Articles: opioid.
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Patients and caregivers participate in decision-taking, and their views should be considered in the preparation of Clinical Practice Guidelines (CPGs). We involved them in the development of a CPG on the safe use of major opioids. ⋯ These patients and caregivers demonstrated a preference for pain alleviation by opioid treatment and gave negative assessments on adverse digestive effects that can cause this treatment to be abandoned. They expressed interest in receiving more information and in participating in therapeutic decision making, and they reported erroneous beliefs and a lack of information about the effects of these drugs.
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The veterinary journal · Apr 2014
Randomized Controlled TrialRandomized clinical trial of the effects of a combination of acepromazine with morphine and midazolam on sedation, cardiovascular variables and the propofol dose requirements for induction of anesthesia in dogs.
The present study evaluated the effects of acepromazine combined with midazolam and morphine on sedation and cardiovascular variables as well as the propofol dose required for induction of anesthesia in dogs compared with acepromazine-morphine or midazolam-morphine. Dogs were randomly assigned to receive an intramuscular administration of (1) acepromazine (0.05 mg/kg) with 0.5mg/kg of morphine (group AM, n=10), (2) midazolam (0.5mg/kg) with 0.5mg/kg of morphine (group MM, n=9), or (3) acepromazine with midazolam and morphine at the same doses (group AMM, n=10). After 30 min, sedation was assessed by a numeric descriptive scale (NDS, range 0-3) and a simple numerical scale (SNS, range 0-10). ⋯ Blood pressure decreased in groups AM and AMM following treatment and in all groups after intubation. The combination AMM resulted in intense sedation more frequently than AM and MM, and provided the greatest sparing effect in the propofol dose. Administration of AM and AMM but not MM decreased blood pressure although hypotension was not recorded in healthy dogs.
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Systematic review and meta-analysis. ⋯ There is evidence of short-term efficacy (moderate for pain and small for function) of opioids to treat CLBP compared with placebo. The effectiveness and safety of long-term opioid therapy for treatment of CLBP remains unproven.
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J Pain Symptom Manage · Apr 2014
Dying with dementia: symptoms, treatment, and quality of life in the last week of life.
Burdensome symptoms present frequently in dementia at the end of life, but we know little about the symptom control provided, such as type and dosage of medication. ⋯ Symptoms are common in dementia at the end of life, despite the large majority of residents receiving opioids. Dosages may be suboptimal with regard to weighing of effects and side effects. Future research may employ observation on a day-to-day basis to better assess effectiveness of symptom control and possible side effects.
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Paediatric anaesthesia · Apr 2014
Anesthesia- and opioids-related malpractice claims following tonsillectomy in USA: LexisNexis claims database 1984-2012.
Although commonly performed, tonsillectomy is not necessarily a low-risk procedure for litigation. We have reviewed malpractice claims involving fatal and nonfatal injuries following tonsillectomy with an emphasis on anesthesia- and opioid-related claims and their characteristics. ⋯ Tonsillectomy carries a high risk from a medical malpractice standpoint for the anesthesiologists and otolaryngologists. Although surgery-related claims were more common, opioids- and anesthetic-related claims were associated with larger median monetary verdicts, especially those associated with anoxic, nonfatal injuries. Caution is necessary when opioids are prescribed post-tonsillectomy, especially in patients with sleep apnea.