Acta anaesthesiologica Scandinavica. Supplementum
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Although the scientific study of pain in the modern sense was initiated 150 years ago, and a number of theories were subsequently proposed, until two decades ago pain research remained conceptually stagnant and the meager amount done was not commensurate with the magnitude and clinical importance of pain. Consequently, pain treatment remained somewhat empirical and ineffective. ⋯ Fortunately, during the past 20 years significant advances have been made in our knowledge of basic mechanisms of acute pain and about some chronic pain syndromes, and a variety of new therapeutic modalities have been introduced and old ones have been refined. Among the most important advances of the past decade have been the discovery of opiate receptors, the extensive pharmacokinetic and pharmacodynamic studies of narcotics, the development of very sensitive analytic techniques and mathematic knowledge and many other advances which have prompted the development of new drugs, novel drug preparations and novel methods of administration, of which intraspinal narcotic therapy is the most important and widely used.
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This study presents a review of 961 patients treated in the general intensive care unit (ICU) of Akershus Central Hospital (ACH) from 1978 to 1981, including also a follow-up study of the 419 patients treated in 1978 and 1979 who were observed for an average period of 20 months after admittance to the ICU. The ICU patients represented 1.7% of all the patients admitted to the referring departments. Approximately 2/3 (67.3%) of the patients were surgical patients, representing 2.9% of the patients treated in that department, 19.6% were medical patients, and 8.6% came from the department of pediatrics. ⋯ Improvement by intensive care was achieved in 81.4% of the patients, 5.2% were unchanged, and 13.4% died while in the ICU. Mortality was 9.5% below and 19.3% above the age of 60 years. Of the 419 patients who were followed for an average period of 20 months after admittance to the ICU, 56 died in the ICU, 28 died later during the same stay in ACH, and another 47 died after discharge from ACH, whereas 288 (68.7%) were still alive.(ABSTRACT TRUNCATED AT 400 WORDS)
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Acta Anaesthesiol Scand Suppl · Jan 1987
Drug delivery systems for epidural administration of opioids.
From a practical and cost-effective viewpoint, the bolus administration of opiates via an implanted epidural catheter and portal injection system offers improved pain control for a good percentage of patients suffering pain secondary to cancer who are not responding to oral analgesia. However, considerable research is required into the mechanism of action, drug of choice, and optimal drug delivery system for the epidural administration of opiate drugs. Although this system is still in its infancy, it would be fair to say that it is one of the most significant advances for the control of pain in patients with cancer this century.