Meperidine Research Articles

The Role of Adrenaline, Noradrenaline, and Cortisol in the Pathogenesis of the Analgesic Potency, Duration, and Neurotoxic Effect of Meperidine.

Background and Objectives: The purpose of the study was to investigate the role of adrenaline (ADR), noradrenaline (NDR), and cortisol in the pathogenesis of the analgesic potency, duration, and epilepsy-like toxic effect of meperidine. Materials and Methods: The experimental animals were separated into 11 groups of six rats. In the meperidine (MPD) and metyrosine + meperidine (MMPD) groups, paw pain thresholds were measured before and after the treatment between the first and sixth hours (one hour apart). In addition, ADR and NDR analyses were performed before and after the treatment, between the first and fourth hours (one hour apart). For the epilepsy experiment, caffeine, caffeine + meperidine, and caffeine + meperidine + metyrapone groups were created, and the treatment was applied for 1 day or 7 days. Groups were created in which caffeine was used at both 150 mg/kg and 300 mg/kg. Epileptic seizures were observed in epilepsy groups, latent periods were determined, and serum cortisol levels were measured. Results: In the MPD group, pain thresholds increased only at the first and second hours compared to pre-treatment, while ADR increased at the third hour, leading to a decrease in pain thresholds. In the MMPD group, the increase in paw pain thresholds at 1 and 6 h was accompanied by a decrease in ADR and NDR. In the caffeine (150 mg/kg) + meperidine group, 1-day treatment did not cause epileptic seizures, while seizures were observed and cortisol levels increased in the group in which treatment continued for 7 days. When cortisol levels were compared between the group in which caffeine (300 mg/kg) + meperidine + metyrapone was used for 7 days and the animals receiving caffeine (300 mg/kg) + metyrapone for 7 days, it was found that cortisol levels decreased and the latent period decreased. Conclusions: The current study showed that if serum ADR and cortisol levels are kept at normal levels, a longer-lasting and stronger analgesic effect can be achieved with meperidine, and epileptic seizures can be prevented.

An analytical approach to determining pethidine: An investigation of 18 patients’ urine

Pethidine (PET) is an opioid pain-relief medicine with high addiction potential, especially among health professionals. Pethidine is commonly prescribed in Turkey as a pain-relieving medication for operative purposes. Due to its accessibility, low cost, user-friendliness, and effectiveness, PET is often misused by both healthcare professionals and patients. For this reason, analytical determination methods for PET abuse are essential in terms of forensic toxicology. In this study, a fast, reliable, and accurate gas chromatography-mass spectrometry method was developed for the first time in Turkey for the simultaneous detection of PET and its main urinary metabolite norpethidine (NPET). The method was validated in terms of selectivity, linearity, the limit of detection (LOD), the limit of quantification (LOQ), trueness, and precision according to the Scientific Working Group for Forensic Toxicology guidelines. The linear range was between 0.125‐25.00 μg/mL for PET and 1.00–20.00 μg/mL for NPET. The LOD values for PET and NPET were 0.05 µg/mL and 0.49 µg/mL, while the LOQ values were 0.125 µg/mL and 1.00 µg/mL, respectively. Extraction efficiencies were calculated as 113% for PET and 104% for NPET. The intra-assay and inter-assay precision results were within acceptable limits. In the presented study, the validated method was applied to the urine of 18 patients collected at the 1st and 3rd hours after receiving PET. All samples in the study were collected under patients’ consent and in line with ethical guidelines.

NiO Nanoparticle-decorated graphene oxide nanosheets modified glassy carbon electrode for sensitive electrochemical detection of pethidine

Pethidine (PTD), a synthetic opioid prescribed frequently as a painkiller, was included in the WADA list of prohibited substances in sports. The purpose of this study is to investigate the electrochemical determination of PTD using a modified glassy carbon electrode decorated with NiO nanoparticles and decorated graphene oxide nanosheets (NiO-GO/GCE). NiO-GO nanocomposite was created using a straightforward chemical reduction technique. SEM, TEM, and XRD analysis of the structure and morphology pointed to the NiO-GO nanocomposite's effective production. Results showed that NiO-GO/GCE responded to PTD determination in a sensitive, focused, and stable manner with a relatively low detection limit value (3.8 ng/mL) and a wide linear range (0–500 μg/mL) compared to other PTD sensors. Results on the appropriateness and validation of the NiO-GO/GCE for determining PTD content in clinical and human fluid samples illustrated good recoveries between 90.00 % and 99.66 % with a relative standard deviation less than 5.41 %, which were acceptable and corroborated the appropriateness and validation of the NiO-GO/GCE results for PTD sensor in urine samples from healthy athlete volunteers.

An Objective Measure of Recovery.

Effective ambulatory anesthesia is based on a predictable pattern of recovery. This, of course, varies with the agent used, the inherent differences in how patients metabolize or detoxify a drug, as well as the duration and dosage of the drug administered. The development of a straightforward objective test to measure recovery accurately was undertaken in an effort to provide reliable and reproducible data.Other methods of measuring psychomotor performance have been used. These include testing special sensory functions such as vision and hearing,1 various verbal, drawing and bead threading parameters,2 as well as the use of a complex reaction timer developed by the American Automobile Association.3 Other studies of recovery from methohexital anesthesia have involved measuring waking time, the ability to speak rationally and coherently,4 as well as the use of a driving simulator.5 Porteus mazes and ‘“draw a person test” have also been proposed. All available methods are very involved, and require special equipment or personnel.The Bender Motor Gestalt Test, a series of drawings developed by Lauretta Bender in 1938, was copyrighted in 1946.6 This test is used on children and adults as a maturational test involving visual-motor gestalt function. The main aim of the test is to determine the individual’s capacity to experience visual-motor stimuli (gestalten). It has been used to explore mental retardation, regression, loss of function, organic brain damage and personality deviations. Clinical psychologists made extensive use of the Bender tests in cases of neuroses in World War II Army medical installations. Both fatigue and central nervous system depression tend to magnify the sensory-motor disturbances seen in the performance of the Bender Motor Gestalt Test.One of the figures of the Bender Test was selected and modified. Dots were substituted for the continuous lines and spaced approximately 12–13 mm. (See Fig. 1.) In this way, fine motor coordination and perception of the entire outline form could be measured.Patients admitted to the Oral Surgical Clinic were requested to carry out the drawing test, to provide their own pre-operative, pre-anesthetic baseline. Patients were asked to simply “connect the dots in Figure 1.” All patients in this study received either intravenous sedation consisting of pentobarbital sodium or hydroxyzine and meperidine hydrochloride, with scopolamine hydrobromide or atropine sulfate and/or general anesthesia (methohexital) in addition to a local anesthetic. (No oral or intramuscular pre-medications were administered). Ten patients who received only local anesthesia served as one control.This same drawing test was then repeated at appropriate intervals before and after the anesthesia experience to evaluate recovery. Patients were observed and timed in their performance of this test. Their position, cooperativeness and general attitude were noted and scaled.Immediately following the operation, as soon as the patient became conscious and responsive, a second test was administered. Ten minutes later a third test was given. The decision to discharge the patient was made by the doctor and was based on his clinical assessment of recovery. At that time, the final drawing was administered.Scoring: Data processing was done on the IBM 7094 computer. Pearson Correlation Coefficients with 50 variables in Matrix form; variances and standard deviations as well as multidimensional analysis of variance and quadratic and linear trends were computed and analyzed, and are reported elsewhere.8Recovery was taken as the period from awakening to discharge for those patients who received general anesthesia; or from the end of the surgical procedure to discharge for those patients receiving only intravenous sedation.It was determined that performance of this test is directly and significantly related to recovery time. Connecting the series of dots, proved to be a reliable and reproducible index of psychomotor performance. (Subsequent studies of drug effects, utilizing this modified Bender test have repeatedly demonstrated its validity and reliability.)Visual-motor incoordination appears most frequently in the production of sweeping, uninhibited lines, the substitution of dashes for lines, exaggeration or minimization of curves, and fragmentation.7 These aberrations, together with the psychological trauma resulting from the surgery and drug infusion, become evident in the patient’s performance. The following illustrations demonstrate the obvious deviations in performance and eventual return to baseline with recovery.This study provides statistical and clinical evidence in support of the validity of a simple, direct, self-administered, objective test to measure recovery time from ambulatory anesthesia. This test measures sensory-motor performance, which is a critical determinant of recovery. With the aid of this test, the patient’s return towards his own pre-anesthetic baseline becomes more evident and objective. It may also serve as a helpful medical-legal record of recovery from anesthetic influence.Postscript: Detailed data generated from this experiment were published in Anesth. & Analg., 1969.8 This simple drawing test has been effectively used since its development, in subsequent studies which involve comparison of various anesthetic and pre-anesthetic agents. It may provide a helpful tool for both the researcher and the clinician in anesthesiology.

Voltammetric determination of pethidine in biofluids at a carbon cloth electrode modified by carbon selenide nanofilm

Developing a sensitive portable sensor for the screening of illicit drugs is always challenging. Due to the importance of pethidine (PTD) tracking in addiction diagnosis, many demands have recently increased for a selective and real-time sensor. Herein, a simple electrochemical sensor has been developed based on conductive carbon cloth (CC) modified with carbon selenide nanofilms (CSe2NF) to provide a CSe2NF/CC electrode as a novel PTD sensing tool. Profiting from the ingenious design of doping strategy during the synthesis process, Se was doped in the carbonaceous skeleton of the CC. Thus, the active surface area of the CSe2NF (4.61 cm2) increased respect to the unmodified CC (0.094 cm2) to embed a suitable sensing interface in the fast PTD assay. By optimizing some effective experimental parameters such as pH, supporting electrolyte, Se powder amount, scan rate and accumulation time, the sensor catalyzed efficiently the oxidation reaction of PTD at 0.97 V. Based on peak current variations, the PTD was measured over a broad concentration range from 29 nM up to 181.8 μM with a limit of detection (LOD) as low as 19.3 nM compared to the other reported PTD sensors. The developed flexible sensor recognized the spiked PTD concentrations in some biofluids, including human blood, urine and saliva. The results of PTD analysis in the non-spiked and spiked blood, urine and saliva samples as the real samples by the developed sensor were validated by HPLC analysis as the reference method using t-test statistical method at confidence level of 5%. This sensing strategy based on the binder‐free electrode could be promising for designing some sizable wearable sensors at a low cost. The high sensitivity of the sensor, which is a bonus for the rapid and on-site measurement of PTD, may open up a route for noninvasive routine analysis in clinical samples.

Der prix de morale der Akademie von Dijon für das Jahr 1750

Abstract The article reconsiders Rousseau’s famous Discours sur les sciences et les arts within the medial and institutional context of the prize question (prix de morale) proposed by the Academy of Dijon for the year 1750. To do so, it pays special attention to the contributions submitted by Rousseau’s (thirteen) competitors, which so far have hardly been analysed by historians of literature and philosophy. The paper also expands on the institutional and social structure of the Academy of Dijon as well as the particular profile of its morality prizes organized since 1743. In addition, the article situates the contest of 1750 in the broader context of the concours académique and outlines the evolution of the genre with its specific rhetorical traditions since the end of the seventeenth century. Thus, the crucial question, how the Academy of Dijon came to select Rousseau’s text, can be approached from a different angle. Finally, this perspective also sheds new light upon certain aspects of a major work in the history of philosophy - the Discours sur les sciences et les arts.

Comparison of the Analgesic Effectof Intramuscular Pethidine andIntramuscular Morphine on anOrthopedic Population in a CaribbeanTerritory

Introduction: Comparison of the analgesic effect of Intramuscular Pethidine and Intramuscular Morphine on an Orthopedic Population. Settings and Design: 1) Single Blinded Randomized Controlled study: Patients were divided into Morphine group or Pethidine group 2) Patient Satisfaction survey was administered to patients at the end of stay. Material and Methods: 1) Visual Analogue Scores (VAS) were taken at eight hourly intervals for three consecutive days or until the day of discharge. Incidence of opioid related complications was noted 2) A patient satisfaction survey was administered at the end of stay. Statistical Analysis: Average VAS during movement on day one during the 8am to 4pm period was calculated for both the morphine group and pethidine group. The percentage decrease in VAS was calculated for morphine vs. pethidine group on movement on Day 1. Pearson’s correlation was used to assess the relationship between opioid, side effects and overall patient satisfaction. T-test was used to evaluate the relationship between morphine, pethidine and twenty-four-hour pain relief.A one-way ANOVA test was used to evaluate the statistical significance between the morphine and the pethidine group and patient satisfaction. Results: The morphine group as compared with the pethidine group experienced an 18.5% decrease in Visual Analogue Score for pain on movement on day 1 (8 am-4 pm period). The morphine group was associated more drowsiness and prolonged time to first bowel action compared to the pethidine group. Only 1.4% (1) of patients experienced desaturation during the study which occurred in the morphine group. Overall, opioids were associated with minimal side effects and were generally safe to use. Patients who underwent regional anaesthesia used more morphine equivalents compared to those undergoing general anaesthesia. The morphine group was associated with overall increased patient satisfaction when compared to the Pethidine group. Conclusion: The study demonstrated a notable 18.5% decrease in VAS on movement with the morphine group as compared to pethidine group. Statistical significance was placed at 15%. Opioids were found to have a limited adverse side effect profile, with drowsiness and time to first bowel action being the most predominant. Only one patient representing 1.4% of the population had an episode of desaturation (Sp02 < 90%). Due to the minimal side effect profile opioids should be considered safe to use.

Intradermal sterile water injection versus intramuscular pethidine injection for pain relief in first stage of labor

Objectives To compare the effectiveness and safety of intradermal sterile water injection versus pethidine to decrease labor pain. Background In this study, we tried to clarify the possible role of sterile water injection as alternative to pethidine for relieving labor pain. Patients and methods A randomized controlled clinical trial was carried out on 78 parturient women in active phase of first stage of labor. Patients were randomly assigned to either one of two groups: group A (intradermal sterile water injection group) received four intradermal injections of 0.5-ml sterile water in the lumbosacral region, and group B (pethidine group) received 1 mg/kg intramuscular pethidine. The primary outcome of this study included the effect of two techniques in reliving labor pain according to visual analog scale. The secondary outcome included labor duration and delivery mode. Results Intradermal sterile water injection had significantly higher pain scores immediately before injection (P = 0.04), significantly lower pain scores at 60 min after injection (P = 0.009), and nonsignificantly lower pain scores at 30 min (P = 0.07) and 90 min (P = 0.12) after injection. Sterile water injection had significantly lower maternal vomiting (P Conclusion Sterile water injection is considered to be effective, safe, inexpensive, and acceptable method for decreasing labor pain.

Comprehensive Prospective Analysis of the Factors Contributing to Aspiration Pneumonia Following Endoscopic Submucosal Dissection in Patients with Early Gastric Neoplasms.

Endoscopic submucosal dissection (ESD) has become the first-line treatment for early gastric neoplasms; however, a subset of patients treated by this method develop aspiration pneumonia. We conducted a comprehensive prospective analysis of the factors contributing to post-ESD aspiration pneumonia in early gastric neoplasms in this study, with special focus on whether pre-treatment oral care can prevent aspiration pneumonia. Sixty-one patients who underwent ESD for gastric neoplasms were randomly assigned to the oral care or control groups. ESD was performed under deep sedation. Of 60 patients whose data were available for analysis, 5 (8.3%) experienced pneumonia confirmed either by chest radiography or computed tomography. Although no difference in the rate of pneumonia was found between the control and oral care groups, the post-oral care bacteria count was significantly higher in the saliva of patients who developed pneumonia compared to those without pneumonia. In addition, the presence of vascular brain diseases and the dose of meperidine were also significantly associated with the occurrence of pneumonia. These results suggest that the number of oral bacteria as well as pre-existing vascular brain diseases and high-dose narcotics can affect the incidence of post-ESD pneumonia.

The stability study of meperidine hydrochloride injection from different ampules

Meperidine hydrochloride is used extensively as an analgesic agent. Although it is generally stable, it is not uncommon that the hydrolysis to meperidinic acid rendered this ester drug to a decrease in pH value. Therefore the stability of Meperidine HCl injection is of pharmaceutical concen. The objet of the present research is to assess the decomposition of Meperidine HCl in sealed injection packaged in colorless or in amber ampules. Accelerated tests as well as storage tests were executed at 40°C, 60°C and 80°C for both ampule types. No differences in transparency, pH change or quanty of meperidine were observed either in accelerated tests at 40°C or storage test for six months. Nevertheless, a decrease in pH value without significant changes of transparency and meperidine content was observed in accelerated tests at 60°C after storage for 15 weeks. The pH value and meperidine content decrease significantly in both types of ampules when subjected to accelerated tests at 80°C for 15 weeks. Since the decreases of meperidine content were found to be similar for both types of ampules, the stability of meperidine is not correlated with ampule type.

Pethidine abuse and overdose

Pethidine abuse and overdose

Pharmacological Approach for the Prevention of Postoperative Shivering: A Systematic Review of Prospective Randomized Controlled Trials

Shivering is a common postoperative complication that occurs after both general and regional anesthesia even in the cases when hypothermia during surgery has been averted. Patients describe it as a highly unpleasant experience, while clinicians are concerned due to its adverse effects such as increased oxygen consumption. In this article, we present a summary of the pathophysiological mechanisms involved in postoperative shivering (POS), risk factors, and inadvertent effects. The major objective of this article was to review the existing literature on the effi ciency of various drug interventions as a prophylactic measure against POS. Since α2-adrenergic, opioid, anticholinergic, and serotonergic pathways are thought to play a role in the pathogenesis of POS, a wide variety of drugs has been investigated in this regard. Although the methodological diversity of the study designs and regimens does not support drawing defi nite conclusions, there is evidence indicating a benefi cial effect of dexmedetomidine, ketamine, tramadol, meperidine, dexamethasone, nefopam, granisetron, and ondansetron in the prevention of POS. The purpose of this review is to provide a thorough insight on various drug options and to serve as an aid for clinicians for careful analysis of the advantages and disadvantages of each regimen to decide which regimen will be ideally suited for the medical profi le of each patient.

The International Union of Social Studies of Malines and the Catholic Cultural Turn

Abstract The present article argues that the unexpected end of the Union de Malines’ Code de morale culturelle, an international collaboration of prominent twentieth-century Catholic moral theologians, should be attributed to three shifts in Catholic Social Teaching, only the first two of which the Union de Malines managed to undergo: from scholastic hegemony to theological diversity, from social doctrine to personalism, and from a juridical style of writing to a humanistic one. Particularly this last shift, introduced by the Second Vatican Council, proved to be a too big a leap for the Union, understood as a ‘little social tradition,’ to take. The cultural turn, which the Union de Malines had in fact anticipated, proved by the end of the council to belong to the future.

Postincision wound infiltration with bupivacaine versus pethidine for postoperative pain relief following myomectomy under spinal anesthesia

Context: Bupivacaine is commonly used agent for wound infiltration because of its local anesthetic effect. However, pethidine an opioid has both local anesthetic and systemic analgesic effect. The combined analgesic effect of pethidine may be superior to bupivacaine that has only a local anesthetic effect. Few studies have however supported the superiority of pethidine over bupivacaine for wound infiltration. Aims: The aim of this study is to evaluate the analgesic effect of pethidine in comparison with bupivacaine wound infiltration for postoperative pain control in nonparturients scheduled for myomectomy under spinal anesthesia. Setting and Design: This study is a prospective, randomized, double-blinded control trial of the analgesic efficacy of plain bupivacaine versus pethidine for patients scheduled for myomectomy under spinal anesthesia in a Tertiary Healthcare center in Nigeria. Subjects and Methods: Seventy-six American Society of Anesthesiologists 1 and 11 patients billed for myomectomy using spinal anesthesia were randomized into two groups. Group bupivacaine had wound infiltration with 50 mg isobaric bupivacaine at a concentration of 0.25%. Group pethidine had 1 mg/kg pethidine. In the ward, pain was assessed at various intervals at rest and on coughing using the numerical rating scale (NRS) pain assessment tool and the time of the first analgesic request. Statistical Analysis: NRS scores were presented as median with interquartile range, Continuous variables such as duration of analgesia and total analgesic consumption were analyzed using the unpaired Student's t-test. Results: The pethidine group had a longer time to first analgesic request, lower pain scores and a higher level of satisfaction. Conclusion: This study showed that postincision wound infiltration with pethidine at 1 mg/kg as a component in multimodal analgesia is more effective than 0.25% bupivacaine in the management of postmyomectomy pain.

Effect of compound coeruleum methylenum preparation on postoperative analgesia after thoracoscopic surgery

Objective To observe the analgesic effect of compound coeruleum methylene blue preparation after thoracoscopic surgery, and to provide a new idea for the choice of analgesic drugs for thoracoscopic patients. Methods The clinical data of 116 patients who underwent selective thoracoscopic surgery in the Department of Cardiothoracic Surgery of Jieyang People′s Hospital from January 2016 to May 2018 were analyzed. This study was a prospective study. Research subjects were divided into control group (n=57) and observation group (n=59) by random digital table. In the two groups, no analgesic measures were used in advance, of which the patients in the control group were given the routine injection of piperidine hydrochloride by intramuscular injection after operation. While patients in the observation group were given intercostal nerve block across the upper and lower ribs after operation, and the dosage of compound methylene blue was 1 ml in each rib. on the basis with pethidine hydrochloride. The visual analog score and Ramsay sedation score were compared between the two groups of patients at 4 h, 12 h 24 h and 48 h after operation and compared the use of pethidine hydrochloride, adverse drug reactions, ambulation time and hospitalization time. The counting data was expressed in terms of frequency and percentage (%). The measurement data were represented by (±s). The comparison of different time points within the group was performed by single-factor analysis of variance, and the comparison between the two groups was performed by independent sample t test. Results Compared with the control group’s patients[in resting state, 12 h: (3.85±1.97) points; 24 h: (2.74±1.91) points; 48 h: (2.11±1.70)points; in activity state, 12 h: (5.02±1.64) points; 24 h: (4.89±1.36)points; 48 h: (3.83±1.51) points], the VAS scores of the patients in the observation group in resting state [12 h: (2.68±1.24) points; 24 h: (1.35±1.16) points; 48 h: (0.74±0.63) points] and activity state[12 h: (3.81±1.53) points; 24 h: (3.25±1.71) points; 48 h: (2.42±1.33)points] were significantly lower at 12 h, 24 h and 48h after operation. Compared with the control group′s patients 12 h [(2.58±0.41) points] and 24 h [(2.29±0.34) points], the Ramsay scores were significantly higher at 12 h[(2.93±0.35)points] and 24 h [(2.79±0.30)points] after operation (P 0.05). Conclusions Compound coeruleum methylenum′s analgesic effect after thoracoscopic surgery is accurate and maintains long time, and the side effects are less and the operation is convenient. It is worthy of clinical application. Key words: Thoracoscopes; Analgesia; Pain, postoperative; Compound methylene blue preparation

Efficacy of oxycodone combined with thoracic paravertebral block for postoperative analgesia in patients undergoing minimally invasive direct coronary artery bypass grafting

Objective To evaluate the efficacy of oxycodone combined with thoracic paravertebral block (TPVB) for postoperative analgesia in patients undergoing minimally invasive direct coronary artery bypass grafting (MIDCABG). Methods Thirty-two American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 60-75 yr, weighing 50-85 kg, scheduled for elective MIDCABG under general anesthesia, were divided into 2 groups (n=16 each) using a random number table method: morphine plus TPVB group (group MT) and oxycodone plus TPVB group (group OT). Paravertebral catheter was placed at T4, 5 before induction of anesthesia to perform left thoracic paravertebral puncture, patients were tracheally intubated, and 0.375% ropivacaine 15 ml was injected followed by continuous infusion of 0.375% ropivacaine 5 ml/h until 0.5 h before the end of surgery.Both groups received patient-controlled analgesia (PCA) after surgery.The PCA solution contained 1 mg/ml morphine 60 ml in group MT or 1 mg/ml oxycodone 60 ml in group OT, and the PCA pump was set up to deliver a 1 mg bolus dose with a 10-min lockout interval and background infusion at 1 ml/h after a loading dose of 2 mg, with the maximum dose of 20 mg every 4 h. Pethidine 50 mg was intravenously injected as a rescue analgesic to maintain visual analog scale≤4.The intraoperative consumption of fentanyl, consumption of analgesics for PCA within 48 h after surgery, ratio of total to effective pressing times of PCA, consumption of analgesics for rescue analgesia, requirement for rescue analgesia, score of satisfactory analgesia, extubation time, duration of intensive care unit stay and length of hospital stay were recorded.The development of nausea and vomiting, pruritus, respiratory depression, atelectasis and somnolence was recorded within 72 h after surgery. Results Compared with group MT, the intraoperative consumption of fentanyl, consumption of analgesics for PCA, consumption of analgesics for rescue analgesia, requirement for rescue analgesia and ratio of total to effective pressing times of PCA were significantly decreased, the score of satisfactory analgesia was increased, the extubation time and duration of intensive care unit stay were shortened, and the incidence of nausea and vomiting, pruritus, respiratory depression and somnolence was decreased in group OT (P<0.05). Conclusion Oxycodone combined with TPVB provides safe and effective efficacy for postoperative analgesia in patients undergoing MIDCABG. Key words: Oxycodone; Analgesia, patient-controlled; Nerve block; Coronary artery bypass, off-pump

Pharmacokinetics of meperidine (pethidine) in rabbit oral fluid: correlation with plasma concentrations after controlled administration.

Oral fluid assays for quantifying drugs are useful in forensic toxicology and drug monitoring. Compared with blood and urine specimens, oral fluid collection is simple, non-invasive, and more difficult to adulterate. Therefore, we investigated whether meperidine and its metabolites could be detected in oral fluid and whether there was a predictable relationship between oral fluid and plasma concentrations. Male New Zealand white rabbits (n = 10) were administered meperidine hydrochloride (20 mg/kg, intravenous). Then, plasma and oral fluid were collected at various time points up to 10 h after administration. We developed a simple and sensitive gas chromatography-mass spectrometry method for the determination of meperidine and normeperidine in oral fluid and plasma. We estimated the apparent pharmacokinetic parameters for meperidine in oral fluid and plasma and determined the ratio and correlation between oral fluid and plasma concentrations. The results demonstrate that this method has excellent specificity, linearity, precision, and recovery. Meperidine and normeperidine were detected in both body fluids; meperidine was the most abundant analyte in oral fluid. The oral fluid-to-plasma drug concentration ratios did not differ significantly over time (p > 0.05). In addition, oral fluid and plasma levels of meperidine and normeperidine were significantly correlated over time (r = 0.713 and 0.725, respectively; p < 0.05). These results provide context for interpreting meperidine and metabolite concentrations in oral fluid and support the utility of oral fluid as an alternative matrix in clinical and forensic testing.

Investigation and analysis on recognition of high-alert medications of physician's advice among clinical nurses from grade three and first-class hospital in chongqing

Objective To investigate the recognition of physicians′ advice about high-alert medications among clinical nurses from grade three and first-class hospitals in Chongqing and to analyse the relevant training requirements. Methods Using a multistage stratified cluster sampling strategy, the physicians′ advice recognition questionnaire of High-alert medications for clinical nurses was administered to 3 029 nurses in eight hospitals, to test the nurses′ advice recognition of high-alert medication and collecte training suggestions. Results More than 82.70% (1 946/2 353) of nurses responded correctly for 8 out of the 12 questions, the accuracy rate of pethidine hydrochloride injection test was 97.11% (2 285/2 353) and the dopamine hydrochloride injection test was only 28.56% (672/2 353). The nurses′ recognition of physicians′ advice of high-alert medications in gender, department, working time and annual income was statistically significant (P<0.10). 81.34% (1 914/2 353) of the nurses were able to recognize 11 out of the total 24 wrong advices. Pre-job training、theoretical knowledge related to physicians′ advice and case-based learning are the best training time, content and form. Conclusions The recognition level of high-alert medications by clinical nurses from grade three and first-class hospitals in Chongqing was not high and the clinical nurses with different gender, department, working time and annual income had different abilities, the targeted training for clinical nurses should be provided. Key words: Nurses; Grade three and first-class hospital; High-alert medications; Physician's advice recognition; Questionnaire

Application of continuous iliac fascial interstitial obstruction in the placement of anaesthesia in the vertebral canal of the elderly femoral fractures and postoperative analgesia

Objective To investigate the effect of continuous iliac fascia space block on the placement of body position and postoperative analgesia in patients with femoral fractures. Methods 60 patients with senile selective unilateral femoral fracture, aged 68-87 years old, weight 49-70kg, ASA grade II-III were selected, and they were randomly divided into iliac fascia block group (A group) and intravenous analgesia group (B group) according to the digital, 30 cases in each group.The two groups underwent lumbar epidural anesthesia, A group received continuous fascia iliaca compartment block 15 min before the the body position.B group was routinely given combination of lumbar and hard anesthesia.After operation, A group was connected with the automatic infusion pump continuous infusion of 0.2% ropivacaine 0.1mL·kg-1·h-1.B group received controlled intravenous analgesia, postoperative given loading dose of dezocine intravenous infusion of 5mg with automatic injection pump for dezocine 0.01mg·kg-1·h-1.When the patients entered the room (T0) and just after the placement of the body position (T1), the heart rate, diastolic blood pressure and systolic blood pressure were measured and recorded.At postoperative 2, 4, 6, 12, 24 and 48h, the VAS scores and pethidine usage during surgery, the adverse reaction were recorded. Results The heart rate, diastolic pressure and systolic pressure at T1 in A group had no significant change compared with T0 (all P>0.05). The heart rate, diastolic pressure and systolic pressure in the control group (B group) at T1 were significantly higher than at T0(t=5.302, 7.369, 5.629, all P<0.05). At T1, T2, T4, T6, T12, T24 and T48, the pain VAS scores in A group were lower than those in B group (t1=66.401, t2=7.719, t4=25.260, t6=13.170, t12=3.837, t24=3.081, t48=6.202.all P<0.05). The study group had no complications such as puncture hematoma, intoxication of local anesthetic and other complications. Conclusion Continuous iliofascial block can provide continuous analgesia for elderly patients with femoral fractures.It is safe and effective, and is easy to perform.It provides favorable conditions for later operative treatment. Key words: Iliac fascia space block; Femoral fracture; Elderly; Postoperative analgesia

Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Female-to-Male Transgender Men

Study ObjectivePrevious studies suggest female-to-male transgender men tend to choose less invasive procedures, but the superior route of hysterectomy for them remains undetermined. DesignA retrospective study (Canadian Task Force Classification II-3). SettingAn academic tertiary hospital. PatientsFifty-six female-to-male transsexuals received total vaginal hysterectomy (VH) with bilateral salpingo-oophorectomy (BSO) between April 2008 and August 2016 at Taipei Veterans General Hospital, Taipei, Taiwan. InterventionsThe patients underwent natural orifice transluminal endoscopic surgery (NOTES) (n = 14) or the conventional approach (n = 42). Measurements and Main ResultsMedical charts and surgical records were reviewed retrospectively. The general characteristics of the patients were similar in both groups. There were no statistically significant differences in operative time, estimated blood loss, intraoperative and immediate postoperative complications, or length of hospital stay between the 2 groups. However, postoperative pain was significantly reduced in the NOTES group compared with the conventional group as evidenced by lower mean scores on the visual analog scale (4.9 ± 3.0 vs 7.1 ± 1.4 at 2 hours, p = .008; 1.5 ± 1.2 vs 3.0 ± 1.7 at 48 hours, p = .001; and 1.7 ± 1.0 vs 2.7 ± 1.1 at 72 hours, p < .001) and a lower mean accumulated dose of postoperative analgesics (38.9 ± 49.2 mg vs 88.8 ± 82.3 mg meperidine hydrochloride, p = .037). Analysis of variance with repeated measures with a Greenhouse-Geisser correction also showed that the mean scores for wound pain were statistically lower in the NOTES group (p < .001). There was no significant difference in the complication rate between the NOTES and conventional groups (7% vs 12%, p = .618). There were no severe complications, including infection episodes or internal bleeding events, within the NOTES group. ConclusionNOTES VH with BSO in female-to-male transgender men significantly decreases postoperative pain and analgesic use. NOTES in female-to-male sex reassignment surgery provides a novel choice for transgender men, with equivalent safety compared with VH.