Journal of post anesthesia nursing
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Butorphanol tartrate (Stadol; Anaquest, Madison, WI/Bristol-Meyers Squibb, Evansville, IN) is an analgesic possessing mixed agonist-antagonist activity at opiate receptors. Receptor specificity has been used to limit respiratory depression, gastrointestinal side effects, and reduce the risk of dependency. Theoretically it offers an advantage over traditional opiates such as morphine and meperidine in the treatment of moderate pain. ⋯ Its lack of euphoric effects may be useful in emergency medicine for clinical populations prone to drug-seeking behavior. Butorphanol has been used more recently for epidural analgesia or for intravenous patient-controlled analgesia when allergies to opiates exist. Since butorphanol is not a controlled substance, its use can reduce administrative liability for abuse and can lower the number of distribution records associated with Schedule II narcotics.
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Opiates remain the choice of analgesia for severe pain despite numerous side effects. They possess the unique ability to alter the interpretation of noxious sensations normally sensed as pain, while leaving the sensations of touch, temperature, and proprioception essentially unchanged. Opiates act by mimicking naturally occurring endogenous peptides at a variety of receptors in the central nervous system (CNS). ⋯ A brief description of nociceptive (pain) pathway anatomy is also presented. Application of knowledge has allowed the development of mixed agonist-antagonist drugs such as butorphanol (Stadol; Anaquest, Madison, WI/Bristol Meyers Squibb, Evansville, IN) that capitalize on specific opiate receptor activation or antagonism to decrease adverse side effects and abuse-dependence potential. Future research areas are discussed.
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The physiology of the neuromuscular junction has a significant impact on the pharmacology of neuromuscular blockade and associated reversal. Depolarizing and nondepolarizing agents for blockade and enzyme inhibitors for reversal of blockade are discussed. Clinical applications are also reviewed.
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Seventy percent of all postoperative patients--over 14 million cases annually- suffer from hypothermia, which is caused by the combination of the anesthetics preventing thermal homeostasis and the cold operating room environment. Therapeutic goals are to treat shivering, prevent the severe discomfort of hypothermia, maximize rewarming rate to shorten PACU time, and maximize patient safety. Traditional warming therapies do not actively heat the patient nor do they prevent the continued loss of endogenously produced heat. Convective warming therapy is a new technology that clinical studies have demonstrated to be effective in preventing intraoperative or treating postoperative hypothermia.