Current drug targets
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Using a portable infusion pump, intravenous opioid patient-controlled analgesia (PCA) permits a patient to self-deliver a small bolus of opioid to achieve prompt relief without over sedation. Use of PCA for pain management is increasing in hospitals, largely because it can provide equivalent or better analgesia than conventional nurse-administered opioid analgesia, and patients are more satisfied with its use. There is no decisive pharmacological or clinical argument for the choice of one opioid rather than another. ⋯ Caution is required among patients with respiratory or renal insufficiency. In the future, the indispensable improvement in the management of postoperative pain should lead to a greater expansion of PCA. However, more pharmaco-economic evaluations will be needed on the cost-effectiveness issue.
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The aim of the present article is to review the indications, the monitoring and the complications of sedation in the post-anaesthesia care unit (PACU). In this setting, sedation is often an unwanted side effect of anaesthetic drugs that delay discharge, however it could be specifically indicated. Such indications include postoperative anxiety and agitation, airway management and mechanical ventilation, protection against myocardial ischaemia and intracranial hypertension control. ⋯ The target score of the most common clinical scales has been reviewed according to the specific indication. An adequate monitoring is fundamental to avoid the complications of sedation including bradycardia, hypotension, prolonged mechanical ventilation and increased risk of respiratory tract infection as pointed out by many recent data. Therefore, sedation should be used carefully and with an adequate monitoring in post-operative patients not to affect negatively morbidity and mortality.
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Many patients in the ICU receive mechanical ventilation and require sedative medications. Anxiolysis, hypnosis, and amnesia can be considered the primary objects of sedative therapy. Intravenous benzodiazepines are the drugs most commonly used for sedation in ICU. ⋯ Diazepam has become less used with the introduction of the shorter-acting and less irritating benzodiazepine. The recent literature focuses on the differences between Midazolam and Propofol, the most used sedatives in ICU, their sequential use and combination. Relevant studies have been performed about propylene glycol toxicity.
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Current drug targets · Feb 2005
ReviewNeuropathic pain: is the end of suffering starting in the gene therapy?
Neuropathic pain is defined as pain initiated or caused by a primary lesion or dysfunction in the nervous system. It is a devastating and difficult to manage consequence of peripheral nerve injury and has a variety of clinical symptoms. Neuropathic pain is a major health problem. ⋯ Chronic pain is debilitating and cause of depression and decreasing quality of life. Pharmacological treatment for the symptoms of painful neuropathy is difficult, because there has been limited understanding of the underlying causes and systemic levels that an effective dose can have on multiple side effects. The use of molecular methods, such as gene therapy, stem cell therapy and viral vector for delivery of biologic antinociceptive molecules, has led to a better understanding of the underlying mechanisms of the induction of intractable neuropathic pain.
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Current drug targets · Jul 2004
ReviewIs surfactant a promising additive drug in ALI/ARDS-patients?
The rationale for surfactant replacement therapy in patients with acute respiratory distress syndrome (ARDS) is to restore the normal composition of the surfactant system, as well as to overcome ongoing inactivation of present surfactant. Indeed, surfactant replacement therapy can normalize the composition of the surfactant system and restore its surface activity, which results in restoration of the gas exchange. Several phase II- and phase III-studies have been performed to investigate safety and efficacy of surfactant replacement therapy in patients with ARDS. In this manuscript we will discuss the differences in the composition of exogenous surfactant, the diverse modes of delivery of surfactant, and timing of therapy, in relation to the efficacy of surfactant instillation in several published and yet unpublished studies.