharmacological approach, a terminology has developed which centres around whether or not pain will respond to opioid analgesics. ⋯ The underlying pathophysiology remains unclear but abnormal metabolism of morphine is not the cause of a poor response to this drug. Patients with opioid-poorly-responsive-pain should be considered for treatment with the same opioid by an alternative (spinal) route or with an alternative opioid agonist administered by the same route (whether oral or parenteral), in conjunction with adjuvant analgesics such as tricyclic antidepressants. The most commonly used alternative oral opioids are phenazocine and methadone; transdermal fentanyl is an additional option.
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Acta Anaesthesiol Scand · Jan 1997
Epidural analgesia following upper abdominal surgery: United Kingdom practice.
Epidural Analgesia (EA) may be used to provide pain relief after upper abdominal surgery. A variety of drugs and combinations may be used. Potential side effects lead some to believe EA should be restricted to high care areas. ⋯ EA is widely used in the United Kingdom following upper abdominal surgery. A degree of consensus exists on the choice of drug types, their method of administration and duration. There is no consensus as to whether the technique should be used on a general ward, which opioid should be used or the timing of heparin.
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The aim of the present study was to analyse the opioid consumption in the 10 most opioid-consuming countries in relation to the Danish consumption. The results revealed, that the total opioid consumption has increased in all of the 10 most opioid consuming countries (range 26-1423%). In Denmark, the total opioid consumption increased 353% from 1981 to 1993, exceeding 1.45 million defined daily doses per 1 million inhabitants in 1993, which is the highest in the world. ⋯ The consumption of long-acting opioids (morphine sustained release, methadone, buprenorphine) and short acting opioids (others) increased 1427% and 105%, respectively. Analysis of a sample of 1854 prescriptions made by general practitioners for opioids revealed, that less than 10% of the prescriptions were issued for cancer pain conditions. In conclusion of other countries consider Denmark as worthy of imitation concerning opioid treatment in cancer pain, attention should be paid to the pattern of the Danish opioid consumption, which is outstanding with respect to quantity.
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About three quarters of patients with advanced cancer experience pain. Most of these have multiple pains. Causes of pain fall into four broad categories: the cancer itself, related to the cancer +/- debility, related to treatment, concurrent disorder. ⋯ Recognition of functional muscle pain is important. Patients with severe chronic pain do not necessarily look in pain because of the absence of autonomic concomitants. Whatever the cause, pain is a "somatopsychic' experience.
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Acta Anaesthesiol Scand · Jan 1997
Hemodynamic, sympathetic and angiotensin II responses to PEEP ventilation before and during administration of isoflurane.
Positive end-expiratory pressure (PEEP) ventilation and isoflurane anesthesia may opposingly affect the sympathetic nervous and renin-angiotensin systems. This study was performed to elucidate the modulatory effects of isoflurane anesthesia on the neurohumoral and cardiovascular responses to PEEP. ⋯ The data suggest that renin-angiotensin activation is important to attenuate the impact of PEEP ventilation on cardiovascular performance during administration of the sympathodepressant isoflurane. Interference with the renin-angiotensin system may cause cardiovascular decompensation in isoflurane anesthetized patients subjected to PEEP-ventilation.