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The Journal of Clinical Pediatric... Mar 2022This retrospective study compares the efficacy and safety of variable dosing of Midazolam (Mid) with and without Meperidine (Mep) combinations for managing varying...
Retrospective Comparisons of the Efficacy and Safety of Variable dosing of Midazolam with and without Meperidine for Management of Varying Levels of Anxiety of Pediatric Dental Patients: 35 years of Sedation Experience.
PURPOSE
This retrospective study compares the efficacy and safety of variable dosing of Midazolam (Mid) with and without Meperidine (Mep) combinations for managing varying levels of anxiety and uncooperative behavior of young pediatric dental patients over a thirty-five-year period.
STUDY DESIGN
Reviews of the sedation logs of 1,785 sedation visits are compared with emphasis on what dosing proves both safe and effective for differing levels of challenging pediatric behavior. Variable dosing of midazolam with and without meperidine which spanned low-end, mid-range, and upper-end were judged making use of a pragmatic approach which defined sedation success as optimal, adequate, inadequate, or over-dosage. Behavioral and physiologic assessment was included with attention to readily observable analysis of the extent to which need for physical restraint occurred to control interfering behavior. Assessment of arousal levels requiring stimulation along with the frequency of alterations in oxygen de-saturation and adverse reactions were included as indications of safety.
RESULTS
Where Mep was used, success rates were consistently higher; working times were significantly prolonged and greater control was provided to avoid adverse reactions by virtue of reversal capability for both agents.
CONCLUSIONS
Predictability and working time of Midazolam was enhanced by combination with narcotic for all levels of patient anxiety. Dosages of 0.7-1.0 mg/kg Mid combined with 1.0-1.5 mg/kg Mep offers the most effective and safe results to overcome need for restraint for moderate and severe levels of anxiety, respectively.
Topics: Anxiety; Child; Conscious Sedation; Humans; Hypnotics and Sedatives; Meperidine; Midazolam; Retrospective Studies
PubMed: 35533228
DOI: 10.17796/1053-4625-46.2.11 -
Journal of Integrative Medicine Jul 2022This study evaluated the effectiveness of acupuncture treatment on postoperative pain in patients with degenerative lumbar spine disease, and explored the relationship...
Using a consensus acupoints regimen to explore the relationship between acupuncture sensation and lumbar spinal postoperative analgesia: A retrospective analysis of prospective clinical cooperation.
OBJECTIVE
This study evaluated the effectiveness of acupuncture treatment on postoperative pain in patients with degenerative lumbar spine disease, and explored the relationship between the postoperative analgesic effect of acupuncture and the sensation of acupuncture experienced by the patients.
METHODS
This retrospective study analyzed the medical records of 97 patients who had undergone an operation by the same surgeon due to degenerative lumbar disease. These patients were divided into acupuncture group (n = 32), patient-controlled analgesia (PCA) group (n = 27), and oral analgesia group (n = 38) according to the different postoperative analgesic methods. During their hospitalization, patients completed daily evaluations of their pain using a visual analogue scale (VAS), and injection times of supplemental meperidine were recorded. Also, the Chinese version of the Massachusetts General Hospital Acupuncture Sensation Scale (C-MASS) was used in the acupuncture group.
RESULTS
Each of the three treatment groups showed significant reductions in postoperative pain, as shown by reduced VAS scores. The acupuncture group, however, had less rebound pain (P < 0.05) than the other two groups. Both the acupuncture and PCA groups experienced acute analgesic effects that were superior to those in the oral analgesia group. In addition, the higher the C-MASS index on the second day after surgery, the lower the VAS score on the fourth day after surgery. There was also a significant difference in the "dull pain" in the acupuncture sensation.
CONCLUSION
The results demonstrated that acupuncture was beneficial for postoperative pain and discomfort after simple surgery for degenerative spinal disease. It is worth noting that there was a disproportionate relevance between the patient's acupuncture sensation and the improvement of pain VAS score.
Topics: Acupuncture Points; Acupuncture Therapy; Analgesia; Analgesics; Consensus; Humans; Pain, Postoperative; Prospective Studies; Retrospective Studies; Sensation
PubMed: 35487866
DOI: 10.1016/j.joim.2022.04.003 -
Chemosphere Aug 2022The present work focuses on the development of a new electrochemical platform based on CoMnO-rGO/1-ethyl-3-methylimidazolium chloride modified carbon paste electrode...
A novel platform based on CoMnO-rGO/1-ethyl-3-methylimidazolium chloride modified carbon paste electrode for voltammetric detection of pethidine in the presence morphine and olanzapine.
The present work focuses on the development of a new electrochemical platform based on CoMnO-rGO/1-ethyl-3-methylimidazolium chloride modified carbon paste electrode (CoMnO-rGO/IL/CPE) for electrochemical determination of pethidine in the presence of biological species. For the first time, the electrooxidation mechanism of pethidine in presences of morphine and olanzapine is investigated by cyclic voltammetry (CV) and differential pulse voltammetry (DPV) technologies. The as-synthesized CoMnO-rGO nanocomposites are characterized by physicochemical measurements such as X-ray diffraction (XRD), energy dispersive X-ray spectroscopy (EDX), Field emission scanning electron microscopy (FE-SEM), and Fourier transform infrared (FT-IR). The obtained results illustrated synergistic interactions between rGO and CoMnO structures. Also, to investigate the electrode charge-transfer resistances, electrochemical features of the resulting nanocomposites are studied via electrochemical impedance spectroscopy (EIS) analysis. Based on the result, three segmented linear ranges are observed over the range 0.08-900 μM and detection limit of 0.024 μM. Over the 10.0-40.0 μM ranges of pethidine in phosphate buffer solution (PBS-pH 7.0), suitable diffusion coefficient of 5.67 × 10 cm s is evaluated by chronoamperometry technique (CHA). Finally, the CoMnO-rGO/IL/CPE with high sensitivity, selectivity and repeatability is successfully used for determination of pethidine in real sample and drug formulation.
Topics: Carbon; Chlorides; Electrochemical Techniques; Electrodes; Ethyl Chloride; Graphite; Imidazoles; Meperidine; Morphine; Olanzapine; Spectroscopy, Fourier Transform Infrared
PubMed: 35487358
DOI: 10.1016/j.chemosphere.2022.134710 -
Inflammopharmacology Jun 2022Imrecoxib is a novel cyclooxygenase-2 inhibitor independently developed in China, which exhibits a good efficacy and tolerance in orthopedic disorders. The current study... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Imrecoxib is a novel cyclooxygenase-2 inhibitor independently developed in China, which exhibits a good efficacy and tolerance in orthopedic disorders. The current study aimed to further compare its efficacy and safety with celecoxib as postoperative analgesia in arthroscopic knee surgery (AKS).
METHODS
Patients receiving AKS were enrolled and randomly assigned to imrecoxib (n = 64) and celecoxib (n = 62) group to receive analgesia for 72 h after surgery. Pain at rest and movement, pethidine consumption, patient's satisfaction, Lysholm score, and adverse events were assessed after AKS. Meanwhile the upper limit of 95% CI of pain-score mean difference (MD) between imrecoxib and celecoxib was calculated, then, the non-inferiority was defined if the all-time-point upper limits of 95% CI less than 1.
RESULTS
Imrecoxib was non-inferior to celecoxib for alleviating pain at rest (upper limit of 95% CI of MD ranging from 0.443 to 0.782, all time-point values less than 1); as well as for attenuating pain at movement (upper limit of 95% CI of MD ranging from 0.398 to 0.582, all time-point values less than 1). Moreover, rescue analgesia rate (P = 0.583), pethidine consumption (P = 0.454), patient's satisfaction at 72 h (P = 0.408), and Lysholm score at M3 (P = 0.776) were of no difference between imrecoxib group and celecoxib group. Additionally, the main adverse events in two groups were nausea (P = 0.425), constipation (P = 1.000), vomiting (P = 0.715), headache (P = 1.000), and dizziness (P = 0.667), which were mild and manageable.
CONCLUSION
Imrecoxib is non-inferior to celecoxib in postoperative analgesia and exhibits an acceptable tolerance in patients undergoing AKS.
Topics: Analgesia; Celecoxib; Humans; Meperidine; Pain, Postoperative; Pyrroles; Sulfides
PubMed: 35445990
DOI: 10.1007/s10787-022-00938-8 -
Minerva Anestesiologica Jun 2022
Topics: Humans; Meperidine; Postoperative Complications; Postoperative Period; Shivering
PubMed: 35416469
DOI: 10.23736/S0375-9393.22.16624-1 -
Drug and Alcohol Dependence Jun 2022Prior research demonstrates a high prevalence of substance use, including opioid use, among those who have had personal or vicarious contact with the correctional...
BACKGROUND
Prior research demonstrates a high prevalence of substance use, including opioid use, among those who have had personal or vicarious contact with the correctional system. Relatedly, alongside patterns of rising opioid use in general, opioid use during pregnancy is becoming a growing public health concern. Still, risk factors for prescription opioid use during pregnancy remain understudied. This study is the first to assess the connection between a women's personal or vicarious exposure to incarceration in the 12 months prior to birth and patterns of prenatal opioid use.
METHODS
Data are from the Pregnancy Risk Assessment Monitoring System (PRAMS) in 2019 (N = 17,551 mothers). Logistic and multinomial logistic regression are used to assess the association between incarceration exposure and patterns of opioid use during pregnancy.
RESULTS
Incarceration-exposed women were more likely to use all eight types of prescription opioids assessed in this study (Hydrocodone, Codeine, Oxycodone, Tramadol, Hydromorphone/Meperidine, Oxymorphone, Morphine, and Fentanyl). After adjustment for control variables, incarceration-exposed women were significantly more likely to report any prescription opioid use during pregnancy (OR = 1.745, 95% CI = 1.194, 2.554). Furthermore, relative to no opioid use, incarceration exposure was also associated with illicit prescription opioid use (RRR = 2.979, 1.533, 5.791).
CONCLUSIONS
Incarceration exposure in the year prior to birth is associated with higher odds of prescription opioid use. These findings add to the burgeoning literature that details a women's exposure to incarceration is a risk marker for substance use and engagement in health risk behaviors that can jeopardize maternal and infant wellbeing.
Topics: Analgesics, Opioid; Female; Humans; Opioid-Related Disorders; Oxycodone; Pregnancy; Prescriptions; Tramadol
PubMed: 35405460
DOI: 10.1016/j.drugalcdep.2022.109434 -
Ethiopian Journal of Health Sciences Nov 2021Post-anesthetic shivering is one of the most common complications after anesthesia. Ketamine has been considered to be an effective treatment for post-anesthetic... (Randomized Controlled Trial)
Randomized Controlled Trial
Comparison of Intravenous Ketamine with Intrathecal Meperidine in Prevention of Post-anesthetic Shivering after Spinal Anesthesia for Lower Limb Orthopedic Surgeries: A Double-blind Randomized Clinical Trial.
BACKGROUND
Post-anesthetic shivering is one of the most common complications after anesthesia. Ketamine has been considered to be an effective treatment for post-anesthetic shivering, but the evidence for its therapeutic benefit after spinal anesthesia is limited. The aim of this study was to compare the effects of intravenous ketamine with intrathecal meperidine in the prevention of post-anesthetic shivering after spinal anesthesia for lower limb orthopedic surgeries.
METHODS
In a double-blind randomized parallel-group clinical trial, a total of 150 patients scheduled for lower limb orthopedic surgeries under spinal anesthesia were selected and randomly divided into three equally sized groups of intravenous ketamine (0.5 mg/kg), intrathecal meperidine (0.2mg/kg) or intravenous normal saline (as placebo). The intensity of shivering in patients were evaluated during surgery and after transfer into the post anesthesia care unit. Also, changes in patients' drowsiness, nausea, vomiting, pruritus, mean arterial pressure, heart rate, and arterial oxygen saturation (SPO2) during surgery and until the end of anesthesia were evaluated.
RESULTS
In all times of evaluation (20, 60, 80, 100 and 120 minutes after onset of spinal anesthesia) patients in control group showed a greater intensity of shivering compared to other groups. However, patients who received intrathecal meperidine experienced significantly lower intensity of post anesthetic shivering (p<0.05). The results showed a significant mean arterial pressure and heart rates differences between the three groups, only on 20 and 60 minutes after initiation of spinal anesthesia. The incidence of nausea, vomiting, and pruritus was not significantly different in all three groups, although all patients who received ketamine experienced drowsiness after surgery (p<0.001).
CONCLUSION
The results of the present study showed that, although both intrathecal meperidine and intravenous ketamine could effectively prevent postoperative shivering after spinal anesthesia in lower limb orthopedic surgeries, intrathecal meperidine was associated with more efficacy benefits and a lower frequency of side effects such as post-anesthesia drowsiness.
Topics: Analgesics, Opioid; Anesthesia, Spinal; Anesthetics; Double-Blind Method; Humans; Injections, Spinal; Ketamine; Lower Extremity; Meperidine; Nausea; Orthopedic Procedures; Shivering; Vomiting
PubMed: 35392354
DOI: 10.4314/ejhs.v31i6.16 -
Veterinary Medicine and Science Jul 2022The use of combinations of α -adrenergic agonists and opioids has been published as providing superior sedation than either drug alone.
BACKGROUND
The use of combinations of α -adrenergic agonists and opioids has been published as providing superior sedation than either drug alone.
INTRODUCTION
The present study aims to compare the sedative and physiological effects of intravenous (IV) administration of medetomidine alone and in combination with methadone, morphine, tramadol, and pethidine in goats.
METHODS
Ten healthy goats aged 12 ± 3 months and weight of 22 ± 4 kg were used in an experimental, crossover (Latin square), randomized, and blinded study. The animals were assigned to five IV treatments with a minimum washout period of 8 days between treatments: medetomidine (20 μg kg ), medetomidine/methadone (0.5 mg kg ), medetomidine/morphine (0.5 mg kg ), medetomidine/tramadol (5 mg kg ), and medetomidine/pethidine (1 mg kg ).
RESULTS
Clinical adverse effects such as tremors (facial and generalized), bruxism, nystagmus, mydriasis, and vocalization were presented in all the medetomidine/opioid treatments. Clinical adverse effects were observed at 10-90 minutes in medetomidine/opioid treatments. Animals in all treatments were sedated at 5-90 minutes. Sedation was significantly higher in medetomidine/opioid treatments than in medetomidine at 15-30 minutes after administration (P < 0.05). In all treatments, heart rate and respiratory rate significantly decreased from baseline at 5-105 and 30-60 minutes, respectively. There was no significant difference in heart and respiratory rates between different treatments at any time point. Ruminal motility was decreased in medetomidine and medetomidine/opioid treatments at 10-75 and 10-105 minutes, respectively. Compared with medetomidine, ruminal motility was significantly lower in medetomidine/opioid treatments at 75-105 minutes.
CONCLUSION
The use of combinations of medetomidine/opioids would be considered for superior sedation at 15-30 minutes after administration in goats. No significant differences were detected among opioids in combination with medetomidine in goats.
Topics: Analgesics, Opioid; Animals; Goats; Hypnotics and Sedatives; Medetomidine; Meperidine; Methadone; Morphine; Tramadol
PubMed: 35353952
DOI: 10.1002/vms3.806 -
Journal of the Chinese Medical... May 2022Opioids are effective for severe pain; however, the safety issue is also a primary concern. To better understand the opioid use in Taiwan, we conducted this study.
BACKGROUND
Opioids are effective for severe pain; however, the safety issue is also a primary concern. To better understand the opioid use in Taiwan, we conducted this study.
METHODS
Data on patients with opioid prescriptions, including morphine, fentanyl, pethidine, codeine, oxycodone, hydromorphone, and buprenorphine were collected using the Taiwan National Health Insurance Database (NHID).
RESULTS
Our analysis of opioid prescriptions from 2008 to 2018 in Taiwan indicated that (1) A slow increase in prevalence of opioid prescription was found during the study period. Among the drugs studied, morphine accounted for the majority of the prescriptions written, with a gradual increase annually. Pethidine prescriptions showed a significant and rapid decline over the years; (2) medical centers prescribed the largest number of opioids, followed by regional hospitals, local hospitals, and clinics; (3) the number of prescriptions per year per capita in cancer group was much higher than that in noncancer group. In noncancer group, most of the prescriptions were used in acute pain service (98.7%); and (4) use of opioids increased with age in both cancer and noncancer patients.
CONCLUSION
The total number of opioid prescriptions in Taiwan gradually increased annually, among which morphine was the most commonly used opioid. Cancer patients consumed more opioid prescriptions than noncancer patients and most of the prescriptions in noncancer patients were used in acute pain service. The number of prescriptions increased with the age of the patients in both cancer and noncancer patients. The low prescription rate of opioids in chronic pain in Taiwan is not similar as those in high opioid-consuming countries, such as United States.
Topics: Analgesics, Opioid; Chronic Pain; Drug Prescriptions; Humans; Meperidine; Morphine; Neoplasms; Oxycodone; Prevalence; Taiwan; United States
PubMed: 35353736
DOI: 10.1097/JCMA.0000000000000720 -
Clinical Neurology and Neurosurgery Apr 2022Meperidine (pethidine) is a µ-opioid receptor (MOR) agonist widely used in the treatment of cancer pain. While MOR agonists in experimental models have demonstrated... (Review)
Review
Meperidine (pethidine) is a µ-opioid receptor (MOR) agonist widely used in the treatment of cancer pain. While MOR agonists in experimental models have demonstrated both pro- and antitumorigenic properties, meperidine has unique features which may be predominantly anticancer in nature. Meperidine both inhibits NMDA (N-methyl-D-Aspartate) receptors, which are involved in the progression of glioblastoma, and blocks NADH:Ubiquinone Oxidoreductase, which may hinder mitochondrial respiration. In the developing embryonic neural tissue, meperidine reduces cell proliferation around the neural tube and lowers the expression of the B RE (brain and reproductive organ-expressed). This is notable given that the B RE gene is implicated in cancer chemoresistance and gliomagenesis. Further, meperidine inhibits P-glycoprotein, which is involved in cancer multidrug resistance and the degradation of the sphingolipid backbone, ceramide. By enhancing the pro-autophagic and pro-apoptotic ceramide levels in cancer cells, meperidine stimulates cell death and reverses multidrug resistance. Tamoxifen, a safe medication employed in the treatment of breast cancer, directly blocks P-glycoprotein and boosts levels of ceramide both via inhibition of glycosylceramide synthase and ceramidase. Further, tamoxifen blocks NMDA-neurotoxicity and therefore it may act synergistically with meperidine in reducing glioblastoma progression associated with NMDA-activation. Finally, tamoxifen blocks glycolysis which may enhance the mitochondrial-blocking activity of meperidine to shut down energy metabolism of glioblastoma cells. Because of these properties, we believe that the combination of meperidine and tamoxifen merits study in cell culture and animal models to investigate a potential synergistic relationship in the treatment of glioblastoma.
Topics: ATP Binding Cassette Transporter, Subfamily B, Member 1; Apoptosis; Ceramides; Glioblastoma; Humans; Meperidine; Metabolic Networks and Pathways; N-Methylaspartate; Tamoxifen
PubMed: 35316699
DOI: 10.1016/j.clineuro.2022.107208