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Dexmedetomidine is an a2-adrenergic agonist that promotes deep sedation and analgesia. Ketamine is a dissociative anesthetic that exerts a negative inotropic effect, resulting in increased heart rate. Methadone, a full opioid agonist, causes mild respiratory depression and bradycardia. This study aimed to demonstrate the cardiovascular effects of the combination of dexmedetomidine, ketamine, and methadone in sedating a healthy dog undergoing echocardiographic and electrocardiographic examinations. The patient was sedated, and one hour after the sedative effects had subsided, the mentioned examinations were performed. Six months later, the examinations were repeated without the use of sedatives. The dog received 2 µg/kg of dexmedetomidine, 1 mg/kg of ketamine, and 0.3 mg/kg of methadone intramuscularly. The electrocardiogram showed sinus bradycardia, first-degree atrioventricular block, second-degree atrioventricular block Mobitz type II, and an increase in QRS duration, suggesting left ventricular overload. When performed without sedation, only sinus arrhythmia was observed. The echocardiogram showed normal parameters for the species in both evaluation periods. It can be concluded that the cardiovascular effects observed are attributable to dexmedetomidine, given that the dose of ketamine used was analgesic, and the sedative effect of dexmedetomidine was enhanced by methadone. [ABSTRACT FROM AUTHOR]

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Copyright of Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The phenomenon of substance use disorders (SUDs) represents a continuous challenge from medical, psychological, social and economic perspectives, although constant efforts have been made in the last decades to elucidate the pathophysiological, clinical and therapeutic aspects of this type of pathology. Intensely studied at the clinical and translational level, SUDs can also be subjected to a phenomenological analysis, more specifically for this review, from the perspective of substance-induced altered states of consciousness (ASC). Such an approach is considered useful because of the need to define the vulnerability and resilience factors for addictive disorders, and how each individual perceives the experience of intoxication with psychoactive substances can contribute to the description of a person’s path from the status of an occasional user to that of a patient diagnosed with a SUD. This literature review is focused on self-experiments with psychoactive substances in the scientific and literary world, presented in parallel with data obtained from studies with healthy volunteers or clinical trials. All relevant reports found during the literature search that were based on exploring the psychological effects of psychoactive substances during intoxication were reviewed. In this first article, the most relevant self experiments from the scientific world (where mescaline and LSD were used), as well as clinical experimental data (that involved the use of alcohol, opioids, cannabis, PCP, cocaine, hallucinogens, and amphetamines) will be presented. [ABSTRACT FROM AUTHOR]

Die Nachweisbarkeit eines Drogenkonsums hängt von der konsumierten Substanz, der Dosis sowie der zur Untersuchung verwendeten Matrix und Nachweismethode ab. Eine besondere Herausforderung für die Labore stellen neue Drogen wie synthetische Cannabinoide dar. Erschwert wird die Analytik und die Interpretation der Messergebnisse auch dadurch, dass es sich bei manchen Vertretern der verschiedenen Wirkstoffgruppen um handelsübliche Medikamente handelt. [ABSTRACT FROM AUTHOR]

It aimed to compare the trans anesthetic clinical and perioperative analgesic effects by prolonged continuous infusion of fentanyl (GF, bolus of 5 µg/kg and continuous infusion (CI) of 15 µg/kg/h) or remifentanil (GR, CI of 18 µg/kg/h) in dogs undergoing to elective ovariohysterectomy. Twenty female healthy dogs were premedicated with acepromazine, inducted to unconsciousness with propofol and kept under anesthesia with isoflurane. The M0 (baseline) was recorded and animals were randomly allocated in GF (n = 10) or GR (n = 10), recording clinical and blood gas parameters every 15 minutes (M15...M120) for two hours and, after, during surgery, adjusting the opioid rate according to surgical requirement. The isoflurane vaporization reduced by up to 47% and 42% in GF and GR, respectively, when compared to M0. During the first two hours of CI, six animals of each group required atropine intervention and three animals of GF required ephedrine. The number of rate adjustments during intraoperative was significant higher in GR when compared to GF (P = 0.0248). By the Log-rank test, there was a higher possibility of not receiving analgesic rescue in the first 30 minutes of postoperative in GF when compared to GR (P < 0.0001) and all animals required analgesic rescue during the firsts 3 and 6 hours in GR and GF, respectively. It is concluded that, when the proposal continuous infusions were compared, fentanyl required fewer analgesic rescues during perioperative, nonetheless, it is recommended rate adjustment during intraoperative and additional analgesia for postoperative for both treatments. [ABSTRACT FROM AUTHOR]

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Abstract:Aims: Opioid misuse is an epidemic in the United States and globally, with adolescents affected by negative consequences including overdoses and deaths. Understanding how mental health and substance use relate to specific types of opioid use is thus important. Methods: Data from the 2019 Connecticut Youth Risk Behavior Survey were analyzed. Chi squares and adjusted odds ratios were computed to relate demographic variables, mental health, and substance use measures to misuse of prescription pain medications with and without heroin use, as compared to neither. Results: Among 1,931 high-school respondents, 8.8 % (n=180) reported prescription pain medication misuse (PPMM+), and 1.4 % (n=28) also reported using heroin (PPMM/HU+). PPMM+ was associated with being female while PPMM/HU+ was associated with being non-White and male. Poorer mental health was associated with PPMM+, and suicidality measures were strongly related to PPMM/HU+. Use of other substances was reported with PPMM+ and PPMM/HU+, with use of vapor products, including on school grounds, particularly linked to the latter. Conclusions: PPMM+ and PPMM/HU+ are associated with suicidality and substance use among adolescents, with suicidality particularly related to PPMM/HU+. Having access to and using substances on school property suggests the need for school-based and other interventions. [ABSTRACT FROM AUTHOR]

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Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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General anesthesia is the most complex form of anesthesia. The American Society of Anesthesiology defines general anesthesia as a drug-induced loss of consciousness during which patients are unresponsive to painful stimulation. Both in induction and in maintenance, hypnotics, opioids, muscle relaxants are used. Hypnosis is achieved by the administration of anesthetic agents, either intravenously or by inhalation, or in combination. The ASA (American Society of Anesthesiologists) classification is a simple way to describe the condition of the patient who will undergo a surgical intervention with anesthesia, the purpose of which is to evaluate the patient’s pre-anesthesia medical comorbidities. Despite the fact that general anesthesia is a safe way to ensure comfort during surgery, there may still be complications that must be recognized such as: anaphylaxis, respiratory and cardiovascular complications, hypothermia, awareness, nausea and vomiting in the postoperative period, ocular injuries and peripheral nerves lesions. [ABSTRACT FROM AUTHOR]

Chronic noncancer pain (CNCP) is a widespread disease pattern in Germany that severely affects the quality of life of those affected and also burdens the national economy. Frequently, comorbidities such as depression and medication abuse occur. Treatment of CNCP requires individualized,multimodal pain management that includes both drug and nondrug interventions. Opioids are the most effective single intervention for CNCP, but their use must be guideline-driven to ensure safety and efficacy. The german S3 guideline on long-term opioid therapy for chronic noncancer pain (LONTS) provides a helpful resource to improve treatment decisions for CNCP. It is important to communicate realistic prognosis and treatment goals and to clearly state the risks of opioid therapy. When opioids are used incorrectly, the risk to patients is high. Prevention and discontinuation strategies are therefore of great importance. [ABSTRACT FROM AUTHOR]

Background: Oxycodone entered the market in Germany in 1998 as an oral opioid analgesic, after it had been withdrawn from the market in 1990. Today it is the most prescribed oralWorld Health Organization (WHO) level 3 opioid, although its analgesic effect is no different from that of other opioid analgesics. In 2017, it was prescribed more often than ibuprofen in Germany. Objectives: What is the explanation for this rise? Methods: Scoping literature review, evaluation of pharmaceutical statistics and guidelines, discussion of recommendations. Results: The rise of oxycodone prescriptions is not due to its pharmacological or medicinal properties. The causes of its frequent prescription are the marketing efforts of a pharmaceutical company. Medical sources of information have been influenced or changed on a large scale. Conclusions: The rise in the popularity of prescribing oxycodone was possible because physicians have paid too little attention to the quality of sources providing pharmacological information. [ABSTRACT FROM AUTHOR]

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O objetivo do presente estudo foi avaliar a capacidade do midazolam e do fentanil em reduzir da dose de indução do propofol e a qualidade de indução de cadelas pré-medicadas com acepromazina (0,03 mg/kg) e morfina (0,3 mg/kg). Trinta minutos após a administração da pré-medicação (T30) foram avaliadas a frequência cardíaca (FC) e respiratória (FR), pressão arterial sistólica (PAS), temperatura retal (TR). Em seguida, os cães foram aleatoriamente designados a receber um dos três tratamentos (n = 8): midazolam-propofol (grupo MP), fentanil-propofol (grupo FP) ou solução salina-propofol (grupo SP). Imediatamente após a administração do agente de co-indução, a anestesia foi induzida com propofol IV (2 mg/kg/minuto). A dose de propofol necessária para a intubação orotraqueal, a qualidade da indução e a ocorrência de efeitos indesejáveis foram registradas. Em T30, foi observado incremento sedativo nos grupos MP, FP e SP em relação ao momento basal (P < 0,05). Em T30, foi observada diminuição na FC, PAS e TR em relação ao basal (P < 0,05). Não houve diferença entre os grupos em relação aos escores de sedação, FC, FR, PAS, TR, dose de indução do propofol e qualidade de indução anestésica (P > 0,05). Foi observada apneia em quatro cães do grupo MP e em dois cães do grupo FP. Um cão do grupo MP apresentou rigidez muscular. Nas doses utilizadas, o midazolam e fentanil não foram capazes de reduzir a dose de indução do propofol em cães pré-medicados com acepromazina-morfina. A qualidade de indução anestésica foi excelente, com possível ocorrência de apneia e rigidez muscular. A associação acepromazina-morfina resulta em sedação de leve a moderada, e diminuição da FC, PAS e TR.

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Copyright of Actualités Pharmaceutiques is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Schmerz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The aim of this study was to determine the impact of Hospice Casa Sperantei Brasov outpatient palliative care service on opioid treatment compliance of cancer patients. Material and methods: The research retrospectively analyzes, from 01.01.2022 to 30.06.2022, the observation charts of patients who accessed the outpatient department of Hospice Casa Speranței Brașov to determine the need to initiate and ensure continuity of opioid treatment. Compliance to opioid treatment of oncology patients monitored in this department was also assessed. Results: The research group consisted of 52 patients, female = 36, male = 16, urban = 36, rural = 16, mostly belonging to the age groups 60 - 69 years = 21 patients. 35 patients had an ECOG performance status = 2, 10 patients had an ECOG = 1. 22 patients had nociceptive pain; 20 patients had neuropathic pain. Patients with moderate pain are 40, 12 patients stated that the pain is severe. 40 patients use minor opioids, 12 patients use major opioids. 26 patients who presented for consultation had opioid analgesic treatment initiated by other healthcare providers, 16 patients returned for continuation of treatment initiated at some point, for 10 patients consulted during this period opioid analgesic treatment was initiated. 33 patients stated that pain was controlled, 18 patients stated that pain was partially controlled. For 1 patient the pain was not controlled. Conclusions: The study found that the specialized outpatient clinic of Hospice Casa Speranței Brașov has a positive impact by initiating and ensuring continuity of opioid treatment. [ABSTRACT FROM AUTHOR]

Introduction: the detection of Carfentanil, a dangerous opioid, is critical due to its appearance in other drugs and its high potency. Its consumption carries a series of negative effects such as respiratory depression, hypotension, bradycardia and decreased intestinal motility. Objectives: the purpose of this systematic review is to examine or evaluate or summarize the main toxicological detection methods related to deaths caused by carfentanil, focusing on the study of the adverse chemical effects it produces in humans. Methodology: this research collected relevant information in the field of forensic toxicology. Which focused on carfentanil detection methods and how it affects people. PRISMA review guidelines were followed and the PICO strategy was used to define the focus of the study. Results: different detection methods have been found such as blood, urine, saliva, liver, pericardial fluid and vitreous humor tests. These methods involve the extraction of biological samples and their subsequent analysis using advanced techniques such as chromatography and mass spectrometry. Even advanced techniques, such as portable mass spectrometry, have been developed to rapidly identify the presence of carfentanil in drug samples. However, the availability of these methods in healthcare settings remains limited. Conclusions: it is crucial to understand the deterioration and damage caused to the body and address the crisis regarding the marketing of this highly dangerous substance. This highlights the urgent need to address this issue and protect society from the risks associated with carfentanil. [ABSTRACT FROM AUTHOR]

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Copyright of CES Medicina is the property of Universidad CES and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Schmerz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introducción: la neurotoxicidad por opioides (NpO) se puede manifestar en forma de mioclonías, siendo una complicación poco frecuente que requiere intervención temprana. Objetivos: reportar un efecto poco frecuente del uso de opioides e identificar los factores de riesgo. Caso clínico: mujer de 78 años procedente del suroccidente colombiano, con diagnóstico de cáncer de mama y de tiroides con metástasis a pulmón. Presenta cervicalgia crónica secundaria al vaciamiento ganglionar, tratada con la combinación de dos opioides (hidrocodona-oxicodona) de manera inadecuada, posterior a lo cual presentó un cuadro de movimientos mioclónicos en miembros superiores. Durante su atención se realizaron diferentes estudios que estuvieron dentro de la normalidad, concluyendo que se trataba de un cuadro de neurotoxicidad por opioides. Se hizo ajuste farmacológico con suspensión de un opioide y dosis apropiada, con buena evolución en el seguimiento clínico. Conclusiones: la investigación de factores de riesgo y el uso adecuado de los medicamentos opioides favorecen la seguridad farmacológica del paciente. La identificación temprana de los síntomas garantiza el éxito de las intervenciones y el control de los síntomas.

Opioids have been used for thousands of years for the treatment of pain. Records on papyri in Ancient Egypt reported the use of opium to relieve pain. In 1973, Candace Pert used radioactive morphine to assess its place of action and, surprisingly, found that the drug attaches to specific areas of the brain, namely on receptors called “morphine receptors”. Because animal model studies have debunked that a receptor would not be needed for the alkaloid in the Papaver somniferum plant, this finding sparked a search for the molecule that would endogenously stimulate that receptor, culminating in the discovery of “endogenous opiopeptides” or “endorphins” by John Hughes and Hans Kosterlitz in 1975. Most clinically relevant opioids operate at the level of the “morphine receptor” or “μ receptors”, and are therefore considered “agonists μ”. This paper looks at opioids in an effort to better understand the side effects and drug interactions. [ABSTRACT FROM AUTHOR]

The therapy of back pain – especially the medication with opioids – can be challenging for the treating physician. Specific back pain can often be diagnosed by imaging and successfully treated by surgery or medication. In contrast, nonspecific back pain can be worsened by inappropriate imaging, questionable surgical indications and uncontrolled drug use. For the therapy of nonspecific back pain, maintaining daily activity and exercise therapy is central. Opioids are effective drugs for short-term use. However, long-term use often leads to opioid-induced hyperalgesia and hormonal dysfunction with decreased quality of life and libido. Furthermore, opioids can lead to abuse and addiction. After an ineffective treatment with non-opioids, opioids may be given for a limited time period (if possible shorter than four weeks) according to international guidelines. [ABSTRACT FROM AUTHOR]

Background: Non-pharmacologic treatment, including chiropractic care, is now recommended instead of opioid prescriptions as the initial management of chronic spine pain by clinical practice guidelines. Chiropractic care, commonly including spinal manipulation, has been temporally associated with reduced opioid prescription in veterans with spine pain. Purpose: To determine if chiropractic management including spinal manipulation was associated with decreased pain or opioid usage in financially disadvantaged individuals utilizing opioid medications and diagnosed with musculoskeletal conditions. Methods: A retrospective analysis of quality assurance data from a publicly funded healthcare facility was conducted. Measures included numeric pain scores of spine and extremity regions across three time points, opioid utilization, demographics, and care modalities. Results: Pain and opioid use significantly decreased concomitant with a course of chiropractic care. Conclusions: A publicly funded course of chiropractic care temporally coincided with statistically and clinically significant decreases in pain and opioid usage in a financially disadvantaged inner-city population. [ABSTRACT FROM AUTHOR]

Der μ‐Opioidrezeptor (μOR) ist das Haupt‐Angriffsziel für opioide Analgetika. Die Aktivierung des μORs initiiert die Signaltransduktion über G‐Protein‐vermittelte Wege und durch β‐Arrestin‐Rekrutierung. μOR‐Agonisten, die bevorzugt die G‐Protein‐vermittelte Signalübertragung aktivieren, weisen deutlich geringere Nebenwirkungen auf. Der Wirkstoff PZM21, welcher durch computergestütztes Docking entdeckt wurde, ist ein solcher funktionell‐selektiver Agonist (biased agonist) des μORs. In dieser Publikation stellen wir die Kryoelektronenmikroskopie‐Struktur (Cryo‐EM‐Struktur) des PZM21 gebundenen μOR im Komplex mit einem Gi Protein vor. Strukturbasiertes Wirkstoffdesign brachte eine Vielzahl an PZM21‐Analoga hervor, die einerseits eine noch deutlichere Gi‐Bevorzugung und andererseits, durch ihre höhere Lipophile, eine verbesserte ZNS‐Gängigkeit aufweisen. Darunter zeigt FH210 eine sehr geringe Wirkstärke bei der Arrestin‐Rekrutierung. Wir haben außerdem die Kryo‐EM‐Struktur von FH210, das an den μOR im Komplex mit dem Gi‐Protein gebunden ist, bestimmt und die erwartete Bindungsposition bestätigt. Die strukturellen und pharmakologischen Studien offenbaren einen potenziellen Mechanismus zur Verringerung der β‐Arrestin‐Rekrutierung durch den μOR und versprechen die Entwicklung von Analgetika der nächsten Generation mit weniger Nebenwirkungen. [ABSTRACT FROM AUTHOR]

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Una parte fundamental en el manejo del paciente quemado es el control del dolor por medio de analgesia correcta, conocer el tipo de dolor y la fase en que se encuentra el paciente es necesario para la elección del medicamento, donde el pilar del tratamiento suelen ser un opioide, actualmente la terapia debe ser multimodal con el objetivo de limitar los requerimientos de los opioides y así evitar dos fenómenos de importante conocimiento como la tolerancia y la hiperalgesia inducida por opioides, una tratamiento multimodal limita la aparición de efectos secundarios en estos pacientes. Aparte de eso, las estrategias no farmacológicas son relevantes para un manejo a largo plazo de estos individuos. Un control adecuado influye positivamente en la cicatrización y en la calidad de vida de estos pacientes. Un mal control del dolor no solo exacerba el evento agudo, sino que aumenta las morbilidades que se desarrollan de forma segundaria como la ansiedad y el trastorno de estrés postraumático.

Background: Areas of activity with many intersections pose an increased risk for errors and critical incidents. Therefore, procedures for acute pain therapy are potentially associated with an increased risk for adverse patient outcomes.Objective: The aim was to identify and grade the risk of critical incidents in the context of acute pain management.Material and Methods: The register of the nationwide reporting system critical incident reporting system of the Professional Association of German Anesthesiologists, the German Society for Anesthesiology and Intensive Care Medicine and the Medical Center for Quality in Medicine (CIRSmedical Anesthesiology) was screened for incidents concerning pain management. Out of 5365 cases reported nationwide up to 24 March 2020, 508 reports with the selection criterion "pain" could be identified and reviewed and 281 reports (55%) were included in a systematic analysis.Results: Of the 281 reports most came from anesthesiology departments (94%; 3% from surgery departments and 3% from other departments). The reported cases occurred most frequently on normal wards but a relevant proportion of the reports concerned intermediate and intensive care units or areas covered by a pain service (PS). Based on the description of the incident in the report, an involvement of the PS could be assumed for 42% of the cases. In terms of time, most of the events could be assigned to normal working hours (90%) and working days (84%; weekends 16%). The analyzed reports related to parenteral administration of analgesics (40%) and central (40%) or peripheral regional anesthesia procedures (23%) and 13% of the reports related to patient-controlled intravenous analgesia (PCIA; multiple answers possible). Most of the events were caused by technical errors, communication deficits and deviations from routine protocols. A relevant number of the cases were based on mix-ups in the administration route, the dosage, or the active agent. About one third of the sources of error were of an organizational nature, 59% of the cases posed a possible vital risk and in 16% of cases patients had vital complications. The risk grading by risk matrix resulted in an extremely high risk in 7%, a high risk in 62%, a moderate risk in 25% and a low risk in 6% of the cases. Comparing risk assessment of events with involvement of different analgesic methods, multiple medication, combination of analgesic methods or involvement of PS showed no significant differences. Likewise, no differences could be identified between the risk assessments of events at different superordinate cause levels. If more than one overriding cause of error had an impact, initially no higher risk profile was found.Conclusion: Incidents in the context of acute pain management can pose high risks for patients. Incidents or near-incidents are mostly related to mistakes and lack of skills of the staff, often due to time pressure and workload as well as to inadequate organization. [ABSTRACT FROM AUTHOR]

Psychoactive substances are an important public health issue, especially with the upward trend in the number of cases in recent years. The COVID-19 pandemic, with its major impact on lifestyle, has brought an additional level of stress to the population and, thus, has led to changes in substance use-related caseloads in terms of number of admissions, but especially in terms of severity of symptoms at the time of presentation to mental health services. These changes accentuate the need to increase the capacity of substance abuse services to prepare the healthcare system for an increasing number of new cases with severe symptoms at presentation, including potential somatic, sometimes life-threatening problems. The lack of specific treatment, with the exception of opioids, means that a multidisciplinary specialist approach is required for the management of drug use cases and raises the need for specialized staff and the establishment of drug addiction wards across the country where there is currently no such coverage. Keywords: psychoactive substances, opioids, COVID-19, hospitalization, average length of stay. [ABSTRACT FROM AUTHOR]

Anesthetic protocols have been developed to obtain the most effective and safe association in wildlife. This study compared the anesthetic effects and cardiorespiratory parameters of ketamine-S (+) (10 mg/kg)/dexmedetomidine (0.020 mg/kg) (KD) and ketamine-S (+) (10 mg/kg)/midazolam (0.5 mg/kg)/methadone (1.0 mg/kg) (KMM) in capuchin monkeys (Sapajus apella). Eight capuchin monkeys were randomly assigned to KD (n = 4) or KMM (n = 4) to evaluate induction, immobilization, and recovery scores, heart and respiratory rate parameters, besides systolic, mean, diastolic arterial pressure and arterial blood gas. There was no difference (P = 0.56) in the quality of induction, immobilization, and anesthetic recovery between the protocols. The time for anesthetic induction was 4 ± 1 min in the KD group and 5 ± 1 min in the KMM group, and these values were statistically equal (P = 0.28). The mean immobilization time in the KD and KMM groups were 35 ± 13 and 33 ± 15 min, respectively. Heart rate was lower in animals in the KD group (P < 0.001), while respiratory rate (P = 0.03), and mean blood pressure (P = 0.046) were higher than that of the animals in the KMM group. Respiratory acidosis occurred in the KMM group, with lower pH (7.25±0.047; P = 0.0055) and higher pCO2 (51 ± 6;mmHg; P = 0.008). Both protocols exhibited good induction quality, immobilization, and anesthetic recovery, despite cardiorespiratory and blood gas alterations observed, which warrants monitoring of cardiorespiratory variables during KD or KMM chemical restraint. [ABSTRACT FROM AUTHOR]

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Although the chronic consumption of alcohol and sedatives, and increasingly opioids, represents a major problem in old age with consequential damage for those affected, little attention has been paid to the substance abuse disorders in old age. The aim of the present recommendations, a collaboration work of the Swiss Society for Geriatric Psychiatry and Psychotherapy (SGAP), Swiss Nurses Association (SBK) and Swiss Society of Addiction Medicine (SSAM), is to summarize the current state of knowledge in prevention, diagnostics and therapy of substance abuse disorders in old age for an interprofessional clinical team. They are intended to help strengthen prevention and early diagnosis, and consciously emphasize psychotherapy and nursing intervention options. [ABSTRACT FROM AUTHOR]

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Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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Pain is a common reason for consultation in family practice and palliative care. The article addresses an update of the WHO guidelines and the benefits and disadvantages of opioids in palliative care. In addition to the "loud symptom" of pain, fatigue, depression and anxiety can be referred to as "silent symptoms" which are easily forgotten in the fast-paced daily practice. In the case of inadequate symptom control, co-care should be provided by specialized palliative care services in the outpatient or, if necessary, inpatient setting. In addition, psychosocial and, if desired, spiritual support should be offered with the involvement of relatives. [ABSTRACT FROM AUTHOR]

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Background: Patient-controlled intravenous analgesia (PCIA) is a well-established technique in acute pain management and available in most German hospitals. Despite its widespread use, information on current clinical practice is limited. This investigation evaluated clinical practice and monitoring as well as PCIA-associated adverse events and critical incidents in German hospitals.Methods: An invitation to participate in this online-survey was sent to 995 heads of anesthesiology departments belonging to the "German Society of Anaesthesiology and Intensive Care Medicine".Results: Of the departments receiving the link, 244 took part (response rate 25%). PCIA was used in 193 of these hospitals (79%). All the following statements relate to the hospitals in which PCIA was used. Piritramide was the most frequently used opioid. In parallel with PCIA, additional nonopioid analgesics were used in 94% of the hospitals, and in 38%, additional slow-release oral opioids were used. Parenteral opioids were administered by the ward staff in 4% of the hospitals. In 75% of hospitals, there were standardized indications for PCIA therapy, with almost two thirds of respondents stating that PCIA was the technique of second choice if regional procedures were contraindicated or failed. In all, 76% of the hospitals had an acute pain service. Twenty-four percent of the hospitals regularly used PCIA in non-surgical patients. In pediatric patients, PCIA was used in 62 hospitals (32%). Only 31% of the hospitals reported the use of standardized protocols for the specific monitoring of patients' vital signs on general wards, exceeding general care. Of the department, 158 (82%) reported adverse events in connection with the use of PCIA within the six-month period preceding the survey (most frequently due to patients' noncompliance [52%], dislocated intravenous lines [41%], communication errors [16%], administration of additional analgesics [16%] and/ or sedatives [14%], problems with the pump [16%], programming errors [9%], incorrect opioid concentration in the reservoir [8%], non-observance of contraindications [7%], incorrect dosing [6%] and self-dosing by the patient [4%] or by third parties [3%], filling the reservoir with thewrong medication [2%]; and other problems [5%]). Only 35 of the hospitals (18%) reported no problems associated with PCIA therapy. Seventy-five of the 193 respondents (39%) stated that at least one critical incident had occurred in the context of the use of PCIA. This resulted in a total of 335 cases out of an estimate of 50.000 patients treated with PCIA. The respondents classified these as follows: I) 273 incidents requiring a prolonged stay in the recovery room, but without further complications, II) 58 requiring transfer to the intensive care unit, but without further complications, III) three resulting in permanent harm to the patient and IV) one resulting in the death of the patient. A comparison of the monitoring standards for PCIA showed that critical incidents were reported less frequently in hospitals with less intensive monitoring, and more frequently in hospitals with higher monitoring standards.Conclusion: PCIA is a frequently used analgesic technique in German hospitals. There were many differences in how PCIA therapy was applied and monitored on general wards. Adverse events occurred to a significant extent, with a considerable part of them, which might be preventable. Critical incidents were perceived more often when standards for monitoring on general wards were higher. Consented current recommendations regarding treatment and monitoring standards as well as the systematic recording of complications when using PCIA are pending. [ABSTRACT FROM AUTHOR]

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