BACKGROUND: Dipyrone (metamizole) is widely used for perioperative pain management in countries where it is marketed; however, uncertainty exists concerning the safe use of this drug, specifically considering the rare adverse event of an agranulocytosis. METHODS: As evidence from published studies was lacking, an expert panel developed recommendations for the perioperative use of dipyrone. After a formal, structured consensus process, the recommendations were approved by the involved medical societies. RESULTS: The panel agreed that blood cell counts shall not be standard for short-term perioperative use in patients unless they are at risk for neutropenia. The medical staff shall be aware of the symptoms and course of action when agranulocytosis is suspected. Patients shall be informed about the risks and benefits of dipyrone and about potential alternatives. The expert group concluded that dipyrone has a relatively positive risk-benefit ratio compared to other nonopioid analgesics. The group strongly recommended educating patients about the symptoms of agranulocytosis if they have received dipyrone over several days and/or treatment is to be continued after discharge, because agranulocytosis can occur several days after discontinuation of metamizole. Further recommendations refer to the information of the physician taking over the patient's care after discharge and the avoidance of re-exposure in patients having previously suffered from dipyrone-induced agranulocytosis. CONCLUSION: The group's recommendations shall be communicated in order to raise medical staff's and patients' awareness of the appropriate use of dipyrone in the perioperative period.
Acute Pain/drug therapy , Agranulocytosis/chemically induced , Analgesics, Non-Narcotic/therapeutic use , Dipyrone/therapeutic use , Perioperative Period , Societies, Medical , Analgesics, Non-Narcotic/adverse effects , Anesthesiology , Dipyrone/adverse effects , Germany , Humans , Switzerland
BACKGROUND: Dipyrone (metamizole) is widely used for perioperative pain management in countries where it is marketed; however, uncertainty exists concerning the safe use of this drug, specifically considering the rare adverse event of an agranulocytosis. METHODS: As evidence from published studies was lacking, an expert panel developed recommendations for the perioperative use of dipyrone. After a formal, structured consensus process, the recommendations were approved by the involved medical societies. RESULTS: The panel agreed that blood cell counts shall not be standard for short-term perioperative use in patients unless they are at risk for neutropenia. The medical staff shall be aware of the symptoms and course of action when agranulocytosis is suspected. Patients shall be informed about the risks and benefits of dipyrone and about potential alternatives. The expert group concluded that dipyrone has a relatively positive risk-benefit ratio compared to other nonopioid analgesics. The group strongly recommended educating patients about the symptoms of agranulocytosis if they have received dipyrone over several days and/or treatment is to be continued after discharge, because agranulocytosis can occur several days after discontinuation of metamizole. Further recommendations refer to the information of the physician taking over the patient's care after discharge and the avoidance of re-exposure in patients having previously suffered from dipyrone-induced agranulocytosis. CONCLUSION: The group's recommendations shall be communicated in order to raise medical staff's and patients' awareness of the appropriate use of dipyrone in the perioperative period.
Acute Pain , Anesthesiology , Anti-Inflammatory Agents, Non-Steroidal , Dipyrone , Acute Pain/drug therapy , Analgesics , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Critical Care , Dipyrone/therapeutic use , Humans
BACKGROUND: Dipyrone (metamizole) is widely used for perioperative pain management in countries where it is marketed; however, uncertainty exists concerning the safe use of this drug, specifically considering the rare adverse event of an agranulocytosis. METHODS: As evidence from published studies was lacking, an expert panel developed recommendations for the perioperative use of dipyrone. After a formal, structured consensus process, the recommendations were approved by the involved medical societies. RESULTS: The panel agreed that blood cell counts shall not be standard for short-term perioperative use in patients unless they are at risk for neutropenia. The medical staff shall be aware of the symptoms and course of action when agranulocytosis is suspected. Patients shall be informed about the risks and benefits of dipyrone and about potential alternatives. The expert group concluded that dipyrone has a relatively positive risk-benefit ratio compared to other nonopioid analgesics. The group strongly recommended educating patients about the symptoms of agranulocytosis if they have received dipyrone over several days and/or treatment is to be continued after discharge, because agranulocytosis can occur several days after discontinuation of metamizole. Further recommendations refer to the information of the physician taking over the patient's care after discharge and the avoidance of re-exposure in patients having previously suffered from dipyrone-induced agranulocytosis. CONCLUSION: The group's recommendations shall be communicated in order to raise medical staff's and patients' awareness of the appropriate use of dipyrone in the perioperative period.
Agranulocytosis , Dipyrone , Acute Pain/drug therapy , Acute Pain/prevention & control , Agranulocytosis/chemically induced , Agranulocytosis/prevention & control , Analgesics/administration & dosage , Analgesics/adverse effects , Anesthesiology/standards , Association , Critical Care , Dipyrone/administration & dosage , Dipyrone/adverse effects , Humans , Perioperative Period
Stimulation of the outer periphery of a cell's receptive field with phase-reversing gratings leads to mainly excitatory phasic or tonic responses in the dorsal lateral geniculate nucleus (dLGN) of the cat. This lateral excitation is of retinal origin. Following destruction of the retinal receptive field area by localized photocoagulation, pure inhibitory periphery effects are observed in the majority of deafferented cells. This inhibition acts beyond the boundaries of the antagonistic receptive field and is based on neuronal mechanisms on the geniculate level.
Geniculate Bodies/physiology , Animals , Cats , Neural Inhibition , Reaction Time/physiology , Retina/physiology , Visual Cortex/physiology , Visual Pathways/physiology
