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Oxadol (nefopam hydrochloride), a central analgesic, was used for postoperative pain relief in patients operated on the abdominal and pelvic organs for cancer. The analgesic effect of oxadol was sufficient for arresting moderate postoperative pain. Although the drug exerts rather many side effects, none of them notably deteriorated the clinical status of patients.
OBJECTIVE: To determine whether medullary reaming alone, or followed by cemented hemiarthroplasty, influenced porosity, vascularity, and new bone formation in the proximal portion of the femur in dogs. ANIMALS: 12 adult mixed-breed dogs. PROCEDURE: Unilateral femoral head and neck excisions were performed, followed by femoral medullary reaming in 6 dogs and femoral medullary reaming and cemented hemiarthroplasty in 6 dogs; the contralateral femur was used as a control. All dogs were euthanatized 28 days after surgery, and femurs were harvested. Vascularity, porosity, and new bone formation were quantified for all femurs of dogs from both groups at 3 proximal-to-distal levels, 3 regions (periosteal, midcortical, and endosteal), and 4 quadrants (cranial, caudal, medial, and lateral) of the femur. RESULTS: Medullary reamed and cemented hemiarthroplasty femurs had significant increases in vascularity and porosity at all levels and in new bone formation at levels 2 and 3. Porosity was increased significantly in the periosteal region of the cemented hemiarthroplasty (9.7+/-0.7%), compared with control (2.3+/-0.2%) and medullary reamed (8.4+/-0.7%) femurs. Porosity was increased in the caudal and medial quadrants in the medullary reamed and cemented hemiarthroplasty femurs; vascularity results were similar. CONCLUSION: Increased porosity, vascularity, and new bone formation in reamed and cemented hemiarthroplasty-treated femurs supports the theory that surgical trauma associated with medullary reaming is an important factor in early cortical bone loss after hip arthroplasty. CLINICAL RELEVANCE: Femoral remodeling associated with reaming and broaching is appreciable but may be only a temporary response, whereas other factors may be responsible for chronic cortical bone loss.
Acute cat experiments were conducted to study the effect of naloxone, moradol and dalargin on the formation of afferent reactions of gastroduodenal complex components by registration of cortical and subcortical evoked potentials during electrostimulation of the stomach and duodenum at an early stage of their acute lesion. It is found that agonists and antagonists of opiate receptors prevent the depression of afferentation of gastroduodenal complex components early after acute lesion. It is suggested that the main mechanism underlying the depression of gastric and duodenal afferent reactions at early post-alteration period may be related to activation of intraorganic opioid systems.
The present-day problem is the development of effective methods of general anesthesia and postoperative anesthesia on the basis of nonopiate central analgesics possessing no hazardous side effects of opiates. A study was made of synthetic analgesics of the last generation as agents for intra- and postoperative anesthesia as compared with conventional opiates. It has been established that synthetic analgesics belonging to the class of opiate agonists-antagonists, namely moradol and norphine, compare favourably enough with fentanyl. They are superior to fentanyl in antistressor properties, provide for a more powerful and longer analgesic effect and can replace conventional opiates in all the stages of surgical treatment of the patients. This is particularly important for the oncological clinic where opiates are to be preserved as reserve for the treatment of chronic painful syndrome.
Opioid analgesics were used in 282 patients on the first-third day after heart, lung and abdominal surgery. The main indication for their use was pain syndrome. Adequate analgesia with tramal, nubain and moradol was noted in 73, 76 and 81% of cases. In marked pain syndrome after thoracotomy the most effective agents were moradol and morphine. Computer monitoring of the respiratory function in tramal analgesia has shown a decrease in lung ventilation, esophageal pressure, inhalation volume, O2 production. Tramal, nubain and moradol in analgesic doses did not inhibit respiration. In adequate analgesia there was a decrease in lung ventilation which was not accompanied by shifts in acid-base balance of the arterial blood. The above analgesics had no considerable effect on systemic hemodynamics, though the use of tramal decreased systemic blood pressure and the use of moradol decreased systemic blood pressure and total peripheral vascular resistance. Tramal was most effective for synchronization of spontaneous respiration with a lung ventilation device in prolonged ventilation, as well as for the arrest of muscular tremor in the postoperative period. Tramal was effective in 95% of patients in the early post-anesthesia and postoperative period.
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Pharmacodynamic and pharmacokinetic peculiarities of moradol have been studied during natural delivery. It has been shown that moradol injected both intramuscularly and intravenously in the first period of labour did not inhibit the circulation in the women in labour, had no impact on the course of labour and had no negative effect on the newborn. The use of moradol is recommended for analgesia of natural delivery. A correlation has been established between blood drug concentration and its pharmacodynamic indexes in women.
Previous investigators have demonstrated that oxygen desaturation may occur in laboring women. The purposes of this study were to identify groups at risk for desaturation and to seek correlation with newborn outcome. Volunteers in labor were evaluated for oxygen desaturation, analgesic exposure, magnesium sulfate administration, and various medical illnesses. Desaturations were noted more frequently in women exposed to narcotic analgesics, sedatives, and magnesium sulfate. A trend toward more desaturations in the women with preeclampsia was noted. Although desaturations related to narcotic analgesics and sedatives are most likely due to hypoventilation, the mechanism in women treated with magnesium sulfate is uncertain. Maternal peripartum desaturations did not result in unfavorable neonatal Apgar scores, cord blood gas measurements, or neonatal oxygen desaturation values, but the staff was aware of the events and prompt treatment was instituted.
The purpose of this article is to describe the phenomenon of postanesthesia shaking (PS) and discuss its significance to the patient recovering from anesthesia, and to review the literature on the subject. Based on this review, future studies are recommended to replicate previous work, and to provide a more comprehensive picture of PS. Results of research may determine further treatment for PS.
OBJECTIVES: To develop a systems approach to identify, for further evaluation, patients with potential controlled substance misuse or mismanagement using software queries applied to administrative health claims data. STUDY DESIGN: Retrospective validation of the system using insurance claims. PATIENTS AND METHODS: Data from administrative health claims databases representing nearly 7 million individuals younger than 65 years were used by multidisciplinary expert panels to develop and validate controlled substance patterns of utilization requiring evaluation (CS-PURE) criteria. RESULTS: Thirty-four CS-PURE queries were developed in SAS and applied to administrative claims records to identify patients with potential controlled substance misuse or mismanagement. From these, we identified 10 CS-PURE with the highest expert agreement that intervention was warranted. Expert panel agree, ment that CS-PURE correctly identified cases ranged from 48% to 100%, with at least 50% agreement in 9 of 10 CS-PURE. The prevalence rates for CS-PURE ranged from 0.001% to 0.252%. This translates to identifying between 5 and 1116 patients for individual CS-PURE in a 500 000-member health plan. CONCLUSIONS: We developed and empirically validated a group of queries using CS-PURE to identify patients with potential controlled substance misuse or mismanagement that would warrant further evaluation by the treating physician, a quality assurance function, or the medical director. Claims-based CS-PURE identification is generalizable to most health insurers with access to medical and pharmaceutical claims records. Although CS-PURE are not direct measures of misuse, they can direct attention to potential problems to determine if intervention is needed.
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The study has been performed right after surgery in 20 patients of the test group (subgroups I and II) and 20 control patients. Surgery for urologic cancer has been performed in all the patients by transabdominal approach using general anesthesia based on neuroleptanesthesia (NLA). It has been shown that in patients with hypoventilation moradol, administered intravenously at a dose of 1 mg, restores adequate respiration and gas exchange. Patients with apnea upon administration of 1 mg moradol recovered respiration in hypoventilation regimen. Repeated injection of 1 mg moradol promoted the recovery of adequate respiration and gas exchange in all the patients. The patients of the test group were extubated 12.4 +/- 0.1 min on an average after the operation. Control patients, who had not been administered moradol, were extubated 20.4 +/- 0.7 min on an average after the operation. It is shown that the use of moradol in patients after NLA leads to a drastic decrease in the incidence and degree of postoperative pain syndrome and postanesthesia chill.
The efficacy of local anesthesia during upper abdominal endoscopy was compared to that of local anesthesia in combination with moradol. Local anesthesia of the throat combined with intramuscular moradol (0.04 mg/kg) helps retain psychoemotional indifference and stable hemodynamic and autonomous system parameters in such traumatic moments of the endoscopy as irritation and dilatation, which cannot be said of patients who were subject to such interventions under local anesthesia alone.
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Osteoplastic operations on the jaws were carried out in 19 patients aged 14-64 under moradol anesthesia. The mean length of the operation was 3 hours. The authors come to a conclusion that moradol in a dose of 0.3 mg/kg b. w. ensures adequate anesthesia, with a high level of analgesia persisting in the immediate postoperative period.
Moradol ("Galenika", Yugoslavia)/butorphanol tartrate ("Bristol--Mayers C.", USA)/, a synthetic analgesic representing a new generation of opiate receptors agonists-antagonists, devoid of any narcogenic potential has been used as the only analgesic at all stages of anesthesia during cancer surgery in 26 patients. For premedication moradol was used in a mean dose of 0.032 +/- 0.003 mg.kg-1 in combination with diazepam (0.153 +/- 0.005 mg.kg-1) and atropine (0.01 mg X X kg-1). For induction to anesthesia moradol was used in a dose of 0.72 +/- 0.003 mg.kg-1 and diazepam in a dose of 0.27 +/- 0.015 mg.kg-1. General anesthesia was maintained with moradol, diazepam, nitrous oxide and droperidol. The data presented in the paper demonstrate the advantages of moradol at all stages of intra- and postoperative analgesia, which ensures stable anesthetic background (according to hemodynamic parameters) and reduces considerably an overall postoperative analgesic dose.
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Moradol was used for postoperative analgesia in 39 patients subject to urgent surgery. Promedol was used as a control. It has been found that a marked pain syndrome in the early postoperative period in patients examined was characterized by certain deviations of the parameters studied. Moradol, as compared to promedol, has a better analgesic effect, causing milder respiration and hemodynamic changes. With intravenous drug injection, a more profound analgesia is associated with a greater respiratory depression.