Articles: patients.
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Hydromorphone is a micro receptor agonist opioid. According to WHO recommendations, hydromorphone is to be classified in step III of pain therapy. An oral formulation with a prolonged duration of action of 12 hours has been evaluated only recently. The controlled release capsule is especially suited for the regular twice a day administration in cases of severe and persistent pain. The oral formulation of hydromorphone increases the number of opioid analgesics available for pain therapy in step III. Hydromorphone is recommended when morphine fails to produce sufficient pain relief (despite increase of doses) or causes intolerable side effects (despite treatment of symptoms). In principle, no differences in efficacy of morphine and hydromorphone are to be expected. However, clinical experience shows that changing one opioid analgesic to another one can improve the treatment of patients so that hydromorphone may replace another opioid analgesic to which a patient fails to respond well or develops side effects. The dose of hydromorphone equivalent to 2 times 30 mg controlled release morphine is about 2 times 4 mg. The values for the absorption, bioavailability and maximum plasma concentration after the administration of controlled release hydromorphone every 12 hours -of three times the dose- are equivalent to those of an immediate release tablet given every 4 hours. In several open label and controlled studies, hydromorphone proved to be of good efficacy in the treatment of acute and persistent pain, especially in patients with severe cancer pain. With regard to the incidence of side effects, no significant differences between morphine and hydromorphone could be established. In general, the side effects of hydromorphone are typical for opioid analgesics. ⋯ In conclusion, controlled release hydromorphone seems to be well suited for the control of severe chronic pain when given twice daily.
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J. Cardiovasc. Pharmacol. Ther. · Jul 1998
A Multicenter Study Evaluating the Effects of Sevoflurane on Renal Function in Patients With Renal Insufficiency.
This multicenter study was undertaken to compare the effect of sevoflurane with that of isoflurane on renal function in 26 patients with pre-existing renal insufficiency. Sevoflurane undergoes hepatic metabolism, with release of inorganic fluoride. Elevated fluoride levels have been associated with renal impairment in patients undergoing methoxyflurane anesthesia raising concerns about the nephrotoxic potential of sevoflurane. ⋯ Sevoflurane metabolism produces elevations in plasma fluoride concentrations relative to isoflurane. Despite the increase in plasma fluoride levels, the administration of sevoflurane to patients with renal insufficiency did not produce any adverse effects on renal function as measured by serum creatinine concentration when compared with isoflurane.
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J. Cardiovasc. Pharmacol. Ther. · Jul 1998
Significance of Supraventricular Tachyarrhythmias After Coronary Artery Bypass Graft Surgery and Their Prevention by Low-Dose Sotalol: A Prospective Double-Blind Randomized Placebo-Controlled Study.
The single most frequent complication after coronary artery bypass graft surgery is the occurrence of supraventricular tachyarrhythmias leading to a prolonged hospital stay. Although several drugs have been used to treat these arrhythmias, effective prevention was only possible with beta-blocking drugs in selected patients. It was, therefore, the aim of the present study to evaluate the significance of supraventricular tachyarrhythmias in presence of today's cardioprotective management in a broad spectrum of patients and to assess the possible preventive effect and safety of low-dose sotalol after coronary artery bypass graft surgery. METHODS AND ⋯ These data show that without antiarrhythmic therapy the incidence of supraventricular arrhythmias after coronary artery bypass graft surgery is high (43%) and that supraventricular arrhythmias were associated with a prolonged hospital stay (+/-2 days). Prophylactic treatment with low-dose sotalol reduced the incidence of supraventricular arrhythmias significantly (by 40%), thereby reducing overall hospital stay in treated patients. Because more than 90% of all supraventricular arrhythmic episodes occurred within 10 days after surgery and considering the small proarrhythmic effect of sotalol late after surgery, prophylactic treatment with sotalol may be recommended for the first 10 postoperative days to safely reduce supraventricular tachyarrhythmias.
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Exercise echocardiography is a widely used modality for the noninvasive assessment of coronary artery disease. However, limitations exist inherent to the acquisition of transthoracic echocardiographic images. Although transesophageal echocardiography has been used during pacing or pharmacological stress, its use during exercise stress testing has not been clinically feasible due to the large probe size. ⋯ Excellent-quality monoplane two-dimensional echocardiographic images were obtained in all patients in the upright position. During exercise treadmill testing, high quality clinically useful echocardiographic images of the left ventricular short axis could be maintained. We conclude that transnasal transesophageal stress echocardiography may offer a new modality for the exercise assessment of ischemic heart disease.
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We describe seven patients presenting with combination substance abuse involving γ-Hydroxybutyric acid (GHB). ⋯ Emergency physicians should be alerted to this agent, its characteristic effects, and its potential for serious sequelae including respiratory arrest and death. [Li J, Stokes SA, Woeckener A: A tale of novel intoxication: Seven cases of γ-Hydroxybutyric acid overdose. Ann Emerg Med June 1998;31:723-728.].