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PubMed1985

Atracurium infusion requirements in children during halothane, isoflurane, and narcotic anesthesia.

We were interested in determining the dose-response relationship of atracurium in children (2-10 yr) during nitrous oxide-isoflurane anesthesia (1%) and the atracurium infusion rate required to maintain about 95% neuromuscular blockade during nitrous oxide-halothane (0.8%), nitrous oxide-isoflurane (1%), or nitrous oxide-narcotic anesthesia. Neuromuscular blockade was monitored by recording the electromyographic activity of the adductor pollicis muscle resulting from supramaximal stimulation at the ulnar nerve at 2 Hz for 2 sec at 10-sec intervals. To estimate dose-response relationships, three groups of five children received 80, 100, 150 micrograms/kg atracurium, respectively. During isoflurane anesthesia, the neuromuscular block produced by 80 micrograms/kg was 23.6% +/- 6.5 (mean +/- SEM), by 100 micrograms/kg was 45% +/- 7.2, and by 150 micrograms/kg was 64% +/- 8.7. The ED50 and ED95 (estimated from linear regression plots of log dose vs probit of effect) were 120 micrograms/kg and 280 micrograms/kg, respectively. At equipotent concentrations, halothane and isoflurane augment atracurium neuromuscular block to the same extent, compared to narcotic anesthesia. Atracurium steady-state infusion requirements averaged 6.3 +/- 0.6 micrograms . kg-1 . min-1 during halothane or isoflurane anesthesia; the requirements during balanced anesthesia were 9.3 +/- 0.8 micrograms . kg-1 . min-1 (P less than 0.05). There was no evidence of cumulation during prolonged atracurium infusion.

Anesthesia, General↗
PubMed1988

Use of narcotic antagonists to modify stereotypic self-licking, self-chewing, and scratching behavior in dogs.

We evaluated 2 narcotic antagonists, naltrexone and nalmefene, for treatment of refractory self-licking, self-chewing, and scratching behavior in dogs. Eleven dogs with various irritative or pruritic disorders were medicated with naltrexone (1 mg/kg of body weight, sc) or nalmefene (1 to 4 mg/kg, sc), after a period of control observation during which the dogs had not been medicated. The time for which the dogs were involved in self-licking, self-chewing, or scratching was determined retrospectively by analysis of videotapes. The rates of involvement in either activity before and after treatment were calculated and compared statistically. Treatment with a narcotic antagonist significantly reduced the time spent self-licking, self-chewing, or scratching in 7 of 11 dogs, was partially effective in 3 dogs, and was ineffective in one dog. Dogs with acral lick dermatitis responded most to treatment.

Animals↗
PubMed1988

Clinical pharmacology of antagonists of narcotic-induced respiratory depression. A brief review.

A variety of drugs have been used to antagonize the respiratory depression caused by narcotics. Some of these drugs, such as nalorphine, naloxone, butorphanol, and nalbuphine, are opiates, which interact directly with opiate receptors. Others, such as physostigmine, doxapram, and aminophylline, probably act indirectly by stimulating neuronal pathways involved in the regulation of ventilation. None of these drugs is ideal, and all have adverse side effects. Cardiovascular instability and eradication of analgesia have been troublesome, especially with the use of naloxone. The newer mixed agonist-antagonist agents, butorphanol and nalbuphine, may have significant advantages compared with naloxone. The purpose of this review is to summarize the pharmacology of the common narcotic antagonists, with an emphasis on obtaining acceptable results while avoiding adverse side effects.

Animals↗
PubMed1978

Hepatic extraction of long- and short-acting narcotics in the isolated perfused rabbit liver.

Hepatic extraction of the long-acting narcotic, methadone, was compared to that of the short-acting narcotics, morphine, diacetylmorphine, and meperidine, using an isolated perfused rabbit liver preparation. Methadone was avidly extracted from portal venous blood (86.1 +/- 0.81%) in a single pass through the liver after a bolus injection (1.5 mg) into a nonrecirculating perfusion system. Hepatic extraction of methadone was independent of rate of hepatic blood flow (0.59 to 1.53 ml per g of liver per min) but was altered by increasing the total amount of methadone injected. After a bolus injection of 15.0 and 75.0 mg, the proportions of methadone extracted were reduced to 75 and 56%, respectively. The hepatic extraction of morphine (1.5 mg) was 25%, of diacetylmorphine (1.5 mg) 59%, and of meperidine (1.5 mg) 66% in a single pass, all significantly lower (P less than 0.01) than that of methadone. Subcellular fractionation of whole liver homogenates after a single pass of drug showed that methadone and its metabolites were localized primarily in the fractions containing nuclei, mitochondria, microsomes, and other membranes, whereas morphine was primarily localized in the supernatant cytosol. Unchanged methadone was shown to be slowly released from the liver into hepatic effluent blood along with small amounts of the inactive pyrrolidine and pyrroline metabolites (identified by gas chromatography and mass spectrometry). These findings suggest that the liver may serve not only as a site of biotransformation of methadone, but also as a major reservoir for storage and subsequent release of unchanged compound.

Animals↗
PubMed1983

Withdrawal tolerance and unidirectional non-cross-tolerance in narcotic pellet-implanted mice.

Analgesic ED50 values were determined for s.c. morphine, etorphine, heroin and methadone in mice implanted for 3 days with etorphine pellets. Tolerance to morphine (9-fold) was greater than to the other agents (2- to 4-fold). These results agreed with the previously reported unidirectional non-cross-tolerance effect seen after morphine pellet implantation where tolerance to the hydrophilic agent (morphine) was greater than for the more lipophilic agents (etorphine and heroin). As greater tolerance was found to s.c. morphine than for i.c.v. morphine, this manifestation of tolerance was described as a dispositional tolerance. Experimentally, we were able to observe two additional manifestations of tolerance. After pellet removal, the ED50 values for s.c. morphine, heroin and methadone initially increased before returning to control values. Similarly, both morphine and etorphine ED50 values, after i.c.v. administration, initially increased after pellet removal. Because this second manifestation of tolerance occurred during the rapid disappearance of the tolerance-induction drug, it was called withdrawal tolerance. The third manifestation of tolerance, seen after 3 days of pellet implantation, was characterized by the animal's return to a normal nociceptive sensitivity (control tail-flick latency) in the continued presence of the narcotic pellet. Because this adjustment involved an adaptation by the mice to high brain concentrations of narcotic, this third manifestation of tolerance was designated as a physiologic or homeostatic tolerance. The lability of this new homeostatic state (physiologic tolerance) may be associated with an altered sensitivity to naloxone as evidenced by naloxone-induced jumping (precipitated withdrawal).

Animals↗
PubMed1982

The use of non-narcotic drugs and other alternatives for analgesia as part of a comprehensive pain management program.

Chronic pain remains an enigma which mystifies the most experienced clinicians. The traditional approaches to malignant pain employ narcotic analgesics, radiotherapy, surgical intervention, and chemotherapy. Within the context of a "therapeutic community" oriented pain unit, we attack this major public health problem differently. The use of non-narcotic analgesics, mood altering medications, various forms of psychotherapy (individual, group, family, gestalt, psychomotor) and peer pressure when used in conjunction with various physical modalities of treatment (including biofeedback, transcutaneous electrical nerve stimulator, physical therapy, whirlpool, massage, ice, heat, etc.) appear most efficacious. Frequently, the powerful tools of psychological medicine are taken for granted; yet, depression in the United States is widespread and so significantly complicates medical illness that any treatment program designed for pain patients must be holistic in its orientation if it is to be effective.

Analgesia↗
PubMed1982

Analysis of fatalities from acute narcotism in a major urban area.

The incidence of acute, fatal narcotism in San Francisco was determined to be 3.2% of all deaths (10 882) subject to medical examiner's inquiry in a five-year period. Heroin was responsible for the greatest number of these cases, usually accompanied by alcohol or other abused drugs. The median concentration of the heroin metabolite, morphine, in the blood in fatal cases was 20 microgram/dL. Death from propoxyphene, the second most frequently encountered narcotic, was generally determined to be suicidal, while death from heroin was judged to be accidental. The highest rate occurred in black males between the ages of 21 and 30 years. The three most consistent findings were positive identification of the drug in the body (100% of the cases), pulmonary edema (90.4% of the cases), and microscopic liver changes (71.1% of the cases).

Adolescent↗
PubMed1982

Some observations on the effects of enantiomers of two benzomorphan narcotic antagonists and atropine on analgesia, tremor and hypothermia produced by oxotremorine.

The action of the benzomorphan narcotic antagonists Mr-1452 and Mr-2266 and their respective (+) isomers Mr-1453 and Mr-2267 as well as the antimuscarinic agent atropine upon oxotremorine (OTMN)-induced analgesia, tremor, and hypothermia were investigated in mice. The (+) isomers Mr-1453 (1.0 mg kg-1 i.p.) and Mr-2267 (2.0 mg kg-1 i.p.), but not the (-) isomers (Mr-1452 and Mr-2266) in doses up to 2.0 mg kg-1 i.p. after 30 min pretreatment produced a significant and parallel shift in OTMN's analgesic dose-response line, assessed by the hot plate test (55 degrees C). None of the isomers tested produced any significant change in OTMN induced tremor or hypothermia. This contrasted with atropine (0.5 mg kg-1 i.p.) which antagonized all three pharmacological parameters. The present data indicate that OTMN-induced analgesia in mice may involve a neuronal substrate which, at least partly, differs from those subserving tremor and hypothermia. In addition it supports the notion that cholinergic analgesia exhibits stereospecific sensitivity to the (+) isomers of narcotic antagonists.

Animals↗
PubMed1978

Nitrous-narcotic-relaxant anesthesia vs. volatile anesthesia in the adult surgical outpatient.

A review of the advantages and disadvantages of nitrous-narcotic-relaxant vs. inhaled volatile anesthesia for outpatients results in the following conclusion: For most anesthesiologists in most settings, inhaled volatile anesthesia (with or without supplemental neuromuscular blocking agents) is probably superior to nitrous-narcotic-relaxant anesthesia (Table 1). Every anesthesiologist administering anesthesia to adult surgical patients on an outpatient basis must evaluate the surgical procedure being performed and his own anesthetic skill in deciding which of these techniques is best suited to any particular patient. It is only by constant attention to all factors that we can continue to provide the finest in anesthetic care for adult outpatients.

Adult↗
PubMed1976

Stereoselective and calcium-dependent contractile effects of narcotic antagonist analgesics in the vascular smooth muscle of the rat.

In patients, pentazocine administered i.v. can have an unusual action for a strong analgesic-an elevation of blood pressure. The objective of this study in rats was to better quantify and explain the molecular mechanism for the vascular action of l-pentazocine and compare it with other analgesics and narcotic antagonists. In anesthetized rats, l-pentazocine (0.3-3 mg/kg i.v.) elevated blood pressure and this effect was potentiated in pithed rats. The contraction appeared to be nonadrenergic as it was not blocked by the alpha blocker, phenoxybenzamine. In vitro, morphine (ED50 = 4 X 10(-5) M) and the l-isomers of pentazocine (ED50 = 8 X 10(-6) M) contracted the spirally cut aortic strip. The l-isomers were approximately 5 times more potent than their d-enantiomers. Contraction of the aorta by l-pentazocine was not inhibited by dibenamine, atropine, diphenhydramine, pyrilamine or indomethacin nor potentiated by propranolol. On the other hand, not only was the contraction highly dependent on the concentration of calcium in the bath but it was also blocked by verapamil and SKF-525A, drugs known to inhibit transmembrane calcium influx. Naloxone (3 X 10(-4) to 1 X 10(-3) M), which produced no contractile effect by itself, reduced aortic contraction of l-pentazocine to the greatest extent, that of potassium moderately and that of norepinephrine only slightly. The naloxone blockade of l-pentazocine vascular contraction was reversed by increasing Ca++ concentration in the media, suggesting the action of naloxone may resemble a calcium blocker. It is proposed that a direct, stereoselective and calcium dependent vascular action of l-pentazocine contributes to its ability to raise blood pressure. The possibility that in high doses narcotic antagonists may decrease calcium influx should also be considered.

Analgesics, Opioid↗
PubMed1995

A case study: identification and treatment of narcotic depression in the ambulatory surgical patient.

The staff in a freestanding ambulatory surgical center (ASC) must be prepared to identify and treat all emergencies and untoward patient responses. This case study exemplifies some of the problems encountered with a patient who had surgery late in the day and who did not have local anesthetic infiltrated for pain control after inguinal herniorrhaphy. In a retrospective analysis and discussion of the case, the caregivers identified that, in addition to the narcotics given, this patient's lengthy postoperative course was further complicated by inadequate intravenous fluid replacement and ambulation too soon after narcotic administration. From this case study a number of lessons were identified, particularly for the freestanding ASC. These lessons relate to adequate staffing (two nurses) for late cases, the importance of the presence of the anesthesiologist at the center until all patients have been discharged, the need to assure that home conditions are adequate for patients discharged late in the day, and the staff's ability to quickly and accurately identify and treat untoward patient responses.

Ambulatory Surgical Procedures↗
PubMed1994

[Smuggling of narcotics in body cavities].

Smuggling of narcotics by internal concealment has increased considerably worldwide, including in the Scandinavian countries. During the period 1988-92, Norwegian custom officials reported 245 seizures where packets of narcotics had been inserted into the rectum or vagina, or had been swallowed. Based on two fatal cases as a result of intestinal obstruction and cocaine intoxication respectively, this report summarizes the main features of the "body packer" syndrome.

Adult↗
PubMed1976

Actions of narcotics on brain dopamine metabolism and their relevance for "psychomotor" effects.

A review is given about the effects of narcotic analgesics, particularly of morphine, on the dopamine metabolism in the corpus striatum and about the relations of these effects to motility and "psychomotor" phenomena. In rats, acute doses of morphine decrease the dopaminergic neurotransmission in brain, without blocking postsynaptic dopamine receptors. Chronic treatment of rats with morphine reverses these acute effects of morphine and induces symptoms of an increased dopaminergic neurotransmission in brain. In mice and cats on the other hand, acute doses of morphine apparently increase dopaminergic neurotransmission. The effects of morphine on striatal dopamine metabolism seem to be a model well suited to study opioid-specific effects on a cellular level. Furthermore, they might also be responsible for some narcotic-specific effects on behaviour observed in animals and man.

Analgesics, Opioid↗
PubMed1994

Investigating narcotic diversion.

Management is responsible for developing policies and procedures not only for handling of narcotics but also for investigating and intervening in drug-related incidents. Both nurse managers and peers often feel ill-prepared to deal with drug impairment. Nurses who suspect a peer of substance abuse should notify the manager, who must cross-check all medication documentation and look for the many tell-tale signs of narcotic diversion. If sufficient evidence is discovered, the nurse must be confronted and directed to some type of peer assistance or other recovery program.

Drug and Narcotic Control↗
PubMed1993

Benefits of an automated narcotic retrieval system.

A comparison was made in effectiveness of lock and key and automated narcotics retrieval systems. Time required per narcotic averaged 137 seconds for the traditional mode and 48 seconds for the automated system. This resulted in a monthly savings of $594, along with general nurse satisfaction and a perception of increased security.

Automation↗
PubMed1997

[Poisoning with narcotics and hallucinogens in material from the Clinic of Acute Poisoning in Lodz (1993-1996)].

Our material consists of the patients treated for poisonings with street-drugs in Clinic of Acute Poisonings, Lódź, Poland during the period 1993-1996. During the time of 4 years, the number of hospitalised patients have grown up 4.5 times. The structure of used drugs has also changed. Up to 1993 the most popular were opiates derivatives and narcotic analgetics-morphine derivatives. In 1996 almost all narcotics are common, opiates (both natural and synthetic), cocaine, LSD, amphetamine and commonly used (by youngsters especially) Cannabis sativa (marihuana etc). The most common sources of poisoning in our material were opiates and amphetamine, followed by tetrahydrocannabinol derivatives-marijuana.

Adolescent↗
PubMed1976

Circling behavior after narcotic drugs and during naloxone-precipitated abstinence in rats with unilateral nigral lesions.

Unilateral lesions of the substantia nigra zona compacta (SNC) in rats were produced by electrolytic coagulation or by an injection of 6-hydroxydopamine. Two to 5 weeks later, after being preselected for amphetamine-induced ipsilateral circling behavior, the animals were administered narcotic agonists or antagonists and their circling behavior was observed. Morphine, methadone, levorphanol, nalorphine or pentazocine induced ipsilateral circling movements; both naloxone and dextrorphan were without effect. Ipsilateral circling was also observed in rats with unilateral electrolytic lesions after administration of agents that are thought to enhance central dopaminergic activities: d-amphetamine, l-dopa and apomorphine. In rats with unilateral electrolytic or 6-hydroxydopamine SNC lesions that were rendered highly morphine-dependent by multiple-morphine pellet implantation, contralateral (C) circling behavior was observed within 1 to 2 minutes after a naloxone challenge; the onset and duration of C circling behavior coincided with the initial appearance and duration of precipitated-morphine withdrawal signs. C circling was also observed after administration of putative dopamine receptor blockers, haloperidol and pimozide in rats with either unilateral electrolytic or 6-hydroxydopamine SNC lesions. Morphine pretreatment diminished both the C circling intensity and the appearance of withdrawal signs observed after a naloxone challenge in morphine-dependent, SNC-lesioned rats. The naloxone-precipitated withdrawal in unilaterally lesioned morphine-dependent rats was accompanied by a 20% elevation of neostriatal dopamine in the intact side. In contrast to the effects of a chronic SNC lesion in decreasing neostriatal dopamine, a 77% increase was observed in the lesioned side 30 minutes after electrolytic coagulation. Thus, narcotic agonists and partial agonists may enhance central dopaminergic activities and naloxone-precipitated withdrawal may involve a diminution in central dopaminergic activities of the nigroneostriatal pathway.

Animals↗
PubMedDate not supplied

Withdrawal after narcotic therapy: a survey of neonatal and pediatric clinicians.

Pharmacists at the 1995 American College of Clinical Pharmacy Pediatric Practice and Research Network meeting volunteered to act as coordinators at their sites and survey pediatric and neonatal nurses, pharmacists, and physicians regarding dependency in neonatal and pediatric patients after therapeutic administration of narcotics. Thirteen (60%) of 21 coordinators returned 244 surveys. Primary symptoms of withdrawal reported by clinicians were agitation (100%), irritability (100%), inconsolability (100%), crying (99%), tremors (98%), high heart rate (98%), fidgets (98%), high blood pressure (97%), less sleep (96%), and sweating (94%). Most clinicians considered narcotic withdrawal to be a problem (74%) that should be treated (87%). A dependency scale is being developed and will include symptoms reported by more than 75% of respondents.

Child, Preschool↗