RESUMEN
Continuous flow pumps are being used for the delivery of morphine sulfate to the intrathecal and epidural space for control of pain. We have encountered several patients who had a combination of pain and spasticity or who had spasticity so intense that it was the source of pain. One to two milligrams of intrathecal morphine dramatically relieved their spasticity and pain. Three such patients have subsequently undergone pump implantation with prolonged control of their spasticity. This has initiated a formal clinical investigation directed at determining the physiological mechanism of this phenomenon, as well as its long term efficacy.
Asunto(s)
Morfina/uso terapéutico , Espasticidad Muscular/tratamiento farmacológico , Adulto , Anciano , Espacio Epidural , Humanos , Inyecciones , Inyecciones Espinales , Masculino , Persona de Mediana Edad , Morfina/administración & dosificación , Dolor/tratamiento farmacológicoRESUMEN
Premedication with diazepam, hydroxyzine or secobarbital significantly increased ketamine-induced sleep time (137 +/- 3.5 min, 135 +/- 9.2 min, 128 +/- 4.7 min) over that of unpremedicated controls (98.5 +/- 4.4 min) in man. The corresponding mean plasma half-lives (t1/2) of ketamine were longer in patients premedicated with diazepam or seconbarbital (57.8 +/- 4.9 min, 46 +/- 3.2 min) than in controls (36 +/- 1.8 min). Ketamine t1/2 in the perfusate of isolated, perfused rat livers was prolonged 30 to 50 per cent by addition of diazepam, secobarbital, or hydroxyzine. The data suggest that these commonly used premedicants decrease the rate of ketamine metabolism.