American journal of therapeutics
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Randomized Controlled Trial
A pharmacokinetic analysis of diclofenac potassium soft-gelatin capsule in patients after bunionectomy.
The clinical utility of diclofenac potassium, a nonsteroidal anti-inflammatory drug, may be lessened by inconsistent gastrointestinal absorption. Diclofenac potassium liquid filled soft-gelatin capsule (DPSGC) is an investigational formulation that uses ProSorb dispersion technology to facilitate rapid and consistent gastrointestinal absorption. In this study, the pharmacokinetic (PK) properties of DPSGC are investigated and compared with a commercially available oral diclofenac potassium tablet in patients after primary unilateral first metatarsal bunionectomy. ⋯ Mean times to Cmax (tmax) were 0.49, 0.63, 0.95, and 1.26 h, respectively. When compared with absorption characteristics of diclofenac potassium 50-mg tablet, DPSGC was more rapidly and consistently absorbed after bunionectomy. These characteristics should be advantageous when rapid pain relief is desired.
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Review Case Reports
Effectiveness of full agonist opioids in patients stabilized on buprenorphine undergoing major surgery: a case series.
A review of the medical literature failed to reveal clear, agreed-upon guidelines for practitioners on the postoperative provision of full agonist opioids for patients maintained on buprenorphine. Some controversy appears to exist about whether to maintain patients on their buprenorphine regimen up to the time of surgery. ⋯ Postoperative pain was adequately controlled using full agonist opioids according to self-report and physician assessment. The observations from this case series lend support to the practice of maintaining stable buprenorphine dosing for patients who require major surgery.
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A review of the history, incidence, presentation, pathophysiology, and treatment of propofol infusion syndrome.
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Nausea and vomiting are 2 of the most upsetting adverse reactions of chemotherapy. Current guidelines propose 5-hydroxytryptamine3 (5-HT3) receptor antagonists as a pharmacologic intervention for acute and delayed nausea and vomiting [chemotherapy-induced nausea and vomiting (CINV)] associated with moderately and highly emetogenic chemotherapy. Meanwhile, both postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting are challenging situations after surgeries and procedures. ⋯ There has been mounting interest in exploring integrative medicine, either acupuncture or acustimulation of P6 (Nei-Kuwan), to complement the western medicine for prevention and management of nausea and vomiting. The potential application of cannabinoids, either alone or in combination with other agents of different mechanism, could contribute further to improve outcome in CINV. Implementation of future treatment guidelines for more effective management of CINV and PONV could certainly improve the efficacy and outcome of cancer and postoperative care.
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Ketamine has been recognized as an anesthetic agent of choice in areas with limited resources, particularly in emergency situations. Unlike other commonly used induction agents, it preserves respiratory drive and maintains predominant sympathetic tone. ⋯ Despite these drawbacks, ketamine has become a favorable drug for the sedation of children undergoing various procedures. Here we propose 3 clinical paradigms where ketamine may be the agent of choice for the pediatric patient requiring sedation or anesthesia, including (1) the child with a difficult airway, (2) the child with a reactive airway disease, and (3) the uncooperative child requiring intravenous access.