Articles: analgesics.
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Cahiers d'anesthésiologie · Jan 1991
Review[Opioids by the perimedullary route: mechanisms of opioid analgesia].
The identification of multiple opioid receptors and opioid peptides in the 1970 was the starting point of an increasing knowledge on opioid physiology and pharmacology. The mechanisms of action of spinally supraspinal levels. At the spinal level, opioids act by a modulation of specific supraspinal effect is the consequence of the migration of opioids, other in the bloodstream or in the cerebrospinal fluid, towards the encephalon. ⋯ At the receptor level, opioid agonists act, hypothetically via the system of adenylcylase, more certainly via a modulation of membrane tonic channels. Thus, opioids modify sodium, calcium and potassium currents, and modify the successives phases of the membrane action potential. The result is an hyperpolarization which is responsible of an inhibition of the release of various neurotransmitters such as P substance.
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Narcotics are used in neuro-anesthesiology according to their pharmacology and their effects on cerebral physiology. New narcotics (fentanyl, sufentanil, alfentanil) fulfill the requirements of modern neurosurgical anesthesiology looking for quick awakening.
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Morphine consumption for medical purposes in Japan showed a 17-fold increase between 1979 and 1989, due to increased use in cancer pain management. This increase is a reflection of the improving attitude of the health care professionals and health policy makers towards narcotics use. The WHO Cancer Pain Relief Programme has ultimately become the basis for a national cancer pain relief programme. The Ministry of Health and Welfare amended the Narcotics and Psychotropics Control Law in 1990, to improve accessibility of morphine preparations to cancer patients with pain, and edited four manuals for palliative care, that include guidelines on cancer pain relief, and legislative management of narcotics use in hospital, clinic and pharmacy.
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Comparative Study
Electroencephalographic quantitation of opioid effect: comparative pharmacodynamics of fentanyl and sufentanil.
The authors compared the pharmacodynamics of sufentanil with those of fentanyl using the electroencephalogram (EEG) as a measure of opioid drug effect. Sixteen patients were given a rapid infusion of sufentanil (18.75 micrograms/min) during EEG recording. To quantitate the opioid-induced slowing of the EEG, the authors analyzed its power spectrum and calculated the spectral edge. ⋯ The time from injection to 50% maximal EEG slowing (T50) was calculated for each patient. The values for T50 for the two groups did not differ. The authors conclude that fentanyl and sufentanil have similar pharmacodynamic profiles, the former being 12 times more potent than the latter.