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Effects of Opioids, Steroids, Benzodiazepines, Anticholinergics, and Antihistamines on the Efficacy of Antipsychotics for Treating Delirium in End-of-Life Adult Patients Undergoing Palliative Care. 阿片类药物、类固醇、苯二氮卓类药物、抗胆碱能药物和抗组胺药物对接受姑息治疗的临终成人患者谵妄的抗精神病药物疗效的影响
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2023-12-01 Epub Date: 2023-09-13 DOI: 10.1080/15360288.2023.2253241
Junya Sato, Rei Tanaka

The purpose of the study was to determine the effect of combination therapy involving opioids, steroids, benzodiazepines, anticholinergics, and antihistamines on antipsychotics efficacy for delirium. The study included adult inpatients receiving end-of-life palliative care and diagnosed with hyperactive delirium. Changes in delirium symptoms were assessed using the Intensive Care Delirium Screening Checklist (ICDSC). A retrospective analysis was conducted on 97 patients with ICDSC scores of ≥4, comparing the scores before and after antipsychotic administration. A mean score <4 sustained for 3 days after antipsychotics administration was considered effective. The mean days with ICDSC <4 within a 3-day period were evaluated as well. The efficacy of antipsychotics was compared between cases with and without the use of opioids, steroids, benzodiazepines, anticholinergics, and antihistamines. The results revealed no significant differences in the efficacy of antipsychotics for delirium when used in conjunction with opioids (odds ratio 0.614, 95% CI [0.179-2.105]), benzodiazepines (0.387, [0.108-1.390]), steroids (1.258, [0.276-5.746]), or anticholinergics (2.085, [0. 148-29.458]). Additionally, no significant differences were observed in the mean days with ICDSC <4 within 3-day period. Although opioids, benzodiazepines, steroids, anticholinergics, and antihistamines are recognized as delirium risk factors, their use for symptom relief in patients with delirium may not affect antipsychotic efficacy.

本研究的目的是确定阿片类药物、类固醇、苯二氮卓类药物、抗胆碱能药物和抗组胺药物联合治疗对谵妄的抗精神病药物疗效的影响。该研究包括接受临终姑息治疗并被诊断为过度活跃谵妄的成年住院患者。使用重症监护谵妄筛查检查表(ICDSC)评估谵妄症状的变化。回顾性分析97例ICDSC评分≥4分的患者,比较给予抗精神病药前后的评分。平均分
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引用次数: 0
Suspected Buprenorphine-Precipitated Opioid Withdrawal following Intercourse: A Case Report. 性交后疑似丁丙诺啡沉淀阿片类药物戒断一例报告。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2023-12-01 Epub Date: 2023-08-28 DOI: 10.1080/15360288.2023.2250344
Davene Lynch, Lyndsey Chitty, Brittany Johnson, Amie L Hoefnagel

Buprenorphine, a partial mu-opioid receptor agonist, is a commonly prescribed medication for opioid use disorder (OUD). There is evidence that drugs may enter the male genitourinary tract by an ion-trapping process, based on the lipid solubility and degree of ionization (1). While little is known about the pharmacokinetics of drugs in seminal fluid, pH is thought to play an integral role. Limited evidence exists surrounding cervical absorption of drugs via seminal fluid transmission. This also prompts survey of the frequency of this event and the influence on treatment within this population.

丁丙诺啡是一种部分阿片受体激动剂,是治疗阿片使用障碍(OUD)的常用处方药。有证据表明,基于脂溶性和电离程度,药物可能通过离子捕获过程进入男性泌尿生殖道(1)。虽然对药物在精液中的药代动力学知之甚少,但pH被认为起着不可或缺的作用。关于宫颈通过精液吸收药物的证据有限。这也促使调查这一事件的频率及其对该人群治疗的影响。
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引用次数: 1
Peer Review Questions & Answers: How? Part III: Writing the Reviewer Report. 同行评议问答:怎么做?第三部分:撰写审稿人报告。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2023-12-01 Epub Date: 2023-11-28 DOI: 10.1080/15360288.2023.2271817
Laura Meyer-Junco
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引用次数: 0
Oxycodone Extended-Release Capsule Utilization for Pain Management in a Cancer Palliative Care Clinic: A Retrospective Review. 羟考酮缓释胶囊用于癌症姑息治疗临床疼痛管理:回顾性回顾。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2023-12-01 Epub Date: 2023-09-13 DOI: 10.1080/15360288.2023.2253248
Jordan Fortunato, Justin Kullgren, Gary Houchard, Jessica Hirsch, Nicole Shirilla, Meridith Bumb, Junan Li

Xtampza ER™, an oxycodone extended-release capsule (OERC), was the first long-acting opioid to feature abuse-deterrent properties and various routes of administration without pharmacokinetic alterations. The primary objective of this study was to evaluate changes in reported pain scores after initiation of or rotation to OERC from a previous opioid.  Baseline scores were from patients' outpatient visits immediately before starting OERC and were compared to those at the next two follow-up visits. Secondary objectives identified variables that influenced pain scores. Methods included screening for cancer patients with outpatient OERC prescriptions seen in the palliative care clinic. Eighty-two charts were reviewed with 66 included. Overall mean pain scores at both follow-ups were lower than those at baseline (-0.7 ± 2.1; -1.1 ± 2.4). Results were statistically significant between first and second-reported pain scores versus baseline (p = 0.009; 0.012) but clinically insignificant, defined as a ≥ 2-point change in numeric pain scores. Most patients discontinued OERC at the first or second follow-up (35; 53%), and 12.1% of patients who started OERC were prescribed OERC at the end of the study. There were no significant variables identified to influence pain scores either statistically or clinically. Further studies are needed to determine the long-term efficacy and safety in cancer palliative-care patients.

Xtampza ER™是一种羟考酮缓释胶囊(OERC),是第一个具有滥用威慑特性和多种给药途径而不改变药代动力学的长效阿片类药物。本研究的主要目的是评估从先前的阿片类药物开始或轮换到OERC后报告的疼痛评分的变化。 基线评分来自患者在开始OERC之前的门诊就诊,并与接下来两次随访的结果进行比较。次要目标确定影响疼痛评分的变量。 方法包括筛查姑息治疗诊所门诊OERC处方的癌症患者。回顾了82张图表,其中包括66张。两组随访时的总体平均疼痛评分均低于基线时(-0.7±2.1;-1.1±2.4)。第一次和第二次报告的疼痛评分与基线相比,结果具有统计学意义(p = 0.009;0.012),但临床不显著,定义为数值疼痛评分变化≥2点。大多数患者在第一次或第二次随访时停止OERC治疗(35;53%), 12.1%开始OERC的患者在研究结束时处方OERC。无论在统计学上还是临床上,都没有发现影响疼痛评分的显著变量。需要进一步的研究来确定癌症姑息治疗患者的长期疗效和安全性。
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引用次数: 0
Mpox Pain Management and Topical Agents. m痘疼痛管理和局部药物。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2023-12-01 Epub Date: 2023-11-28 DOI: 10.1080/15360288.2023.2276930
Hinpetch Daungsupawong, Viroj Wiwanitkit
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引用次数: 0
Comparing Post-operative Opioid Consumption before and after a Patient-Controlled Analgesia Shortage: A Re-evaluation of Safety and Effectiveness. 比较患者自控镇痛短缺前后的术后阿片类药物消耗:安全性和有效性的再评估。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2023-12-01 Epub Date: 2023-09-05 DOI: 10.1080/15360288.2023.2250334
Lena Zoma, Renee Alexander Paxton, Michelle Dehoorne, Christopher Giuliano

This retrospective cohort study aimed to compare post-surgical opioid consumption before and after a PCA (patient-controlled analgesia) shortage. The study evaluated patients who received PCA vs. nurse-administered opioid analgesia (non-PCA). Two hundred and twenty-four patients ≥18 years who were initiated on analgesia within 24 h of surgery were included. The primary outcome was opioid consumption in average daily oral morphine milliequivalents (MME). The results showed that patients in the PCA group had increased MME consumption (162 ± 100.4 vs. 70.7 ± 52.8, p < 0.01), increased length of hospital stay (4.2 vs. 3.2 days, p < 0.01), and increased frequency of nausea (33 vs. 17.9%, p < 0.01). After controlling for confounding factors, the PCA group utilized significantly more opioids (84.6 MME/day, p < 0.01) than the non-PCA group. There was no difference in pain AUC/T (0.19 ± 0.07 vs. 0.21 ± 0.08, p = 0.07) and average opioid prescribing upon discharge (150 [77.5-360] vs. 90 [77.5-400], p = 0.64) between the PCA group and non-PCA group, respectively. These results question the routine use of PCA in post-operative patients due to the increased risk of opioid consumption, longer length of hospital stay, and higher incidence of nausea.

这项回顾性队列研究旨在比较PCA(患者自控镇痛)短缺前后的术后阿片类药物消耗。该研究评估了接受PCA与护士给药阿片类镇痛(非PCA)的患者。纳入24例手术后24小时内开始镇痛的≥18岁患者。主要终点是平均每日口服吗啡毫当量(MME)的阿片类药物消耗。结果显示,PCA组患者的MME消耗增加(162±100.4比70.7±52.8,p vs。3.2天,p vs。17.9%, p p vs。分别为(0.21±0.08,p = 0.07)和(150 [77.5-360]vs. 90 [77.5-400], p = 0.64)。由于阿片类药物消耗风险增加、住院时间延长和恶心发生率增加,这些结果对术后患者常规使用PCA提出了质疑。
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引用次数: 0
Potential Drug Interactions in Terminally-Ill Cancer Patients, a Report from the Middle East. 一份来自中东的癌症晚期患者的潜在药物相互作用报告。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2023-12-01 Epub Date: 2023-09-15 DOI: 10.1080/15360288.2023.2253223
Hamed Mahzoni, Erfan Naghsh, Mehran Sharifi, Ayda Moghaddas, Mahnaz Momenzadeh, Azadeh Moghaddas

This study aims to evaluate the epidemiology of potential drug interactions in terminally-ill cancer patients receiving exclusively supportive care. In this cross-sectional study, during a 6-month follow-up, we considered the medical record of terminally-ill cancer patients referred to palliative care at the cancer center in Isfahan, Iran. Potential drug-drug interactions (DDIs) were assessed by Lexi-Interact ver.1.1 online software. During the study period, 133 terminally-ill cancer patients were recruited. We detected 1678 DDIs with moderate or major severity levels. Among them, 330, 219, 32, 1075, and 51 interactions were categorized in B, C, D, and X drug interactions categories, respectively. One hundred and twenty-two patients (91.73%) encountered at least one potential drug-drug interaction during the end of life care. Mechanistically, most drug-drug interactions (64.5%) were pharmacodynamics. The most frequent pharmacological class of drugs responsible for DDIs were quetiapine (91 cases), oxycodone (87 cases), and sertraline (55 cases). Interaction between oxycodone and sertraline was found to be in the top 10 detected DDIs (13.7%). Our results showed that potentially moderate or major drug-drug interactions often occur among terminally-ill cancer patients and the clinical significance of DDIs should be considered meticulously in the palliative care cancer setting.

本研究旨在评估接受独家支持治疗的晚期癌症患者潜在药物相互作用的流行病学。在这项横断面研究中,在为期6个月的随访中,我们考虑了在伊朗伊斯法罕癌症中心接受姑息治疗的晚期癌症患者的医疗记录。采用Lexi-Interact ver.1.1在线软件评估潜在药物-药物相互作用(ddi)。在研究期间,133名晚期癌症患者被招募。我们检测到1678例中度或重度ddi。其中,330例、219例、32例、1075例和51例相互作用分别被归为B类、C类、D类和X类药物相互作用。122名患者(91.73%)在临终关怀期间至少遇到一种潜在的药物-药物相互作用。机制上,大多数药物-药物相互作用(64.5%)为药效学相互作用。导致ddi最常见的药物是喹硫平(91例)、羟考酮(87例)和舍曲林(55例)。羟考酮与舍曲林的相互作用是检测到的ddi前10位(13.7%)。我们的研究结果表明,晚期癌症患者经常发生潜在的中度或严重的药物-药物相互作用,在姑息治疗癌症环境中,ddi的临床意义应该被仔细考虑。
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引用次数: 0
Systematic Review on Barriers to Access Opioid Analgesics for Cancer Pain Management from the Health Worker Perspective. 从卫生工作者的角度对癌症疼痛管理阿片类镇痛药获取障碍的系统评价。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2023-12-01 Epub Date: 2023-11-28 DOI: 10.1080/15360288.2023.2257674
Josephine Fleckner, Katherine Pettus, Nandini Vallath, Tania Pastrana

The increasing incidence of oncological diseases creates a corresponding need for effective cancer pain management (CPM). The lack of access to and availability of opioid analgesics in most countries leads to avoidable suffering. This systematic review aims to identify barriers to accessing opioids, as described in literature that reflects the perspective of health-care workers. A systematic literature search was performed in May 2018 and updated in December 2022, using search terms related to "cancer pain," "opioid analgesics," "access," and "health-care personnel." Medline, Embase, and PsycInfo were searched. Forty-two studies met the inclusion criteria. Principal barriers that have hindered licit access to medical opioids include regulatory, systemic, educational, patient-related, and societal. These barriers are rooted in a lack of adequate education about the importance and significance of appropriate CPM. Barriers were often mutually reinforcing. A interdisciplinary approach is required to overcome them. This research contributes to the important global health issue of unduly limited access to opioid analgesics. It provides interdisciplinary solutions in terms of guidelines to ensure that governments respect, protect, and fulfill the right to the highest attainable standard of health, which includes the relief of severe pain.

肿瘤疾病的发病率不断增加,相应地需要有效的癌症疼痛管理(CPM)。大多数国家缺乏阿片类止痛药的获取和供应,导致了本可避免的痛苦。这项系统综述旨在确定获取阿片类药物的障碍,正如反映医护人员观点的文献所述。2018年5月进行了系统文献检索,并于2022年12月更新,检索词与“癌症疼痛”、“阿片类镇痛药”、“访问”和“医护人员”有关。检索了Medline、Embase和PsycInfo。四十二项研究符合纳入标准。阻碍合法获得医疗阿片类药物的主要障碍包括监管、系统、教育、患者相关和社会。这些障碍的根源在于缺乏关于适当CPM的重要性和重要性的充分教育。障碍往往是相辅相成的。需要采取跨学科的方法来克服这些问题。这项研究有助于解决阿片类止痛药获取途径过度有限这一重要的全球健康问题。它在指导方针方面提供了跨学科的解决方案,以确保政府尊重、保护和履行可达到的最高健康标准的权利,其中包括减轻严重疼痛。
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引用次数: 0
Atypical Withdrawal Symptoms after Abrupt Tramadol Discontinuation: A Case Report. 曲马多突然停药后的非典型戒断症状:一例报告。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2023-12-01 Epub Date: 2023-11-28 DOI: 10.1080/15360288.2023.2261913
Caylee Sams, Serena Cheng

Tramadol is a commonly utilized analgesic in the United States. One common misconception is that tramadol is safer than other opioid medications, or less likely to cause physical dependence. Given these misconceptions, the likelihood of patients experiencing withdrawal after discontinuation may be commonly overlooked as well. A 68-year old female patient with fibromyalgia was referred to a clinical pharmacy pain clinic for medication management. The patient was evaluated one month after abrupt discontinuation of tramadol 50 mg every 6 h for at least 10 years of use. She reports concerning symptoms of significant mucus production, fullness in chest and soreness in neck. Although tramadol is a Schedule IV Controlled Substance the risk of physical dependence and likelihood of patients experiencing withdrawal symptoms after abrupt cessation should not be diminished. Tramadol should not be considered a "safer" opioid therapy without potential of classic or atypical withdrawal symptoms, as well as risk of abuse, misuse or addiction.

曲马多是美国常用的止痛药。一个常见的误解是,曲马多比其他阿片类药物更安全,或者不太可能引起身体依赖。鉴于这些误解,患者在停药后出现戒断症状的可能性通常也会被忽视。一名患有纤维肌痛的68岁女性患者被转诊到临床药房疼痛诊所进行药物管理。患者在曲马多50突然停药一个月后接受评估 mg每6 h至少10 使用年限。她报告了大量粘液分泌、胸部胀满和颈部酸痛的症状。尽管曲马多是附表四管制物质,但不应降低患者突然停止服用后出现身体依赖性和戒断症状的可能性。曲马多不应被视为一种“更安全”的阿片类药物治疗,而不会出现典型或非典型的戒断症状,以及滥用、误用或成瘾的风险。
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引用次数: 0
Accidental Administration of Mega-Dose-Morphine Intrathecally. 鞘内意外使用大剂量吗啡。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2023-09-01 Epub Date: 2023-06-14 DOI: 10.1080/15360288.2023.2219666
Evangelia Samara, Agathi Karakosta, Vasilios Tsionaras, Petros Tzimas
Dear Editor, Intrathecal opioid administration is a common practice in major abdominal surgery, to facilitate postoperative pain management and lower total opioid consumption (1). We report a case of accidental administration of mega-dose-morphine intrathecally. A 64-year-old patient of 84 kg weight and 172 cm height presented to the OR to undergo an elective sigmoidectomy due to malignancy. His medical record was significant for Paget’s disease under no medication. For his postoperative analgesia, an intrathecal administration of ropivacaine 15 mg and morphine 100 mcg in total volume of 3 ml was planned, using an atraumatic needle of 25 G. Immediately after, anesthesia induction was facilitated with propofol 2 mg/kg, fentanyl 250 mcg and rocuronium 0.6 mg/kg. Anesthesia was maintained with sevoflurane. The procedure lasted for two hours and was uneventful. Toward the end, medication syringes were checked prior to discard, to discover that, instead of 100 mcg, 1 mg of morphine had been administered due to wrong dilution. The standard practice is to dilute 1 ampule (10 mg) in 10 ml syringe and then aspirate 1 ml and perform a second dilution in another 10 ml syringe. In this case, the second dilution was omitted. The patient was easily recovered from anesthesia and transferred to PostAnesthesia Care Unit (PACU), where he was started on naloxone drip 0.5 mcg/kg/h, under monitoring and continuous O2 administration via nasal canula. 8 h later, he was transferred to general ward under close monitoring for 24 h. The analgesic result was excellent, with the patient reporting pain on Numerical Rate Scale (NRS) equal to 0 for the first 24 h, with the naloxone drip withdrawn afterwards. Notably, the patient did not experience any of the commonest opioid related adverse events, i.e., respiratory depression, somnolence and nausea (2). Similar intrathecal morphine doses have been described in the literature, followed by naloxone infusion, to override the adverse events of morphine. Rebel et al. have reported 10-fold higher doses of naloxone than the one used in our case, with sustained analgesic results (3). The combination of opioid agonist-antagonist has been used even per os, to alleviate the nausea and constipation in managing both acute and chronic pain (4). To conclude, incorrect dosage administration, attributed to human factor, is common. A thorough checking of the dugs must always precede their administration and local protocols to manage such an unfortunate event should be established.
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引用次数: 0
期刊
Journal of Pain & Palliative Care Pharmacotherapy
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