The Addition of Amphetamine to Potentially Sedating Medication Regimens: An Exploratory Investigation of the Impact upon Reaction Time and Sustained Attention.

OBJECTIVES: The addition of amphetamine to a sedating medication may reduce sedation but does it augment reaction time and sustained attention for workers? The purpose of this exploratory study was gain insight into between group differences that would assist hypothesis formation for a subsequent hypothesis testing study. METHODS: This study examined psychomotor vigilance task (PVT) performance for a group taking potentially sedating medications (opiates, benzodiazepines, anticholinergics, barbiturates or polypharmacy) while taking amphetamine to a group not taking amphetamine. Data was assessed using two-way between groups multivariate analysis of variance. RESULTS: Multivariate testing found a (p = .05; η2 = .044) difference in combined PVT measures between the amphetamine use groups. Tests of between-subjects effects established (p = .006; η2 = .042) a difference in the number of minor lapses between the groups. Estimated marginal means of minor lapses revealed that the group taking amphetamine had 2.8 times the mean number of minor lapses than the group not taking amphetamine. A non-statistically significant trend was noted for the estimated marginal means of each sedating medication class and the use or nonuse of amphetamines that appears to correspond with the sedating medication's effect upon the cholinergic component of the attention system. CONCLUSION: Using PVT data, this exploratory study has provided information useful for generating the hypothesis that co-administration of an amphetamine with a sedating medication will result in arousal with a deficit of sustained attention related to the sedating medication's level of effect upon cholinergic activity.

Comparison of random and postaccident urine drug tests in southern Indiana coal miners.

BACKGROUND: This study examines the relationship between the use of 9 classes of substances (amphetamines, barbiturates, benzodiazepines, cocaine, marijuana, methadone, opioids, phencyclidine, and propoxyphene) and coal-mining accidents. METHODS: The control sample (n = 215) made up of miners that presented for random urine drug testing. The study sample (n = 100) consists of miners that presented for postaccident urine drug testing. Nonparametric Mann-Whitney U tests of creatinine normalized urine drug levels were conducted to compare the medians of the groups. RESULTS: The mean drug concentrations were higher in the postaccident group for each drug tested except marijuana. Two-tailed testing demonstrated statistically significant differences for marijuana (P = 0.000), cocaine (P = 0.008), and opiates (P = 0.037). CONCLUSIONS: The study demonstrates statistically significant higher cocaine and opioid concentrations and lower marijuana concentrations in postaccident urine drug tests of coal miners when compared with random tests.

Persistent hypothermia after intrathecal morphine: case report and literature review.

PURPOSE: To describe a case of persistent hypothermia following spinal anesthesia with intrathecal morphine. CLINICAL FEATURES: Following elective right total knee arthroplasty under spinal anesthesia with isobaric 0.5% bupivacaine 11 mg, fentanyl 15 µg, and preservative-free morphine 150 µg, a 57-yr-old female (93.5 kg, 151 cm) developed postoperative hypothermia with a nadir rectal temperature of 33.6°C four hours after surgery. At times, her temperature could not be measured by tympanic, temporal arterial, oral, axillary, or rectal routes. In spite of the low temperature, the patient complained of feeling hot and was diaphoretic without shivering. With the exception of her temperature, her vital signs were normal postoperatively, and aside from hyperglycemia, complete blood count, electrolytes, thyroid-stimulating hormone, serum cortisol, troponin, and twelve-lead electrocardiogram were normal. Her temperature did not respond to warming efforts with a forced-air warming blanket, infusion of warmed intravenous crystalloid, and hourly bladder irrigation with warm saline through an indwelling urinary catheter. Normothermia returned after she received a small dose of sublingual lorazepam eight hours after surgery. The remainder of her postoperative stay was uneventful. CONCLUSION: Patients undergoing spinal anesthesia with intrathecal morphine may develop postoperative hypothermia that is resistant to warming measures. This complication may be treated successfully with lorazepam.

Emergency tricuspid valve replacement during pregnancy.

A 36 year-old intravenous drug user at 19 weeks' gestation required emergency tricuspid valve replacement for severe tricuspid regurgitation and cardiogenic shock refractory to medical therapy. Normothermic, pulsatile, high-flow, and pressure cardiopulmonary bypass (CPB) was used in the absence of fetal monitoring. Ten days postoperatively, the patient miscarried. She was discharged from hospital two months following surgery. High-flow (> 3.0 L/min(2)), high-pressure (> 70 mmHg), normothermic CPB using pulsatile flow and blood cardioplegia is thought to offer the best outcome to the fetus, although data to support these claims are not compelling.