Articles: opioid.
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Review
Opioid-induced respiratory depression in the acute care setting: a compendium of case reports.
Opioid-induced respiratory depression (OIRD) is a potentially fatal complication of treatment with opioids. Little is known about patient- and case-related factors associated with OIRD. ⋯ The most frequently reported patient-related factors involved were: female gender, sleep-disordered breathing, obesity, renal impairment, pulmonary disease and CYP450 enzyme polymorphisms. While the analysis has limitations, it confirms that OIRD in the acute setting involves complex and interrelated factors and is a significant cause of preventable morbidity and mortality.
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To describe a cohort of new opioid users (adult noncancer patients) in terms of clinical characteristics and treatment patterns in the UK and Germany. ⋯ While both populations were highly morbid populations largely initiated on weak opioids, chronic use was less common in Germany.
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J Pain Symptom Manage · Jul 2014
Comparative StudyA single institution's effort to translate codeine knowledge into specific clinical practice.
Codeine is an unpredictable analgesic because of its variable pharmacokinetic, pharmacodynamic, and pharmacogenetic properties. This variability may lead to ineffective analgesia in some and respiratory depression in others. Despite this, codeine is still widely used. At a pediatric tertiary medical institution, codeine was prescribed despite efforts to inform prescribers of the potentially unpredictable analgesia and serious side effects. ⋯ This quality improvement initiative was successful in eliminating codeine from the hospital formulary. Although education decreased codeine orders, understanding and addressing the barriers to change and directly changing the ordersets were the most effective and efficient for knowledge translation.
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Substance use is overrepresented in dental clinics that provide affordable care and dental clinics provide potential access to opioid analgesics. Research is needed to better understand prescription opioid misuse in this population. ⋯ Within this sample from a dental clinic, nonmedical use of prescription pain medications was more common than in the general population. This suggests that dental clinics may be an appropriate setting for provider education and patient-based intervention strategies to reduce nonmedical use of pain medications.
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J Vet Emerg Crit Care (San Antonio) · Jul 2014
Possible delayed respiratory depression following intrathecal injection of morphine and bupivacaine in an alpaca.
To describe general anesthesia and successful treatment of an alpaca, which developed respiratory arrest 2 hours after intrathecal injection of morphine and bupivacaine. ⋯ Delayed respiratory depression is a potential complication after intrathecal administration of morphine. Careful dose-adjustment may reduce the risk, and close monitoring will result in early detection and treatment of this complication.