Anaesthesia and Past Use Of
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
Evidence for the Involvement of Spinal Cord 1 Adrenoceptors in Nitrous
Anesthesiology 2002; 97:1458–65 © 2002 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Evidence for the Involvement of Spinal Cord ␣ 1 Adrenoceptors in Nitrous Oxide–induced Antinociceptive Effects in Fischer Rats Ryo Orii, M.D., D.M.Sc.,* Yoko Ohashi, M.D.,* Tianzhi Guo, M.D.,† Laura E. Nelson, B.A.,‡ Toshikazu Hashimoto, M.D.,* Mervyn Maze, M.B., Ch.B.,§ Masahiko Fujinaga, M.D.ʈ Background: In a previous study, the authors found that ni- opioid peptide release in the brain stem, leading to the trous oxide (N O) exposure induces c-Fos (an immunohisto- 2 activation of the descending noradrenergic inhibitory chemical marker of neuronal activation) in spinal cord ␥-ami- nobutyric acid–mediated (GABAergic) neurons in Fischer rats. neurons, which results in modulation of the pain–noci- 1 In this study, the authors sought evidence for the involvement ceptive processing in the spinal cord. Available evi- Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/97/6/1458/337059/0000542-200212000-00018.pdf by guest on 01 October 2021 ␣ of 1 adrenoceptors in the antinociceptive effect of N2O and in dence suggests that at the level of the spinal cord, there activation of GABAergic neurons in the spinal cord. appear to be at least two neuronal systems that are Methods: Adult male Fischer rats were injected intraperitone- involved (fig. 1). In one of the pathways, activation of ally with ␣ adrenoceptor antagonist, ␣ adrenoceptor antago- 1 2 ␣ nist, opioid receptor antagonist, or serotonin receptor antago- the 2 adrenoceptors produces either direct presynaptic nist and, 15 min later, were exposed to either air (control) or inhibition of neurotransmitter release from primary af- 75% N2O. -
5-HT2A and 5-HT2C/2B Receptor Subtypes Modulate
5-HT2A and 5-HT2C/2B Receptor Subtypes Modulate Dopamine Release Induced in Vivo by Amphetamine and Morphine in Both the Rat Nucleus Accumbens and Striatum Grégory Porras, M.S., Vincenzo Di Matteo, Ph.D., Claudia Fracasso, B.S., Guillaume Lucas, Ph.D., Philippe De Deurwaerdère, Ph.D., Silvio Caccia, Ph.D., Ennio Esposito, M.D., Ph.D., and Umberto Spampinato, M.D., Ph.D. In vivo microdialysis and single-cell extracellular neuron firing rate in both the ventral tegmental area and recordings were used to assess the involvement of the substantia nigra pars compacta was unaffected by SR serotonin2A (5-HT2A) and serotonin2C/2B (5-HT2C/2B) 46349B (0.1 mg/kg i.v.) but significantly potentiated by SB receptors in the effects induced by amphetamine and 206553 (0.1 mg/kg i.v.). These results show that 5-HT2A morphine on dopaminergic (DA) activity within the and 5-HT2C receptors regulate specifically the activation of mesoaccumbal and nigrostriatal pathways. The increase in midbrain DA neurons induced by amphetamine and DA release induced by amphetamine (2 mg/kg i.p.) in the morphine, respectively. This differential contribution may nucleus accumbens and striatum was significantly reduced be related to the specific mechanism of action of the drug by the selective 5-HT2A antagonist SR 46349B (0.5 mg/kg considered and to the neuronal circuitry involved in their s.c.), but not affected by the 5-HT2C/2B antagonist SB effect on DA neurons. Furthermore, these results suggest 206553 (5 mg/kg i.p.). In contrast, the enhancement of that 5-HT2C receptors selectively modulate the impulse accumbal and striatal DA output induced by morphine (2.5 flow–dependent release of DA. -
Schizophrenia Care Guide
August 2015 CCHCS/DHCS Care Guide: Schizophrenia SUMMARY DECISION SUPPORT PATIENT EDUCATION/SELF MANAGEMENT GOALS ALERTS Minimize frequency and severity of psychotic episodes Suicidal ideation or gestures Encourage medication adherence Abnormal movements Manage medication side effects Delusions Monitor as clinically appropriate Neuroleptic Malignant Syndrome Danger to self or others DIAGNOSTIC CRITERIA/EVALUATION (PER DSM V) 1. Rule out delirium or other medical illnesses mimicking schizophrenia (see page 5), medications or drugs of abuse causing psychosis (see page 6), other mental illness causes of psychosis, e.g., Bipolar Mania or Depression, Major Depression, PTSD, borderline personality disorder (see page 4). Ideas in patients (even odd ideas) that we disagree with can be learned and are therefore not necessarily signs of schizophrenia. Schizophrenia is a world-wide phenomenon that can occur in cultures with widely differing ideas. 2. Diagnosis is made based on the following: (Criteria A and B must be met) A. Two of the following symptoms/signs must be present over much of at least one month (unless treated), with a significant impact on social or occupational functioning, over at least a 6-month period of time: Delusions, Hallucinations, Disorganized Speech, Negative symptoms (social withdrawal, poverty of thought, etc.), severely disorganized or catatonic behavior. B. At least one of the symptoms/signs should be Delusions, Hallucinations, or Disorganized Speech. TREATMENT OPTIONS MEDICATIONS Informed consent for psychotropic -
Neurological Complications of Nitrous Oxide Abuse
Katherine Shoults, MD Case report: Neurological complications of nitrous oxide abuse A patient who presented with limb paresthesia and B12 deficiency was eventually diagnosed with subacute combined degeneration neuropathy secondary to nitrous oxide abuse. Case data ABSTRACT: A 34-year-old female ary to nitrous oxide (“laughing gas”) A 34-year-old female presented with with a history of alcohol and crystal abuse that had affected B12 activa- a 2-week history of progressive bilat- methamphetamine abuse presented tion. The patient was continued on eral limb paresthesia and tenderness, to the emergency department with B12 therapy, neurology follow-up as well as an inability to balance. She limb paresthesia and difficulty walk- was arranged, and addiction coun- had been well previously, although ing. At a primary care visit a week seling services were recommended. she did have a history of alcohol and earlier her progressive neurological Unfortunately, the patient was lost crystal methamphetamine abuse. She compromise had been viewed in the to follow-up after discharge from the had abstained from crystal metham- context of anemia and she was start- hospital. Physicians should be aware phetamine for 5 years and from alco- ed on daily B12 injections. Further that nitrous oxide is easy to acquire hol for 2 months. She was working as a investigations in hospital revealed in the form of commercially available care aid and denied using illegal drugs diminished proprioception, hyperal- cartridges or whipped cream canis- currently, but reported she had been gesia with pinprick and temperature ters called “whippits” and abuse of inhaling nitrous oxide (“laughing tests, a wide-based high-steppage nitrous oxide is increasingly com- gas”) for 6 months, with an escalation gait, elevated levels of B12 and ho- mon. -
Effectiveness of Olanzapine for the Treatment of Breakthrough
Effectiveness of Olanzapine for the Treatment of Breakthrough Chemotherapy Induced Nausea and Vomiting Suthan Chanthawong BPharm*, Suphat Subongkot PharmD*, Aumkhae Sookprasert MD** * Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand ** Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Objective: To evaluate safety and efficacy of olanzapine for breakthrough emesis in addition to standard antiemetic regimen in cancer patients receiving highly emetogenic chemotherapy. Material and Method: A phase II prospective open label clinical trial was conducted in tertiary care based hospital. Forty-six cancer patients diagnosed with solid tumors were enrolled to receive at least one cycle of highly emetogenic chemotherapy (HEC) every two to four weeks. Each patient was provided standard antiemetic consisting of the generic form of ondansetron plus corticosteroids and metoclopramide according to clinical practice guideline. Olanzapine was administered as 5 mg orally every 12 hours for two doses in patients experiencing breakthrough emesis for at least one episode despite standard prevention. The efficacy and tolerability were evaluated every six hours for 24 hours (utilizing Index of Nausea, Vomiting and Retching: INVR tool). Results: Of 46 evaluable patients receiving HEC and additional olanzapine between September 2009 and July 2010, the complete response of breakthrough emesis, retching, and nausea control among patients were 60.9%, 71.7%, and 50.0%, respectively. Adverse events reported were mild and tolerable including dizziness, fatigue, and dyspepsia. Conclusion: Olanzapine is considered to be safe and effective treatment of breakthrough vomiting in cancer patients undergoing highly emetogenic chemotherapy in the present study. Keywords: Olanzapine, Chemotherapy induced nausea and vomiting, Breakthrough vomiting, Ondansetron, Metoclopramide, Dexamethasone J Med Assoc Thai 2014; 97 (3): 349-55 Full text. -
Review of Psilocybin/Psilocin Pharmacology Isaac Dehart
Review of Psilocybin/Psilocin Pharmacology Isaac DeHart Introduction Psilocybin (PY, 4-phosphoryloxy-N,N-dimethyltryptamine or O-phosphoryl-4-hydroxy- N,N-dimethyltryptamine) (Figure 1, 1) is an indolamine (Figure 1, 2), and the primary ingredient in magic mushrooms. It has been implicated as a treatment for a number of psychological ailments including depression, general anxiety disorder, various addictions, obsessive- compulsive disorder, and post-traumatic stress disorder.1–4 Because of the drug’s re-emerging relevance in clinical applications, and because of its distinctive and informative effects on brain function, it is important to understand the pharmacology and general chemistry underlying its metabolism. Psilocybin is a prodrug of psilocin Magic mushrooms, the natural source of psilocybin may refer to several different hallucination-causing fungi, but the most potent of these are found in the genus Psilocybe. When ingested, magic mushrooms cause “trips,” wherein a user experiences euphoria, colorful hallucinations, and changes in perception, cognition and mood. In the case of “bad trips,” a user may experience states of intense panic or paranoia.5,6 More generally, these trips are sometimes described in terms of psychotic states, and behavioral studies involving psilocybin have demonstrated similarities between the effects of psilocybin and schizophrenia both in subjective experience and in physiological response.7 While psilocybin is more widely known as the cause behind these effects, it is referred to by researchers as a prodrug, -
Pharmacology – Inhalant Anesthetics
Pharmacology- Inhalant Anesthetics Lyon Lee DVM PhD DACVA Introduction • Maintenance of general anesthesia is primarily carried out using inhalation anesthetics, although intravenous anesthetics may be used for short procedures. • Inhalation anesthetics provide quicker changes of anesthetic depth than injectable anesthetics, and reversal of central nervous depression is more readily achieved, explaining for its popularity in prolonged anesthesia (less risk of overdosing, less accumulation and quicker recovery) (see table 1) Table 1. Comparison of inhalant and injectable anesthetics Inhalant Technique Injectable Technique Expensive Equipment Cheap (needles, syringes) Patent Airway and high O2 Not necessarily Better control of anesthetic depth Once given, suffer the consequences Ease of elimination (ventilation) Only through metabolism & Excretion Pollution No • Commonly administered inhalant anesthetics include volatile liquids such as isoflurane, halothane, sevoflurane and desflurane, and inorganic gas, nitrous oxide (N2O). Except N2O, these volatile anesthetics are chemically ‘halogenated hydrocarbons’ and all are closely related. • Physical characteristics of volatile anesthetics govern their clinical effects and practicality associated with their use. Table 2. Physical characteristics of some volatile anesthetic agents. (MAC is for man) Name partition coefficient. boiling point MAC % blood /gas oil/gas (deg=C) Nitrous oxide 0.47 1.4 -89 105 Cyclopropane 0.55 11.5 -34 9.2 Halothane 2.4 220 50.2 0.75 Methoxyflurane 11.0 950 104.7 0.2 Enflurane 1.9 98 56.5 1.68 Isoflurane 1.4 97 48.5 1.15 Sevoflurane 0.6 53 58.5 2.5 Desflurane 0.42 18.7 25 5.72 Diethyl ether 12 65 34.6 1.92 Chloroform 8 400 61.2 0.77 Trichloroethylene 9 714 86.7 0.23 • The volatile anesthetics are administered as vapors after their evaporization in devices known as vaporizers. -
An Old Chemical That Became a New Psychoactive Substance: Study on O-Acetylpsilocin Samples Handled for Analysis and Raise of Awareness
An old chemical that became a new psychoactive substance: study on O-Acetylpsilocin samples handled for analysis and raise of awareness A. Palma1,2, L.Galindo1, Marc Grifell1,2, P. Quintana3, A. Toll1,2, M. Ventura3, I. Fornís3, M. Torrens1,2,4, M.Farré4,5, F. Fonseca1,2 1 Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, Spain. 2 Institut Hospital del Mar d'Investigacions Mèdiques, Parc de Salut Mar, Barcelona, Spain. 3 Asociación Bienestar y Desarrollo, Energy Control, Barcelona, Spain. 4 Universitat Autònoma de Barcelona, Barcelona, Spain. 5 Servei de Farmacología Clínica, Hospital Germans Trías i Pujol, Barcelona, Spain. Introduction Objective l New psychoactive substances (NPS) refer to emerging substances that have The aims of this study are appeared on the market and are not under international control (1). According to the m to explore the presence of 4-AcO-DMT from the samples handled to and data provided by the European Monitoring System for Drug and Drug Addiction, NPS analyzed by harm reduction service Energy Control and have experienced an unprecedented increase in number, type and availability during m to evaluate the ratio between 4-AcO-DMT and other related tryptamines the last years (2). (mushrooms, 4-AcO-DIPT, 4-AcO-MIPT and psilocybin). l Non-controlled tryptamines have psychedelic effects similar to the tryptamines already controlled such as psilocybin from Psylocybes mushrooms (3). l O-Acetylpsilocin also known as Psilacetin and 4-Acetoxy- Material and methods DMT (4-AcO-DMT) [Figure 1] is a synthetic tryptamine patented l Sample: all samples delivered for analysis from January 2009 to December in 1963 having a psychedelic effect by stimulating the 2014 were studied: serotoninergic system (3,4) and proposed as a research m handled as 4-AcO-DMT. -
Management of Major Depressive Disorder Clinical Practice Guidelines May 2014
Federal Bureau of Prisons Management of Major Depressive Disorder Clinical Practice Guidelines May 2014 Table of Contents 1. Purpose ............................................................................................................................................. 1 2. Introduction ...................................................................................................................................... 1 Natural History ................................................................................................................................. 2 Special Considerations ...................................................................................................................... 2 3. Screening ........................................................................................................................................... 3 Screening Questions .......................................................................................................................... 3 Further Screening Methods................................................................................................................ 4 4. Diagnosis ........................................................................................................................................... 4 Depression: Three Levels of Severity ............................................................................................... 4 Clinical Interview and Documentation of Risk Assessment............................................................... -
Problematic Use of Nitrous Oxide by Young Moroccan–Dutch Adults
International Journal of Environmental Research and Public Health Article Problematic Use of Nitrous Oxide by Young Moroccan–Dutch Adults Ton Nabben 1, Jelmer Weijs 2 and Jan van Amsterdam 3,* 1 Urban Governance & Social Innovation, Amsterdam University of Applied Sciences, P.O. Box 2171, 1000 CD Amsterdam, The Netherlands; [email protected] 2 Jellinek, Department High Care Detox, Vlaardingenlaan 5, 1059 GL Amsterdam, The Netherlands; [email protected] 3 Amsterdam University Medical Center, Department of Psychiatry, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands * Correspondence: [email protected] Abstract: The recreational use of nitrous oxide (N2O; laughing gas) has largely expanded in recent years. Although incidental use of nitrous oxide hardly causes any health damage, problematic or heavy use of nitrous oxide can lead to serious adverse effects. Amsterdam care centres noticed that Moroccan–Dutch young adults reported neurological symptoms, including severe paralysis, as a result of problematic nitrous oxide use. In this qualitative exploratory study, thirteen young adult Moroccan–Dutch excessive nitrous oxide users were interviewed. The determinants of problematic nitrous oxide use in this ethnic group are discussed, including their low treatment demand with respect to nitrous oxide abuse related medical–psychological problems. Motives for using nitrous oxide are to relieve boredom, to seek out relaxation with friends and to suppress psychosocial stress and negative thoughts. Other motives are depression, discrimination and conflict with friends Citation: Nabben, T.; Weijs, J.; van or parents. The taboo culture surrounding substance use—mistrust, shame and macho culture— Amsterdam, J. Problematic Use of frustrates timely medical/psychological treatment of Moroccan–Dutch problematic nitrous oxide Nitrous Oxide by Young users. -
The Vomiting Center and the Chemoreceptor Trigger Zone
Pharmacologic Control of Vomiting Todd R. Tams, DVM, Dipl. ACVIM VCA West Los Angeles Animal Hospital Pharmacologic Control of Acute Vomiting Initial nonspecific management of vomiting includes NPO (in minor cases a 6-12 hour period of nothing per os may be all that is required), fluid support, and antiemetics. Initial feeding includes small portions of a low fat, single source protein diet starting 6-12 hours after vomiting has ceased. Drugs used to control vomiting will be discussed here. The most effective antiemetics are those that act at both the vomiting center and the chemoreceptor trigger zone. Vomiting is a protective reflex and when it occurs only occasionally treatment is not generally required. However, patients that continue to vomit should be given antiemetics to help reduce fluid loss, pain and discomfort. For many years I strongly favored chlorpromazine (Thorazine), a phenothiazine drug, as the first choice for pharmacologic control of vomiting in most cases. The HT-3 receptor antagonists ondansetron (Zofran) and dolasetron (Anzemet) have also been highly effective antiemetic drugs for a variety of causes of vomiting. Metoclopramide (Reglan) is a reasonably good central antiemetic drug for dogs but not for cats. Maropitant (Cerenia) is a superior broad spectrum antiemetic drug and is now recognized as an excellent first choice for control of vomiting in dogs. Studies and clinical experience have now also shown maropitant to be an effective and safe antiemetic drug for cats. While it is labeled only for dogs, clinical experience has shown it is safe to use the drug in cats as well. Maropitant is also the first choice for prevention of motion sickness vomiting in both dogs and cats. -
FORANE (Isoflurane, USP)
Forane ® (isoflurane, USP) Proposed Package Insert FORANE (isoflurane, USP) Liquid For Inhalation Rx only DESCRIPTION FORANE (isoflurane, USP), a nonflammable liquid administered by vaporizing, is a general inhalation anesthetic drug. It is 1-chloro-2, 2,2-trifluoroethyl difluoromethyl ether, and its structural formula is: Some physical constants are: Molecular weight 184.5 Boiling point at 760 mm Hg 48.5°C (uncorr.) 20 1.2990-1.3005 Refractive index n D Specific gravity 25°/25°C 1.496 Vapor pressure in mm Hg** 20°C 238 25°C 295 30°C 367 35°C 450 **Equation for vapor pressure calculation: log10Pvap = A + B where A = 8.056 T B = -1664.58 T = °C + 273.16 (Kelvin) Partition coefficients at 37°C: Water/gas 0.61 Blood/gas 1.43 Oil/gas 90.8 1 Forane ® (isoflurane, USP) Proposed Package Insert Partition coefficients at 25°C – rubber and plastic Conductive rubber/gas 62.0 Butyl rubber/gas 75.0 Polyvinyl chloride/gas 110.0 Polyethylene/gas ~2.0 Polyurethane/gas ~1.4 Polyolefin/gas ~1.1 Butyl acetate/gas ~2.5 Purity by gas >99.9% chromatography Lower limit of None flammability in oxygen or nitrous oxide at 9 joules/sec. and 23°C Lower limit of Greater than useful concentration in flammability in oxygen anesthesia. or nitrous oxide at 900 joules/sec. and 23°C Isoflurane is a clear, colorless, stable liquid containing no additives or chemical stabilizers. Isoflurane has a mildly pungent, musty, ethereal odor. Samples stored in indirect sunlight in clear, colorless glass for five years, as well as samples directly exposed for 30 hours to a 2 amp, 115 volt, 60 cycle long wave U.V.