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Prospective Randomized Trial of Patient-Controlled Analgesia: PATIENTS AND METHODS part 2
4 Dec2010
Before the hysterectomy procedure, each patient received ranitidine 150 mg orally. The general anesthetics thiopental and propofol were used for all patients. Rocuronium or vecuronium was used for muscle relaxation. A preoperative antibiotic, either cefazolin (1 g) or cefotetan (1 g), was given intravenously. PCA was started in the Post-Anesthetic Care Unit. The PCA device was programmed to deliver 1-mL doses of medication— either ketamine and morphine combined or morphine alone—with a bolus dose of 2 mL permitted and a lock-out time of 6 min. The aim of the lock-out period is to prevent overdose through excessive demands for analgesia. Postoperative antiemetics were allowed at the discretion of the anesthesiologist, who used a standardized postoperative nausea and vomiting protocol specific to the hospital. If nausea and vomiting occurred, the patient was to receive dimenhydrinate initially, followed by metoclopramide. If nausea and vomiting continued, ondansetron was to be given.
- In: Drugs
- Tags: ketamine, morphine, Pain, randomized study
The Pharmacy and Therapeutics Committee at the authors’ institution reviewed the protocol for this study, and approval was obtained from the Research Ethics Board. The study began in July 2001, and the original goal was to recruit 50 patients. However, in July 2002 the study was interrupted by a labour disruption and was never resumed.
- In: Drugs
- Tags: ketamine, morphine, Pain, randomized study
INTRODUCTION
Morphine is commonly used as an analgesic for the control of postoperative pain and is the “gold standard” against which all other analgesics are compared. Morphine acts mainly as an agonist at specific receptor sites in the central nervous system. Evidence suggests that both hyperanalgesic effects after tissue injury and opioid tolerance involve activation of the Л-methyl- D-aspartate (NMDA) receptor and subsequent biochemical processes that result in central sensitization. Morphine also causes many undesirable side effects, including nausea and vomiting through direct stimulation of the chemoreceptor trigger zone.
- In: Drugs
- Tags: ketamine, morphine, Pain, randomized study
Adherence to Canadian Diabetes Association Clinical Practice Guidelines: DISCUSSION part 2
1 Dec2010
The CDA’s 2003 CPGs recommend use of acetyl- salicylic acid (unless contraindicated) for all patients with evidence of cardiovascular disease, as well as those with atherosclerotic risk factors. Some consider people with diabetes to have the same high risk of myocardial infarction as people without diabetes who have had a previous myocardial infarction.23,24 This study used a conservative definition of patients eligible for treatment with acetylsalicylic acid, whereby atherosclerotic risk was defined as a
At least 63% of the patients in this study had initial monitoring parameters measured; however, achievement of follow-up monitoring was much lower. The hemoglobin AK target was achieved for 93% of the patients, but less than 45% of patients achieved other laboratory targets. Less than 60% of eligible patients received recommended medications.
Much controversy surrounds the use of CPGs. Some guidelines do not adhere well to established method- ologic standards, and the 2003 CPGs of the CDA in particular have been criticized for possible financial conflicts of interest. Despite this criticism, these guidelines were used as the basis for the study reported here because they represent the current standard for management of diabetes in Canada.
Of the 349 patients with type 2 diabetes who first visited the Diabetes Education Centre in 2004, 167 (48%) met the inclusion criteria. The other patients were excluded because they did not meet age criteria (140 [40%]), they did not attend a formal Session 1 class (40 [11%]), or they died (causes of death unknown) (2 [<1%]). Patients’ data were available for a median period of 120 days (range 1-645 days) from their first visit to the Diabetes Education Centre.
Selected baseline characteristics are displayed in Table 3. Of the 167 patients, 104 (62%) were men; their mean age was 53 years, and at the time of first visit to the Diabetes Education Centre, the mean time since diagnosis was 54 days. At baseline, 30/166 (18%) patients were current smokers, 90/100 (90%) had metabolic syndrome, and the mean body mass index was 32 kg/m2. Mean fasting plasma glucose, blood pressure, and LDL cholesterol were all above CDA targets.
This quality assessment was performed at the Diabetes Education Centre of Lions Gate Hospital. The study was approved by the University of British Columbia Clinical Research Ethics Board.