Log in to search using one of your social media accounts:

 

An observational study examining the effects of a surgically induced inflammatory response on the distribution of morphine and its metabolites into cerebrospinal fluid

AbstractPurpose Morphine is administered intravenously for pain management in the perioperative period. The effect of the inflammatory response to surgery on morphine distribution across the blood-brain barrier (BBB) in humans was investigated. We hypothesized that a graded surgically induced, systemic inflammatory response alters cerebrospinal fluid (CSF) levels of morphine, morphine-3-glucuronide (M3G), and morphine-6-glucuronide (M6G) through a temporary reduction in BBB drug efflux transporter function.MethodsWe conducted a prospective pharmacokinetic study of the plasma and CSF distribution of the P-glycoprotein (PGP) substrate morphine in 33 patients undergoing open thoracic (n = 18) or endovascular (n = 15) aortic aneurysm repair. Morphine was administered with induction of anesthesia and in the intensive care unit. Plasma and CSF concentrations of interleukin (IL)-6, morphine, M3G, M6G, and albumin were measured prior to surgery (baseline), during surgery, and postoperatively every six hours until removal of the CSF drain. The area under the curve (AUC) was determined for plasma and CSF IL-6, morphine, M3G, and M6G concentrationsvs time. The primary endpoint measures were the correlations between the morphine, M6G, and M3G AUC CSF/plasma ratios and systemic inflammation as quantified by the time-normalized IL-6 exposure, which was calculated for each individual by dividing the total exposure (AUC) by time (t). A Bonferroni correctedP 
Source: Canadian Journal of Anesthesia - Category: Anesthesiology Source Type: research

Related Links:

n A Abstract Acute aortic dissection is a rare but life-threatening condition with a lethality rate of 1 to 2% per hour after onset of symptoms in untreated patients. Therefore, its prompt and proper diagnosis is vital to increase a patient's chance of survival and to prevent grievous complications. Typical symptoms of acute aortic dissection include severe chest pain, hypotension or syncope and, hence, mimic acute myocardial infarction or pulmonary embolism. Advanced age, male gender, long-term history of arterial hypertension and the presence of aortic aneurysm confer the greatest population attributable risk. H...
Source: Swiss Medical Weekly - Category: General Medicine Authors: Tags: Swiss Med Wkly Source Type: research
Abstract: Chronic contained rupture of an abdominal aortic aneurysm with vertebral body erosion most commonly presents with symptoms of low back pain. Although not well known, vertebral body erosion or destruction may be seen in up to 25% of patients with sealed or contained rupture of an abdominal aortic aneurysm. This appearance on cross-sectional imaging may mimic a malignant or infectious process. Although these cases can present a diagnostic challenge, published cases of chronic contained rupture of an abdominal aortic aneurysm with vertebral body erosion demonstrate clinical and imaging similarities that, when recogn...
Source: Journal of Computer Assisted Tomography - Category: Radiology Tags: Musculoskeletal Radiology Source Type: research
We report the case of a previously healthy adolescent who presented with chest pain and fever and who developed a mycotic aneurysm of the aorta after contracting community-acquired, methicillin-resistant Staphylococcus aureus. Early recognition of widening of the patient's superior mediastinum, noted during a comparison of the patient's initial and follow-up chest radiographs, prompted computed tomographic angiography of the chest and led to a timely diagnosis, rapid surgical intervention, and a good clinical outcome. To our knowledge, this is the first reported case of mycotic aortic aneurysm from community-acquired methi...
Source: Texas Heart Institute Journal - Category: Cardiology Authors: Tags: Tex Heart Inst J Source Type: research
Abstract PURPOSE: Morphine is administered intravenously for pain management in the perioperative period. The effect of the inflammatory response to surgery on morphine distribution across the blood-brain barrier (BBB) in humans was investigated. We hypothesized that a graded surgically induced, systemic inflammatory response alters cerebrospinal fluid (CSF) levels of morphine, morphine-3-glucuronide (M3G), and morphine-6-glucuronide (M6G) through a temporary reduction in BBB drug efflux transporter function. METHODS: We conducted a prospective pharmacokinetic study of the plasma and CSF distribution of the P...
Source: Canadian Journal of Anaesthesia - Category: Anesthesiology Authors: Tags: Can J Anaesth Source Type: research
We describe a man with the Marfan syndrome and a prior ascending aortic aneurysm resection who presented with knee pain and concern of endocarditis. Transesophageal echocardiogram showed no vegetations, and computed tomography angiogram of the heart showed a possible pseudoaneurysm. Cardiac catheterization and aortogram revealed the diagnosis of an aorto-right atrial fistula, which was then operatively repaired. This case highlights the role that cardiac catheterization with aortogram can play in the detection of aorto-atrial fistula. PMID: 28670063 [PubMed - in process]
Source: Baylor University Medical Center Proceedings - Category: Universities & Medical Training Authors: Tags: Proc (Bayl Univ Med Cent) Source Type: research
An 85-year-old man presented with dyspnea and mild left precordial pain. He was a heavy smoker with chronic obstructive pulmonary disease, diabetes, hypertension, and a 20-year history of thoracic aortic aneurysm (TAA) that he refused to have repaired. Over the past few weeks he became increasingly dyspneic, dysphonic, and developed solid-food dysphagia.
Source: Mayo Clinic Proceedings - Category: Internal Medicine Authors: Tags: Medical images Source Type: research
A 56-year-old man with long-standing Beh çet’s disease presented with recurrent sepsis attacks resulting from an aortoenteric stent placed 2 years previously. The patient initially was evaluated for abdominal pain with a computed tomography (CT) scan that showed a 5 × 3-cm aortic aneurysm. A laparotomy was performed and a Dacron graft was placed after the removal of the aneurysmatic aortic segment. One year after surgery, the patient was hospitalized for osteomyelitis and an abscess in the fascial planes surrounding the femur.
Source: Clinical Gastroenterology and Hepatology - Category: Gastroenterology Authors: Tags: Electronic Image of the Month Source Type: research
By KENNETH BARTHOLOMEW, MD My big brother Bill, may he rest in peace, taught me a valuable lesson four decades ago. We were gearing up for an extended Alaskan wilderness trip and were having trouble with a piece of equipment. When we finally rigged up a solution, I said “that was harder than it should have been” and he quipped in his wry monotone delivery, “There are no hard jobs, only the wrong tools.” That lesson has stuck in my mind all these years because, as simple as it seems, it carries a large truth. It rings of Archimedes when he was speaking about the simple tool known as the lever: &ldquo...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Uncategorized EHR EMR Knowledge Coupler Number Needed to Kill POMR value-based care Source Type: blogs
Among-51 patients with Behcet's disease diagnosed at our centers between 1979 and May 1989, nine had major pulmonary involvement (18%). All were males with a mean age of 30 years. Four presented with hemoptysis, three with chest pain, and two with both; all had oro-genital ulcers but only one patient had uveitis. Three patients were found to have pleural effusion, four had pulmonary artery aneurysm with vasculitis, one had thoracic aortic aneurysm, and one had widespread pulmonary thromboembolism. Good clinical and radiological responses were seen after treatment with either steroids alone or in combination with immunosuppressive agents.
Source: Annals of Saudi Medicine - Category: Journals (General) Tags: ISSUE 4 Source Type: research
[Image from unsplash.com]This week we saw a few FDA 510(k) clearances and one of the 1st uses of a next-generation surgical robot in Asia. Here are 7 medtech stories we missed this week but thought were still worth mentioning: 1. Corindus touts first Asian use of next-generation robot Corindus Vascular Robotics announced in a March 31 press release that robot-assisted PCI procedures were performed for the first time in Asia using the CorPath GRX system. The procedures were performed at Fu Wai Hospital. This is the first time the system has been used outside of the U.S. CorPath GRX enhances the precision and workflow of the...
Source: Mass Device - Category: Medical Equipment Authors: Tags: Clinical Trials Food & Drug Administration (FDA) Robot-Assisted Surgery Robotics Stent Grafts Amniox Bodycad Corindus Endologix MedTech NeoSurgical NeoTract Providence Medical Tissuetech Source Type: news
More News: Abdominal Aneurysm Repair | Anesthesia | Anesthesiology | Aortic Aneurysm | Brain | Canada Health | Cardiovascular & Thoracic Surgery | Gastroschisis Repair | Intensive Care | Morphine | Neurology | Pain | Pain Management | Study