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1.
Geriatr Gerontol Int ; 21(10): 887-892, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34427037

RESUMO

AIM: The number of therapeutic endoscopic procedures in elderly individuals keeps increasing and this population has a high risk of adverse events related to sedation and general anesthesia. However, there is a paucity on data about the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in this population. METHODS: In total, 417 consecutive ERCP procedures were performed in 362 patients between September 2018 and January 2020. Of these, 59 patients (74 sessions) were aged ≥80 years (Group A) and 173 patients (193 procedures) were aged ≤65 years (Group B). We analyzed the prospectively collected data of patient- and procedure-related variables. RESULTS: The procedure time was significantly longer in Group A (P < 0.05). The prevalence of comorbidities, use of anticoagulants and American Society of Anesthesiologists (ASA) physical status classification levels were significantly higher in Group A (P < 0.05). The incidence of periampullary diverticula, malignancy, rate of difficult cannulation, mean number of stones, use of biliary stents and stent dysfunction was also significantly higher in Group A (P < 0.05). The medication doses used were significantly higher and emergence symptoms were significantly more frequent in Group B (P < 0.05). The rates of bleeding, pancreatitis, perforation, cholangitis, hypoxia, hypotension and the length of hospital stay did not significantly differ between the two groups. The overall success rate of the procedure was comparable in the two groups (P = 0.874). CONCLUSIONS: ERCP can be safely performed in elderly patients using a combination of midazolam and ketamine without propofol. The incidence of complications is comparable with that observed in younger patients. Geriatr Gerontol Int 2021; 21: 887-892.


Assuntos
Ketamina , Propofol , Idoso , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Humanos , Ketamina/efeitos adversos , Meperidina/efeitos adversos , Midazolam/efeitos adversos
2.
Agri ; 33(1): 28-35, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34254658

RESUMO

OBJECTIVES: This study was an analysis of the effect of different dosages of intrathecal meperidine (40 mg, 50 mg, 60 mg, and 70 mg) on hemodynamic parameters, the duration of neural blockade, and the incidence of meperidine-related side effects in patients who underwent an open prostatectomy. METHODS: Sixty patients who underwent an open prostatectomy with combined spinal-epidural anesthesia were included. The patients were allocated to receive 1 of 4 different dosages of intrathecal meperidine (n=15 for each group): Group I: 40 mg, Group II: 50 mg, Group III: 60 mg, and Group IV: 70 mg. The duration of the block procedure, surgery duration, highest sensory block level, and anesthetic complications were recorded and analyzed. RESULTS: At 20 minutes after the spinal injection, the maximum sensory block level was T6 in Group I and II, and it was T5 in Group III and IV. The mean motor block scores at 20 minutes after the spinal injection were lower in Group I compared with the other groups (p<0.001 for all). The motor block duration was significantly shorter in Group I and II than in Group III and IV (p<0.001 for all). Surgeon satisfaction was greater in Group II, III, and IV compared with Group I (p<0.001 for all). Patient satisfaction was better in Group III and IV compared with Groups I and II (p<0.001 for all). CONCLUSION: Intrathecal meperidine at a dose of 60 mg exerted a sufficient analgesic effect with minimum side effects in patients undergoing open prostatectomy.


Assuntos
Raquianestesia , Meperidina , Método Duplo-Cego , Humanos , Injeções Espinhais , Masculino , Estudos Prospectivos , Próstata
3.
Acta Biomed ; 92(2): e2021065, 2021 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-33988155

RESUMO

BACKGROUND: Opioid analgesics had been used from time to time for treating labor pain. However, their use have been concerning. The aim of this study is to evaluate the effect of pethidine on duration of active phase of labor, labor pain and maternal-neonatal outcomes. METHODS: In the present case-control study, the study group received a 50 mg pethidine intramuscular injection upon the start of active phase of labor, and the control group consisted of patients who receive placebo injeciton. In both groups, vital signs were measured before, and at 0, 5, 15, 30, 45 and 60 minutes after the injection. Pain intensity was evaluated with Visual Analogue Scale (VAS) prior to, and 1 hour and 2 hours after injection. Data regarding labor phase durations, maternal side effects, newborn APGAR scores and fetal respiratory problems were recorded. RESULTS: 102 patients in Pethidine group and 92 patients in control group, were included into the study. Labor pain VAS-scores were significantly lower in the study group (p<0.001). Moreover, active phase of labor duration was significantly shorter in the study group (p<0.001). Maternal pulse significantly decreased, and maternal nausea-vomiting was frequent in the study groups. However, the groups were similar in terms of other side effects and neonatal outcomes. CONCLUSIONS: Pethidine significantly reduces active phase of labor duration, has a favorable analgesic effect in treating labor pain and is not associated with serious maternal or neonatal complications. It is therefore considered an acceptable agent for use during active phase of labor.


Assuntos
Analgesia Obstétrica , Dor do Parto , Analgésicos Opioides , Feminino , Humanos , Recém-Nascido , Dor do Parto/tratamento farmacológico , Meperidina , Manejo da Dor , Gravidez
4.
World Neurosurg ; 150: e613-e620, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33753320

RESUMO

BACKGROUND: Neural tube defects are among the most frequent congenital abnormalities of the central nervous system. Progression of neural tube deficits is affected by hereditary predilection and environmental determinants. Pethidine (meperidine) is a fast and powerful opioid analgesic in U.S. Food and Drug Administration category C. There are reports about developmental anomalies due to this medication. The aim of this study was to investigate the effects of different doses of pethidine hydrochloride on neural tube development in a chick embryo model resembling the first month of vertebral growth in mammals. METHODS: Seventy-five specific pathogen-free eggs were incubated for 28 hours and divided into 5 groups (including the control group), each consisting of 15 eggs. Pethidine hydrochloride was administered sub-blastodermically with a Hamilton microinjector in 4 different doses. Incubation was continued until the end of the 48th hour. Subsequently, all eggs were opened, and embryos were cut from the embryonic membranes and evaluated morphologically, genetically, and histopathologically. RESULTS: Crown-rump length, somite numbers, and silver-stained nucleolar organizer region (AgNOR) number averages, and total AgNOR/nuclear area ratios decreased in a dose-dependent manner. Examination of neural tube closure revealed statistically significant differences in all experimental groups (P<0.05). Messenger RNA levels of the BRE gene were decreased in pethidine hydrochloride-exposed embryos compared with the control group. Although this downregulation was not statistically significant, this decrease was striking with a 0.422-fold change in the fifth group. CONCLUSIONS: We demonstrated that pethidine hydrochloride affects neuronal development in chicken embryos. The teratogenic mechanism of pethidine hydrochloride is unclear; therefore, further investigation is required.


Assuntos
Analgésicos Opioides/toxicidade , Meperidina/toxicidade , Tubo Neural/efeitos dos fármacos , Neurogênese/efeitos dos fármacos , Animais , Embrião de Galinha
5.
Respir Investig ; 59(2): 228-234, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33160904

RESUMO

BACKGROUND: In advanced lung cancer, precision medicine requires repeated biopsies via bronchoscopy at therapy change. Since bronchoscopies are often stressful for patients, sedation using both fentanyl and midazolam is recommended in Europe and America. In Japan, bronchoscopies are generally orally performed under midazolam and oropharyngeal anesthesia. Nasal intubation creates a physiological route to the trachea, causing less irritation to the pharynx than intubation via the oral cavity; however, the necessity of oropharyngeal anesthesia remains unclear. We aimed to compare the safety, patient discomfort, and diagnostic rates for oropharyngeal anesthesia and sedation with pethidine and midazolam (Group A) and sedation with midazolam and fentanyl without oropharyngeal anesthesia (Group B) for ultrathin bronchoscopy of peripheral pulmonary lesions (PPLs) via nasal intubation. METHODS: We retrospectively reviewed 74 consecutive potential lung cancer patients who underwent ultrathin bronchoscopies at the Hakodate Goryoukaku Hospital between July 2019 and June 2020. We reviewed the following: diagnostic rates; cumulative doses of lidocaine, midazolam, and fentanyl; hemodynamic changes; procedural complications in both groups. Pharyngeal anesthesia in group A was administered by spraying 2% (w/v) lidocaine into the pharynx. The chi-squared test was used for statistical analyses. RESULTS: There were no significant changes in hemodynamic parameters and complications. The mean level of discomfort for bronchoscopic examinations was significantly lower in Group B (2.39 vs. 1.64; P = 0.014), with no significant inter-group difference in the diagnostic yields for PPLs (63.0% vs. 71.4%; P = 0.46). CONCLUSIONS: Our findings indicate the advantages of sedation with fentanyl and midazolam without oropharyngeal anesthesia for ultrathin bronchoscopy through nasal intubation.


Assuntos
Biópsia/métodos , Broncoscopia/métodos , Sedação Consciente/métodos , Fentanila/administração & dosagem , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Midazolam/administração & dosagem , Adulto , Anestesia/métodos , Broncoscopia/efeitos adversos , Feminino , Fentanila/efeitos adversos , Hemodinâmica , Humanos , Intubação Gastrointestinal/métodos , Neoplasias Pulmonares/fisiopatologia , Masculino , Meperidina/administração & dosagem , Midazolam/efeitos adversos , Pessoa de Meia-Idade , Estudos Retrospectivos , Segurança
6.
Vet Surg ; 50(2): 410-417, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33242227

RESUMO

OBJECTIVE: To describe the pharmacokinetics and pharmacodynamics of meperidine after IM and subcutaneous administration in horses. STUDY DESIGN: prospective, randomized, blinded, crossover trial. ANIMALS: Six adult horses weighing 494 ± 33 kg. METHODS: Treatments included meperidine 1 mg/kg IM with saline 6 mL subcutaneously, meperidine 1 mg/kg subcutaneously with saline 6 mL IM, and saline 6 mL subcutaneously and 6 mL IM, with a 7-day washout between treatments. Plasma meperidine concentrations and pharmacodynamic values (thermal and mechanical thresholds, physiological variables, fecal production) were collected at various time points for 24 hours. Accelerometry data were obtained for 8 hours to measure locomotor activity. Data were analyzed with a mixed effects model, and α was set at .05. RESULTS: Meperidine terminal half-life (T1/2 ), maximal plasma concentrations, and time to maximal concentration were 186 ± 59 and 164 ± 56 minutes, 265.7 ± 47.2 and 243.1 ± 80.1 ng/mL at 17 ± 6, and 24 ± 13 minutes for IM at subcutaneous administration, respectively. No effect of treatment or time was observed on thermal or mechanical thresholds, heart rate, respiratory rate, locomotor activity, frequency of defecations, or fecal weight (P > .2 for all). CONCLUSION: Maximum meperidine concentrations were achieved quickly with a short T1/2 in both treatment groups. Neither IM nor subcutaneous meperidine influenced thermal or mechanical threshold or physiological variables. CLINICAL SIGNIFICANCE: The short half-life and lack of detectable antinociceptive effect do not support IM or subcutaneous administration meperidine at 1 mg/kg for analgesia in horses.


Assuntos
Analgésicos Opioides/farmacologia , Cavalos/metabolismo , Meperidina/farmacologia , Analgésicos Opioides/farmacocinética , Animais , Feminino , Injeções Intramusculares/veterinária , Injeções Subcutâneas/veterinária , Masculino , Meperidina/farmacocinética
7.
World Neurosurg ; 147: e1-e7, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33340727

RESUMO

OBJECTIVE: To investigate the postoperative analgesic efficacy of ultrasound-guided lumbar erector spinae plane (ESP) blocks in patients undergoing posterior lumbar spinal surgery for lumbar spinal fractures. METHODS: A total of 80 patients who were scheduled for posterior internal fixation for lumbar spinal fractures were divided into a patient-controlled analgesia (PCA) group or a combined ESP-PCA group. Numeric rating scale at rest and during movement, postoperative sufentanil consumption, and accumulative and effective bolus presses of PCA were recorded at 6, 12, 24, and 48 hours postoperatively. Numeric rating scale at rest and during movement was the primary outcome. Incidence of postoperative nausea and vomiting during the first 24-48 hours, pruritus and chronic postoperative pain, and dose of pethidine for rescue analgesia were also recorded. RESULTS: Numeric rating scale at rest and during movement at 6, 12, and 24 hours was lower in the ESP-PCA group (P < 0.001, P < 0.001, P = 0.0016 at rest; all P < 0.001 during movement). Lumbar ESP blocks diminished accumulative bolus presses and effective bolus presses of PCA at 6, 12, 24, and 48 hours postoperatively. Besides, patients in the ESP-PCA group had fewer demands for sufentanil and pethidine. The incidence of postoperative nausea and vomiting in the ESP-PCA group was lower than that in PCA group. CONCLUSIONS: PCA combined with lumbar ESP blocks provided superior postoperative analgesia for patients with lumbar spinal fractures treated with posterior internal fixation. Lumbar ESP blocks decreased postoperative opioid consumption and incidence of postoperative nausea and vomiting, thereby enhancing postoperative recovery.


Assuntos
Analgésicos Opioides/administração & dosagem , Vértebras Lombares/cirurgia , Meperidina/administração & dosagem , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Músculos Paraespinais , Náusea e Vômito Pós-Operatórios/epidemiologia , Prurido/epidemiologia , Fraturas da Coluna Vertebral/cirurgia , Sufentanil/administração & dosagem , Idoso , Analgesia Controlada pelo Paciente , Anestesia por Condução , Feminino , Fixação Interna de Fraturas , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/fisiopatologia , Ultrassonografia
8.
Med Glas (Zenica) ; 18(1): 27-32, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33155461

RESUMO

Aim To investigate analgesic effect of three different regimens of combination of analgesics administered to patients undergoing laparoscopic cholecystectomy. Methods Patients undergoing laparoscopic cholecystectomy were randomly allocated to one of three groups on admission, depending of a prescribed post-operative analgesic regimen. Patients allocated to the group A received a combination of intravenous (IV) acetaminophen and intramuscular (IM) pethidine, patients in the group B received a combination of IV acetaminophen and IV parecoxib, and the patients of the group C received IV acetaminophen monotherapy. Analgesic therapy was administered at regular intervals. Pain was evaluated utilizing the numeric rating scale (NRS) at 5 time points: the first assessment was done at 45 minutes, the second, third, fourth and fifth at 2, 6, 12, and 24 hours post-administration, respectively. Postoperative pain intensity was measured by NRS within the groups and between the groups at each time they analysed using one-way repeat measured ANOVA and Post Hoc Test-Bonferroni Correlation. Results A total of 316 patients were enrolled. The analgesic regimens of groups A and B (combination regimens consisting of IV acetaminophen and intramuscular pethidine and IV acetaminophen and IV parecoxib, respectively) were found to be of equivalent efficacy (p=1.000). In contrast, patients in group C (acetaminophen monotherapy) had higher NRS scores, compared to both patients in groups A (p<0.01) and B (p<0.01). Conclusion This study confirms the notion of a significant opioid-sparing effect of parecoxib in postoperative pain management after laparoscopic cholecystectomy.


Assuntos
Acetaminofen , Colecistectomia Laparoscópica , Acetaminofen/uso terapêutico , Analgésicos , Método Duplo-Cego , Humanos , Isoxazóis , Meperidina/uso terapêutico , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Estudos Prospectivos
9.
Acta Cir Bras ; 35(11): e351107, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33331457

RESUMO

PURPOSE: To evaluate the effects of meperidine on fascial healing. METHODS: Seventy adult male Sprague-Dawley rats divided into 7 groups with 10 rats in each group. One of these groups was determined as the sham group, 3 of the remaining 6 groups as meperidine groups, and 3 as control groups. These were grouped as 1st, 2nd, and 6th weeks. In the anterior abdominal wall of the rat, the skin was detached and a wound model including the peritoneum was created with a median incision. Mice in the meperidine group were injected with meperidine intraperitoneally (IP) 3 × 20 mg/kg meperidine on postoperative days 0, 1 and 2, and 2 × 20 mg/kg meperidine on postoperative days 3, 4, 5, and 6 after surgical intervention. Similar to the control group, an equal volume of saline was administered, corresponding to the doses. After sacrifice, the midline fascia was used for facial tensile strength measurement, and the other for histopathological analysis. RESULTS: When compared, the meperidine and control groups inflammatory cell density was higher in the 1st week (p < 0.05) in the meperidine group, fibroplasia density was found to be higher at the 2nd week in the meperidine group than the control group (p < 0.05) When the tensile strength in the meperidine and control groups were compared, there was no significant difference (p > 0.05) at each of the three weeks. CONCLUSION: The application of postoperative systemic meperidine affects positively wound healing in the inflammatory stage and fibroplasia without changing the resistance to traction.


Assuntos
Meperidina , Cicatrização , Animais , Fáscia , Masculino , Camundongos , Ratos , Ratos Sprague-Dawley , Pele , Resistência à Tração
10.
BMC Geriatr ; 20(1): 455, 2020 11 07.
Artigo em Inglês | MEDLINE | ID: mdl-33160319

RESUMO

BACKGROUND: Malnutrition is common among older adults and is associated with adverse outcomes but remains undiagnosed on healthcare admissions. Older adults use emergency departments (EDs) more than any other age group. This study aimed to determine the prevalence and factors associated with malnutrition on admission and with adverse outcomes post-admission among older adults attending an Irish ED. METHODS: Secondary analysis of data collected from a randomised controlled trial exploring the impact of a dedicated team of health and social care professionals on the care of older adults in the ED. Nutritional status was determined using the Mini Nutritional Assessment- short form. Patient parameters and outcomes included health related quality of life, functional ability, risk of adverse health outcomes, frailty, hospital admissions, falls history and clinical outcomes at index visit, 30-day and 6-month follow up. Aggregate anonymised participant data linked from index visit to 30-days and 6-month follow-up were used for statistical analysis. RESULTS: Among 353 older adults (mean age 79.6 years (SD = 7.0); 59.2% (n = 209) female) the prevalence of malnutrition was 7.6% (n = 27) and 'risk of malnutrition' was 28% (n = 99). At baseline, those who were malnourished had poorer quality of life scores, functional ability, were more frail, more likely to have been hospitalised or had a fall recently, had longer waiting times and were more likely to be discharged home from the ED than those who had normal nutrition status. At 30-days, those who were malnourished were more likely to have reported another hospital admission, a nursing home admission, reduced quality of life and functional decline than older adults who had normal nutrition status at the baseline ED visit. Differences between the MNA SF and 6-month outcomes were similar but not statistically significant. CONCLUSION: Over one-third of older adults admitted to an Irish ED are either malnourished or at risk of malnourishment. Malnutrition was associated with a longer stay in the ED, functional decline, poorer quality of life, increased risk of hospital admissions and a greater likelihood of admission to a nursing home at 30 days. TRIAL REGISTRATION: Protocol registered in ClinicalTrials.gov, ID: NCT03739515 , first posted November 13, 2018.


Assuntos
Avaliação Geriátrica , Desnutrição , Qualidade de Vida , Idoso , Serviço Hospitalar de Emergência , Feminino , Humanos , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Meperidina , Avaliação Nutricional , Estado Nutricional , Penicilinas , Prevalência
11.
BMC Vet Res ; 16(1): 368, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32998730

RESUMO

BACKGROUND: Meperidine is a synthetic opioid that belongs to the phenylpiperidine class and is a weak mu receptor agonist. In horses there are a limited number of published studies describing the analgesic effects of systemically administered meperidine in horses. The objective of this study was to describe the pharmacokinetics, behavioral and physiologic effects and effect on thermal threshold of three doses of intravenously administered meperidine to horses. Eight University owned horses (four mares and four geldings, aged 3-8 years were studied using a randomized balanced 4-way cross-over design. Horses received a single intravenous dose of saline, 0.25, 0.5 and 1.0 mg/kg meperidine. Blood was collected before administration and at various time points until 96 hours post administration. Plasma and urine samples were analyzed for meperidine and normeperidine by liquid chromatography-mass spectrometry and plasma pharmacokinetics determined. Behavioral and physiologic data (continuous heart rate, step counts, packed cell volume, total plasma protein and gastrointestinal sounds) were collected at baseline through 6 hours post administration. The effect of meperidine administration on thermal nociception was determined and thermal excursion calculated. RESULTS: Meperidine was rapidly converted to the metabolite normeperidine. The volume of distribution at steady state and systemic clearance (mean ± SD) ranged from 0.829 ± 0.138-1.58 ± 0.280 L/kg and 18.0 ± 1.4-22.8 ± 3.60 mL/min/kg, respectively for 0.5-1.0 mg/kg doses. Adverse effects included increased dose-dependent central nervous excitation, heart rate and cutaneous reactions. Significant effects on thermal nociception were short lived (up to 45 minutes at 0.5 mg/kg and 15 minutes at 1.0 mg/kg). CONCLUSIONS: Results of the current study do not support routine clinical use of IV meperidine at a dose of 1 mg/kg to horses. Administration of 0.5 mg/kg may provide short-term analgesia, however, the associated inconsistent and/or short-term adverse effects suggest that its use as a sole agent at this dose, at best, must be cautiously considered.


Assuntos
Analgésicos Opioides/farmacologia , Analgésicos Opioides/farmacocinética , Meperidina/farmacologia , Meperidina/farmacocinética , Administração Intravenosa/veterinária , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Animais , Sistema Nervoso Central/efeitos dos fármacos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Cavalos , Temperatura Alta , Masculino , Meperidina/administração & dosagem , Meperidina/efeitos adversos , Meperidina/análogos & derivados , Meperidina/sangue , Meperidina/urina , Nociceptividade/efeitos dos fármacos , Urticária
12.
Anaesthesiol Intensive Ther ; 52(3): 187-196, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32876405

RESUMO

BACKGROUND: Shivering is a common complication of neuraxial anaesthesia. We compared the efficacy of tramadol, clonidine and pregabalin in preventing post-spinal anaes-thesia shivering in hysteroscopic procedures. METHODS: A prospective, randomized, triple-blind, controlled clinical trial involving 120 ASA I-II women, aged 18-60 years. The patients were randomly allocated to receive either oral clonidine 0.2 mg (group C), tramadol 100 mg (group T), pregabalin 150 mg (group P) or placebo (group O) 90 minutes before spinal anaesthesia. The body tempe-rature was monitored at the forehead and tympanic membrane. The primary outcome was the occurrence of perioperative shivering. The secondary outcomes were the side effects and meperidine requirements to treat shivering. RESULTS: All groups had comparable demographic data. Group C showed the lowest incidence, severity and number of intraoperative and postoperative shivering attacks. The time to the first shivering attack was significantly longer in group C than the other groups and in group T than groups P and O. The severity of shivering attacks was comparable among groups C, T and P while being significantly lower than group O. Meperidine requirements were significantly lower in group C. Groups C, T and P had a significantly higher sedation score than group O. The incidences of dizziness, nausea and vomiting were highest in group T. CONCLUSIONS: Tramadol, pregabalin and clonidine seem to be effective oral premedications to reduce the incidence, frequency and severity of post-spinal shivering but clonidine proved to be more effective and tolerable.


Assuntos
Raquianestesia/métodos , Clonidina , Histeroscopia/métodos , Entorpecentes , Pregabalina , Pré-Medicação , Tremor por Sensação de Frio/efeitos dos fármacos , Tramadol , Adolescente , Adulto , Temperatura Corporal/efeitos dos fármacos , Sedação Consciente , Método Duplo-Cego , Feminino , Humanos , Meperidina/administração & dosagem , Meperidina/uso terapêutico , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
13.
Rev. cuba. anestesiol. reanim ; 19(2): e587, mayo.-ago. 2020.
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1126360

RESUMO

Introducción: La meperidina (o petidina) es un opioide sintético que tiene propiedades anestésicas locales bien conocidas, y ha sido utilizada por vía intratecal en cirugía general, urológica y obstétrica de forma segura. Este puede ser usado en anestesia espinal en paciente con hipersensibilidad a los anestésicos locales. Objetivo: Describir el manejo anestésico en una paciente con hipersensibilidad a los anestésicos locales con uso de meperidina intratecal. Presentación del caso: Se presenta una paciente femenina de 54 años de edad con historia previa de hipersensibilidad a los anestésicos locales, programada para colporrafia anterior, a la cual se le realiza una técnica regional, administrando meperidina intratecal. Para la analgesia posoperatoria se suministró diclofenaco de sodio en dosis única de 75 mg, por vía IV previo a la incisión. Conclusiones: Con la técnica descrita se logra un bloqueo sensitivo y motor adecuado, estabilidad de los signos vitales intraoperatoria y recuperación óptima en el posoperatorio inmediato. Es una alternativa más en el manejo de los pacientes con hipersensibilidad a los anestésicos locales(AU)


Introduction: Meperidine (or pethidine) is a synthetic opioid with well-known local anesthetic properties. It has been safely used intrathecally in general, urological and obstetric surgery. This can be used in spinal anesthesia in patients with hypersensitivity to local anesthetics. Objective: To describe anesthetic management of a patient with hypersensitivity to local anesthetics with the use of intrathecal meperidine. Case presentation: The case is presented of a 54-year-old female patient with a previous history of hypersensitivity to local anesthetics, scheduled for anterior colporrhaphy, who is performed regional technique, administering intrathecal meperidine. For post-operative analgesia, diclofenac sodium was administered intravenously in a single dose of 75 mg before the incision. Conclusions: The described technique allowed to achieve adequate sensory and motor block, stability of intraoperative vital signs, and optimal recovery in the immediate postoperative period. It is another alternative in the management of patients with hypersensitivity to local anesthetics(AU)


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Cistocele/cirurgia , Hipersensibilidade , Raquianestesia , Anestésicos Locais/uso terapêutico , Meperidina/uso terapêutico
14.
Gastroenterol Nurs ; 43(3): 258-263, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32433429

RESUMO

Meperidine and fentanyl are opioids currently used in addition to midazolam for sedation and analgesia during colonoscopy in Italy. The aim of the study was to assess the impact of patients' psychological state before elective colonoscopy on the efficacy of the sedation regimens. Eighty outpatients who underwent an elective colonoscopy were included in our study. The Hospital Anxiety and Depression Scale questionnaire was self-administered to evaluate basal anxiety and depression state. The rate of baseline discomfort was evaluated by a standard 100-mm visual analog scale. Sedation was obtained alternatively with a midazolam-meperidine or midazolam-fentanyl combination. There were no statistically significant differences between the fentanyl and meperidine groups on body mass index, age, and gender composition. Patients in the meperidine group reported less pain during colonoscopy than patients in the fentanyl group. There were statistically significant positive correlations in the meperidine group with the distress, anxiety, and depression. Our study has pointed out greater effectiveness of the midazolam plus meperidine regimen, equal recovery times, and no significant differences in the duration of the endoscopic examinations. The evaluation of patients' psychological status seems to predict the efficacy of sedation when the nociceptive component of pain is well controlled.


Assuntos
Colonoscopia/psicologia , Sedação Consciente , Fentanila/uso terapêutico , Meperidina/uso terapêutico , Midazolam/uso terapêutico , Angústia Psicológica , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Quimioterapia Combinada , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Hipnóticos e Sedativos/uso terapêutico , Masculino , Pessoa de Meia-Idade
15.
J Pharm Biomed Anal ; 186: 113320, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32387748

RESUMO

Pethidine is an opiate agonist used orally and parenterally. Pethidine-containing drugs abuse is frequently encountered on health workers and patients. The analysis methods used to determine the abuse of pethidine are important for forensic toxicology. Pethidine is metabolized to norpethidine by the liver. Therefore, the determination of pethidine and norpethidine in urine is one of the methods to determine the abuse of pethidine. In this study, we have developed a precise, simple and rapid ultra-performance liquid chromatography-tandem mass spectrometer method for the determination of pethidine and norpethidine simultaneously. The developed method was validated in terms of selectivity and linearity which was in the range of 9-1800 ng/mL for both pethidine and norpethidine. The intra-assay and inter-assay accuracy and precision were found within acceptable limits of the EMA guideline. Lower limits of quantitation were 9 ng/mL for both pethidine and norpethidine. The developed method was successfully applied for the determination of both analytes in the real samples.


Assuntos
Analgésicos Opioides/urina , Cromatografia Líquida de Alta Pressão/métodos , Meperidina/análogos & derivados , Espectrometria de Massas em Tandem/métodos , Adulto , Analgésicos Opioides/análise , Feminino , Humanos , Limite de Detecção , Masculino , Meperidina/análise , Meperidina/urina , Reprodutibilidade dos Testes , Detecção do Abuso de Substâncias/métodos
16.
Reprod Biomed Online ; 40(5): 653-660, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32299734

RESUMO

RESEARCH QUESTION: Is fentanyl and midazolam non-inferior to pethidine and diazepam in pain relief during oocyte retrieval under conscious sedation? DESIGN: A randomized double-blinded non-inferiority trial of 170 infertile women undergoing oocyte retrieval under conscious sedation in an assisted reproduction centre. The women were randomized to receive intravenously either 0.1 mg fentanyl and 5 mg midazolam or 25 mg pethidine and 5 mg diazepam, plus paracervical block with 10 ml 1% lignocaine. The primary outcome was abdominal pain level during retrieval assessed by linear visual analogue scale from 0-10. Secondary outcomes included vaginal pain levels during and after retrieval and postoperative abdominal pain levels and side-effects, satisfaction level, clinical pregnancy and ongoing pregnancy rates. A pre-defined non-inferiority margin of 1 for the difference in pain levels between two groups was set. RESULTS: Vaginal and abdominal pain levels during retrieval were significantly lower in the fentanyl and midazolam group compared with the pethidine and diazepam group (per-protocol analysis, vaginal pain: 1.6 versus 4.3; mean difference: -2.7, 95% CI -3.7, -1.8; P < 0.001; abdominal pain: 2.9 versus 5.2; mean difference: -2.3, 95% CI -3.3 to -1.3; P < 0.001 for non-inferiority). No differences were observed in these pain levels after retrieval. Most women experienced no postoperative side-effects. The fentanyl and midazolam group had better sedation level, satisfaction level on pain relief and satisfaction on the overall retrieval procedure than the pethidine and diazepam group. No significant differences were found in clinical pregnancy and ongoing pregnancy rates between the two groups. CONCLUSION: The fentanyl and midazolam group had significantly lower vaginal and abdominal pain levels during oocyte retrieval than the pethidine and diazepam group.


Assuntos
Analgésicos/uso terapêutico , Diazepam/uso terapêutico , Fentanila/uso terapêutico , Meperidina/uso terapêutico , Midazolam/uso terapêutico , Recuperação de Oócitos/efeitos adversos , Dor Processual/tratamento farmacológico , Adulto , Sedação Consciente/métodos , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Recuperação de Oócitos/métodos , Manejo da Dor , Medição da Dor , Dor Processual/etiologia , Resultado do Tratamento
17.
Pain Physician ; 23(2): 175-201, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32214301

RESUMO

BACKGROUND: Meperidine, a synthetic opioid, has a rapid onset and short duration of action. Mounting evidence has challenged meperidine's analgesic benefits, and concerns have been raised about its safety profile. Despite recommendations to restrict the prescription of meperidine, the drug remains frequently used. OBJECTIVES: The aim of this study was to evaluate the evidence regarding the efficacy and safety of meperidine for acute postoperative and labor pain. STUDY DESIGN: This was a narrative review of the analgesic efficacy and side effects of meperidine compared to other analgesic drugs for acute postoperative and labor pain in adults. SETTING: Randomized controlled trials that compared the analgesic efficacy and side effect profile of meperidine versus another analgesic drug in adult patients were evaluated. METHODS: A systemized search of randomized controlled trials studying meperidine for acute postoperative or labor pain in the adult patient population from PubMed, Medline, and EMBASE was performed. Included studies reported on different routes of meperidine administration including intramuscular, intravenous, and patient-controlled analgesia in various surgical procedures such as abdominal surgery, Cesarean section, gynecological surgery, orthopedic surgery, cardiothoracic surgery, as well as for labor analgesia. Meperidine's analgesic efficacy and safety profile were compared to other opioids (morphine, tramadol, fentanyl, buprenorphine, nalbuphine, and pentazocine), nonsteroidal anti-inflammatory drugs (ketorolac, diclofenac, and indomethacin), dipyrone, ketamine, and bupivacaine. RESULTS: A total of 62 randomized controlled trials published between 1972 and 2018 were reviewed. Meperidine had a similar or inferior analgesic efficacy compared to other analgesics for acute postoperative or labor pain. Meperidine was associated with more sedation and respiratory depression. LIMITATIONS: The sample sizes of many clinical studies were small, and therefore probably insufficiently powered to detect differences in uncommon side effects, such as central nervous system toxicity. In addition, some of the included clinical studies were old. CONCLUSION: Considering the availability of other effective analgesics with potentially fewer side effects, the use of meperidine for acute postoperative or labor pain should not be recommended. KEY WORDS: Acute postoperative pain, adverse effects, labor analgesia, meperidine, pethidine.


Assuntos
Dor do Parto/tratamento farmacológico , Meperidina/administração & dosagem , Meperidina/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Adulto , Analgesia Controlada pelo Paciente/métodos , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Cesárea/efeitos adversos , Feminino , Humanos , Dor do Parto/diagnóstico , Morfina/uso terapêutico , Dor Pós-Operatória/diagnóstico , Náusea e Vômito Pós-Operatórios/induzido quimicamente , Náusea e Vômito Pós-Operatórios/diagnóstico , Gravidez , Resultado do Tratamento
18.
Xenobiotica ; 50(2): 209-222, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30902024

RESUMO

1. Meperidine is an opioid analgesic that undergoes N-demethylation to form the neurotoxic metabolite normeperidine. Previous studies indicate that meperidine N-demethylation is catalyzed by cytochrome P450 2B6 (CYP2B6), CYP3A4, and CYP2C19.2. The purpose of this study was to examine the relative P450 contributions to meperidine N-demethylation and to evaluate the effect of CYP2C19 polymorphism on normeperidine generation. Experiments were performed using recombinant P450 enzymes, selective chemical inhibitors, enzyme kinetic assays, and correlation analysis with individual CYP2C19-genotyped human liver microsomes.3. The catalytic efficiency (kcat/Km) for meperidine N-demethylation was similar between recombinant CYP2B6 and CYP2C19, but markedly lower by CYP3A4.4. In CYP2C19-genotyped human liver microsomes, normeperidine formation was significantly correlated with CYP2C19 activity (S-mephenytoin 4´-hydroxylation).5. CYP2C19 inhibitor (+)-N-3-benzylnirvanol and CYP3A inhibitor ketoconazole significantly reduced microsomal normeperidine generation by an individual donor with high CYP2C19 activity, whereas donors with lower CYP2C19 activity were sensitive to inhibition by ketoconazole but not benzylnirvanol.6. These findings demonstrate that the relative CYP3A4, CYP2B6, and CYP2C19 involvement in meperidine N-demethylation depends on the enzyme activities in individual human liver microsomal samples. CYP2C19 is likely an important contributor to normeperidine generation in individuals with high CYP2C19 activity, but additional factors influence inter-individual metabolite accumulation.


Assuntos
Inibidores da Colinesterase/metabolismo , Sistema Enzimático do Citocromo P-450/metabolismo , Meperidina/análogos & derivados , Citocromo P-450 CYP2C19/metabolismo , Desmetilação , Humanos , Meperidina/metabolismo , Mefenitoína
19.
Gastrointest Endosc ; 91(3): 595-605.e3, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31756314

RESUMO

BACKGROUND AND AIMS: The administration of intravenous conscious sedation to patients undergoing GI endoscopy carries a risk of cardiopulmonary adverse events. Our study aim was to create a score that stratifies the risk of occurrence of either high-dose conscious sedation requirements or a failed procedure. METHODS: Patients receiving endoscopy via endoscopist-directed conscious sedation were included. The primary outcome was occurrence of sedation failure, which was defined as one of the following: (1) high-dose sedation, (2) the need for benzodiazepine/narcotic reversal agents, (3) nurse-documented poor patient tolerance to the procedure, or (4) aborted procedure. High-dose sedation was defined as >10 mg of midazolam and/or >200 µg of fentanyl or the meperidine equivalent. Patients with sedation failure (n = 488) were matched to controls (n = 976) without a sedation failure by endoscopist and endoscopy date. RESULTS: Significant associations with sedation failure were identified for age, sex, nonclonazepam benzodiazepine use, opioid use, and procedure type (EGD, colonoscopy, or both). Based on these 5 variables, we created the high conscious sedation requirements (HCSR) score, which predicted the risk of sedation failure with an area under the curve of 0.70. Compared with the patients with a risk score of 0, risk of a sedation failure was highest for patients with a score ≥3.5 (odds ratio, 17.31; P = 2 × 10-14). Estimated area under the curve of the HCSR score was 0.68 (95% confidence interval, 0.63-0.72) in a validation series of 250 cases and 250 controls. CONCLUSIONS: The HCSR risk score, based on 5 key patient and procedure characteristics, can function as a useful tool for physicians when discussing sedation options with patients before endoscopy.


Assuntos
Analgésicos Opioides/administração & dosagem , Sedação Consciente , Endoscopia do Sistema Digestório , Hipnóticos e Sedativos/administração & dosagem , Adulto , Idoso , Analgésicos Opioides/efeitos adversos , Sedação Consciente/efeitos adversos , Sedação Consciente/métodos , Relação Dose-Resposta a Droga , Fentanila/administração & dosagem , Fentanila/efeitos adversos , Humanos , Hipnóticos e Sedativos/efeitos adversos , Meperidina/administração & dosagem , Meperidina/efeitos adversos , Midazolam/administração & dosagem , Midazolam/efeitos adversos , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Resultado do Tratamento
20.
J Matern Fetal Neonatal Med ; 33(2): 191-197, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29886798

RESUMO

Objective: The aim of this study was to determine the effects of preoperative anxiety on the postoperative pain and analgesic consumption in patients undergoing cesarean deliveries (CDs).Materials and methods: This observational cohort study included 160 women, with ages ranging from 18 to 40 years old and a 37-week minimum gestation, received general (Group 1, n = 80) or spinal (Group 2, n = 80) anesthesia during an elective CD. The State Anxiety Inventory (SAI), Trait Anxiety Inventory (TAI), and Somatosensory Amplification Scale (SSAS) were used to measure the prenatal anxiety. The postoperative pain intensity was evaluated using the Visual Analogue Scale (VAS), and the pain and analgesic requirements were recorded at the 1st, 6th, 12th, 18th, and 24th postoperative hours.Results: No statistically significant differences were found between the groups in the demographics, clinical characteristics, or laboratory parameters. In addition, there were no differences with regard to the mean SAI, TAI, and SSAS scores and the diclofenac and pethidine consumptions (p > .05). The 1st hour [4.15 ± 1.84 versus 3.28 ± 2.41, odds ratio (OR) = 0.832, 95% confidence interval (CI) = 0.725-0.956, p = .009], 6th hour (3.85 ± 2.02 versus 3.13 ± 1.51, OR = 0.793, 95% CI = 0.668-0.942, p = .008), and 12th hour (3.64 ± 2.11 versus 2.94 ± 2.03, OR = 0.851, 95% CI = 0.737-0.983, p = .028) VAS scores were lower in Group 2 than in Group 1. No correlations were noted between the SAI, TAI, and SSAS scores and the VAS.Conclusions: While the patients with preoperative SAI scores >45 and who underwent cesarean deliveries (CDs) with general anesthesia had higher pain intensity scores in the first 12 hours than those underwent CDs with the spinal anesthesia, no difference was observed between the groups in terms of the postoperative analgesic requirements. Evaluating the patient's anxiety state and psychiatric evaluation may be useful for decreasing the postoperative pain intensity. Further studies are needed to corroborate our findings.


Assuntos
Anestesia Geral/métodos , Raquianestesia/métodos , Ansiedade/psicologia , Cesárea/psicologia , Dor Pós-Operatória/tratamento farmacológico , Adolescente , Adulto , Analgésicos Opioides/administração & dosagem , Anti-Inflamatórios não Esteroides/administração & dosagem , Ansiedade/diagnóstico , Cesárea/efeitos adversos , Diclofenaco/administração & dosagem , Feminino , Humanos , Meperidina/administração & dosagem , Medição da Dor , Dor Pós-Operatória/etiologia , Gravidez , Período Pré-Operatório , Estudos Prospectivos , Adulto Jovem
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