Neuromodulation : journal of the International Neuromodulation Society
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In intrathecal drug delivery, visualization of the device has been performed with plain radiography. However, the visibility of the related structures can be problematic. In troubleshooting, after the contrast material injection via the catheter access port, a computed tomography (CT) scan has been used. In troubleshooting, we also used a non-contrast CT scan with 2D and 3D reconstructions. With the current phantom study, we aimed to obtain high-resolution imaging of a poor opaque catheter with the use of a low-dose single-energy 2D and 3D CT scan with limited radiation exposure as a substitute for plain radiography. ⋯ Dr. Delhaas reports personal fees from Medtronic Inc., as a previous consultant, outside the submitted work; Prof. van der Lugt reports grants from GE Healthcare, Siemens, Stryker, Medtronic, and Penumbra outside the submitted work.
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Conversion between routes such as intravenous (IV), epidural (EP), and intrathecal (IT) routes for morphine is well established. Conversion ratios for IV:EP:IT fentanyl and conversion from IT morphine/hydromorphone to IT fentanyl have been challenging given the lipophilic nature of fentanyl. Our study reviews the outcomes and conversion ratios reached after converting IT opioids from morphine/hydromorphone to fentanyl in patients with IT pumps. ⋯ Given the pharmacokinetics of lipophilic fentanyl compared to hydrophilic morphine/hydromorphone, the current conversion ratio of IV fentanyl to IT fentanyl and IV morphine to IT fentanyl appears to be conservative.
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DMT-DALDA (H-Dmt-D-Arg-Phe-Lys-NH2; Dmt = 2',6'-dimethyltyrosine) is a selective mu opioid agonist. We sought to characterize efficacy, tolerance, dependence and side-effect profile when given by continuous intrathecal infusion. ⋯ These data suggest that DMT-DALDA is a potent, spinally active agonist with a propensity to produce tolerance dependence and mast cell degranulation. While it was equiactive to morphine in producing mast cell degranulation, it was >1000 fold more potent in producing analgesia, suggesting a possible lower risk in producing a spinal mass at equianalgesic doses.