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PubMed1981

Arterial oxygen tension changes in elderly patients undergoing upper gastrointestinal endoscopy. II. Influence of the narcotic premedication and endoscope diameter.

Changes in arterial oxygen and carbon dioxide tensions were determined in 56 patients, mean age 67 years, during elective upper gastrointestinal endoscopy with standard or pediatric instruments. All the patients received intravenous atropine, diazepam, and either meperidine or fentanyl premedication. There was an immediate and significant fall in PaO2 levels (20.3%-16.5%) after both narcotic injections. The oxygen tension remained significantly depressed during the endoscopic examinations except in the group receiving fentanyl premedication and examined with the narrow pediatric instrument. To minimize hypoxemia in elderly patients during endoscopy, a short-acting narcotic or, preferably, no narcotic at all should be used in the premedication, and a narrow, pediatric instrument be used.

Aged↗
PubMed1981

The Neonatal Narcotic Withdrawal Index: a device for the improvement of care in the abstinence syndrome.

Management of 50 experimental newborn infants ill with narcotic withdrawal has been carried out with the aid of an instrument developed for measuring its severity, the Neonatal Narcotic Withdrawal Index (NNWI). With its use, infants exposed to methadone in utero have been successfully cared for with detoxification needed in less than 25% of cases and for durations of less than 2 weeks. The percentage of cases and the length of treatment is much less than is customary for infants who have been prenatally exposed to similar doses of methadone. Validity of the NNWI is shown by the statistically significant difference between the mean scores for experimental and control subjects, a high significant correlation between simultaneously measured scores by separate examiners, statistically significant correlations between subscores and total withdrawal scores for the narcotic-exposed experimental cases, and for this group, a statistically significant correlation between scores of withdrawal and the maternal dose of methadone. The simplicity of the NNWI should help to make it acceptable for use by physicians.

Female↗
PubMed1976

Contingent naloxone treatment of the narcotic addict: a pilot study.

In a community-based abstinence program, 108 chronic heroin abusers, paroled from Maryland correctional institutions, were administered the narcotic antagonist, naloxone, in escalating 500 mg dosages to a daily maximum dosage of 2,000 mg when either urine analysis indicated narcotic drug use or unexcused absences led to the suspicion of narcotic intake. Dosage was then continued at the maximum level until the record again indicated abstinence. This approach was regarded as such a distinct departure from customary antagonist administration that a pilot investigation of its effectiveness was undertaken. Six month outcome data on all patients were constrasted with those of an historical comparison group previously treated in the same clinic without naloxone administration. Both groups were equivalent on all criminal history, demographic, and prognostic variables. The group receiving contingent naloxone administration showed a significantly lower institutionalization rate (8%) than that for the reference sample (37%). Complete abstinence rates were also in favor of the naloxone group (38 vs. 12%).

Absenteeism↗
PubMed1982

The "urge to classify" the narcotic addict: a review of psychiatric classification. I.

Attempts to classify drug addicts are divided into three main groups: (1) psychiatric classifications, (2) psychological classifications, and (3) classifications by pattern of abuse. An extensive literature review of the psychiatric classifications of narcotic addicts suggests that there is no one diagnosis that fits all narcotic addicts and that the importance of psychopathology in drug addiction has been exaggerated. It is concluded that theoretical psychiatric classifications of narcotic addicts have failed to stimulate empirical research and that empirical classifications have not demonstrated their utility for treatment and prognosis.

Humans↗
PubMed1984

The "urge to classify" the narcotic addict: a review of psychiatric classification. II.

Attempts to classify drug addicts are divided into three main groups: (1) psychiatric classifications, (2) psychosocial classifications, and (3) classifications by pattern of abuse. An extensive literature review of the psychiatric classifications of narcotic addicts suggests that there is no one diagnosis that fits all narcotic addicts and that the importance of psychopathology in drug addiction has been exaggerated. It is concluded that theoretical psychiatric classifications of narcotic addicts have failed to stimulate empirical research and that empirical classifications have not demonstrated their utility for treatment and prognosis.

Humans↗
PubMed1985

Rapid narcotic detoxification in chronic pain patients treated with auricular electroacupuncture and naloxone.

Severe withdrawal signs which accompany the detoxification of narcotic addicts from opiate drugs are also a serious problem for chronic pain patients taking high levels of analgesic medications. A rapid narcotic detoxification procedure utilizing auricular electroacupuncture was applied to 14 chronic pain patients to be withdrawn from their opiate medications. All patients were first switched to oral methadone. They were then given bilateral electrical stimulation to needles inserted in the "lung" and "shen men" acupuncture points on the ear, followed by periodic intravenous injections of low doses of naloxone. Twelve of the patients, 85.7%, were completely withdrawn from narcotic medications within 2-7 days, and they experienced no to minimal side effects. These results are explained by the relationship of electroacupuncture to the release of endorphins.

Acupuncture Therapy↗
PubMedDate not supplied

A multimethod assessment of social intervention effects on narcotics use and property crime.

Log-linear modeling, structural equation modeling, repeated measures analysis of variance, and time series analysis are discussed for their utility in evaluating the temporal effects of social interventions. Methods are illustrated by applications examining the independent and joint temporal effects of methadone maintenance treatment and legal supervision on narcotics use and property crime among narcotics addicts. Convergent results from a multimethod assessment of the issue show that methadone maintenance has long-term and short-term suppressive effects on narcotics use and property crime. More complicated but complementary findings have been found in evaluating the effectiveness of legal supervision.

Analysis of Variance↗
PubMed1990

How willing are general practitioners to manage narcotic misuse?

In 1989 a self-administered questionnaire concerning current management of, attitudes to, and knowledge of, narcotic misuse was completed by 206 Inner London general practitioners. Results showed that whilst over three quarters were prepared to offer patients supportive interviews, few were willing to prescribe for them, most preferring to refer to specialist facilities. Only 33 respondents had received adequate training in the management of narcotic misuse, but over a quarter expressed an interest in small group training to improve their skills. These findings are discussed in relation to Department of Health guidelines concerning the management of narcotic misuse.

Adult↗
PubMed1993

Methadone in maintenance treatment of narcotic addicts; joint revision of conditions for use; interim maintenance treatment; human immunodeficiency virus disease counseling--FDA and SAMHSA. Final rule.

The Food and Drug Administration (FDA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) formerly the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) are revising the conditions for the use of methadone in the maintenance treatment of narcotic addicts. The final rule allows, contingent on FDA and State approval, public and nonprofit private narcotic treatment programs to provide interim maintenance treatment to patients awaiting placement in comprehensive maintenance treatment and to require all narcotic treatment programs to provide counseling on preventing exposure to, and the transmission of, human immunodeficiency virus (HIV) disease.

Acquired Immunodeficiency Syndrome↗
PubMed1976

Interactions between narcotic analgesics and benzodiazepine derivatives on behavior in the mouse.

Interactions between the benzodiazepine derivatives, diazepam and oxazepam, and the narcotic analgesics, morphine and methadone, were evaluated on locomotor activity and in the tail-flick and hot-plate tests for analgesia in the mouse. The dose-related stimulation of locomotor activity by morphine was reduced by diazepam and oxazepam at doses which alone had no effect on locomotor activity. However, only oxazepam reduced the dose-related stimulation of locomotor activity by methadone. The observed decreases produced by diazepam and oxazepam were comparable in magnitude to those produced by naloxone. Stimulation of locomotor activity by d-amphetamine was not affected by either diazepam or oxazepam. Dose-response curves for locomotor activity were also determined with morphine and methadone administered intraventricularly. As before, diazepam and naloxone given i.p. decreased the stimulation of locomotor activity produced by morphine, but only naloxone affected methadone-stimulated locomotor activity. Neither diazepam, oxazepam nor naloxone reduced the brain or plasma levels of 3H-morphine or 3H-methadone. In contrast to the results on locomotor activity, neither of these benzodiazepines significantly modified the dose-response curves of morphine or methadone in either test for analgesia. The mechanisms involved in the observed interactions on locomotor activity may be related to the influences of benzodiazepines and narcotic analgesics on motor efferent pathways summating in such a manner as to interfere with the ability of the mice to locomote. The present results demonstrate that prominent interactions occur between members of the benzodiazepine and narcotic analgesic classes; these interactions are dependent upon both the specific combination of drugs administered and upon the test procedure.

Analgesics, Opioid↗
PubMed1992

Epidural narcotics: mechanism of action and nursing implications.

Patients who receive narcotics by epidural injection or infusion have the potential to develop pharmacological side effects. Theories of epidural pain control and a brief review of spinal anatomy and pain physiology are presented in this article. Narcotic medications used for epidural infusion are pharmacologically distinguished by their hydrophilic or lipophilic character. Important side effects of epidurally administered narcotics, clinical presentation, manifestations, and appropriate nursing interventions are discussed.

Analgesia, Epidural↗
PubMed1992

Subcutaneous narcotic infusions for cancer pain: treatment outcome and guidelines for use.

OBJECTIVE: To provide guidelines for the institution and maintenance of a continuous subcutaneous narcotic infusion program for cancer patients with chronic pain through an analysis of the narcotic requirements and treatment outcomes of patients who underwent such therapy and a comparison of the costs of two commonly used infusion systems. DESIGN: Retrospective study. SETTING: Tertiary care facilities and patients' homes. PATIENTS: Of 481 patients seen in consultation for cancer pain between July 1987 and April 1990, 60 (12%) met the eligibility criteria (i.e., standard medical management had failed, and they had adequate supervision at home). INTERVENTION: Continuous subcutaneous infusion with hydromorphone hydrochloride or morphine started on an inpatient basis and continued at home whenever possible. OUTCOME MEASURES: Patient selectivity, narcotic dosing requirements, discharge rate, patient preference for analgesic regimen, side effects, complications and cost-effectiveness. RESULTS: The mean initial maintenance infusion dose after dose titration was almost three times higher than the dose required before infusion (hydromorphone or equivalent 6.2 v. 2.1 mg/h). Eighteen patients died, and the remaining 42 were discharged home for a mean of 94.4 (standard deviation 128.3) days (extremes 12 and 741 days). The mean maximum infusion rate was 24.1 mg/h (extremes 0.5 and 180 mg/h). All but one of the patients preferred the infusion system to their previous oral analgesic regimen. Despite major dose escalations nausea and vomiting were well controlled in all cases. Twelve patients (20%) experienced serious systemic toxic effects or complications; six became encephalopathic, which necessitated dose reduction, five had a subcutaneous infection necessitating antibiotic treatment, and one had respiratory depression. The programmable computerized infusion pump was found to be more cost-effective than the disposable infusion device after a break-even point of 8 months. CONCLUSIONS: Continuous subcutaneous infusion of opioid drugs with the use of a portable programmable pump is safe and effective in selected patients who have failed to respond to standard medical treatment of their cancer pain. Dose titration may require rapid dose escalation, but this is usually well tolerated. For most communities embarking on such a program a programmable infusion system will be more cost-effective than a disposable system.

Costs and Cost Analysis↗
PubMedDate not supplied

[The trend in lethal poisonings with narcotic substances in Moscow].

The analysis of the 1989-2005 records of the Moscow Bureau of Forensic-Medical Examinations, statistics on lethal narcotic poisonings by gender, age, education, social and family status has revealed that the trend to reduction of the number of narcotic substances (NS) poisonings stopped in 2003. There was a 238.4% rise in the above poisonings in 2004. The highest rise was in the age group of 21-25-year-olds (35.7%; CI = 0.34-0.37; p = 0.05) and 26-30-year-olds (29.6%; CI = 0.28-0.31; p = 0.05). Among lethal cases one-third were unemployed (35.8%; CI = 0.34-0.37; p = 0.05) and one-forth were workers (22.2%; CI = 0.20-0.24; p = 0.05). By the family status, most of the dead were unmarried (57%; CI = 0.55-0.59; p = 0.05). This study gives a complete and accurate picture of the structure of narcotic drug poisonings. Relevant preventive measures are proposed.

Adolescent↗
PubMed1991

Changing attitudes towards narcotic use in cancer pain management in Japan.

Morphine consumption for medical purposes in Japan showed a 17-fold increase between 1979 and 1989, due to increased use in cancer pain management. This increase is a reflection of the improving attitude of the health care professionals and health policy makers towards narcotics use. The WHO Cancer Pain Relief Programme has ultimately become the basis for a national cancer pain relief programme. The Ministry of Health and Welfare amended the Narcotics and Psychotropics Control Law in 1990, to improve accessibility of morphine preparations to cancer patients with pain, and edited four manuals for palliative care, that include guidelines on cancer pain relief, and legislative management of narcotics use in hospital, clinic and pharmacy.

Analgesics, Opioid↗
PubMed1991

[Use of alcohol and narcotics among Danish adolescents in the 1980's].

A review is presented of the results of epidemiological investigations from 1980 to 1988 concerning the use of alcohol and narcotics among adolescents in Denmark. The material includes ten anonymous questionnaire investigations in all of which school pupils participated and a qualitative interview investigation. Comparison of the age-specific prevalence rates reveals that the use of alcohol and narcotics increases with age and that the intake of alcohol is slightly higher in boys than in girls. The majority of the adolescents drink mainly at weekends and in connection with social events. The use of hash is greatest among boys and the average age for commencing is slightly higher than for alcohol. Apart from hash, the employment of narcotics is low in school pupils. Although approximately 24,000 adolescents were questioned, the investigations together provide an uncertain picture of the habits as these are not representative for Danish adolescents. It is not possible to indicate genuine risk groups. It is concluded that initiatives for prophylactic efforts do not have any basis for action. Repeated national representative questionnaire investigations are proposed supplemented by qualitative interviews with particularly selected adolescents and local key-persons.

Adolescent↗
PubMed1988

Rapid administration of a narcotic and neuromuscular blocker: a hemodynamic comparison of fentanyl, sufentanil, pancuronium, and vecuronium.

High-dose narcotic anesthetic inductions usually avoid circulatory depression better than do other techniques; however, the selection of a narcotic and neuromuscular blocker influences subsequent hemodynamic responses. One hundred-one patients having aortocoronary bypass graft (CABG) surgery were investigated using four combinations of a narcotic and neuromuscular blocker: group FP (fentanyl 50 micrograms/kg, pancuronium 100 micrograms/kg); group FV (fentanyl 50 micrograms/kg, vecuronium 80 micrograms/kg); group SP (sufentanil 10 micrograms/kg, pancuronium 100 micrograms/kg); and group SV (sufentanil 10 micrograms/kg, vecuronium 80 micrograms/kg), each combination being administered over 2 minutes. Hemodynamic functions were then monitored for 10 minutes before tracheal intubation. Significant changes included increases in heart rate in the groups receiving pancuronium and decreases in those receiving vecuronium. In all groups mean arterial pressure initially decreased; systemic vascular resistance index decreased significantly in all groups except SV. Cardiac index decreased significantly only in group SV. Circulatory depression requiring treatment with vasopressor or anticholinergic drugs was more common in patients given vecuronium. Cardiac arrhythmia occurred most often in group SP; only in group FP were there no arrhythmias, ischemic changes, or hemodynamic disturbances requiring intervention. Time to onset of neuromuscular blockade did not differ among the four groups, but transient chest wall rigidity occurred significantly more often with sufentanil than with fentanyl. Overall, the fentanyl/pancuronium combination afforded the greatest hemodynamic stability, whereas the sufentanil/vecuronium combination proved least satisfactory because of bradycardia and hypotension, requiring treatment in 35% of group SV patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Analgesics, Opioid↗
PubMed1988

Disposition of intrapartum narcotic analgesics in monkeys.

Maternal-fetal disposition and neonatal respiratory depressant effect of narcotic analgesics were studied by administration of meperidine (2 mg/kg, IV) or alfentanil (IV infusion, 0.1 mg/kg total dose) during labor in rhesus monkeys. Fetal/maternal plasma ratios were lower for alfentanil, the more highly protein-bound drug (fetal/maternal ratio 0.20 at birth versus 0.46 for meperidine). However, elimination of alfentanil was delayed in the neonate. Indeed, plasma concentrations of alfentanil increased during the first 2 postnatal hours, indicating a compartmental shift from tissues to circulation in the neonate. As regards respiratory depression, six of ten narcotic-treated monkeys had suboptimal (less than 60 breath/min) respiratory rates at birth. Respiratory rate was negatively correlated with cord vein normeperidine and meperidine levels; the strongest correlation was with normeperidine (r = -0.84, P less than 0.01). Neonatal normeperidine elimination in the postnatal period was prolonged, as has also been observed in humans. These studies serve as a basis for comparing the neonatal neurobehavioral effects of the two analgesics and support the use of the rhesus monkey as an animal model to further understanding of the effects of narcotic analgesics on neonatal respiration.

Alfentanil↗
PubMed1987

The use of electronarcosis as anaesthetic in the cichlid, Oreochromis mossambicus (Peters). I. General experimental procedures and the role of fish length on the narcotizing effects of electric currents.

Procedures to narcotize fish by means of alternating or direct electrical currents are described and a method of evaluating the narcotic effects on fish of electrical currents is detailed. The role of fish length on the narcotizing potential of electrical currents was investigated. The results indicate that there is a positive correlation between fish length and the duration of narcosis.

Anesthesia Recovery Period↗