ABSTRACT
INTRODUCTION: The role of Olanzapine therapeutic drug monitoring is controversial. The present study explores the associations of Olanzapine plasma concentrations with clinical response and metabolic side effects in first episode psychosis (FEP) after 2 months of treatment. METHODS: Forty-seven patients were included. Improvement in clinical symptomatology was assessed using the PANSS. Metabolic assessment included weight, blood pressure, waist circumference, blood glucose, total cholesterol, high-density lipoprotein, low-density lipoprotein, and triglycerides. RESULTS: The Olanzapine plasma concentrations after 2 months of treatment were positively correlated with weight gain (r = 0.49, p = 0.003), and a concentration > 23.28 ng/mL was identified as a positive predictor of weight gain (≥ 7%). The Olanzapine concentration to dose (C/D) ratio was positively correlated with the percentage of improvement in the total PANSS (r = 0.46, p = 0.004), and a C/D ratio > 2.12 was identified as a positive predictor of a good response (percentage of improvement > 30%) after 2 months of treatment. We also identified several factors that could alter Olanzapine pharmacokinetics: gender (p = 0.03), diagnosis (p = 0.05), smoking habit (p = 0.05), and co-medications such as valproic acid (p = 0.05) and anxiolytics (p = 0.01). DISCUSSION: In conclusion, our results suggest that therapeutic drug monitoring of Olanzapine could be helpful to evaluate therapeutic efficacy and metabolic dysfunction in FEP patients treated with Olanzapine.
Subject(s)
Antipsychotic Agents/blood , Drug Monitoring/methods , Olanzapine/blood , Psychotic Disorders/drug therapy , Adult , Antipsychotic Agents/therapeutic use , Blood Glucose/analysis , Blood Pressure/drug effects , Female , Humans , Male , Middle Aged , Olanzapine/therapeutic use , Psychotic Disorders/blood , Psychotic Disorders/psychology , Smoking/blood , Treatment Outcome , Weight Gain/drug effectsABSTRACT
El bloqueo de las ramas laterales de los nervios intercostales en la línea axilar media (BRILMA) es un bloqueo ecoguiado interfascial para la analgesia en cirugía torácica y abdominal, y es una buena alternativa a las técnicas neuroaxiales. Presentamos el caso de una mujer de 49 años programada para reparación de estenosis idiopática subglótica, con extracción de cartílago costal de la décima costilla y traqueotomía. Tras la cirugía se realizó sin incidencias el bloqueo BRILMA unilateral con 20ml de ropivacaína al 0,2% a nivel de la 6.ª costilla. En el postoperatorio, la paciente refirió un máximo de dolor de 3/10. No requirió opioides tras el segundo día postoperatorio, aunque una incisión subcostal puede producir dolor de considerable intensidad. BRILMA es una técnica superficial, fácilmente reproducible en la mayoría de los pacientes. Mediante una sola punción se logra alcanzar analgesia efectiva en múltiples dermatomas, disminuyendo el riesgo de neumotórax y la toxicidad anestésica local
The block of the lateral branches of the intercostal nerves in the middle axillary line (BRILMA) is an interfascial ultrasound-guided block for analgesia in thoracic wall and upper abdominal surgery, presenting as an adequate alternative to neuraxial techniques. We present the case of a 49-year-old female scheduled for idiopathic subglottic stenosis repair with a costal cartilage graft from the 10th rib and tracheotomy. At the end of the surgery, unilateral ultrasound-guided BRILMA block with 20ml of ropivacaine 0.2% was performed at the level of the 6th rib, uneventfully. Postoperatively, the patient referred a maximum level of pain of 3/10. There was no opioid consumption after the 2nd postoperative day, although a subcostal incision may produce considerable pain. BRILMA is a superficial block, easily reproducible in most patients. It diminishes the number of punctures needed in the thoracic wall, as well as the risk for pneumothorax and local anesthetic toxicity
Subject(s)
Humans , Female , Middle Aged , Nerve Block/methods , Anesthesia, Local/methods , Costal Cartilage/surgery , Intercostal Nerves/drug effects , Laryngostenosis/surgery , Treatment Outcome , Pain, Postoperative/prevention & control , Pain Management/methodsABSTRACT
The block of the lateral branches of the intercostal nerves in the middle axillary line (BRILMA) is an interfascial ultrasound-guided block for analgesia in thoracic wall and upper abdominal surgery, presenting as an adequate alternative to neuraxial techniques. We present the case of a 49-year-old female scheduled for idiopathic subglottic stenosis repair with a costal cartilage graft from the 10th rib and tracheotomy. At the end of the surgery, unilateral ultrasound-guided BRILMA block with 20ml of ropivacaine 0.2% was performed at the level of the 6th rib, uneventfully. Postoperatively, the patient referred a maximum level of pain of 3/10. There was no opioid consumption after the 2nd postoperative day, although a subcostal incision may produce considerable pain. BRILMA is a superficial block, easily reproducible in most patients. It diminishes the number of punctures needed in the thoracic wall, as well as the risk for pneumothorax and local anesthetic toxicity.
