Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jan 1997
Randomized Controlled Trial Clinical TrialPharmacokinetics and pharmacodynamics of controlled-release opioids.
While pharmacokinetic/pharmacodynamic relationships for opioids have not been consistently demonstrable or sufficiently predictive, there remain compelling reasons to pursue such relationships. Among the reasons for pursuing pharmacokinetic/ pharmacodynamic relationships is the prospect of predicting the time-action characteristics of new therapeutics on the basis of early studies in normals using pharmacodynamic surrogates for analgesia. The realization of such a model could improve the efficiency of development of analgesics. ⋯ Concurrent assessments included vital signs and opioid effect VAS questionnaires. The studies demonstrated significant relationships between plasma oxycodone (but not oxymorphone) and pharmacodynamic surrogates (particularly VAS "drug effect") and were predictive of the 12-hour duration of pain control and prompt onset of analgesia subsequently demonstrated in multiple clinical studies involving patients with various pathological pain syndromes. The results suggest that investigators can make earlier, accurate predictions of opioid analgesic pharmacodynamics in patients based on pharmacokinetic/pharmacodynamic studies in normal volunteers.
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Acta Anaesthesiol Scand · Jan 1997
Randomized Controlled Trial Comparative Study Clinical TrialAnalgesia following arthroscopy--a comparison of intra-articular morphine, pethidine and fentanyl.
It has recently been reported that morphine given in low doses intra-articularly can produce significant analgesia in patients undergoing arthroscopic knee joint surgery. Data are lacking on the effect of other opioids using a local approach for drug delivery. We studied the analgesic effect of intra-articular opioids in 70 patients, divided into 7 groups, subjected to arthroscopic knee surgery in general anesthesia. ⋯ If analysing the results with regards to if opioids were given intra-articularly or systemically, not considering the type of opioid given, we did however, find a significantly lower total sum of pain scores at movement following local administration (P < 0.05). No specific side-effects were detected. We conclude that pethidine given intra-articularly merits further investigation with respect to postoperative analgesia following the activation of peripheral opioid mechanisms.
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Acta Anaesthesiol Scand · Jan 1997
Randomized Controlled Trial Clinical TrialSequestration of vecuronium bromide during extremity surgery involving use of a pneumatic tourniquet.
We hypothesized that sequestration of a neuromuscular blocking agent could occur during surgery involving use of an extremity tourniquet and cause changes in neuromuscular function after tourniquet release. ⋯ Sequestration of a bolus dose of vecuronium, by a pneumatic tourniquet, causes transient changes in pharmacokinetics and pharmacodynamics. These changes are of limited clinical importance and do not affect reversibility of neuromuscular block.
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Acta Anaesthesiol Scand · Jan 1997
Comparative StudyA comparison of pressure- and volume-controlled ventilation at different inspiratory to expiratory ratios.
Inverse ratio ventilation (IRV) is frequently used in severe acute respiratory failure. IRV may lead to intrinsic positive end-expiratory pressure (PEEP) and is thought to improve oxygenation and to have advantageous effects on lung mechanics. Published data to support the use of IRV are scarce. This animal study compares external PEEP with intrinsic PEEP in pressure- and volume-controlled ventilation. ⋯ Inverse ratio ventilation did not result in improved FRC in comparison to conventional volume-controlled PEEP ventilation. PCIRV allows for a reduction in minute ventilation but the increase in mean airway pressure compromises circulation.