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oral and maxillofacial surgery procedures. As NSAIDs are generally unavailable, if acetaminophen alone is ineffective, then combined administration with a weak opioid or tramadol can be useful. Pentazocine, which acts mainly as a kappa-opioid receptor agonist but also as a partial mu-opioid receptor agonist/antagonist, is widely used to treat moderate to severe postoperative pain in Japan. 11 Based on its mechanism of action, pentazocine may have weaker side effects in patients with IBD than a full mu-opioid agonist such as morphine or fentanyl. 12 This

available only for oral administration. The equianalgesic dose compared to morphine has not been established, but its potency is low. By convention, 100 mg is considered equipotent to oral codeine 60 mg. It is similar to meperidine in that it is converted to norpropoxyphene, a central nervous system stimulant having an elimination half-life of 30 hours. Its use should be limited to short-term management of mild to moderate pain. Pentazocine Pentazocine is the only oral agonist-antagonist analgesic available in the United States. It

numerous regimens cannot possibly be memorized, but several interesting concepts are discussed. For example, if skin irritation occurs because of a fentanyl patch, a 2-puff spray with beclomethasone from a metered-dose inhaler before applying the patch will often help. Methadone, which is a μ and δ agonist with NMDA blocking properties, will often work when a pure μ agonist (morphine) has not. Ketamine or dextromethorphan, both with NMDA-blocking properties, may behave in a similar fashion. Also, women with dental pain may respond better to κ agonists such as pentazocine

.” However, IgE antibodies have been detected that react with several opioids, including codeine, 38 and nearly all opioids are capable of triggering degranulation of mast cells leading to the direct release of histamine. 39 Until issues regarding cross-reactivity among opioids are resolved, a prudent approach would be to select alternatives that are molecularly dissimilar. For example, when a patient reports clinical signs that are allergic in nature, one should select an agent that is not derived from morphine or codeine (eg, propoxyphene, pentazocine). 40

the systematic review, 2 studies 10 , 12 were conducted in children, while the remaining studies 9 , 11 were conducted in the adult population. Of the studies conducted in the adult population, Lipp et al 9 also used a fixed dose of pentazocine. Since both groups received the same dose of pentazocine, this study was included, as this would not interfere with the results. The characteristics of the included studies are mentioned in Table 1 and risk of bias in Table 2 . Figure 1 Study flow

considered when the presence of the patch has not been identified. Dentists who administer opioid agonist-antagonists such as nalbuphine (Nubain), butorphanol (Stadol), or pentazocine (Talwin), or who foolishly use naloxone reversal of opioids to electively speed recovery, will undoubtedly produce an acute opioid abstinence syndrome (acute narcotic withdrawal) that can be extremely unpleasant for the patient and even life threatening. This possibility is exemplified by a moderate sedationist who was sedating an apparently healthy patient who had indicated on his

initially supplemented by 4 L/min of oxygen via the intake port of the mask. She was administered NCPAP for all sleep periods thereafter for the duration of her stay in the ICU. She experienced no episodes of apnea or desaturation in the ICU and complained of little pain with analgesic agents of pentazocine, 15 mg, and hydroxyzine, 25 mg. Her recovery was uneventful and she was discharged from the hospital 8 days after her operation. Discussion Although many reports have addressed anesthetic management in patients with OSAS, there are

. A continuous infusion of DEX 6.0 mcg/kg/h was started at 1320. Following an IV bolus of hydroxyzine 15 mg, an IV infusion of cefmetazole 1 g diluted with normal saline (NS) 100 mL was administered. Pentazocine 12 mg was given as an IV bolus at 1328. The DEX infusion rate was reduced to 0.7 mcg/kg/h at 1330, at which point the patient's blood pressure, pulse rate, respiratory rate, and SpO 2 were 100/73 mm Hg, 60 bpm, 16 breaths/min, and 96%, respectively. At this time his Ramsay sedation score (RSS) was 3 to 4, which corresponded to moderate sedation. The patient

intraoperative blood loss because the vasoconstrictor does not act within the operative field. 1 2 Peripheral nerve blocks also do not anesthetize the buccal nerve. Therefore, we often administer analgesics such as opioids during conscious sedation when local anesthesia becomes ineffective. There were many cases of ineffective local anesthesia that required removal of those cases from this study. We preferred to avoid the administration of opioids to ambulatory patients because opioids in Japan (fentanyl, pethidine [meperidine], morphine, butorphanol, pentazocine

Alertness/Sedation Scale (OAA/S) between 1 and 2 Pentazocine (7.5–15 mg) was injected intravenously for pain management, as required. Postoperative mean blood pressure, heart rate, mean infusion rate of propofol, and analysis of blood gases were examined. This study demonstrates that the mean infusion rate of propofol was higher in the sedation based on BIS than OAA/S. However, this did not affect the respiration status or hemodynamics. It was considered that BIS might allow for prompt adjustment of propofol administration rate, since BIS could detect changes in