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Mohebbi E, Kamangar F, Rahimi-Movaghar A, Haghdoost AA, Etemadi A, Amirzadeh S, Najafi F, Shafeie F, Fakhari A, Ghaleban K, Shahid-Sales S, Hosseini ZS, Honarvar MR, Majnooni F, Hadji M, Zendehdel K. An Exploratory Study of Units of Reporting Opium Usein Iran: Implications for Epidemiologic Studies. Arch Iran Med 2019; 22:541-545. [PMID: 31679354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/08/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Measuring the amount of opium use is a challenge in epidemiologic studies. Self-report of amount of opium use at each consumption, widely used in the literature, usually fails to provide a good estimate. The purpose of this study is to systematically study the perceived weight units of reported opium use in Iran, and compare them to the standardized units of weight measurement. METHODS An exploratory descriptive study was conducted in six major cities of Iran. Study participants were interviewed and asked to use a Play-Doh-like material to demonstrate the amount of opium they use. To obtain an estimate of the weight of the material used, we multiplied the volume by the density of the opium product. We experimentally determined the density of the commonly used opium products. We used medians and inter-quartile ranges (IQRs) to report the typical amount of each unit. RESULTS A total of 108 individuals participated in this study. The most frequently reported unit was "gram"; the median perceived weight for one gram (g) of opium was 0.24 (IQR: 0.16) g. The second most commonly used unit was nokhod with a median of 0.16 (IQR: 0.16) g, followed by mesghaal and hab/habeh, which were 1.28 (IQR: 0.81) and 0.16 (IQR: 0.16) g, respectively. The median perceived weight of mesghaal and gram in the studied cities was less than the expected standardized values. CONCLUSION In conclusion, the reported amount of opium use is highly inaccurate and unreliable, and is mainly subject to underestimation.
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Affiliation(s)
- Elham Mohebbi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Farin Kamangar
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, MD, USA
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbar Haghdoost
- Modeling in Health Research Center, InstiMetabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USAtute for Future Studies in Health, Kerman Medical Science University, Kerman, Iran
| | - Arash Etemadi
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Saber Amirzadeh
- Social Determinants of Health Research Centre, Institute for Futures studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Farid Najafi
- Research Center for Environmental Determinants of Health, Institute of Health, Kermanshah Medical Sciences University, Kermanshah, Iran
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fariba Shafeie
- Treatment Affairs Deputy, Department of Substance Abuse Treatment, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Fakhari
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Karim Ghaleban
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Soodabeh Shahid-Sales
- Department of Radiation Oncology, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mohammad Reza Honarvar
- Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Fatemeh Majnooni
- Public Health Deputy, Golestan University of Medical Sciences, Gorgan, Iran
| | - Maryam Hadji
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Zendehdel
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
- Cancer Biology Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
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Zamani N, Hassanian-Moghaddam H, Bahrami-Motlagh H, Ahmadi S, Phillips S. Lead poisoning due to ingestion of lead-contaminated opium: A diagnostic study on patients' imaging findings. J Trace Elem Med Biol 2019; 55:26-32. [PMID: 31345361 DOI: 10.1016/j.jtemb.2019.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/18/2019] [Accepted: 04/24/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Our study attempts to determine if for patients following ingestion of lead-contaminated opium, radiographs [plain X-ray (KUB)] or unenhanced computed tomography (CT scan) of the abdomen may be predictive of lead poisoning. METHODS Our study is concerned with patients of >21 years with elevated lead concentrations, who had undergone KUB or CT. Patients with other toxicities who had undergone similar imaging profiles but who had low blood lead level (BLL) were enrolled as controls. RESULTS We evaluated a total of 79 cases and 79 controls with median [IQR] BLLs of 126 [97.4, 160] μg/dL and 8.7 [5.5, 15] μg/dL. All cases and eleven controls (13.9%) were addicted to oral opium, and of these cases, anemia (94.9%) and abdominal pain (92.4%) were the two most common clinical manifestations. Two radiologists reviewed the X-ray and non-contrast CTs. Fifty (63.3%) and 53 (67.1%) cases and controls underwent CT scanning with 34 (68%) vs. 6 (11.3%) positive CTs (P < 0.001) while 43 (54.4%) and 39 (43.3%) underwent X-rays with 21 (48.8%) vs. 4 (11.8%) positive X-rays, respectively (P < 0.001). Positive CT is associated with BLL between 10 and 45 μg/dL with a specificity of 96.9%, 88.7% and positive predictive value of 97.5% and 85% respectively. CONCLUSIONS In suspected cases of lead exposure due to ingested opium, and if BLL is not readily available, a positive imaging result may guide radiologists and physicians to consider lead poisoning.
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Affiliation(s)
- Nasim Zamani
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Hassanian-Moghaddam
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hooman Bahrami-Motlagh
- Department of Radiology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Ahmadi
- Department of Radiology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Fetzer SJ, Goodwin L, Stanizzi M. Effectiveness of a Pre-emptive Preoperative Belladonna and Opium Suppository on Postoperative Urgency and Pain After Ureteroscopy. J Perianesth Nurs 2018; 34:594-599. [PMID: 30528307 DOI: 10.1016/j.jopan.2018.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/14/2018] [Accepted: 09/15/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE Postoperative ureteroscopy patients can develop bladder spasms, complaints of pain, and the urgent need to void during emergence from anesthesia. Discomfort leads to patient agitation, resulting in a risk to patient safety. The purpose of this study was to determine the effectiveness of a preemptive preoperative belladonna and opium (B + O) suppository on postoperative bladder comfort, narcotic requirements, and length of stay of ureteroscopy patients. DESIGN A prospective double-blind study was conducted. METHODS Fifty adult outpatients scheduled for ureteroscopy were assigned to routine care or a B + O suppository immediately after anesthesia induction. Urinary urgency and pain were assessed every 15 minutes. FINDINGS Urgency significantly decreased in the B+O group, with less than half reporting urgency at discharge. CONCLUSIONS Pre-emptive preoperative administration of a B + O suppository before ureteroscopy results in decreased urinary urgency during the postoperative recovery. Pre-emptive preoperative interventions can result in positive outcomes before discharge.
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Ghane T, Zamani N, Hassanian-Moghaddam H, Beyrami A, Noroozi A. Lead poisoning outbreak among opium users in the Islamic Republic of Iran, 2016-2017. Bull World Health Organ 2018; 96:165-172. [PMID: 29531415 PMCID: PMC5840624 DOI: 10.2471/blt.17.196287] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To describe an outbreak of lead poisoning among opium users in the Islamic Republic of Iran and estimate the number of affected people in the country. METHODS We used data from the country's largest poison treatment centre to illustrate the epidemiology of an outbreak of lead poisoning in oral opium users. We describe the government's referral and treatment guidelines in response to the outbreak. Based on the number of individuals treated and previous studies on the prevalence of oral opium use we estimated the total number of people at risk of lead-contaminated opium nationwide. FINDINGS In February 2016, we noticed a steep increase in the numbers of oral opium users referred to our poison treatment centre with abdominal pain, anaemia and constipation. Numbers peaked in June 2016 but the outbreak was ongoing in August 2017. The mean blood lead level in a sample of 80 patients was 140.3 µg/dL (standard deviation: 122.6). Analysis of an illegal opium sample showed 3.55 mg lead in 1 g opium. Treatment was exposure reduction with opioid substitutes and laxatives, or chelation therapy if indicated. Over 7 months, 4294 poison cases were seen at main referral hospitals in Tehran out of an estimated 31 914 oral opium users in the city. We estimate more than 260 000 out of 773 800 users nationwide remain untreated and at risk of poisoning. CONCLUSION Lead-contaminated opium and heroin that has transited through the Iranian markets is a global risk and highlights a need for better monitoring of illegal drug supplies.
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Affiliation(s)
- Talat Ghane
- Drug and Poison Information Centre, Food and Drug Administration of the Islamic Republic of Iran, Tehran, Iran
| | - Nasim Zamani
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Teheran, Islamic Republic of Iran
| | - Hossein Hassanian-Moghaddam
- Department of Clinical Toxicology, School of Medicine, Shahid Beheshti University of Medical Sciences, Arabi Ave, Daneshjoo Blvd, Velenjak, Tehran 19839-63113, Islamic Republic of Iran
| | - Ali Beyrami
- Office of Narcotics and Controlled Substances, Food and Drug Administration of the Islamic Republic of Iran, Tehran, Islamic Republic of Iran
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
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Paracetamol + opium (Izalgi) higher-dose for oral administration. A poor choice for analgesia. Prescrire Int 2016; 25:39. [PMID: 27042727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Everett N, Gabra M. The pharmacology of medieval sedatives: the "Great Rest" of the Antidotarium Nicolai. J Ethnopharmacol 2014; 155:443-449. [PMID: 24905867 DOI: 10.1016/j.jep.2014.05.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 05/12/2014] [Accepted: 05/23/2014] [Indexed: 06/03/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Past practices of compound drugs from different plant ingredients enjoyed remarkable longevity over centuries yet are largely dismissed by modern science as subtherapeutic, lethal or fanciful. AIM OF THE STUDY To examine the phytochemical content of a popular medieval opiate drug called the "Great Rest" and gauge the bioavailability and combined effects of its alkaloid compounds (morphine, codeine, hyoscyamine, scopolamine) on the human body according to modern pharmacokinetic and pharmacodynamic parameters established for these compounds. CALCULATIONS AND THEORY We reviewed the most recent studies on the pharmacodynamics of morphine, codeine, hyoscyamine and scopolamine to ascertain plasma concentrations required for different physiological effects and applied these findings to dosage of the Great Rest. RESULTS Given the proportional quantities of the alkaloid rich plants, we calculate the optimal dose of Great Rest to be 3.1±0.1-5.3±0.76 g and reveal that the lethal dose of Great Rest is double the therapeutic concentration where all three alkaloid compounds are biologically active. CONCLUSION This study helps establish the effective dose (ED50), toxic dose (TD50) and lethal dose (LD50) rates for the ingestion of raw opium, henbane and mandrake, and describes their probable combined effects, which may be applied to similar types of pre-modern pharmaceuticals to reveal the empirical logic behind past practices.
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Affiliation(s)
- Nicholas Everett
- History Dept and Centre for Medieval Studies University of Toronto, 100 St. George Street, Toronto, ON, Canada M5S 3G3.
| | - Martino Gabra
- Department of Pharmacology and Toxicology University of Toronto Medical Sciences Building, Rm 4207, 1 King׳s College Circle, Toronto, ON, Canada M5S 1A8.
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Khadivi E, Nahid K, Afshari R, Ziaolhagh R. Black spotted larynx, a finding in patients addicted to inhalational opium. Eur Arch Otorhinolaryngol 2014; 272:257-8. [PMID: 24880468 DOI: 10.1007/s00405-014-3085-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 05/03/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Ehsan Khadivi
- Sinus and Surgical Endoscopic Research Center, Emam Reza Hospital, Mashhad University of Medical Science, Mashhad, Iran,
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Barna B, Gerevich J. [The failures of Géza Csáth: his self-treatment and women]. Lege Artis Med 2014; 24:312-320. [PMID: 25199275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Khan M, Subhan F, Khan AU, Abbas M, Ali G, Rauf K, Gilani AH. Nature cures nature: Hypericum perforatum attenuates physical withdrawal signs in opium dependent rats. Pharm Biol 2014; 52:586-590. [PMID: 24256159 DOI: 10.3109/13880209.2013.854811] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 10/09/2013] [Indexed: 06/02/2023]
Abstract
CONTEXT Hypericum perforatum Linn. (Hypericaceae) (St. John's wort) attenuates opium withdrawal signs. AIM To explore the therapeutic potential of Hypericum perforatum in the management of opium-induced withdrawal syndrome. MATERIALS AND METHODS The effect of the Hypericum perforatum hydro-ethanol extract was investigated for potential to reverse naloxone (0.25 mg/kg)-induced opium withdrawal physical signs. Rats received opium extract (80-650 mg/kg) twice daily for 8 days along with Hypericum perforatum (20 mg/kg, orally) twice daily in chronic treatment and the same single dose 1 h before induction of withdrawal syndrome in the acute treated group. RESULTS Hypericum perforatum reduced stereotype jumps and wet dog shake number in the chronic treatment compared to the saline control group (F(2, 24) = 3.968, p < 0. 05) and (F(2, 24) = 3.689, p < 0.05), respectively. The plant extract in the acutely treated group reduced diarrhea (F(2, 24) = 4.850, p < 0. 05 vs. saline). It decreased rectal temperature by chronic treatment at 30 min (F(2, 24) = 4.88, p < 0.05), 60 min (F(2, 240 = 5.364, p < 0.01) and 120 min (F(2, 24) = 4.907, p < 0.05). DISCUSSION AND CONCLUSION This study reveals that the extract of Hypericum perforatum attenuates some physical signs of opium withdrawal syndrome possibly through direct or indirect interaction with opioid receptors. Further study is needed to clarify its mechanism.
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Affiliation(s)
- Munasib Khan
- Department of Pharmacy, University of Peshawar , Peshawar , Pakistan
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Scavonetto F, Lamborn DR, McCaffrey JM, Schroeder DR, Gettman MT, Sprung J, Weingarten TN. Prophylactic belladonna suppositories on anesthetic recovery after robotic assisted laparoscopic prostatectomy. Can J Urol 2013; 20:6799-6804. [PMID: 23783051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Two prospective trials have demonstrated prophylactic antimuscarinics following prostatectomy reduce pain from bladder spasms. Our practice adopted the routine administration of prophylactic belladonna and opium (B&O) suppositories to patients undergoing robotic assisted laparoscopic radical prostatectomy (RALP). The aim of this study is to determine if this change in clinical practice was associated with improvement of postoperative outcomes. MATERIALS AND METHODS The medical records of 202 patients that underwent RALP surgery who were or were not administered prophylactic B&O suppositories in the immediate postoperative period were abstracted for duration of anesthesia recovery, pain and analgesic use. RESULTS Patient and surgical characteristics between groups were similar except B&O group were slightly older (p = 0.04) and administered less opioid analgesics (p = 0.05). There was no difference between groups in the duration of phase I recovery from anesthesia (p = 0.96). Multivariable adjustments for age, body mass index, American Society of Anesthesiologists physical status, and surgical duration were made, and again it was found that suppository administration had no association with phase I recovery times (p = 0.94). The use of antimuscarinic medication for bladder spams in the B&O group was less during phase I recovery (p < 0.01), but was similar during the first 24 hours (p = 0.66). Postoperative sedation, opioid analgesic requirements and pain scales were similar during phase I recovery and the first 24 postoperative hours. Hospital length of stay was similar. DISCUSSION The introduction of prophylactic B&O suppositories at the immediate conclusion of RALP surgery was not associated with improvements of the postoperative course.
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Affiliation(s)
- Federica Scavonetto
- Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, MN, USA
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Okutomi T. [The first labor analgesia with drug was already performed in late Meiji-Period (1868-1912): trace of opioid-scopolamine which was used in Akiko Yosano, back to its origins]. Masui 2013; 62:239-243. [PMID: 23479935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
There have been some records of labor analgesia with intravenous or rectal anesthetics in early Showa-period (1926-1989). However, the author found that labor analgesia had been already attempted for some women in late Meiji-period (1868-1912). One of agents used was pantopon, a water-soluble opioid without serious respiratory depression as morphine. The drug was developed and produced in Germany. Some doctors applied this agent with scopolamine to labor analgesia in Europe. They also reported that this combination also conferred excellent analgesic effects without any serious complications in the mother and fetus. This combination was originally used for general surgery with inhaled anesthesia at that period. It remains uncertain how Japanese doctors got pantopon scopolamine from Germany.
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Affiliation(s)
- Toshiyuki Okutomi
- Division of Obstetric Anesthesia, Center for Perinatal Medicine, Kitasato University Hospital, Sagamihara 252-0375
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Armentia A, Ruiz-Muñoz P, Quesada JM, Postigo I, Herrero M, Martín-Gil FJ, Gonzalez-Sagrado M, Martín B, Castrodeza J. Clinical value of morphine, pholcodine and poppy seed IgE assays in drug-abusers and allergic people. Allergol Immunopathol (Madr) 2013; 41:37-44. [PMID: 21940094 DOI: 10.1016/j.aller.2011.05.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 05/07/2011] [Accepted: 05/16/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND The diagnosis of anaphylactic reactions due to opiates during anaesthesia can be difficult, since in most cases various drugs may have been administered. Detection of specific IgE to poppy seed might be a marker for sensitisation to opiates in allergic people and heroin-abusers. This study assessed the clinical value of morphine, pholcodine and poppy seed skin-prick and IgE determination in people suffering hypersensitivity reactions during anaesthesia or analgesia and drug-abusers with allergic symptoms. METHODS We selected heroin abusers and patients who suffered severe reactions during anaesthesia and analgesia from a database of 23,873 patients. The diagnostic yield (sensitivity, specificity and predictive value) of prick and IgE tests in determining opiate allergy was analysed. RESULTS Overall, 149 patients and 200 controls, mean age 32.9 ± 14.7 years, were included. All patients with positive prick to opiates showed positive prick and IgE to poppy seeds, but not to morphine or pholcodine IgE. Among drug-abusers, 13/42 patients (31%) presented opium hypersensitivity confirmed by challenge tests. Among non-drug abusers, sensitisation to opiates was higher in people allergic to tobacco (25%), P<.001. Prick tests and IgE against poppy seed had a good sensitivity (95.6% and 82.6%, respectively) and specificity (98.5% and 100%, respectively) in the diagnosis of opiate allergy. CONCLUSIONS Opiates may be significant allergens. Drug-abusers and people sensitised to tobacco are at risk. Both the prick and specific IgE tests efficiently detected sensitisation to opiates. The highest levels were related to more-severe clinical profiles.
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Affiliation(s)
- A Armentia
- Allergy Unit, Rio Hortega University Hospital, UMDAI, Valladolid, Spain.
| | - P Ruiz-Muñoz
- San Juan de Dios Centre, Palencia and Castile-Leon Association For the Aid of Drug Abusers (ACLAD), Valladolid, Spain
| | - J M Quesada
- Immunology, Microbiology and Parasitology Department, University of the Basque Country, Vitoria, Spain
| | - I Postigo
- Immunology, Microbiology and Parasitology Department, University of the Basque Country, Vitoria, Spain
| | - M Herrero
- Allergy Unit, Rio Hortega University Hospital, UMDAI, Valladolid, Spain
| | - F J Martín-Gil
- Clinical Chemistry Service, Hospital Universitario Rio Hortega, Valladolid, Spain
| | | | - B Martín
- Research Unit, IEN, Rio Hortega University Hospital, Valladolid, Spain
| | - J Castrodeza
- Direction of Public Health, Investigation, Development and Innovation, SACYL, Valladolid, Spain
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Heydari M, Hashempur MH, Zargaran A. Medicinal aspects of opium as described in Avicenna's Canon of Medicine. Acta Med Hist Adriat 2013; 11:101-112. [PMID: 23883087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Throughout history, opium has been used as a base for the opioid class of drugs used to suppress the central nervous system. Opium is a substance extracted from the opium poppy (Papaver somniferum L.). Its consumption and medicinal application date back to antiquity. In the medieval period, Avicenna, a famous Persian scholar (980-1037 AD) described poppy under the entry Afion of his medical encyclopedia Canon of Medicine. Various effects of opium consumption, both wanted and unwanted are discussed in the encyclopedia. The text mentions the effects of opioids such as analgesic, hypnotic, antitussive, gastrointestinal, cognitive, respiratory depression, neuromuscular disturbance, and sexual dysfunction. It also refers to its potential as a poison. Avicenna describes several methods of delivery and recommendations for doses of the drug. Most of opioid effects described by Avicenna have subsequently been confirmed by modern research, and other references to opium use in medieval texts call for further investigation. This article highlights an important aspect of the medieval history of medicine.
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Affiliation(s)
- Mojtaba Heydari
- Research Office for the History of Persian Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Zamani N, Jamshidi F. Abuse of lead-contaminated opium in addicts. Singapore Med J 2012; 53:698. [PMID: 23112025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Meybodi FA, Eslick GD, Sasani S, Abdolhoseyni M, Sazegar S, Ebrahimi F. Oral opium: an unusual cause of lead poisoning. Singapore Med J 2012; 53:395-397. [PMID: 22711039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION The number of cases of lead poisoning (LP), a widely known disease with various aetiologies, being reported globally has decreased over the years due to both limited domestic applications of lead and enforcement of stringent safety measures. However, a new presentation of lead poisoning, lead-contaminated opium (LCO), is gradually emerging in our region. This study aimed to determine the prevalence and clinical effects of lead toxicity associated with opium use. METHODS Between November 2006 and December 2007, all patients diagnosed with LP at a central laboratory in Tehran, Iran, were assessed for potential causes of poisoning. Patients with a history of LCO abuse were evaluated and recruited for the study. RESULTS Overall, there were 240 patients with LP, and poisoning from LCO was diagnosed in 25 patients. The duration of addiction was between three months and 40 years, and the duration of symptoms was 28.1 ± 17.7 days. Mean blood lead levels of the patients were 145 ± 61 (range 61-323) μg/dL. The average creatinine and haemoglobin levels were 77.4 ± 8.1 μmol/L and 105 ± 25 g/L, respectively. The association between the duration of addiction and levels of lead in blood was not statistically significant (r = -0.142, p = 0.54). The most common symptoms were gastrointestinal complaints, followed by musculoskeletal complaints with muscle weakness (92%). Anorexia was also a leading complaint. CONCLUSION The results of our study suggest that the possibility of LP should be considered with high suspicion among opium users presenting with acute abdominal symptoms.
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Affiliation(s)
- Farid Aghaee Meybodi
- Discipline of Surgery, Sydney Medical School, The University of Sydney, Nepean Hospital, NSW, Australia
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Asadikaram G, Asiabanha M, Sayadi A, Jafarzadeh A, Hassanshahi G. Impact of opium on the serum levels of TGF-β in diabetic, addicted and addicted-diabetic rats. Iran J Immunol 2010; 7:186-192. [PMID: 20876989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Several cells of immune system such as regulatory T cells and macrophages secrete transforming growth factor-β (TGF-β) in response to different stimuli. This cytokine has inhibitory effect on immune system and diminished production of this cytokine is associated with autoimmune disorders. OBJECTIVE The aim of this study was to evaluate the influence of opium addiction on serum level of TGF-β in male and female diabetic and non-diabetic Wistar rats. METHODS This experimental study was performed on normal, opium addicted, diabetic and addicted-diabetic male and female rats. Serum level of TGF-β was measured by ELISA. RESULTS The results of our study indicated that the mean serum level of TGF-β in female addicted rats was significantly increased compared to control group (p<0.004). Conversely, in male addicted rats the mean serum level of TGF-β was lower compared with control (p<0.065). CONCLUSION Our results suggest that opium and its derivatives have differential inductive effects on the cytokine expression in male and female rats.
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Affiliation(s)
- Gholamreza Asadikaram
- Department of Biochemistry, Rafsanjan University of Medical Sciences, Rafsanjan, Iran, e-mail:
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Nasibova EM. [Evaluation of the adequacy of analgesia using sensometry method during sacral anesthesia in proctological operations]. Klin Khir 2010:21-23. [PMID: 20623974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Adequacy of epidural-sacral anesthesia in proctological operations was studied. Sensometry occupies a special place among the methods, estimating the sacral anesthesia adequacy, owing the advantage of possibility for quantitative estimation of such an important index, as a patient reaction on external irritants, including such of a pain. Sensometry, according to A. K. Sangaylo method, using portative apparatus "Nil - 3" was conducted in 50 patients while proctological operations performance for estimation of various variants of sacral anesthesia efficacy. There was established, that sensometry constitutes the most informative quantitative method of estimation of the anesthesia adequacy.
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Najafipour H, Joukar S, Malekpour-Afshar R, Mirzaeipour F, Nasri HR. Passive opium smoking does not have beneficial effect on plasma lipids and cardiovascular indices in hypercholesterolemic rabbits with ischemic and non-ischemic hearts. J Ethnopharmacol 2010; 127:257-263. [PMID: 19914364 DOI: 10.1016/j.jep.2009.11.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Revised: 11/05/2009] [Accepted: 11/09/2009] [Indexed: 05/28/2023]
Abstract
BACKGROUND To scientifically test a traditionally belief of some Asian countries residents that opium may prevent or have ameliorating effects on cardiovascular diseases (CVD) we investigated the effect of passive opium smoking (POS) on plasma lipids and some cardiovascular parameters in hypercholesterolemic rabbits with ischemic and non-ischemic hearts. METHODS 40 rabbits were fed for 2 weeks with cholesterol-enriched diet and divided to control (CTL), short-term opium (SO) and long-term opium (LO) groups. SO and LO groups were exposed to POS for 3 days and 4 weeks respectively. ECG, blood pressure (BP) and left ventricular pressure recorded and serum lipid and cardiac troponin I levels were measured. Isoproterenol (ISO) injected for induction of cardiac ischemia and after 4h the above variables were measured along with cardiac histopathology assessment. RESULTS HDL cholesterol decreased significantly in LO compared to CTL group (35+/-5 vs 53+/-5mg/dl). Groups treated with ISO showed significantly higher increments in troponin I level (P<0.05) except for LO group and reduction of BP was higher in ISO and SO+ISO groups compared to CTL and SO groups respectively (-38+/-6 vs -23+/-4 and -37+/-11 vs -11+/-3 percent respectively, P<0.05). Reduction in BP was significantly lower in LO+ISO compared to ISO group. Opium exposure caused a trend of increase in blood pressure, LDL cholesterol and ECG disturbances, attenuated ISO induced myonecrosis but augmented tissue congestion and hemorrhage. CONCLUSION POS can be considered as a CVD risk factor. Opium does not reduce BP or cholesterol level, as is anticipated by its users.
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Affiliation(s)
- Hamid Najafipour
- Department of Physiology and Physiology Research Center, Kerman University of Medical Sciences, Medical Faculty, Bulvd. 22 Bahman, Postal Code 7616914111, Kerman, Iran.
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Salehi H, Sayadi AR, Tashakori M, Yazdandoost R, Soltanpoor N, Sadeghi H, Aghaee-Afshar M. Comparison of serum lead level in oral opium addicts with healthy control group. Arch Iran Med 2009; 12:555-558. [PMID: 19877747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Drug abuse and its consequences are major health problems in Middle-East countries such as Iran. Salesmen and smugglers may add lead to opium during the process of opium preparation to increase the weight of opium for more profit. Several reports have found lead poisoning symptoms in opium addicted patients and there are many nonspecific symptoms mimicking lead poisoning in opium addicted patients. As far as the literature review is concerned, there is no comparative study about blood lead level (BLL) in addicted patients with healthy controls. Therefore, it seems evaluation of blood lead level in opium addicted patients to be important. METHODS In this study, the BLL of forty-four subjects in two patient and control groups was evaluated. The patient group (22 subjects) was comprised of patients who used oral opium. Control group (22 subjects) was matched with the patient group for age and sex, considering inclusion and exclusion criteria with a mean age of 38.8+/-6.7. For blood lead assay, 3 mL of whole blood was obtained from both groups by venipuncture and BLL was assessed immediately using an atomic absorption spectrophotometer. RESULTS The BLL in patient group had a range of 7.2 to 69.9 g/dL with a mean of 21.9+/-13.2. In the healthy control group, BLL was between 4.1 to 17.4 g/dL with a mean of 8.6+/-3.5. The mean difference of both groups (t=4.56) was statistically significant (P<0.0001). In the patient group, BLL had a significant correlation with the amount of opium ingested (r=0.65, P<0.01). However, there was no significant correlation with duration of opium ingestion in the patient group. CONCLUSION It would be concluded that opium addicts have an elevated BLL compared to healthy controls. Therefore, screening of blood lead concentration is helpful for opium addicted people especially with non-specific symptoms. In this regard, a similar investigation with a larger sample size of opium addicted patients (including both oral and inhaled) and a control group is suggested to confirm the findings of this research.
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Affiliation(s)
- Hossein Salehi
- Department of Surgery, Iran University of Medical Sciences, Tehran, Iran.
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Mohammadi A, Darabi M, Nasry M, Saabet-Jahromi MJ, Malek-Pour-Afshar R, Sheibani H. Effect of opium addiction on lipid profile and atherosclerosis formation in hypercholesterolemic rabbits. ACTA ACUST UNITED AC 2008; 61:145-9. [PMID: 18838257 DOI: 10.1016/j.etp.2008.08.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 08/02/2008] [Accepted: 08/04/2008] [Indexed: 11/18/2022]
Abstract
In some Asian and Middle Eastern societies, opium consumption has traditionally been regarded as a way to lower blood lipids and to prevent heart diseases. This could eventually lead to addiction. In this study, the effect of oral opium consumption on serum lipids and atherogenesis in rabbits was investigated. Twenty-eight male New Zealand white rabbits were divided into control, hypercholesterolemic, addicted, and hypercholesterolemic-addicted groups and were studied for 3 months. Serum lipid profile was determined at the beginning of the study and at 1 month intervals thereafter. At the end of the study period, aortic plaque formation was assessed. Compared with control, in the hypercholesterolemic and hypercholesterolemic-addicted groups, cholesterol, triglycerides, and low-density lipoprotein cholesterol levels were significantly increased (P<0.01). The increases in lipids and lesion areas in the aorta were higher in hypercholesterolemic-addicted than hypercholesterolemic group (P<0.05). Our findings suggest that opium consumption can have aggravating effects in atherosclerosis formation related with hypercholesterolemia, mainly affecting lipid profile.
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Affiliation(s)
- Abbas Mohammadi
- Department of Biochemistry, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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22
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Frenger P. Human narcotic use emulator. Biomed Sci Instrum 2007; 43:278-83. [PMID: 17487094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Last year the author extended his modular, open-systems, computerized human nervous system function emulator (HNSFE) by adding simulated hormone action. This year he extends the HNSFE with a related capability: emulation of the effects of therapeutic and non-therapeutic drug use. The opioid narcotic drug model was chosen because of its importance in medicine and because of its potential for misuse. For this research the author utilized a frequency-to-voltage converter (FVC) as an analog calculational element to simulate the effects of drug binding to neural cell membrane receptors. The resulting voltages are utilized in this human narcotic use emulator (HNUE) to represent the level of opioid drug activity at the cellular level which initiates high level somatic and behavioral responses in the HNSFE artificial intelligence system. The HNUE is compatible with the computerized postoperative pain / narcotic dosing model of Liu and Northrop. Some effects of long-term drug use (the development of tolerance, physical and psychological dependence, addiction and the withdrawal syndrome) are emulated.
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Affiliation(s)
- Paul Frenger
- A Working Hypothesis, Inc., P.O. Box 820506, Houston, TX 77282-0506, USA.
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Langenfeld S, Birkenfeld L, Herkenrath P, Müller C, Hellmich M, Theisohn M. Therapy of the neonatal abstinence syndrome with tincture of opium or morphine drops. Drug Alcohol Depend 2005; 77:31-6. [PMID: 15607839 DOI: 10.1016/j.drugalcdep.2004.07.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2004] [Revised: 07/02/2004] [Accepted: 07/16/2004] [Indexed: 11/16/2022]
Abstract
BACKGROUND Treating opioid-addicted women with methadone in pregnancy increased the number of newborns suffering from neonatal abstinence syndrome (NAS). High-pitch crying, insomnia, tremor, myoclonic jerks, vomiting, diarrhoea and poor weight gain were reported symptoms, which were evaluated using the Finnegan (F)-score. Earlier phenobarbital or paregoric had been used to suppress symptoms. We surveyed the administration of pure mu-agonist morphine (MO) in comparison to the alcoholic opioid mixture in tincture of opium (TO). Thirty-three newborns were included in the survey, after informed consent by their parents. RESULTS NAS started 3-5 days after delivery and lasted for 27 or 30 days (mean) in the TO and MO groups, respectively. In either of the tested parameters, we found no significant differences between the two groups (2P < 0.05). The maximum F-score was similar in both groups, but the dose to suppress NAS was higher in the MO group (0.6-0.5 mg/day; total dose 61.6-42.7 mg of morphine). The duration of the therapy was longer in the MO than in the TO group (37.5-32.4 days). On the other hand the weight gain was better in the MO group than in the TO group (25-19 g/day), but was reduced in both groups compared with healthy newborns. CONCLUSIONS Morphine is suitable to treat NAS in a similar manner as tincture of opium, but avoids unwanted effects of the alcoholic extracts with various alkaloids in the tincture of opium and allows better weight gain of the newborns.
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Affiliation(s)
- Stefan Langenfeld
- Children's Hospital, University of Cologne, Joseph Stelzmann Str. 9, Cologne 50931, Germany
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Abstract
Microprocessor-controlled insulin pumps designed for continuous delivery of short-acting insulin analogs into subcutaneous tissues offer several important potential benefits for diabetic patients. The delivery of other substances using these systems is technically feasible. We present a case of homicide involving lethal doses of etomidate and atracurium injected via the victim's insulin pump. This unique situation could be encountered by homicide investigators more frequently as the popularity of these systems continues to grow.
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Affiliation(s)
- Butch Benedict
- Forrest County Coroner's Office, Hattiesburg, Mississippi, USA
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Kikura-Hanajiri R, Kaniwa N, Ishibashi M, Makino Y, Kojima S. Liquid chromatographic-atmospheric pressure chemical ionization mass spectrometric analysis of opiates and metabolites in rat urine after inhalation of opium. J Chromatogr B Analyt Technol Biomed Life Sci 2003; 789:139-50. [PMID: 12726852 DOI: 10.1016/s1570-0232(03)00096-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To examine the urinary excretion of opiates and their metabolites following inhalation exposure of rats to opium, analytical procedures for the simultaneous determination of the compounds in opium, the vapor derived by the volatilization of opium and the urine of rats exposed to the opium vapor were developed using liquid chromatography-atmospheric pressure chemical ionization mass spectrometry (LC-APCI-MS). Seven compounds were determined in the opium, namely morphine, codeine, thebaine, noscapine, papaverine, meconic acid and meconin. All seven were extracted with 2.5% acetic acid solution and subjected to LC-APCI-MS analysis. The separation was performed on an ODS column in acetonitrile-50 mM ammonium formate buffer (pH 3.0) using a linear gradient program and quantitative analysis was carried out in the selected ion monitoring mode ([M+H](+)). For the analysis of the volatilization of opium, the opium (1 g) was added to a glass pipe, which was then heated at 300 degrees C for 20 min. Negative pressure (air flow-rate; 300 ml/min) was used to draw the vapor through a series of glass wool and methanol traps. The total amount of each compound in the vapor was estimated by measurement of the compounds trapped in the glass wool and methanol. Wister rats (n=3) were exposed to the vapor derived from the volatilization system and the urinary amounts (0-72 h) of the six opiates and metabolites including morphine-3-grucronide (M3G) and morphine-6-grucronide (M6G) were measured after solid-phase extraction. The calibration curves for those compounds in the rat urine were linear over the concentration range 10-500 ng/ml. The recoveries for each analyte from the rat urine sample spiked with standard solution were generally greater than 80%, and the relative standard deviation for the analytical procedure was less than 8% with the exception of meconin. After inhalation exposure of rats to opium, M3G (5.45-14.38 micro g), morphine (2.27-4.65 micro g), meconin (0.54-1.85 micro g), codeine (0.54-1.85 micro g), noscapine (0.34-0.40 micro g) and papaverine (0.01-0.04 micro g) were detected in the urine over 72 h. However, only trace levels of thebaine were observed despite it being one of the major alkaloids found in the opium. On the other hand, a relatively large amount of meconin was detected in the vapor and the urine as compared with the opium. It is suggested that the presence of meconin in biological fluids could be indicative of opium ingestion by inhalation.
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Affiliation(s)
- R Kikura-Hanajiri
- National Institute of Health Sciences, 1-18-1, Kamiyoga, Setagaya, Tokyo, 158-8501, Japan.
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Abstract
The occurrence of an opioid addiction within an opioid treatment of pain or diarrhoea in inflammatory bowel disease is rarely reported. We report on a 36-year-old male with a 14 years lasting left sided chronic ulcerative colitis who developed after the initiation of a therapy with tincture of opium because of abdominal pain and diarrhoea an opioid addiction with the consumption of opium and later buprenorphin. Additionally to the diagnostics and therapy of the ulcerative colitis a detoxication was carried out. The diarrhoea slightly increased during the buprenorphin withdrawal. Diarrhoea refractory to other treatment should be treated by loperamid because of its lacking effects on the central nervous system. In chronic abdominal or musculoskeletal pain in inflammatory bowel disease opioids can be used if no surgical or other medical pain relief is possible. A consequent control of the therapeutic and side effects of the opioid therapy is necessary, especially of an abuse of opioid medication. The published case reports of a therapeutic induction of opioid addiction demonstrate that psychiatric comorbidity is an essential or even necessary risk factor. A checklist with seven criteria of opioid addiction during opioid therapy is presented.
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Affiliation(s)
- W Häuser
- Medizinische Klinik I, Klinikum Saarbrücken gGmbH, Saarbrücken, Germany.
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Abstract
The aim of the present study is to evaluate lofexidine and clonidine, in an accelerated opiate detoxification procedure (3 days), without anaesthesia. Forty heroin-dependent individuals were detoxified, evaluating withdrawal symptoms, craving levels, mood changes, urine toxicologic screens, and dropout during therapy with either (1) clonidine, oxazepam, baclofen, and ketoprofene, with naloxone and naltrexone for 3 days (20 subjects) or (2) lofexidine, oxazepam, baclofen, and ketoprofene with naloxone and naltrexone for 3 days (20 subjects). Both clonidine and lofexidine rapid detoxifications were found effective. The subjects treated with lofexidine showed significantly lower levels of withdrawal symptoms, fewer mood problems, less sedation and hypotension. No significant differences in craving levels, morphine metabolites in urine, or dropout rate were evidenced between the two groups. The early use of naltrexone during detoxification in combination with either alpha-2-agonist facilitated the acceptance for long-term naltrexone treatment. Lofexidine appeared to be more useful than clonidine in a 3-day accelerated opiate detoxification, not only to counteract withdrawal symptoms, but also in the treatment of dysphoria and mood changes. Because lofexidine does not produce hypotension, safe outpatient treatment, without hospital support, could be possible.
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Affiliation(s)
- G Gerra
- Centro Studi Farmacotossicodipendenze, Ser. T. Az., USL di Parma, Parma, Italy.
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McCoy CB, McCoy HV, Lai S, Yu Z, Wang X, Meng J. Reawakening the dragon: changing patterns of opiate use in Asia, with particular emphasis on China's Yunnan province. Subst Use Misuse 2001; 36:49-69. [PMID: 11305354 DOI: 10.1081/ja-100000228] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Asian countries adjacent to the Golden Triangle and their neighbors have witnessed an evolution in "drug abuse" from traditional opium smoking to heroin eating, smoking, and finally heroin injection. A recent study of 630 heroin users was conducted in China's Yunnan Province, located close to the Golden Triangle. Data collected between August 1997 and February 1998 indicate injecting heroin users, in comparison to noninjectors, were more likely to have used drugs for a longer period of time, and to use drugs more frequently everyday. Other major differences existed between urban and rural subjects, especially highlighting differences between men and women. Women comprised a much higher proportion of urban subjects than rural subjects. Rural injectors were much more likely to be male, but urban injectors were almost evenly split between men and women. The emerging epidemic of heroin use in China and the continuing substance abuse problem in the United States provide an opportunity for collaborative research of mutual benefit.
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Affiliation(s)
- C B McCoy
- University of Miami School of Medicine, Department of Epidemiology and Public Health, Florida 33136, USA.
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O'Brien B, Nevin B, Patterson K. A comparison of papaveretum-promethazine with morphine-ondansetron for patient-controlled analgesia. Ir J Med Sci 2000; 169:58-9. [PMID: 10846862 DOI: 10.1007/bf03170488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patient-controlled analgesia (PCA) with intravenous morphine is commonplace. Antiemetics are often added to reduce side-effects. In our institution an unusual combination of papaveretum-promethazine is in use. AIMS We set out to compare this combination with a more commonly used one (morphine-ondansetron) by auditing the records of our pain-control team assessing analgesia and control of side-effects. METHODS The records of two groups of 100 consecutive patients were studied. Pain scores were recorded 24 hours post-operatively on a scale of zero to ten. Also recorded were sedation scores, pruritus, emesis, and usage of breakthrough analgesia. The groups contained the work of a variety of anaesthetists and surgeons, though the majority were orthopaedic cases. All results were recorded by one pain-control nurse, using the same question, over a nine-month period. RESULTS Sedation scores were identical, while side-effects were few and similar in both groups. The use of breakthrough analgesia was also similar. However, the median pain-score of zero in the papaveretum group was significantly lower than that of two in the morphine group, (p < 0.001, Mann-Whitney U). CONCLUSION Papaveretum-promethazine appeared to be effective for PCA. This combination is also much less expensive than morphine-ondansetron. A previously described synergistic interaction between promethazine and opiates may be a factor in its success. Further evaluation of these drugs in PCA is warranted.
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Affiliation(s)
- B O'Brien
- Department of Anaesthesia, University College Hospital, Galway
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Theis JG, Selby P, Ikizler Y, Koren G. Current management of the neonatal abstinence syndrome: a critical analysis of the evidence. Biol Neonate 1997; 71:345-56. [PMID: 9197336 DOI: 10.1159/000244435] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To systematically and critically analyse and summarise the published evidence for the rational choice of pharmacologic treatment of the neonatal abstinence syndrome (NAS), a frequently observed condition in neonates born to mothers who are dependent on physically addicting drugs. DESIGN Studies comparing different pharmacological agents for the treatment of NAS were identified utilising MEDLINE and additionally the references cited in pertinent articles. The identified studies were critically analysed regarding their study designs and outcome measures. The reported data for the comparative efficacy of the drugs were summarised and evaluated. RESULTS Fourteen studies were identified, most of them comparing treatment of NAS with phenobarbital, paregoric or diazepam. However, none of these studies was conducted in a double-blind fashion. Frequently, treatment allocations were not properly randomised. Prenatal drug exposure varied and was often not sufficiently verified. Outcome measures and their evaluations differed widely. Due to the different study objectives and flaws in study design, a combined analysis of the published data in the form of a meta-analysis was not deemed possible. When attempting to compare efficacy, diazepam appears to be less efficacious in treating NAS than phenobarbital or paregoric. The relative efficacy of paregoric and phenobarbital appears to depend upon the antenatal exposure of the neonate and on the outcome measure of the study. Only two studies evaluate the efficacy of pure opioids, none of them in direct comparison to paregoric. It remains questionable whether paregoric, which contains the central stimulant camphor and a large amount of alcohol, should be the opioid of choice for the treatment of NAS. CONCLUSION Most published studies were conducted prior to the development of clinical epidemiology and modern study design and thus yielded only very limited comparative data on the benefits of different treatment protocols. There is very little evidence regarding the efficacy of different pharmacological therapy regimens to treat NAS. More studies are required to produce the evidence needed to allow a rational choice between treatment modalities of NAS and thus to ensure optimal care of the neonates suffering from this condition.
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Affiliation(s)
- J G Theis
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ont., Canada
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31
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Gostomzyk JG. [Opium drops in Crohn disease-induced diarrhea]. Dtsch Med Wochenschr 1996; 121:852-3. [PMID: 8665833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Ganta R, Samra SK, Maddineni VR, Furness G. Comparison of the effectiveness of bilateral ilioinguinal nerve block and wound infiltration for postoperative analgesia after caesarean section. Br J Anaesth 1994; 72:229-30. [PMID: 8110580 DOI: 10.1093/bja/72.2.229] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
We have studied the effects of bilateral ilioinguinal nerve block and wound infiltration with 0.5% bupivacaine on postoperative pain and analgesic requirements in 62 patients undergoing Caesarean section under general anaesthesia. A control group received no local anaesthetic supplementation. Both ilioinguinal block and wound infiltration reduced significantly the pain scores and analgesic requirements in the immediate postoperative period (P < 0.05). The differences in pain scores and analgesic requirements between the study groups were not statistically significant (P > 0.05).
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Affiliation(s)
- R Ganta
- Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City 73152
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Beemer GH, Bjorksten AR. Pharmacodynamics of atracurium in clinical practice: effect of plasma potassium, patient demographics, and concurrent medication. Anesth Analg 1993; 76:1288-95. [PMID: 8498667 DOI: 10.1213/00000539-199306000-00018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
To determine which factors influenced the pharmacodynamics of atracurium in clinical practice, the steady-state plasma concentration of atracurium for 90% paralysis (Cpss90) was measured in 100 adult patients. Neuromuscular block was maintained at 88%-92% of the control response by adjusting the target concentration being delivered by preprogrammed intravenous atracurium infusion. The Cpss90 was measured empirically from plasma samples taken when the block had been stable for 15 min with no adjustment in the infusion rate for 20 min. To describe how factors influenced the Cpss90 of atracurium, a model was developed by multiple stepwise linear regression analysis. Influencing variables retained in the final model were plasma potassium concentration, intraoperative administration of gentamicin, and premedication with papaveretum and hyoscine. The model predicted that the Cpss90 of atracurium would decrease with decreasing serum potassium according to the relationship log10(Cpss90) = 2.380 + 0.171 x [K mmol/L] (n = 100; ANOVA, P < 0.001). Intraoperative administration of gentamicin modified this relationship resulting in a 25.1% decrease in the predicted Cpss90 (n = 15; ANOVA, P < 0.001). Premedication with papaveretum and hyoscine also modified this relationship resulting in a 21.2% decrease in predicted Cpss90 (n = 30; ANOVA, P < 0.001). The model predicted that administration of both would decrease the Cpss90 by 41.0%. Patients aged > or = 70 yr had a slight, but statistically insignificant, increase in the Cpss90 compared to younger adult patients. No other factor was found to influence the Cpss90, including patient sex, body fluid, and other drugs administered in the perioperative period, including calcium channel antagonists and ranitidine.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G H Beemer
- Department of Anaesthesia, Royal Melbourne Hospital, Victoria, Australia
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Green DW, O'Connor L, Hanna M. Efficacy of postoperative pain treatment regimens using both buprenorphine and papaveretum sequentially after abdominal hysterectomy. Br J Anaesth 1993; 70:626-30. [PMID: 8329254 DOI: 10.1093/bja/70.6.626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
We have undertaken a double-blind, controlled study to test the hypothesis that the efficacy of standard postoperative analgesia by papaveretum or buprenorphine is not compromised by previous or subsequent standard doses of the other agent. After total abdominal hysterectomy under a standardized general anaesthetic, 120 patients (four groups of 30) were allocated randomly to receive, on demand, a single i.v. dose of buprenorphine 0.15 mg or papaveretum 10 mg, followed sequentially by a single dose of i.m. buprenorphine 0.3 mg or papaveretum 20 mg. Three hours after the i.m. dose, all patients received sublingual buprenorphine 0.4 mg. Pain was scored using both a 10-cm horizontal visual analogue scale (VAS) and a nominal scale. Pain intensity differences and patient and nurse satisfaction with the regimens were recorded. Observations were continued for 8 h after operation. The efficacy of papaveretum or buprenorphine was not compromised by previous or subsequent standard doses of the other agent. All four treatment regimens were similarly well tolerated and gave acceptable analgesia in the immediate postoperative period.
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Affiliation(s)
- D W Green
- Department of Anaesthesia, Intensive Care and Pain Relief, King's College Hospital, Denmark Hill, London
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Wilmot G, Bhimsan N, Rocke DA, Murray WB. Intubating conditions and haemodynamic changes following thiopentone or propofol for early tracheal intubation. Can J Anaesth 1993; 40:201-5. [PMID: 8467540 DOI: 10.1007/bf03037030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Intubating conditions and haemodynamic changes were studied 30 sec after a fixed induction dose of thiopentone or propofol in patients scheduled for elective surgery. The hypnotic agent was preceded by the administration of papaveretum 10 mg three minutes before induction and alcuronium 0.2 mg.kg-1 at induction. Ease of intubation was graded and the study conducted in a randomised double-blind fashion. In the thiopentone group (n = 30) intubation was very easy in 73% compared with 79% in the propofol group (n = 29). In two patients in the propofol group the tracheas were moderately difficult to intubate but there were no failed intubations in either group. No patients recalled the intubation period on subsequent postoperative questioning. The immediate post-induction average systolic pressure in the thiopentone group decreased by 0.7% (range 15.9% increase to 25.3% decrease) whilst the post-intubation systolic pressure increased by 6.3% (range - 31.5% increase to 24.2% decrease). In the propofol group there was a decrease in systolic pressure after induction (average 14.4%; range 15.5% increase to 41.4% decrease, P < 0.05) but the subsequent pressor response to intubation was markedly attenuated compared with baseline (average systolic pressure decreased 15.5% (range 22.4% increase to 42.7% decrease)). Following intubation and maintenance, ventilation with nitrous oxide 70% and halothane 1% the systolic pressure decreased markedly in both groups with a greater reduction in the propofol group (P < 0.05). Compared with baseline there were increases (P < 0.0001) in heart rate in both groups from induction of anaesthesia to the end of study.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G Wilmot
- Department of Anaesthetics, University of Natal, Congella, Durban, South Africa
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Abstract
The analgesic efficacy of a single intramuscular dose of 75 mg diclofenac given after elective Caesarean section was studied in 50 women in a double-blind randomised manner using a patient-controlled analgesia system. The mean 18 h papavaretum consumption of the placebo group was significantly greater (91.4 mg compared to 61.4 mg). Subjective experience of pain and observed sedation were significantly greater in the control group up to 6 h after operation.
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Affiliation(s)
- D J Bush
- Anaesthetic Department, St James's University Hospital, Leeds
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Abstract
We have studied patterns of oxygen saturation (SpO2) before and after thoracotomy in 20 patients monitored nightly from the preoperative night to the fourth postoperative night. After operation, 10 patients received paravertebral bupivacaine (PVB) infusion and 10 received paravertebral saline (PVS) infusion. Papaveretum was given as required. Before operation the SpO2 profiles formed two groups: stable with SpO2 greater than 94% and stable with a median SpO2 less than 94% (hypoxaemia). During the first night after operation SpO2 profiles formed four groups: stable, not hypoxaemic (2/20); stable, hypoxaemic but improving (8/20); stable and constant hypoxaemia (5/20); unstable, hypoxaemic and deteriorating (5/20). Eleven patients remained hypoxaemic as late as the fourth night after operation. All patients who were hypoxaemic before operation were hypoxaemic after operation. Postoperative hypoxaemia was predicted in only 50% of cases. Papaveretum requirement was reduced in the PVB group, but regional analgesia did not affect the proportion of patients showing each SpO2 profile. Papaveretum caused a decrease in SpO2 in both analgesic groups.
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Affiliation(s)
- M D Entwistle
- Department of Anaesthetics, Bradford Royal Infirmary
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38
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Abstract
The effect of intramuscular diclofenac or placebo on analgesia obtained and on opiate and antiemetic requirements was observed in a randomised double-blind study of sixty patients receiving continuous intravenous papaveretum. Those patients receiving diclofenac required less papaveretum (P = 0.001) than those receiving placebo. They also had lower visual analogue pain scores (VAS) at four hours (P less than 0.05) and decreased requirement for antiemetics (P less than 0.02). No gastrointestinal complications were observed in either group and blood loss did not differ significantly between the two.
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Affiliation(s)
- S K Anderson
- Department of Anaesthesia, Royal National Orthopaedic Hospital, Middlesex, United Kingdom
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McCrirrick A, Ramage DT. Caudal blockade for postoperative analgesia: a useful adjunct to intramuscular opiates following emergency lower leg orthopaedic surgery. Anaesth Intensive Care 1991; 19:551-4. [PMID: 1750637 DOI: 10.1177/0310057x9101900411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The efficacy of a single caudal epidural injection of bupivacaine 20 ml 0.5% following emergency orthopaedic surgery to the lower leg and ankle was investigated. Forty adult patients were studied, randomised to either the caudal or control group. The mean 24 hour postoperative papaveretum consumption was significantly reduced in the caudal group. Analogue pain scores as assessed in a double-blind manner were also significantly reduced in this group. The duration of analgesia after caudal blockade was approximately eight hours as estimated by the average time to the first dose of papaveretum. Our study demonstrates that caudal blockade represents an effective adjunct to intramuscular opiates following this type of surgery.
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Affiliation(s)
- A McCrirrick
- Department of Anaesthetics, Fremantle Hospital, Western Australia
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40
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Abstract
Nurse-controlled continuous intravenous opioid analgesia was evaluated prospectively in 60 patients after thoracotomy. The rate of opioid infusion was adjusted, and bolus does were administered, as required to maintain patient comfort. The patients evaluated their pain using a visual analogue scale on 10 occasions during the first 48 hours after surgery. Pain scores remained consistently low throughout the period of measurement. Over the study period there was a 30-fold difference between the least and greatest requirement for opioid to achieve adequate analgesia. No major side effects were encountered. The study indicates that nurse-controlled intravenous analgesia can be successfully used for pain relief after thoracotomy.
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Affiliation(s)
- D F Murphy
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia
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41
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Abstract
The effectiveness of a continuous low dose papaveretum infusion for the relief of postoperative pain was assessed in 29 infants aged 1-6 months nursed on the infant surgical ward following major abdominal surgery. Trained nursing staff were able to adjust the dosage within prescribed guidelines and satisfactory analgesia was obtained with a regimen which delivered up to 0.0375 mg/kg/hour, approximately half the dose recommended in children older than 12 months. There was one case of clinically significant respiratory depression.
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Affiliation(s)
- S E Jones
- Department of Anaesthesia, Birmingham Children's Hospital, Ladywood Middleway, Birmingham
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Abstract
A wide variety of surgical and pharmacological methods have been described in an attempt to reduce pain after tonsillectomy, with conflicting results. Opiates are still widely used, despite unwanted side-effects. Recently the non-steroidal anti-inflammatory drugs have been shown to be effective against a variety of post-operative pains. Diclofenac is effective in both children and adults in the relief of pain after tonsillectomy when administered rectally, but absorption is variable, and suppositories are not widely accepted in the UK. The present double-blind study compared a single intramuscular dose of diclofenac with papaveretum in adults undergoing tonsillectomy. Post-operatively, the patients who received diclofenac had less pain and started drinking significantly sooner than the control group. There were no undesirable side-effects. Intramuscular diclofenac is superior to papaveretum in the relief of pain in adults undergoing tonsillectomy.
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Affiliation(s)
- B Kotecha
- Department of Ear, Nose and Throat Surgery, Hope Hospital, Salford, UK
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Abstract
An acute pain service in a new district general hospital is described. We have reported incidence of severe pain, common postoperative anaesthetic problems and patient satisfaction in relation to the analgesic technique. Over half the patients were treated by intermittent intramuscular injection of opioid, but increase in the use of continuous intravenous therapy and in particular patient-controlled analgesia, was welcomed by both medical and nursing staff.
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Affiliation(s)
- P D Cartwright
- Department of Anaesthesia, Princess Royal Hospital, Telford
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Nigam A, Narula AA. Intramuscular papaveretum in the management of food bolus impaction. Ear Nose Throat J 1990; 69:737-8. [PMID: 2276345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- A Nigam
- Department of Otolaryngology, Leicester Royal Infirmary
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Abstract
The effect of indomethacin on postoperative pain was studied in 60 adult patients undergoing thoracotomy in a prospective, randomized, double-blind manner. Patients receiving indomethacin required significantly less opioid after operation and had significantly lower pain scores compared with the control group. Pain on movement and on coughing were reduced also. No major adverse effects were encountered.
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Affiliation(s)
- T Pavy
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Perth, Western Australia
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Shepherd JK, Hall-Craggs MA, Finn JP, Bingham RM. Sedation in children scanned with high-field magnetic resonance; the experience at the Hospital for Sick Children, Great Ormond Street. Br J Radiol 1990; 63:794-7. [PMID: 2242477 DOI: 10.1259/0007-1285-63-754-794] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Patient movement is the most common cause of image degradation when performing magnetic resonance scans in children. This is a particular problem scanning at high field, as noise levels of up to 90 dB may be reached. Movement can be reduced by adequate sedation. We present the results of two sedation protocols when scanning with a 1.5T Magnetom scanner. Optimal scan quality can be achieved in up to 85% of scans using Pethco combined with triclofos in children aged 1 month-2 years, and trimeprazine combined with papaveretum in children over 2 years. When heavy sedation is used, patient selection must be cautious, and there is a minimum acceptable level of monitoring including close physical observation, electrocardiographic and apnoea monitoring.
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Affiliation(s)
- J K Shepherd
- NMR Unit, Department of Radiology, Hospital for Sick Children, London
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Abstract
We describe our experience of using continuous papaveretum infusions to control pain in 24 children admitted on 45 occasions with painful sickling crisis. The children were aged from 1.7 to 14.3 years. Infusion duration ranged from one to nine days (median three days), total dose from 0.3 to 21 mg/kg (median 2.4 mg/kg), with a pronounced tendency for dosage to increase with increasing age. No respiratory depression was observed. One infusion was discontinued because of cerebral toxicity.
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Affiliation(s)
- P C Sartori
- Department of Haematology, Birmingham Children's Hospital
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Abstract
Fifty patients were allocated randomly to receive placebo or piroxicam 40 mg, 2.5 h before surgical removal of lower third molars under general anaesthesia. A significantly greater number of patients in the piroxicam group did not require opioid analgesia after operation (P less than 0.05). The piroxicam group also required fewer doses of paracetamol in the first 24 h after recovery from anaesthesia (P less than 0.05), and the time from recovery to first postoperative analgesia was longer in those patients who had received piroxicam (P less than 0.05). Piroxicam did not significantly prolong the duration of recovery from anaesthesia.
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Affiliation(s)
- G L Hutchison
- Department of Anaesthesia, Ninewells Hospital & Medical School, Dundee
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Abstract
Sixteen otherwise healthy women undergoing cholecystectomy were randomized to receive postoperative analgesia either by continuous infusion of papaveretum (n = 8), or by continuous interpleural infusion of bupivacaine (n = 8). Postoperative pain was assessed by linear analogue and ventilatory capacity. Changes in body protein were measured by in vivo neutron activation analysis. Clinical course was also noted. Pain scores were significantly lower in the interpleural group over the first 48 h (P less than 0.02). Ventilatory capacity was also significantly better for the first 24 h (P less than 0.025). There was no evidence of shortened postoperative ileus; hospital stay and postoperative fatigue were similar for the two groups. Weight and protein losses over a 2 week period were similar in the two groups. It is concluded that the apparent advantages in patient comfort and mobility offered by interpleural infusion are most marked in the first 48 h postoperatively, with an advantage in ventilatory capacity over the first 24 h.
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Affiliation(s)
- D Schroeder
- Department of Surgery, University of Auckland Medical School, New Zealand
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50
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Sonczyk W, Radomska I, Burda H. [Symptoms of neonatal abstinence syndrome. Case report]. Pol Tyg Lek 1990; 45:253-4. [PMID: 2235702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A case of the neonatal narcotic abuse syndrome is presented. A newborn baby additionally suffered from the congenital infection. Marked symptoms of narcotic withdrawal required an administration of the opiates and tranquillizers for three weeks.
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