Mg Of Acetaminophen Research Articles

Management Options for Patients with Aspirin and Nonsteroidal Antiinflammatory Drug Sensitivity

To evaluate and provide management strategies for patients with aspirin or nonselective nonsteroidal antiinflammatory drug (NSAID) sensitivity. Literature retrieval was accessed through MEDLINE (1966-March 2007) using the terms acetaminophen, aspirin, antiinflammatory agents nonsteroidal, urticaria, angioedema, asthma, leukotriene antagonists, desensitization, and tacrolimus. Article references retrieved were hand-searched for other relevant articles. All studies published in English were evaluated. Studies, review articles, and commentaries on aspirin-induced asthma and aspirin- or NSAID-induced urticaria/angioedema were included in the review. Aspirin sensitivity is most often manifested as respiratory reactions (eg, bronchospasm, profuse rhinorrhea, conjunctival injection) or urticaria/angioedema. The primary mechanism is believed to be inhibition of the cyclooxygenase 1 (COX-1) enzyme; as such, patients with aspirin sensitivity often display cross-reactions to nonselective NSAIDs that inhibit the COX-1 enzyme. Management strategies include avoidance of aspirin and cross-reacting nonselective NSAIDs. However, desensitization to aspirin is a viable option for patients with aspirin-induced respiratory reactions, especially for those who require aspirin for thromboembolic prophylaxis. Aspirin desensitization is maintained indefinitely with a daily aspirin dose. There is limited evidence of the use of leukotriene modifiers in preventing aspirin-induced asthma. COX-2 selective NSAIDs, especially in patients with aspirin-induced asthma, have not been found to cross-react. However, approximately 4% of patients with a history of aspirin-induced skin reactions may experience a cutaneous reaction following a challenge to a COX-2 selective NSAID. Since acetaminophen is a weak inhibitor of the COX-1 enzyme, patients with aspirin-induced asthma should not take more than 1000 mg of acetaminophen in a single dose. Management of patients with aspirin/NSAID sensitivity includes avoidance of aspirin/nonselective NSAIDs, use of COX-2 selective NSAIDs, acetaminophen in doses less than 1000 mg, and desensitization. The role of leukotriene modifiers requires further study before they can be recommended for patients.

Comparison of Urine and Serum Testing for Early Detection of Acetaminophen Ingestion

Acetaminophen is a common ingestant that is routinely screened for, with serum testing, after overdoses. We compared a modified, qualitative, colorimetric, o-cresol urine test for acetaminophen with the standard laboratory serum immunoassay. Twenty-nine adult volunteers were given 975 mg of acetaminophen, and then serum and urine samples were tested at predefined intervals for up to 4 hours. The presence of acetaminophen in the urine samples was determined with a modified o-cresol assay by two independent reviewers and was verified by using high-performance liquid chromatography. Compared with the acetaminophen serum immunoassay, the acetaminophen urine test had specificity of 97% (95% confidence interval, 80-100%) and sensitivity of 100% (95% confidence interval, 81-100%) at 45 minutes. Further studies to improve and to accelerate processing of the qualitative colorimetric o-cresol urine test could allow the test to be used in specific military and civilian clinical scenarios.

Metabonomics and Biomarker Discovery: LC−MS Metabolic Profiling and Constant Neutral Loss Scanning Combined with Multivariate Data Analysis for Mercapturic Acid Analysis

In the field of metabonomics, 1H NMR and full scan mass spectrometry methods have usually been combined with principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA) to detect patterns in biofluids that correspond to specific effects, usually a toxic site effect of a compound. Confounders together with great interindividual variation complicate such analysis in humans, and therefore, metabonomic data are almost restricted to animals. In our study, a constant neutral loss (CNL) scan on a linear ion trap demonstrated increased sensitivity and specificity compared to a full scan approach and was performed to detect mercapturic acids (MA), a class of effect markers. The method was applied to human volunteers administered 50 and 500 mg of acetaminophen (AAP), a model compound known to form MAs. Using a new algorithm to prepare the CNL data for chemometrics, discrimination of control and postdose samples could be performed using PCA and PLS-DA. The loadings plots clearly revealed AAP-MA as a marker, even at low-dose levels. Orthogonal signal correction (OSC) was carried out to investigate background information that is not due to exposure. Surprisingly, the OSC data provided a classification of male and female subjects showing the performance of the new approach.

Patient Management Exercise For Delirium

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Poster 105: Chronic headaches after unilateral cochlear implant placement: a case report.

Setting: Outpatient rehabilitation clinic. Patient: A 46-year-old woman with medical history of migraines and sensorineural hearing loss. Case Description: The patient, who was treated with left cochlear implant placement on December 2000, was referred to our pain management outpatient clinic in August 2001 with chronic left-sided headache since the surgery. On initial evaluation, she reported having constant fluctuating left facial and temporal vibrating headaches rated 8/10 on the visual analog scale (VAS) for pain, along with disabling left ear tinnitus and difficulty sleeping. She was initially treated with 5mg of zolpidem orally at bedtime and 7.5mg of hydrocodone and 750mg of acetaminophen orally every 6 hours as needed for pain but with no relief. The patient received several trials of multiple narcotic medications and tricyclic antidepressants until December 2001. She began receiving an 80mg dose of oxycodone orally every 8 hours. In August 2002, 50mg of nortriptyline orally at bedtime was added. Assessment/Results: Monthly follow-up for 6 months. Her pain rating improved to 3/10 on the VAS, the vibration dysesthesia decreased significantly, and her sleep, quality of life, and wellness markedly improved. Discussion: This is the first case report in the literature on chronic disabling headache after cochlear implant surgery, designated cochlear implant pain syndrome. Conclusion: Cochlear implants are now widely use in the pediatric and adult population with sensorineural hearing loss. It was only in 1984 that the US Food and Drug Administration approved the implants for use in adults. The reported surgical complications are wound infection and breakdown (most common), along with less frequent facial paralysis, cerebrospinal leak, meningitis, and device-related complications. Clinicians should be aware that headache symptoms in these patients can be related to cochlear implant placement.

Induction and maintenance of mild hypothermia by surface cooling in non-intubated subjects

Mild induced hypothermia holds promise as an effective therapy for acute ischemic stroke. We developed a novel strategy to rapidly induce and maintain mild hypothermia in unanesthetized, non-intubated subjects as a model for the treatment of acute stroke patients. We induced and maintained mild hypothermia (tympanic membrane temperature 34°C–35°C) for over 5 hours in 10 healthy volunteers. All subjects received 1000 mg of acetaminophen orally and meperidine intravenously for comfort and suppression of shivering. In phase 1, subjects (n=5) were cooled using Arctic Sun Energy Transfer Pads (Medivance, Inc., Louisville, CO) with manual temperature control. In phase 2, subjects (n=5) were cooled using the Arctic Sun® Energy Transfer Pads™ connected to the Arctic Sun Model 200 Temperature control module (Medivance, Inc.). Core temperatures were measured at the tympanic membrane and rectum. All subjects reached the target tympanic temperature range. The mean time to reach a tympanic temperature of 35°C was 90±53 minutes (1.4°C/hour) in phase 2. The most common side effect was nausea, observed in 30% of subjects. There was no statistically significant change in heart rate, blood oxygenation, or diastolic blood pressure compared with baseline; systolic blood pressure was significantly elevated for the 180 minute time point only (140±20mm Hg v 122±13mm Hg; P = .042). We developed a method to rapidly and comfortably induce and maintain mild hypothermia in unanesthetized, non-intubated humans. Further study to optimize the pharmacologic inhibition of thermoregulation and to assess tolerability over longer durations is warranted.

A Comparison of Caudal Block and Acetaminophen Preemptive Analgesia in Pediatric Peritoneoscopy

Although both caudal block and acetaminophen have been shown to be effective in the management of postoperative pain in children, their efficacy after peritoneoscopy has not been compared. This study included 32 children with an American Society of Anesthesiologist (ASA) score of I or II who were undergoing peritoneoscopy. Their ages ranged from 55 gestational weeks to 10 years. The children were randomly assigned to receive a preoperative caudal block with 0.6 mL of bupivacaine per kilogram or preoperative rectal acetaminophen at a dose of 30 mg/kg. Each group also received 20 mg of acetaminophen per kilogram every 6 hours to a total of four doses. A blinded observer used the Objective Pain Scale to assess the patients on awakening, in the postanesthesia care unit (PACU), and at discharge. A telephone survey to assess satisfaction was conducted 1 day later. Acetaminophen was given to 18 patients, and 14 had a caudal block. The initial PACU score was 4.1 ± 3.1 for acetaminophen and 2.3 ± 3.0 for the cauda...

COMPARISON OF PROTEASE AND NSAID SUPPLEMENTATION ON MUSCLE SORENESS AND PAIN THRESHOLD FOLLOWING DOWNHILL RUNNING

Both protease and non-steroidal anti-inflammatory drug (NSAID) supplementation have been shown to attenuate the effects of delayed onset muscle soreness (DOMS) resulting from intense exercise. PURPOSE To evaluate the effects of protease and NSAID supplementation on perceived muscle soreness (MS) and pressure pain threshold (PPT) following downhill running (DHR). METHODS Results were examined on data collected from 17 male participants who ran at a −10% grade for 30 min at 80% predicted maximum heart rate. Subjects consumed either 2 protease tablets (PRO) (325 mg pancreatic enzymes, 75 mg trypsin, 50 mg papain, 50 mg bromelain, 10 mg amylase, 10 mg lipase, 10 mg lysozyme) or 1000 mg of acetaminophen (NSAID) four times a day for four days (from 24 H pre-DHR to 72 H post-DHR). Supplementation was administered in randomized, double-blind fashion. Each subject's PPT was evaluated by dolorimetry of the thigh (the anterior medial quadrant (AMQ), anterior lateral quadrant (ALQ), posterior medial quadrant (PMQ), and posterior lateral quadrant (PLQ)) and the shank (tibialis anterior (TA) and lateral (LG) and medial gastrocnemius (MG)). Additionally, a questionnaire was administered to evaluate MS of the front and back of the dominant thigh and shank. RESULTS There were no differences seen for MS between the NSAID and PRO groups. PPT for the PMQ and AMQ was higher 48 H and 72 H, respectively, after DHR for the PRO group. PPT was also superior in the ALQ and PLQ for PRO as compared to NSAID 48 H and 72 H after DHR. Additionally, LG and MG also showed less sensitivity to PPT in the PRO 48 H after DHR. CONCLUSIONS The results of this investigation indicate that individuals taking PRO can tolerate higher relative PPT subsequent to DHR. This finding is consistent with previous research that demonstrated a facilitated recovery of contractile capabilities with PRO following DHR. This finding may be attributable to the potential anti-inflammatory and healing properties of PRO.

High altitude headache: efficacy of acetaminophen vs. ibuprofen in a randomized, controlled trial

Ibuprofen has been shown to be more effective than placebo in the treatment of high altitude headache (HAH), but nonsteroidal anti-inflammatory agents have been linked to increased incidence of gastrointestinal (GI) side effects and high-altitude pulmonary edema (HAPE). We postulated that acetaminophen, which does not share ibuprofen’s theorized causal link to GI side effects or HAPE, could provide effective HAH therapy. We conducted a prospective, randomized, double-blind, clinical trial of ibuprofen vs. acetaminophen in the Solu Khumbu, Nepal: Mt. Everest Base Camp, Pheriche, Dingboche (4240 m to 5315 m). Seventy-four consecutive patients (ages 13 to 61 years) were randomized, were assessed with the Lake Louise Acute Mountain Sickness (AMS) criteria, and received a physical examination (which included vital signs, oxygen saturation as measured by pulse oximetry (SpO 2), and assessment of clinical Lake Louise AMS criteria). Patients then received either 400 mg of ibuprofen (IBU) or 1000 mg of acetaminophen (ACET), and were asked to rate their cephalgia using a 10-cm visual analog scale (VAS). Thirty-nine patients received IBU, and 35 received ACET. Baseline Lake Louise AMS scores were identical in the two groups (mean = 5.9). No differences in mean VAS scores between IBU and ACET groups were noted at time 0 (presentation), 30, 60, or 120 min. No cases of HAPE or high altitude cerebral edema were noted during the study period. In this study population, acetaminophen was as effective as ibuprofen in relieving the pain of HAH.

PERSONALITY CORRELATES ON RPE DURING AND MUSCLE SORENESS FOLLOWING DOWNHILL RUNNING

Recent exercise recommendations suggest that individual differences be taken into consideration when developing exercise prescriptions. Personality traits are one such individual factor that may influence exercise behavior. PURPOSE To evaluate the influence of personality variables on RPE responses during and muscle soreness (MS) following high-intensity exercise. METHODS 15 male participants ran at a −10% grade for 30 min at 80% predicted HR max. Participants consumed two protease tablets (PRO) (325 mg pancreatic enzymes, 75 mg trypisn, 50 mg papain, 50 mg bromelain, 10 mg amylase, 10 mg lipase, 10 mg lysozyme) or 1000 mg of acetaminophen (NSAID) 4 times a day for 4 days (from 24 H pre-downhill running (DHR) to 72 H post-DHR). Supplementation was administered in randomized, double-blind fashion. Prior to the exercise session, the Preference-Tolerance for Intensity of Exercise Questionnaire (Ekkekakis, Hall & Petruzzello, 2001) was administered to determine preference (PREF) and tolerance (TOL) of high intensity exercise. Ratings of Perceived Exertion (RPE) were assessed during exercise at the end of warm-up, and at min 10, 20, and 30 during DHR. Perceived MS of the front and back of the right thigh and on the back of the right shank was assessed 24-H following DHR. RESULTS RPE during DHR significantly increased with time; however, there was no main effect for supplement. Similarly, there was a significant increase in muscle soreness 24 H post-DHR at all 3 sites, but no main effect for supplement. PREF and TOL were both positively correlated with RPE at all 4 time points (warm-up, 10, 20, and 30-min) during exercise. PREF was positively correlated with MS at back of the shank and TOL was significantly correlated with MS at front of the right thigh and back of the shank. CONCLUSION The results of this study indicate that personality traits have an influence on RPE and MS associated with downhill running; however, supplements of PRO and NSAID do not influence RPE or MS.

Effect of Narcotic Pain Reliever on Pulp Tests in Women

The purpose of this study was to determine the effect of one dose of a common narcotic-based pain reliever (Vicodin) on a battery of oral sensitivity tests across time in women. Fifteen Caucasian women randomly were given an oral dose of 10 mg of hydrocodone/1000 mg of acetaminophen or placebo in a double-blind, cross-over design. At baseline (before drug) and after 2, 4, and 8 h each subject was evaluated for sensitivity thresholds with four tests around an experimental tooth: (a) electric pulp tester applied to exposed root; (b) electric pulp tester on adjacent mucosa; (c) increasing probe pressure (grams) on adjacent mucosa; and (d) decreasing cold probe (degrees C) on the exposed root. The outcomes of all tests were not statistically different between drug and placebo treatments at any time point (p > 0.05). These results suggest that a systemic dose of hydrocodone/acetaminophen has little impact on healthy pulp or mucosa sensitivity in women as measured by common diagnostic tests.

COMPARISON OF PROTEASE AND NSAID SUPPLEMENTATION ON MUSCLE SORENESS AND CONTRACTILE PERFORMANCE FOLLOWING ECCENTRIC CONTRACTIONS

Both protease and non-steroidal anti-inflammatory drug (NSAID) supplementation have been shown to attenuate the effects of delayed onset muscle soreness (DOMS) resulting from intense exercise. PURPOSE: To evaluate the effects of protease and NSAID supplementation on muscle soreness and contractile performance following downhill running (DHR). METHODS: Preliminary results were examined on data collected from male participants who ran at a - 10% grade for 30 min at 80% predicted maximum heart rate. Subjects consumed either 2 protease tablets (PRO) (325 mg pancreatic enzymes, 75 mg trypsin, 50 mg papain, 50 mg bromelain, 10 mg amylase, 10 mg lipase, 10 mg lysozyme), 1000 mg of acetaminophen (NSAID) or a placebo (PLAC) four times a day for four days (from 24 H pre-DHR to 72 H post-DHR). Supplementation was administered in randomized, double-blind fashion. Subjects were evaluated for perceived muscle soreness (MS) of the front and back of the dominant thigh and on the back of the shank of the same leg, pressure pain threshold (PPT) by dolorimetry of 4 locations on the thigh (the anterior medial, anterior lateral, posterior medial, and posterior lateral quadrants) and 3 locations on the shank (tibialis anterior and lateral and medial gastrocnemius), peak knee extension (KE)/flexion (KF) and plantar/dorsi-flexion torque and power at 3 speeds (90°/s, 180°/s, and 300°/s) immediately prior to DHR, 24 post-DHR, 48 H post-DHR, and 72 H post-DHR. RESULTS: PPT for the posterior aspects of the thigh was reduced at 24 and 48 H after DHR. PPT was lower in the back and front of the right leg in PLAC and NSAID as compared to PRO 24 and 48 H after DHR. KE torque and power at 90°/s and 180°/s was superior among the PRO compared to the PLAC and NSAID at 24 H, 48 H and 72 H after DHR. CONCLUSION: The results of this investigation indicate that protease supplementation may attenuate muscle soreness and facilitate the restoration of muscle function following downhill running. A potential explanation for these findings may lie within the action of protease to minimize inflammation and accelerate muscle healing. Supported by Enzymatic Therapy, Green Bay WI

A report of a rare immediate reaction after ingestion of acetaminophen

Acetaminophen hypersensitivity is rare and, when seen, is usually in association with sensitivity to nonsteroidal anti-inflammatory drugs. This is a case report of an immediate reaction to acetaminophen, confirmed by a drug challenge, in a subject who tolerated ibuprofen. After an oral challenge with 50 mg of acetaminophen, the subject had generalized pruritus, urticaria, and dyspnea. This patient demonstrates a rare but potentially severe reaction to acetaminophen that may occur in patients who are not otherwise sensitive to other nonsteroidal anti-inflammatory drugs.

Comparison of fever treatments in the critically ill: a pilot study

Fever in critically ill patients is often treated with antipyretics or physical cooling methods. Although fever is a host defense response that may benefit some critically ill patients, others may not tolerate the cardiovascular demands associated with fever. To compare antipyretics and physical cooling for their effects on core body temperature and cardiovascular responses in critically ill patients. The antipyretic administered was 650 mg of acetaminophen. Physical cooling was accomplished by anterior placement of a cooling blanket at 18 degrees C. Core temperature and cardiovascular responses were measured in 14 febrile (body temperature, 38.8 degrees C) critically ill patients at baseline before treatment and up to 3 hours after treatment. Patients able to receive acetaminophen were randomly assigned to receive either acetaminophen only (n = 5) or acetaminophen in combination with a cooling blanket (n = 3). Patients not able to receive acetaminophen were treated with physical cooling only (n = 6). Mean body temperature decreased minimally from baseline to 3 hours after treatment in the physical-cooling-only group (from 39.1 degrees C to 39.0 degrees C) and in the physical cooling and acetaminophen group (from 39.1 degrees C to 38.6 degrees C), but the mean body temperature increased in the acetaminophen-only group (from 39.2 degrees C to 39.4 degrees C). Other notable findings included a slight increase in systemic vascular resistance index in the physical-cooling-only group and in the physical-cooling-plus-acetaminophen group. Although the study included only 14 subjects, the findings will provide information for future studies in febrile critically ill patients.

Use of Acetaminophen for Large-Scale Control of Brown Treesnakes

Because the brown treesnake (Boiga irregularis) has virtually extirpated the avifauna on Guam and is a threat to other Pacific islands, the development of alternative and efficient control methods is required. Therefore. we performed a large-scale field experiment to determine whether the acetaminophen baits we developed could be used to reduce population levels of brown treesnakes on Guarn. Toxic baits were made by inserting 80 mg of acetaminophen into dead neonatal mice, and these mouse baits were used to treat plots. Reference plots were baited with unadulterated baits. We used mark-recapture methods to estimate snake abundance on plots before treatment, monitored bait-take rates on treated plots for 30 days, and used mark-recapture to estimate snake populations post-treatment. Bait-take rates were reduced on treated plots by 83% relative to reference plots after 14 days, when they reached an asymptote. Using a robust design model in program MARK, snakes on'reference plots had high-er apparent survival rates (x = 0.3505) than those on treated plots (x = 0.0072) for the duration of the study, but estimates were influenced by snake movement between plots. When we accounted for movement using a multistrata model, survival on treated plots was estimated as zero. High mobility of brown treesnakes presents difficulty for complete removal of snakes from large areas, but we conclude that acetaminophen baits may provide an effective and selective management tool for quickly and efficiently reducing populations of brown treesnakes on Guam.

Early pregnancy termination with vaginal misoprostol combined with loperamide and acetaminophen prophylaxis

The objectives of this prospective non-concurrent cohort study were to confirm the efficacy of vaginal misoprostol for early pregnancy termination and to determine whether the incidence of side effects is lower with prophylactic loperamide and acetaminophen. Two-hundred women with an intrauterine pregnancy ≤56 days gestational age seeking medical pregnancy termination in an ambulatory research clinic were enrolled in the study. One-hundred participants (group 1) ingested 4 mg of loperamide and 500 mg of acetaminophen before the vaginal placement of 800 μg of misoprostol moistened with 2 mL of saline. If abortion had not occurred, the same regimen was repeated every 24 h (maximum three doses). One-hundred participants (group 2) from the same clinic who previously underwent the same misoprostol regimen without prophylactic medication served as a control group for comparison with respect to abortion success and the incidence of side effects. The rate of successful abortion was not statistically significantly different between the two groups (group 1 93%, group 2 89%). The incidence of opiate analgesic use was significantly less in group 1 (4%) compared with group 2 (16%) (OR 0.22, 95% CI 0.06–0.73, p = 0.01). There was a significantly lower incidence of diarrhea in group 1 (23%) compared with group 2 (44%) (OR 0.38, 95% CI 0.20–0.73, p = 0.003). There was no difference in the incidence of fever/chills or the incidence of emesis between the two groups. Vaginal misoprostol is effective for termination of pregnancy ≤56 days and the incidence of diarrhea and the use of opiate analgesia is significantly reduced with prophylactic loperamide and acetaminophen.

Adequacy of Analgesia After Outpatient Surgery

Anesthesia| June 01 2000 Adequacy of Analgesia After Outpatient Surgery AAP Grand Rounds (2000) 3 (6): 60. https://doi.org/10.1542/gr.3-6-60 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Adequacy of Analgesia After Outpatient Surgery. AAP Grand Rounds June 2000; 3 (6): 60. https://doi.org/10.1542/gr.3-6-60 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: ambulatory surgical procedures, pain management, pain Source: Munro HM, Malviya S, Lauder GR, et al. Pain relief in children following outpatient surgery. J Clin Anesth. 1999;11:187–191. This study was conducted to determine whether children undergoing outpatient surgery have adequate pain control at home. The authors prospectively collected data on 471 children at the University of Michigan Medical Center, aged 10 months to 18 years (mean 5.4+/− 4.4 years), who underwent outpatient surgical procedures expected to be associated with pain. Information about the surgical procedure, perioperative analgesia and anti-emetic administration, postoperative pain scores, and discharge prescriptions was collected. Parents were called 24 hours after the procedure and questioned about their child’s pain, analgesic and anti-emetic usage, and their ability to care for their child. The most common procedures were hernia/hydrocele repair (17%), excision of lumps/cysts (12%), adenoidectomy/adenotonsillectomy (13%), strabismus correction (9%), and orchidopexy (7%). Other procedures included orthopedic hardware removal, dental restoration, and circumcision. No cardiothoracic or neurosurgical procedures were included in the group. Four hundred and sixty parents were questioned by phone (11 patients were admitted unexpectedly after surgery) and 97% reported that their child’s analgesia was adequate or better during that first 24-hour period after surgery. The 15 (3%) children whose parents reported unacceptable analgesia were more likely to report postoperative nausea and vomiting and be difficult to care for at home. In the 185 children who received intraoperative regional analgesia for genitourinary procedures (hernia, hydrocele, orchidopexy, etc), pain relief was superior when compared to those who received only non-regional analgesia. Discharge pain scores assigned by the PACU nurses were consistent with minimal pain but 18% of parents assessed their child’s pain at discharge as moderate or severe. Acetaminophen, with or without codeine, was prescribed by the surgical service in nearly 95% of cases, while 4% did not receive a prescription. In almost one-half of the cases, the dose of acetaminophen was < 10 mg/kg PO and the codeine dose was < 1.0 mg/kg PO. Although most children in this study experienced minimal pain in the first postoperative day, from a parent’s perspective there is still room for improvement.1 Many surgeons prefer to avoid ibuprofen and aspirin because of fears that clot formation may be compromised. Therefore, pediatricians should be familiar with commonly used oral opioids. Since codeine is frequently associated with nausea and vomiting, its utility is limited, especially in the postoperative setting. Alternatives to codeine include Percocet (a combination of 5 mg oxycodone and 325 mg of acetaminophen) or PO oxycodone. Percocet dosing is generally limited by the acetaminophen dose, which should be kept below 80–90 mg/kg/24 hours. The dose for oxycodone is 0.05–0.15 mg/kg/dose up to 10 mg/dose. When prescribing opioids, it is important to keep in mind the concept of equianalgesic dosing: the relative analgesic potencies of the various opioids.3,4 When changing from one opioid to another the dose must be adjusted based on the relative potencies, different kinetics and different bioavailability. If pain control is not adequate, pediatricians should review the analgesic... You do not currently have access to this content.

Determination of acetaminophen by thermometric titrimetry

A sensitive, accurate and precise thermometric titration is described for the direct determination of ⩾75 mg of acetaminophen in pure form or in pharmaceutical formulations. Titrations are performed with aqueous sodium hydroxide solution. Excipients tested (starch, talc, lactose) had no effect on the accuracy and precision.

Acetaminophen-induced urticaria and tolerance of ibuprofen in an eight-year-old child

J Allergy Clin Immunol 1997;99:151-2.

Restless Legs Syndrome

I read with interest the review article on restless legs syndrome, which appeared in the February 12, 1996, issue of theArchives.¹I have suffered from this benign syndrome for 40 years (when I first developed it as a medical student, always assuming the worst, I thought it was amyotrophic lateral sclerosis) and find that it can usually be aborted with 500 or, occasionally, 1000 mg of acetaminophen. I also find that, if not aborted, a headache often develops 1 or 2 hours afterward.