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Outcomes of total pancreatectomy with islet autotransplantation:A systematic review and meta-analysis 被引量:1
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作者 Shrouq Khazaaleh Sumbal Babar +4 位作者 Mohammad Alomari Zaid Imam Pravallika Chadalavada Adalberto Jose Gonzalez Bara El Kurdi 《World Journal of Transplantation》 2023年第1期10-24,共15页
BACKGROUND Despite the increased use of total pancreatectomy with islet autotransplantation(TPIAT),systematic evidence of its outcomes remains limited.AIM To evaluate the outcomes of TPIAT.METHODS We searched PubMed,E... BACKGROUND Despite the increased use of total pancreatectomy with islet autotransplantation(TPIAT),systematic evidence of its outcomes remains limited.AIM To evaluate the outcomes of TPIAT.METHODS We searched PubMed,EMBASE,and Cochrane databases from inception through March 2019 for studies on TPIAT outcomes.Data were extracted and analyzed using comprehensive meta-analysis software.The random-effects model was used for all variables.Heterogeneity was assessed using the I2 measure and Cochrane Q-statistic.Publication bias was assessed using Egger’s test.RESULTS Twenty-one studies published between 1980 and 2017 examining 1011 patients were included.Eighteen studies were of adults,while three studied pediatric populations.Narcotic independence was achieved in 53.5%[95% Confidence Interval(CI):45-62,P<0.05,I2=81%]of adults compared to 51.9%(95%CI:17-85,P<0.05,I2=84%)of children.Insulinindependence post-procedure was achieved in 31.8%(95%CI:26-38,P<0.05,I2=64%)of adults with considerable heterogeneity compared to 47.7%(95%CI:20-77,P<0.05,I2=82%)in children.Glycated hemoglobin(HbA1C)12 mo post-surgery was reported in four studies with a pooled value of 6.76%(P=0.27).Neither stratification by age of the studied population nor metaregression analysis considering both the study publication date and the islet-cell-equivalent/kg weight explained the marked heterogeneity between studies.CONCLUSION These results indicate acceptable success for TPIAT.Future studies should evaluate the discussed measures before and after surgery for comparison. 展开更多
关键词 Islet autotransplantation PANCREATECTOMY PANCREATITIS NARCOTICS
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Predictors of suboptimal bowel preparation in asymptomatic patients undergoing average-risk screening colonoscopy 被引量:7
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作者 Shail M Govani Eric E Elliott +6 位作者 Stacy B Menees Stephanie L Judd Sameer D Saini Constantinos P Anastassiades Annette L Urganus Suzanna J Boyce Philip S Schoenfeld 《World Journal of Gastrointestinal Endoscopy》 CAS 2016年第17期616-622,共7页
AIM To identify risk factors for a suboptimal preparation among a population undergoing screening or surveillance colonoscopy.METHODS Retrospective review of the University of Michigan and Veteran's Administration... AIM To identify risk factors for a suboptimal preparation among a population undergoing screening or surveillance colonoscopy.METHODS Retrospective review of the University of Michigan and Veteran's Administration(VA) Hospital records from 2009 to identify patients age 50 and older who underwent screening or surveillance procedure and had resection of polyps less than 1 cm in size and no more than 2 polyps. Patients with inflammatory bowel disease or a family history of colorectal cancer were excluded. Suboptimal procedures were defined as procedure preparations categorized as fair, poor or inadequate by the endoscopist. Multivariable logistic regression was used to identify predictors of suboptimal preparation.RESULTS Of 4427 colonoscopies reviewed, 2401 met our inclusion criteria and were analyzed. Of our population, 16% had a suboptimal preparation. African Americans were 70% more likely to have a suboptimal preparation(95%CI: 1.2-2.4). Univariable analysis revealed that narcotic and tricyclic antidepressants(TCA) use, diabetes, prep type, site(VA vs non-VA), and presence of a gastroenterology(GI) fellow were associated with suboptimal prep quality. In a multivariable model controlling for gender, age, ethnicity, procedure site and presence of a GI fellow, diabetes [odds ratio(OR) = 2.3; 95%CI: 1.6-3.2], TCA use(OR = 2.5; 95%CI: 1.3-4.9), narcotic use(OR = 1.7; 95%CI: 1.2-2.5) and Miralax-Gatorade prep vs 4L polyethylene glycol 3350(OR = 0.6; 95%CI: 0.4-0.9) were associated with a suboptimal prep quality. CONCLUSION Diabetes, narcotics use and TCA use were identified as predictors of poor preparation in screening colonoscopies while Miralax-Gatorade preps were associated with better bowel preparation. 展开更多
关键词 preparation quality NARCOTICS DIABETES COLONOSCOPY
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Postoperative delirium after major orthopedic surgery 被引量:8
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作者 Michael K Urban Mayu Sasaki +1 位作者 Abigail M Schmucker Steven K Magid 《World Journal of Orthopedics》 2020年第2期90-106,共17页
BACKGROUND Postoperative delirium(POD)is one of the most common complications in older adult patients undergoing elective surgery.Few studies have compared,within the same institution,the type of surgery,risk factors ... BACKGROUND Postoperative delirium(POD)is one of the most common complications in older adult patients undergoing elective surgery.Few studies have compared,within the same institution,the type of surgery,risk factors and type of anesthesia and analgesia associated with the development of POD.AIM To investigate the following three questions:(1)What is the incidence of POD after non-ambulatory orthopedic surgery at a high-volume orthopedic specialty hospital?(2)Does surgical procedure influence incidence of POD after nonambulatory orthopedic surgery?And(3)For POD after non-ambulatory orthopedic surgery,what are modifiable risk factors?METHODS A retrospective cohort study was conducted of all non-ambulatory orthopedic surgeries at a single orthopedic specialty hospital between 2009 and 2014.Patients under 18 years were excluded from the cohort.Patient characteristics and medical history were obtained from electronic medical records.Patients with POD were identified using International Classification of Diseases,9^th Revision(ICD-9)codes that were not present on admission.For incidence analyses,the cohort was grouped into total hip arthroplasty(THA),bilateral THA,total knee arthroplasty(TKA),bilateral TKA,spine fusion,other spine procedures,femur/pelvic fracture,and other procedures using ICD-9 codes.For descriptive and regression analyses,the cohort was grouped,using ICD-9 codes,into THA,TKA,spinal fusions,and all procedures.RESULTS Of 78492 surgical inpatient surgeries,the incidence from 2009 to 2014 was 1.2%with 959 diagnosed with POD.The incidence of POD was higher in patients undergoing spinal fusions(3.3%)than for patients undergoing THA(0.8%);THA patients had the lowest incidence.Also,urgent and/or emergent procedures,defined by femoral and pelvic fractures,had the highest incidence of POD(7.2%)than all other procedures.General anesthesia was not seen as a significant risk factor for POD for any procedure type;however,IV patient-controlled analgesia was a significant risk factor for patients undergoing THA[Odds ratio(OR)=1.98,95%confidence interval(CI):1.19 to 3.28,P=0.008].Significant risk factors for POD included advanced age(for THA,OR=4.9,95%CI:3.0-7.9,P<0.001;for TKA,OR=2.16,95%CI:1.58-2.94,P<0.001),American Society of Anesthesiologists score of 3 or higher(for THA,OR=2.01,95%CI:1.33-3.05,P<0.001),multiple medical comorbidities,hyponatremia(for THA,OR=2.36,95%CI:1.54 to 3.64,P<0.001),parenteral diazepam(for THA,OR=5.05,95%CI:1.5-16.97,P=0.009;for TKA,OR=4.40,95%CI:1.52-12.75,P=0.007;for spine fusion,OR=2.17,95%CI:1.19-3.97,P=0.01),chronic opioid dependence(for THA,OR=7.11,95%CI:3.26-15.51,P<0.001;for TKA,OR=2.98,95%CI:1.38-6.41,P=0.005)and alcohol dependence(for THA,OR=5.05,95%CI:2.72-9.37,P<0.001;for TKA,OR=6.40,95%CI:4.00-10.26,P<0.001;for spine fusion,OR=6.64,95%CI:3.72-11.85,P<0.001).CONCLUSION POD is lower(1.2%)than previously reported;likely due to the use of multimodal regional anesthesia and early ambulation.Both fixed and modifiable factors are identified. 展开更多
关键词 DELIRIUM ARTHROPLASTY Replacement KNEE Hip Risk factors Pain management Spinal fusion ORTHOPEDICS Incidence ANESTHESIA General Opioid-related disorders NARCOTICS
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Fluctuation of visual analog scale pain scores and opioid consumption before and after total hip arthroplasty 被引量:2
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作者 Vivek Singh Alex Tang +4 位作者 Thomas Bieganowski Utkarsh Anil William Macaulay Ran Schwarzkopf Roy I Davidovitch 《World Journal of Orthopedics》 2022年第8期703-713,共11页
BACKGROUND Patients who undergo orthopedic procedures are often given excess opioid medication.Understanding the relationship between pain and opioid consumption following total hip arthroplasty(THA)is key to creating... BACKGROUND Patients who undergo orthopedic procedures are often given excess opioid medication.Understanding the relationship between pain and opioid consumption following total hip arthroplasty(THA)is key to creating safe and effective opioid prescribing guidelines.AIM To evaluate the association between the quantity of opioid consumption in relation to pain scores both pre-and postoperatively in patients undergoing primary THA.METHODS We retrospectively reviewed patients who underwent primary THA from November 2018-May 2019 and answered both the visual analog scale(VAS)pain and opioid medication questionnaires pre-and postoperatively.Both surveys were delivered daily for 7-days before surgery through the first 30 postoperative days.Survey results were divided into preoperative,postoperative days 1-7,postoperative days 8-14,and postoperative days 15-30 for analysis.Mean opioid pill consumption and VAS pain scores in each time period were determined and compared to patients’preoperative status using hierarchical Poisson and linear regressions,respectively.RESULTS There were 105 patients included.Mean VAS pain scores were the highest preoperatively 7.41±1.72.However,VAS pain scores significantly declined in each successive postoperative category compared to preoperative scores:postoperative day 1-7(5.07±1.79;P<0.001),postoperative day 8-14(3.60±1.64;P<0.001),and postoperative day 15-30(3.15±1.63;P<0.001).Mean opioid pill consumption preoperatively was 0.68±1.29 pills.Compared to preoperative opioid consumption,opioid use was significantly greater between postoperative days 1-7(1.51±1.58;P=0.001)and postoperative days 8-14(1.00±1.27;P=0.043).Opioid consumption declined below preoperative levels between postoperative days 15-30(0.35±0.72;P=0.160)which correlates with a VAS pain score of 3.15.CONCLUSION All patients experienced significant benefit and pain relief from having undergone THA.Average postoperative opioid consumption decreased below preoperative consumption between postoperative days 15-30,which was associated with a VAS pain score of 3.15.These results can be used to appropriately guide opioid prescribing practices and set patient expectations regarding pain management following THA. 展开更多
关键词 OPIOIDS NARCOTICS PAIN Visual analog scale Total hip arthroplasty
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A new understanding of inert gas narcosis 被引量:1
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作者 张萌 高嶷 方海平 《Chinese Physics B》 SCIE EI CAS CSCD 2016年第1期238-243,共6页
Anesthetics are extremely important in modem surgery to greatly reduce the patient,s pain. The understanding of anesthesia at molecular level is the preliminary step for the application of anesthetics in clinic safely... Anesthetics are extremely important in modem surgery to greatly reduce the patient,s pain. The understanding of anesthesia at molecular level is the preliminary step for the application of anesthetics in clinic safely and effectively. Inert gases, with low chemical activity, have been found to cause anesthesia for centuries, but the mechanism is unclear yet. In this review, we first summarize the progress of theories about general anesthesia, especially for inert gas narcosis, and then propose a new hypothesis that the aggregated rather than the dispersed inert gas molecules are the key to trigger the narcosis to explain the steep dose-response relationship of anesthesia. 展开更多
关键词 CLUSTER inert gas ANESTHESIA narcotic potency
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Effect of opioid dependence or abuse on opioid utilization after shoulder arthroplasty
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作者 Derek D Berglund Samuel Rosas +2 位作者 Jennifer Kurowicki Dragomir Mijic Jonathan C Levy 《World Journal of Orthopedics》 2018年第8期105-111,共7页
AIM To examine whether opioid dependence or abuse has an effect on opioid utilization after anatomic or reverse total shoulder arthroplasty(TSA).METHODS All anatomic TSA(ICD-9 81.80) and reverse shoulder arthroplasty(... AIM To examine whether opioid dependence or abuse has an effect on opioid utilization after anatomic or reverse total shoulder arthroplasty(TSA).METHODS All anatomic TSA(ICD-9 81.80) and reverse shoulder arthroplasty(RSA)(ICD-9 81.88) procedures from 2007 to 2015 were queried from within the Humana claims database utilizing the Pearl Diver supercomputer(Colorado Springs, CO). Study groups were formed based on the presence or absence of a previous history of opioid dependence(ICD-9 304.00 and 304.03) or abuse(ICD-9 305.50 and 305.53). Opioid utilization among the groups was tracked monthly up to 1 year post-operatively utilizing National Drug Codes. A secondary analysis was performed to determine risk factors for pre-operative opioid dependence or abuse.RESULTS Two percent of TSA(157 out of 7838) and 3% of RSA(206 out of 6920) patients had a history of opioid dependence or abuse. For both TSA and RSA, opioid utilization was significantly higher in opioid dependent patients at all post-operative intervals(P < 0.01) although the incidence of opioid use among groups was similar within the first post-operative month. After TSA, opioid dependent patients were over twice as likely to fill opioid prescriptions during the post-operative months 1-12. Following RSA, opioid dependent patients were over 3 times as likely to utilize opioids from months 3-12. Age less than 65 years, history of mood disorder, and history of chronic pain were significant risk factors for pre-operative opioid dependence/abuse in patients who underwent TSA or RSA.CONCLUSION Following shoulder arthroplasty, opioid use between opioid-dependent and non-dependent patients is similar within the first post-operative month but is greater among opioid-dependent patients from months 2-12. 展开更多
关键词 OPIOID NARCOTIC ABUSE Dependence ANATOMIC total SHOULDER ARTHROPLASTY Reverse SHOULDER ARTHROPLASTY Chronic pain Mood disorder
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Incidental biliary dilation in the era of the opiate epidemic:High prevalence of biliary dilation in opiate users evaluated in the Emergency Department
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作者 Monique T Barakat Subhas Banerjee 《World Journal of Hepatology》 2020年第12期1289-1298,共10页
BACKGROUND Biliary dilation is frequently related to obstruction;however,non-obstructive factors such as age and previous cholecystectomy have also been reported.In the past two decades there has been a dramatic incre... BACKGROUND Biliary dilation is frequently related to obstruction;however,non-obstructive factors such as age and previous cholecystectomy have also been reported.In the past two decades there has been a dramatic increase in opiate use/dependence and utilization of cross-sectional abdominal imaging,with increased detection of biliary dilation,particularly in patients who use opiates.AIM To evaluate associations between opiate use,age,cholecystectomy status,ethnicity,gender,and body mass index utilizing our institution’s integrated informatics platform.METHODS One thousand six hundred and eighty-five patients(20%sample)presenting to our Emergency Department for all causes over a 5-year period(2011-2016)who had undergone cross-sectional abdominal imaging and had normal total bilirubin were included and analyzed.RESULTS Common bile duct(CBD)diameter was significantly higher in opiate users compared to non-opiate users(8.67 mm vs 7.24 mm,P<0.001)and in patients with a history of cholecystectomy compared to those with an intact gallbladder(8.98 vs 6.72,P<0.001).For patients with an intact gallbladder who did not use opiates(n=432),increasing age did not predict CBD diameter(r^2=0.159,P=0.873).Height weakly predicted CBD diameter(r^2=0.561,P=0.018),but weight,body mass index,ethnicity and gender did not.CONCLUSION Opiate use and a history of cholecystectomy are associated with CBD dilation in the absence of an obstructive process.Age alone is not associated with increased CBD diameter.These findings suggest that factors such as opiate use and history of cholecystectomy may underlie the previously-reported association of advancing age with increased CBD diameter.Further prospective study is warranted. 展开更多
关键词 Biliary dilation OPIATE NARCOTIC Endoscopic ultrasound Endoscopic retrograde cholangiopancreatography Bile duct
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呼吸气中吸入麻醉药浓度监测的临床观察
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作者 潘贤佖 李国红 +3 位作者 任继鑫 王汝敏 杜新民 马亚群 《解放军医药杂志》 CAS 1995年第6期410-413,共4页
为了解N_2—O_2—安氟醚或异氟醚低流量吸入麻醉期间,呼吸气中吸入或呼气末吸入麻醉药浓度的变化规律,本组在临床上将挥发器开启到1%档,气体流量固定在1或2L/min持续在3h以上,结果显示,麻醉初期吸入麻醉药浓度远低于挥发器开启后的浓度... 为了解N_2—O_2—安氟醚或异氟醚低流量吸入麻醉期间,呼吸气中吸入或呼气末吸入麻醉药浓度的变化规律,本组在临床上将挥发器开启到1%档,气体流量固定在1或2L/min持续在3h以上,结果显示,麻醉初期吸入麻醉药浓度远低于挥发器开启后的浓度,但逐渐升高,120~180min呼吸气中麻醉药浓度仅为挥发器开启浓度的70%~80%,以后趋于平稳,在少数病人长达7h手术时,未发现吸入浓度超过挥发器开启的浓度。 展开更多
关键词 吸入麻醉药物 inhale NARCOTIC 浓度监测 CONCENTRATION SURVEILLANCE
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Energy Aspects of Sodium Thiopental Action on Nervous Activity
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作者 Yulia S. Mednikova Mikhail K. Kozlov Alexander N. Makarenko 《Journal of Behavioral and Brain Science》 2019年第2期33-53,共21页
Sodium thiopental, used in a narcotic dose, makes it possible to identify the nervous processes that underlie consciousness and establish the causes of its disorder. When studying the cortical EEG activity, the impuls... Sodium thiopental, used in a narcotic dose, makes it possible to identify the nervous processes that underlie consciousness and establish the causes of its disorder. When studying the cortical EEG activity, the impulses of individual nerve cells and the electromyographic activity of the muscles of the forelimb, it was found that thiopental blocks a number of neuronal reactions requiring energy support: tonic activating reactions to acetylcholine, applied to neurons, cease;the rate of spontaneous neuronal activity drops;the stage of non-specific activation in response to electrocutaneous stimulation disappears. So, thiopental blocks consciousness by significant limitation of the brain energy metabolism. This results in a loss of the adaptive function of the central nervous system. At the same time, glutamatergic excitation, the formation of which does not depend on energy support, is resistant to the action of thiopental. The blocking of the brain’s energy supply caused by thiopental, in accordance with its depth, develops in two stages—hypoxic and narcotic. The hypoxic stage is accompanied by hyperactivity in the nervous system, which is manifested by epileptiform discharges on the EEG and powerful unmotivated movement;the narcotic stage is associated with blockade of motor activity and flattening of EEG oscillations. The post-narcotic state associated with the consequence of the hypoxic effect of thiopental leads to the loss of ionic homeostasis and is accompanied by a steady drop in the amplitude of cortical neuron spikes. 展开更多
关键词 SODIUM THIOPENTAL ACETYLCHOLINE HYPOXIC State NARCOTIC Condition Post-Narcotic PATHOLOGY
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Opioid use and misuse in ulcerative colitis
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作者 Maithili V Chitnavis Merwise Baray +2 位作者 Patrick G Northup Anne G Tuskey Brian W Behm 《World Journal of Gastrointestinal Pharmacology and Therapeutics》 CAS 2019年第1期22-28,共7页
BACKGROUND Patients with ulcerative colitis(UC) may be exposed to opioids over their disease duration. The use of such medications carries significant risk, including intestinal dysmotility and potential for addiction... BACKGROUND Patients with ulcerative colitis(UC) may be exposed to opioids over their disease duration. The use of such medications carries significant risk, including intestinal dysmotility and potential for addiction. However, the rates of narcotic use and misuse in patients with UC have not been studied extensively. Functional gastrointestinal disorders(FGID) are prevalent in patients with UC, and have been shown to increase the risk of narcotic use and misuse in patients with Crohn's disease. We hypothesized that patients with UC and a concurrent diagnosis of FGID would have increased rates of both opioid use and misuse in our patient cohort.AIM To evaluate the prevalence of chronic opioid use and misuse in UC.METHODS A retrospective chart review of UC patients seen at the University of Virginia Digestive Health Center was performed on all patients evaluated between 2006 and 2011. Patient demographics, medical, surgical, and medication histories were obtained from the electronic medical record. Concomitant diagnosis of FGID was also noted at the time. The electronic prescription monitoring program was accessed to obtain prescription opioid filling histories. Prescription opioid misuse was defined as opioid prescriptions filled from four or more prescribers and four or more different pharmacies in a 12-mo period.RESULTS A total of 497 patients with UC were included. Patients with UC and FGID were more likely to be female, but no other demographic variables were associated with FGID. Of the UC patients who had FGID, a greater proportion were found to be using opioids chronically(36% with FGID vs 9% without FGID, P < 0.0001)and were misusing prescription opioids(12.8% vs 1.3%, P < 0.001). Multivariate logistic regression demonstrated a significant association with FGID and chronic opioid use(OR = 4.50; 95%CI: 1.91-10.59) and opioid misuse(OR = 5.19; 95%CI1.04-25.76). Tobacco use(OR 2.53; 95%CI: 1.06-6.08) and anxiety(OR 3.17; 95%CI:1.08-9.26) were other variables associated with an increased risk of chronic narcotic use.CONCLUSION FGID was associated with a 4.5-fold increase in chronic opioid use and a 5-fold increased risk of opioid misuse in this patient cohort with UC. 展开更多
关键词 ULCERATIVE COLITIS Chronic OPIOID use OPIOID MISUSE NARCOTIC Functional gastrointestinal disorder
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Mass Spectrometric Structure Elucidation of the Trivalent and Pentavalent Nitrogen Contaminants of Pholcodine in the Cough Relief Medical Form Tuxidrin
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作者 Ilia Brondz 《International Journal of Analytical Mass Spectrometry and Chromatography》 2013年第1期5-10,共6页
In the paper “Supercritical Fluid Chromatography-Mass Spectrometry (SFC-MS) and MALDI-TOF-MS of Heterocyclic Compounds with Trivalent and Pentavalent Nitrogen in Cough Relief Medical Forms Tuxi and Cosylan” [1], the... In the paper “Supercritical Fluid Chromatography-Mass Spectrometry (SFC-MS) and MALDI-TOF-MS of Heterocyclic Compounds with Trivalent and Pentavalent Nitrogen in Cough Relief Medical Forms Tuxi and Cosylan” [1], the presence of morphine and other degradation products of pholcodine in cough relief medical forms of Tuxi are discussed. Tuxiis recalled from the Norwegian market by Weifa pharmaceutical company, and hence it no longer presents problems to users and health authorities there;however, the medical form Tuxidrin, which contains a significant amount of pholcodine as the active pharmacological ingredient, is still marketed. In the present paper, Tuxidrin is analyzed to determine the presence of degradation products of pholcodine. The degradation of pholcodine to morphine has been discussed previously as a factor in the development of addiction to narcotics in young persons. The structures of the contaminants in Tuxidrin, such as oxides of pholcodine, are elucidated in the present paper. The toxicity and pharmacology of oxides of alkaloids have generally not been well studied, and very little is known about the toxicity and pharmacology of the degradation (oxidation) products of pholcodine: the N-oxide and the N, N'-dioxide of pholcodine. According to Brondz and Brondz[1], the N-oxide and possibly also the N, N'-dioxide are less toxic than the original alkaloids and possess greater pharmacological activity, and hence they may be a source of useful new semisynthetic drugs. The question of possible addiction to pholcodine oxides has not been studied, and the potential of these substances to provoke allergies is unclear. The recall of Tuxi from the Norwegian marketis mainly based on the fact that pholcodine causes significantly increased levels of IgE antibodies in sensitized patients. Tuxidrin contains pholcodine and has the same negative effect as Tuxi, namely provoking allergies or even anaphylactic shock. From this point of view, Tuxidrin has no advantage over Tuxi. These two medical forms only differ in one respect: Tuxidrin requires a prescription (prescription duty medicine), but Tuxi doesnot (prescription free medicine). This aspect is also discussed in the present paper. 展开更多
关键词 High Performance Liquid Chromatography-Mass Spectrometry (HPLC-MS) TRIVALENT NITROGEN Pentavalent NITROGEN Pholcodine Alkaloids ADDICTION to NARCOTICS Allergy Tuxidrin Morphine Pholcodine-N-oxide 10-Hydroxy-pholcodine IgE Antibodies
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Use of Liposomal Bupivacaine (Exparel) for Reduction in the Use of Postoperative Narcotics in an Obese Patient Undergoing Modified Radical Mastectomy
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作者 Charles Keilin Evan P. Salant +3 位作者 Charusheela Andaz Reet Lawhon Piyush Gupta Dennis E. Feierman 《Open Journal of Anesthesiology》 2015年第6期113-115,共3页
Background: Obesity, particularly in the setting of comorbid disease, presents a unique challenge. Clinicians are pursuing areas of multimodal analgesia in an effort to minimize narcotic dosages. Post-operatively, the... Background: Obesity, particularly in the setting of comorbid disease, presents a unique challenge. Clinicians are pursuing areas of multimodal analgesia in an effort to minimize narcotic dosages. Post-operatively, their pain management can be even more challenging, which includes appropriate use of narcotics in a patient that has a high probably of sleep apnea. Aim: To show that the use of liposomal bupivacaine (Exparel) can provide effective post-operative pain relief and decrease the use of post-operative narcotics. Case: We report on a 62 years old female with a history of hypertension, obesity and a greater than a 40 pack year history of smoking who presented for a modified radical mastectomy with a lymph node dissection. At the end of the case, the patient’s wound was infiltrated with both free bupivacaine and Exparel that minimized her need for post-operative narcotics. Conclusion: We believe that the use of extended release local anesthetics should be considered when there is a need to reduce the use of post-operative narcotics. 展开更多
关键词 LIPOSOMAL BUPIVACAINE Exparel NARCOTIC Sparing
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HPTLC-MS as a Neoteric Hyphenated Technique for Separation and Forensic Identification of Drugs
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作者 Kanak Lata Verma Manoj Kumar Amar Pal Singh 《Journal of Analytical Sciences, Methods and Instrumentation》 2018年第1期1-15,共15页
Drugs are traditionally been identified on basis of chromatographic-spectroscopic hyphenated techniques in instrumental analysis. Gas chromatography (GC) and Liquid chromatography (LC) hyphenated with mass spectroscop... Drugs are traditionally been identified on basis of chromatographic-spectroscopic hyphenated techniques in instrumental analysis. Gas chromatography (GC) and Liquid chromatography (LC) hyphenated with mass spectroscopy (MS) i.e. GC-MS and LC-MS give reliable and confirmatory results in drugs identification. In the present work the novel hyphenated technique High Performance Thin Layer Chromatography-Mass Spectroscopy (HPTLC-MS) has been used. This technique provides efficient, quick and simple method for identification and separation of Narcotic drugs and psychotropic substances. The drugs under study are Papaverine, Methadone, Cocaine, Ketamine, Caffeine, Codeine, Diazepam, Thebaine, Heroin, Methamphetamine, Carbamazepine, Morphine, Narcotine and Ephedrine. The present study comprising of sixteen drugs has been carried out on CAMAG HPTLC instrument with automatic sampling. Thin layer chromatography (TLC) plates were developed in various solvent systems, scanned under TLC scanner and the results in terms of Retention Factor (Rf value) and UV spectrum (λmax) are presented in the manuscript. Using hyphenated technique of HPTLC-MS (MS 2020 SHIMADZU) spots of these drugs from TLC plate was lifted with CAMAG TLC-MS interface and confirmed by the mass spectrum of the individual drugs by their m/z values thus delivering fast and accurate confirmatory result on the TLC plate. 展开更多
关键词 NARCOTIC DRUGS PSYCHOTROPIC Substances HPTLC-MS CHROMATOGRAPHY Mass Spectroscopy Hyphenated Techniques Forensic Science
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Comparative Study of Solubility of Tranquilizers(Alternative Date Rape Drugs)in Stomach Acid
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作者 Aditya More Smitesh Nalage Anita Mali 《Journal of Pharmacy and Pharmacology》 CAS 2021年第8期278-286,共9页
Date Rape Drugs are the members of tranquilizers and sedative class of drugs.These are the substances that make it easier for someone to rape or assault sexually.The person who is administrated by these drugs can caus... Date Rape Drugs are the members of tranquilizers and sedative class of drugs.These are the substances that make it easier for someone to rape or assault sexually.The person who is administrated by these drugs can cause sleepiness,slow breathing,slow heartbeat rate,trouble in muscle coordination,loss of consciousness.GHB(gamma-hydroxybutyric acid),Rohypnol(flunitrazepam),Ketamine are generally considered as date rape drugs.As Food and Drug Administration Department of Central Government of India considered this issue and placed these drugs under the schedule of Narcotic Drugs and Psychotropic Substances Act.Thereafter it is nearly impossible to get these drugs easily.But criminals have been searched new way through it.Normal tranquilizers and sedatives are also being used for committing such crimes.These drugs are also scheduled,but one can get them with prescription from a registered medical practitioner.So we carried out a comparative study of 3 tranquilizers from the benzodiazepine class that are Diazepam,Alprazolam,and Librium to check their dissolving rate in stomach acid.Estimation of action time of drug can help an investigator to identify the class of drug and time of drug injected(early phase).In our study,we found that the dissolving period of Diazepam and Alprazolam is more than conventional drugs. 展开更多
关键词 GHB(gamma-hydroxybutyric acid) Rohypnol(Flunitrazepam) KETAMINE Narcotic Drugs Psychotropic Substances Act.
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Narcotics Control in China
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《China Today》 2000年第6期24-25,共2页
关键词 Narcotics Control in China In
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Advances in Toxins and Narcotics Determination Techniques in China During 2013 被引量:1
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作者 Ling Zeng Zhicheng Liu +1 位作者 Xu Han Hongxia Hao 《Journal of Forensic Science and Medicine》 2015年第1期54-60,共7页
Recently,toxin and narcotics detection techniques have been developed in China.A number of new technologies have been applied.The pretreatment technologies such as solid‑phase extraction(SPE)techniques,solid‑phase mic... Recently,toxin and narcotics detection techniques have been developed in China.A number of new technologies have been applied.The pretreatment technologies such as solid‑phase extraction(SPE)techniques,solid‑phase microextraction(SPME)techniques,hollow‑fiber liquid‑phase microextraction(HF‑LPME)techniques,etc.,have matured,and thus have greatly improved both the accuracy and efficiency of the analysis of toxins and narcotics as well as the technical system of analysis.Based on analyses conducted using the traditional methods of gas chromatography(GC)as well as other conventional methods,various new methods of analysis have been gradually discovered and developed.For instance,ultra‑performance liquid chromatography(UPLC)‑mass spectrometry(MS)and other combination technologies have enriched the variety of detection methods that are available to researchers.These highly precise methods are developed on the basis of and as extensions of traditional applications and still draw the attention of researchers from a variety of disciplines. 展开更多
关键词 NARCOTICS toxicological analysis TOXINS
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Opioid prescribing patterns within otolaryngology
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作者 Alexander W.Murphey Suqrat Munawar +2 位作者 Shaun A.Nguyen Ted A.Meyer Ashli K.O'Rourke 《World Journal of Otorhinolaryngology-Head and Neck Surgery》 2019年第2期112-116,共5页
Objective:Determine current opioid prescribing patterns for adult procedures within an academic Otolaryngology-Head and Neck Surgery training program in order to establish a general guideline and more uniform approach... Objective:Determine current opioid prescribing patterns for adult procedures within an academic Otolaryngology-Head and Neck Surgery training program in order to establish a general guideline and more uniform approach to narcotic prescribing practices.Methods:The is a prospective,single-center pilot study.An online,anonymous survey was sent to all members of the Otolaryngology-Head and Neck Surgery training program at Medical University of South Carolina including residents,fellows,and attending surgeons,and advanced practice providers (APP).The survey consisted of questions including demographics,most commonly prescribed analgesic and the average number of opioid tablets prescribed postoperatively for eleven of the most common adult procedures within Otolaryngology.Results:Forty-two participants responded to the survey.Of the 42 respondents,20 were attending surgeons,11 junior level residents (year 1-3),6 senior level residents (year 4-5),and 5 A.P.P.s.The most commonly prescribed narcotic was hydrocodone-acetaminophen with 83.3% (35/42) of respondents prescribing this medication.Tonsillectomy or uvulopalatopharyngoplasty had the highest average number of tablets prescribed at 32.3 (Range:5 to 90).Neck dissection,parotidectomy,and thyroidectomy procedures all averaged over 20 tablets.Direct laryngoscopy opioid dose was the lowest at 4.8 tablets (range 0-20).Opioid prescriptions by surgery were broken down by provider class with only septoplasty showing a significant difference with attending physicians prescribing an average of 20 tablets vs 14.1 tablets for residents (P =0.034).Conclusion:We believe there remains an unacceptably high variability in current opioid prescribing patterns within otolaryngology especially within more painful procedures.Establishment of standardized post-operative narcotic guidelines is warranted. 展开更多
关键词 OPIOIDS NARCOTICS OTOLARYNGOLOGY
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Tightened Control Over Fentanyl
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作者 Lan Xinzhen 《Beijing Review》 2019年第17期48-48,共1页
China will add fentanyl-related substances to a supplementary list of controlled narcotics and psychotropic substances used for nonmedical purposes starting on May 1.
关键词 FENTANYL substances NARCOTICS
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伊犁口岸7例HIV感染者调查报告
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作者 吴祥瑞 刘志杰 刘平 《旅行医学科学》 1999年第2期24-24,27,共2页
新疆伊犁口岸自1997年3月—1998年7月在对4769名出入境人员进行健康检查中检出7例HIV感染者,现将流行病学调查结果报告如下: 1
关键词 HIV CARRIER NARCOTIC taking PERSON entering or LEAVING the COUNTRY
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霍尔果斯口岸首例HIV感染者的流行病学调查
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作者 刘志杰 《旅行医学科学》 1999年第2期23-23,共1页
1997年3月28日在对出国人员健康监测体检中首次检出1例HIV感染者,对其进行了流行病学调查,现将结果报告如下:
关键词 HIV CARRIER EPIDEMIOLOGICAL SURVEY NARCOTIC taking
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