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Efficacy of Midazolam/Meperidine vs Midazolam/Hydromorphone for Enteral Moderate Sedation in the Pediatric Dental Patient
Bryce W. Kinard DMD,
 Andrew S. Zale DMD, MSD, and
 Kenneth L. Reed DMD
Article Category: Research Article
Volume/Issue: Volume 71: Issue 1
Online Publication Date: May 03, 2024
DOI: 10.2344/22-00037
Page Range: 15 – 18

psychosis. 6 Hydromorphone is an effective alternative that should be assessed. However, a PubMed search of “hydromorphone pediatric dental sedation” produced no results. There was no established research comparing oral midazolam and meperidine vs oral midazolam and hydromorphone in any sedation realm. The purpose of this investigation was to retrospectively compare the sedation and treatment success of enteral midazolam and meperidine with that of enteral midazolam and hydromorphone in a pediatric dental setting. The primary goal was to provide practitioners with an

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Figure 3; Molecular structures of morphine, codeine, and derivatives. The top row illustrates molecular structures for morphine and its two derivatives, hydromorphone and oxymorphone. The subtle changes indicated by the asterisks enhance affinity for the opioid receptors, which accounts for greater potency. The bottom row illustrates codeine and its derivatives, which differ from their morphine-derived counterparts only in a methyl substitution (circled). Approximately 60% of an oral dose of codeine-related products is absorbed and may be subjected to varying degrees of demethylation by CYP2D6 to its active metabolite. Framed molecules are those credited with the analgesic effect provided by various codeine-related products. Codeine has little affinity for opioid receptors. Roughly 10% of an absorbed dose is demethylated to morphine, which is credited with its analgesic effect. Hydrocodone and oxycodone have good receptor affinity and provide an analgesic effect. The analgesic effect of hydrocodone is credited to both the parent drug and its active metabolite, hydromorphone, but analgesia provided by oxycodone is almost entirely the result of the parent drug. Very little is demethylated to oxymorphone.
Daniel E. Becker
Figure 3
Figure 3

Molecular structures of morphine, codeine, and derivatives. The top row illustrates molecular structures for morphine and its two derivatives, hydromorphone and oxymorphone. The subtle changes indicated by the asterisks enhance affinity for the opioid receptors, which accounts for greater potency. The bottom row illustrates codeine and its derivatives, which differ from their morphine-derived counterparts only in a methyl substitution (circled). Approximately 60% of an oral dose of codeine-related products is absorbed and may be subjected to varying degrees of demethylation by CYP2D6 to its active metabolite. Framed molecules are those credited with the analgesic effect provided by various codeine-related products. Codeine has little affinity for opioid receptors. Roughly 10% of an absorbed dose is demethylated to morphine, which is credited with its analgesic effect. Hydrocodone and oxycodone have good receptor affinity and provide an analgesic effect. The analgesic effect of hydrocodone is credited to both the parent drug and its active metabolite, hydromorphone, but analgesia provided by oxycodone is almost entirely the result of the parent drug. Very little is demethylated to oxymorphone.

Managing Pain—the Canadian Healthcare Professional's Reference, 2nd Edition
Dr Earle R. Young BSc, DDS, BScD, MSc, FADSA
Article Category: Book Review
Volume/Issue: Volume 52: Issue 1
Online Publication Date: Mar 01, 2005
DOI: 10.2344/0003-3006(2005)52[42:MPCHPR]2.0.CO;2
Page Range: 42 – 43

or oxycodone than do men. Another interesting point in the area of opioid tolerance is that the presence of metabolites (eg, morphine−3 or 6-glucuronide) may be accumulated and interfere with analgesia and may even cause hyperalgesia. Excitatory amino acids, the NMDA receptor, nitric oxide, protein kinease C, and other secondary messengers may affect the responsiveness of opioid receptors. And oxycodone and hydromorphone are often good first choices in the elderly because of their hydrophilicity and few active metabolites. This manual is clearly written by

New-Onset Accelerated Idioventricular Rhythm During Dental Rehabilitation
Jonathan D. Rizner BA,
 Heather L. Bartlett MD, and
 Robert E. Shaw MD
Article Category: Case Report
Volume/Issue: Volume 69: Issue 4
Online Publication Date: Dec 19, 2022
DOI: 10.2344/anpr-69-02-13
Page Range: 32 – 36

otherwise healthy, and this was his first exposure to any anesthetic agents. After successful oral premedication with midazolam 20 mg, general anesthesia was induced with inhalational sevoflurane, and peripheral intravenous access obtained. Rocuronium 20 mg was given to facilitate nasal intubation, and hydromorphone 0.2 mg was titrated for analgesia. Anesthesia was maintained with 2% sevoflurane in an oxygen/air mixture. Prior to initiation of the dental procedure, the dentist administered 1 mL of 2% lidocaine with 1:100 000 epinephrine (total: lidocaine

Drug Therapy in Dental Practice: Nonopioid and Opioid Analgesics
Daniel E. Becker DDS and
 James C. Phero DMD
Article Category: Other
Volume/Issue: Volume 52: Issue 4
Online Publication Date: Jan 01, 2005
DOI: 10.2344/0003-3006(2005)52[140:DTD]2.0.CO;2
Page Range: 140 – 149

dose and clinical duration in Table 2 . Table 2. Opioid Analgesics * Genetic predisposition for biotransformation of opioids can lead to poor analgesia in certain patients. Codeine has very little affinity for the mu receptor and may be considered a prodrug because 10% of the parent drug is converted to morphine by cytochrome P450 CYP2D6. The same can be said for hydrocodone and oxycodone, which require demethylation to hydromorphone and oxymorphone, respectively ( Figure 3 ). Approximately

Assessing the Effectiveness of Combined Analgesics for Bilateral Ramus Osteotomies
Shigeru Maeda DDS, PhD,
 Hitoshi Higuchi DDS, PhD,
 Maki Fujimoto DDS,
 Saki Miyake DDS,
 Yuka Honda-Wakasugi DDS, PhD, and
 Takuya Miyawaki DDS, PhD
Article Category: Research Article
Volume/Issue: Volume 67: Issue 3
Online Publication Date: Sep 29, 2020
DOI: 10.2344/anpr-67-01-05
Page Range: 140 – 145

and flurbiprofen, a study with a larger sample size or RCT should be considered. Fourth, although fentanyl used for induction of GA was ignored in this study, it might be effective for pain management after surgery to some extent. Fifth, additional studies should likely include the use of alternative analgesics such as intravenous opioids via PCA, liposomal bupivacaine, 13 hydromorphone, 14 other NSAIDs, and long-acting opioids. CONCLUSION The use of combined analgesics administered at the end of the bilateral ramus osteotomy procedures

Pain Management: Part 1: Managing Acute and Postoperative Dental Pain
Daniel E. Becker DDS
Article Category: Research Article
Volume/Issue: Volume 57: Issue 2
Online Publication Date: Jan 01, 2010
DOI: 10.2344/0003-3006-57.2.67
Page Range: 67 – 79

, codeine, and derivatives. The top row illustrates molecular structures for morphine and its two derivatives, hydromorphone and oxymorphone. The subtle changes indicated by the asterisks enhance affinity for the opioid receptors, which accounts for greater potency. The bottom row illustrates codeine and its derivatives, which differ from their morphine-derived counterparts only in a methyl substitution (circled). Approximately 60% of an oral dose of codeine-related products is absorbed and may be subjected to varying degrees of demethylation by CYP2D6 to its active

Preoperative and Postoperative Hyperalgesia in Dental Patients on Chronic Opioid Therapy: A Pilot Study
Peggy Compton RN, PhD,
 Steven Wang DMD, MD, MPH,
 Camron Fakhar MD, DDS,
 Stacey Secreto CCRC,
 Olivia Halabicky Arnold RN, PhD,
 Brian Ford MD, DMD, and
 Elliot V. Hersh DMD, MS, PhD
Article Category: Research Article
Volume/Issue: Volume 70: Issue 1
Online Publication Date: Mar 28, 2023
DOI: 10.2344/anpr-69-03-03
Page Range: 9 – 16

. 19.  Suzan E, Eisenberg E, Treister R, Haddad M, Pud D. A negative correlation between hyperalgesia and analgesia in patients with chronic radicular pain: is hydromorphone therapy a double-edged sword

Cardiac Failure in a Trisomy 9 Patient Undergoing Anesthesia: A Case Report
Cara J. Riley DMD, MS,
 Timothy Moore CRNA, MS, MSNA,
 Lauren Eagelston,
 Dale Burkett MD,
 Scott Auerbach MD, and
 Richard J. Ing MBBCh, FCA(SA)
Article Category: Case Report
Volume/Issue: Volume 64: Issue 1
Online Publication Date: Jan 01, 2017
DOI: 10.2344/anpr-63-04-01
Page Range: 29 – 32

treatment. The patient was maintained on sevoflurane (0.8–2%) combined with a propofol infusion (30–100 mcg/kg/min), and received a dose of 200 mcg hydromorphone approximately halfway through the anesthetic. In view of the hemodynamic and oxygen saturation problems encountered at induction, at the end of the dental procedure a transthoracic echocardiogram was performed. Poor acoustic windows prompted transesophageal echocardiogram to be completed while the patient was still anesthetized. These tests demonstrated an ejection fraction of 25–30% with left ventricular

Psychotropic Drugs: Implications For Dental Practice
Daniel E. Becker DDS
Article Category: Research Article
Volume/Issue: Volume 55: Issue 3
Online Publication Date: Jan 01, 2008
DOI: 10.2344/0003-3006-55.3.89
Page Range: 89 – 99

SSRI antidepressants inhibit several families of hepatic enzymes (CYP-450), which may delay the biotransformation and clearance of numerous other drugs. Of particular importance for dentistry is the CYP2D6 family of enzymes, which is responsible for demethylating codeine, hydrocodone, and oxycodone to their active metabolites; morphine, hydromorphone, and oxymorphone, respectively. The SSRI antidepressants vary in their intensity for inhibiting these enzymes, with fluoxetine (Prozac) and paroxetine (Paxil) having the greatest influence. Patients medicated with these