Maximum tolerated dose of nalmefene in patients receiving epidural fentanyl and dilute bupivacaine for postoperative analgesia.

Abstract:

BACKGROUND:This study investigated the ability of the modified continual reassessment method (MCRM) to determine the maximum tolerated dose of the opioid antagonist nalmefene, which does not reverse analgesia in an acceptable number of postoperative patients receiving epidural fentanyl in 0.075% bupivacaine. METHODS:In the postanesthetic care unit, patients received a single intravenous dose of 0.25, 0.50, 0.75, or 1.00 microg/kg nalmefene. Reversal of analgesia was defined as an increase in pain score of two or more integers above baseline on a visual analog scale from 0 through 10 after nalmefene administration. Patients were treated in cohorts of one, starting with the lowest dose. The maximum tolerated dose of nalmefene was defined as that dose, among the four studied, with a final mean probability of reversal of anesthesia (PROA) closest to 0.20 (ie., a 20% chance of causing reversal). The modified continual reassessment method is an iterative Bayesian statistical procedure that, in this study, selected the dose for each successive cohort as that having a mean PROA closest to the preselected target PROA of 0.20. RESULTS:The modified continual reassessment method repeatedly updated the PROA of each dose level as successive patients were observed for presence or absence of ROA. After 25 patients, the maximum tolerated dose of nalmefene was selected as 0.50 microg/kg (final mean PROA = 0.18). The 1.00-microg/kg dose was never tried because its projected PROA was far above 0.20. CONCLUSIONS:The modified continual reassessment method facilitated determination of the maximum tolerated dose ofnalmefene . Operating characteristics of the modified continual reassessment method suggest it may be an effective statistical tool for dose-finding in trials of selected analgesic or anesthetic agents.

journal_name

Anesthesiology

journal_title

Anesthesiology

authors

Dougherty TB,Porche VH,Thall PF

doi

10.1097/00000542-200004000-00018

subject

Has Abstract

pub_date

2000-04-01 00:00:00

pages

1010-6

issue

4

eissn

0003-3022

issn

1528-1175

journal_volume

92

pub_type

临床试验,杂志文章
  • Positive end-expiratory pressure improves respiratory function in obese but not in normal subjects during anesthesia and paralysis.

    abstract:BACKGROUND:Morbidly obese patients, during anesthesia and paralysis, experience more severe impairment of respiratory mechanics and gas exchange than normal subjects. The authors hypothesized that positive end-expiratory pressure (PEEP) induces different responses in normal subjects (n = 9; body mass index < 25 kg/m2) ...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章

    doi:10.1097/00000542-199911000-00011

    authors: Pelosi P,Ravagnan I,Giurati G,Panigada M,Bottino N,Tredici S,Eccher G,Gattinoni L

    更新日期:1999-11-01 00:00:00

  • Contribution of the chemokine (C-C motif) ligand 2 (CCL2) to mechanical hypersensitivity after surgical incision in rats.

    abstract:BACKGROUND:Neural glial signaling in the spinal cord may underlie pain and sensitization after peripheral injury. The authors test the role of a glial activator, the chemokine (C-C motif) ligand 2 (CCL2), on mechanical hypersensitivity after plantar incision in a rat model of postoperative pain. METHODS:Twenty-four ho...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0b013e3181d3d978

    authors: Peters CM,Eisenach JC

    更新日期:2010-05-01 00:00:00

  • Influence of polyethylene glycol superoxide dismutase/catalase on altered opioid-induced pial artery dilation after brain injury.

    abstract:BACKGROUND:The current study was designed to investigate the influence of pretreatment with the oxygen radical scavengers polyethylene glycol superoxide dismutase and catalase (SODCAT) on altered opioid-induced pial artery dilation after fluid percussion brain injury (FPI) in the newborn pig. It has been observed previ...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199603000-00017

    authors: Thorogood MC,Armstead WM

    更新日期:1996-03-01 00:00:00

  • Clinician-delivered intervention to facilitate tobacco quitline use by surgical patients.

    abstract:BACKGROUND:Telephone quitlines that provide counseling support are efficacious in helping cigarette smokers quit and have been widely disseminated; currently, they are underused. Surgery represents a teachable moment for smoking cessation, which can benefit surgical outcomes; however, few surgical patients receive smok...

    journal_title:Anesthesiology

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/ALN.0b013e31820d868d

    authors: Warner DO,Klesges RC,Dale LC,Offord KP,Schroeder DR,Shi Y,Vickers KS,Danielson DR

    更新日期:2011-04-01 00:00:00

  • Dynamic and static cerebral autoregulation during isoflurane, desflurane, and propofol anesthesia.

    abstract:BACKGROUND:Although inhalation anesthetic agents are thought to impair cerebral autoregulation more than intravenous agents, there are few controlled studies in humans. METHODS:In the first group (n = 24), dynamic autoregulation was assessed from the response of middle cerebral artery blood flow velocity (Vmca) to a t...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000542-199507000-00008

    authors: Strebel S,Lam AM,Matta B,Mayberg TS,Aaslid R,Newell DW

    更新日期:1995-07-01 00:00:00

  • Effects of subanesthetic concentrations of isoflurane and their interactions with epinephrine on acquisition and retention of the rabbit nictitating membrane response.

    abstract:BACKGROUND:Evidence concerning the concentrations of volatile anesthetics that prevent learning and recall is limited. Epinephrine is believed to enable learning during anesthesia. We investigated the effects of isoflurane and its interaction with epinephrine on learning and subsequent retention of the rabbit's classic...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199407000-00029

    authors: el-Zahaby HM,Ghoneim MM,Johnson GM,Gormezano I

    更新日期:1994-07-01 00:00:00

  • Basal forebrain histaminergic transmission modulates electroencephalographic activity and emergence from isoflurane anesthesia.

    abstract:BACKGROUND:The tuberomammillary histaminergic neurons are involved in the sedative component of anesthetic action. The nucleus basalis magnocellularis (NBM) in the basal forebrain receives dense excitatory innervation from the tuberomammillary nucleus and is recognized as an important site of sleep-wake regulation. Thi...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0b013e3181b061a0

    authors: Luo T,Leung LS

    更新日期:2009-10-01 00:00:00

  • Does the brain influence somatic responses to noxious stimuli during isoflurane anesthesia?

    abstract:BACKGROUND:Recent evidence suggests that anesthetic action within the spinal cord is important in suppressing somatic responses to painful stimuli. Whether the brain influences this response is not clear. This study was designed to test the hypothesis that the brain affects anesthetic requirements. METHODS:Six goats w...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199412000-00027

    authors: Borges M,Antognini JF

    更新日期:1994-12-01 00:00:00

  • Forty-eight hours of postoperative pain relief after total hip arthroplasty with a novel, extended-release epidural morphine formulation.

    abstract:BACKGROUND:Epidural morphine has proven analgesic efficacy in the postoperative period and is widely used. This study evaluated the efficacy of extended-release epidural morphine (EREM; DepoDur; Endo Pharmaceuticals Inc., Chadds Ford, PA; SkyePharma, Inc., San Diego, CA) in providing pain relief for 48 h after surgery....

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1097/00000542-200505000-00022

    authors: Viscusi ER,Martin G,Hartrick CT,Singla N,Manvelian G,EREM Study Group.

    更新日期:2005-05-01 00:00:00

  • A brief regional ischemic-reperfusion enhances propofol-induced depression in left ventricular function of in situ rat hearts.

    abstract:BACKGROUND:Propofol is short-acting intravenous general anesthetics that reduces cardiovascular hemodynamics. The effects of propofol on intrinsic myocardial contractility, however, remain debatable. The aim of the current study was to test the hypothesis that inhibitory effects of propofol on left ventricular (LV) con...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-200410000-00012

    authors: Kuzumoto N,Kitagawa Y,Uemura K,Ueyama T,Yoshida K,Furuya H,Takaki M

    更新日期:2004-10-01 00:00:00

  • Influence of mannitol and furosemide, alone and in combination, on brain water content after fluid percussion injury.

    abstract:BACKGROUND:Furosemide and mannitol are used to reduce intracranial pressure, but the impact of furosemide on edema of injured brain is unclear. The authors examined the effects of furosemide and mannitol, alone and in combination, on brain water content in brain-injured rats. METHODS:Anesthetized rats were subjected t...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-200612000-00017

    authors: Todd MM,Cutkomp J,Brian JE

    更新日期:2006-12-01 00:00:00

  • Volume kinetic analysis of the distribution of 0.9% saline in conscious versus isoflurane-anesthetized sheep.

    abstract:BACKGROUND:The distribution and elimination of 0.9% saline given by intravenous infusion has not been compared between the conscious state and during inhalational anesthesia. METHODS:Six adult sheep received an intravenous infusion of 25 ml/kg of 0.9% saline over 20 min in the conscious state and also during isofluran...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-200202000-00033

    authors: Brauer KI,Svensén C,Hahn RG,Traber LD,Prough DS

    更新日期:2002-02-01 00:00:00

  • Magnesium chloride and ruthenium red attenuate the antiallodynic effect of intrathecal gabapentin in a rat model of postoperative pain.

    abstract:BACKGROUND:Gabapentin, a gamma-aminobutyric acid analog anticonvulsant, has been shown to possess antinociceptive effects in animal models and clinical trials. An endogenous binding site of [3H]gabapentin has been revealed to be the alpha(2)delta subunit of voltage-dependent Ca2+ channels. Magnesium chloride, ruthenium...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-200306000-00026

    authors: Cheng JK,Lai YJ,Chen CC,Cheng CR,Chiou LC

    更新日期:2003-06-01 00:00:00

  • Neurologic changes during awakening from anesthesia.

    abstract::Transient hyperreflexia, the Babinski reflex, and other transient neurologic signs may follow anesthesia in healthy persons. The authors describe the appearance and durations of these signs and relate them to anesthetic agent, time following cessation of anesthesia, and state of arousal. Twenty-nine neurologically nor...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-198102000-00005

    authors: Rosenberg H,Clofine R,Bialik O

    更新日期:1981-02-01 00:00:00

  • The influence of isoflurane on the vascular reflex response to lung inflation in dogs.

    abstract::Positive pressure ventilation can affect hemodynamic stability by neuroreflex-mediated activity. Inhalational anesthesia is known to attenuate the arterial baroreflex function; however, little information is known about the effect of volatile anesthetics on the lung inflation reflex. The influence of isoflurane on sta...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199206000-00017

    authors: Cheng EY,Kay J,Hoka S,Bosnjak ZJ,Coon RL,Kampine JP

    更新日期:1992-06-01 00:00:00

  • Pontine cholinergic mechanisms modulate the cortical electroencephalographic spindles of halothane anesthesia.

    abstract:BACKGROUND:Halothane anesthesia causes spindles in the electroencephalogram (EEG), but the cellular and molecular mechanisms generating these spindles remain incompletely understood. The current study tested the hypothesis that halothane-induced EEG spindles are regulated, in part, by pontine cholinergic mechanisms. M...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199604000-00023

    authors: Keifer JC,Baghdoyan HA,Lydic R

    更新日期:1996-04-01 00:00:00

  • Evaluation of acupuncture anesthesia: a psychophysical study.

    abstract::Four volunteers judged eight levels of thermal stimuli induced by a Hardy dolorimeter, varying in intensity from extremely painful to a low level seldom even perceived. Half of the 406 stimuli were applied during acupuncture and half either before insertion or after removal of the needles. The experimental design mini...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-197511000-00005

    authors: Day RL,Kitahata LM,Kao FF,Motoyama EK,Hardy JD

    更新日期:1975-11-01 00:00:00

  • Emulsified isoflurane enhances thermal transient receptor potential vanilloid-1 channel activation-mediated sensory/nociceptive blockade by QX-314.

    abstract:BACKGROUND:QX-314 produces nociceptive blockade, facilitated by permeation through transient receptor potential vanilloid-1 (TRPV1) channels. TRPV1 channel can be activated by noxious heat and sensitized by volatile anesthetics. The authors hypothesized that emulsified isoflurane (EI) could enhance thermal TRPV1 channe...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0000000000000236

    authors: Zhou C,Liang P,Liu J,Zhang W,Liao D,Chen Y,Chen X,Li T

    更新日期:2014-08-01 00:00:00

  • Effect of oxygen treatment on heart rate after abdominal surgery.

    abstract:BACKGROUND:Cardiac complications are common during the postoperative period and may be associated with hypoxemia and tachycardia. Preliminary studies in high-risk patients after operation have shown a possible beneficial effect of oxygen therapy on arterial oxygen saturation and heart rate. METHODS:The authors studied...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000542-199902000-00008

    authors: Rosenberg-Adamsen S,Lie C,Bernhard A,Kehlet H,Rosenberg J

    更新日期:1999-02-01 00:00:00

  • Analgesic concentrations of lidocaine suppress tonic A-delta and C fiber discharges produced by acute injury.

    abstract::Intravenous lidocaine has been shown to relieve acute postoperative pain and chronic neuropathic pain. It is not known whether analgesia produced by 2-10 micrograms/ml plasma concentrations of lidocaine is due to an effect on peripheral-pain-transducing nerves or to central nervous system effects. The current study ex...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199105000-00020

    authors: Tanelian DL,MacIver MB

    更新日期:1991-05-01 00:00:00

  • Efficacy, dose-response, and safety of ondansetron in prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized placebo-controlled trials.

    abstract:OBJECTIVE:The authors reviewed efficacy and safety data for ondansetron for preventing postoperative nausea and vomiting (PONV). METHODS:Systematically searched, randomized, controlled trials (obtained through MEDLINE, EMBASE, Biological Abstracts, manufacturer's database, manual searching of journals, and article ref...

    journal_title:Anesthesiology

    pub_type: 杂志文章,meta分析

    doi:10.1097/00000542-199712000-00004

    authors: Tramèr MR,Reynolds DJ,Moore RA,McQuay HJ

    更新日期:1997-12-01 00:00:00

  • Halothane modulates the type i interferon response to influenza and minimizes the risk of secondary bacterial pneumonia through maintenance of neutrophil recruitment in an animal model.

    abstract:BACKGROUND:To minimize the risk of pneumonia, many anesthesiologists delay anesthesia-requiring procedures when patients exhibit signs of viral upper respiratory tract infection. Postinfluenza secondary bacterial pneumonias (SBPs) are a major cause of morbidity and mortality. An increased host susceptibility to SBP pos...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0000000000000766

    authors: MacDonald BA,Chakravarthy KV,Davidson BA,Mullan BA,Alluri R,Hakansson AP,Knight PR

    更新日期:2015-09-01 00:00:00

  • Comparison of the spinal actions of the mu-opioid remifentanil with alfentanil and morphine in the rat.

    abstract:BACKGROUND:mu-Opioids administered spinally produce a potent, dose-dependent analgesic response in preclinical and clinical investigations. Side-effect profile of these compounds may be altered as a function of pharmacokinetics. The effects of intrathecal and intraperitoneal remifentanil, an esterase-metabolized mu opi...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199601000-00012

    authors: Buerkle H,Yaksh TL

    更新日期:1996-01-01 00:00:00

  • Anesthetics and mild hypothermia similarly prevent hippocampal neuron death in an in vitro model of cerebral ischemia.

    abstract:BACKGROUND:General anesthetics reduce neuron loss following focal cerebral ischemia in rodents. The relative efficacy of this action among different anesthetics clinically used for neuroprotection is uncertain. In addition, it remains unclear how anesthetics compare to neuroprotection afforded by mild hypothermia. This...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-200005000-00024

    authors: Popovic R,Liniger R,Bickler PE

    更新日期:2000-05-01 00:00:00

  • Injuries and liability related to central vascular catheters: a closed claims analysis.

    abstract:BACKGROUND:To assess changing patterns of injury and liability associated with central venous or pulmonary artery catheters, the authors analyzed closed malpractice claims for central catheter injuries in the American Society of Anesthesiologists Closed Claims database. METHODS:All claims for which a central catheter ...

    journal_title:Anesthesiology

    pub_type: 杂志文章,评审

    doi:10.1097/00000542-200406000-00013

    authors: Domino KB,Bowdle TA,Posner KL,Spitellie PH,Lee LA,Cheney FW

    更新日期:2004-06-01 00:00:00

  • Muscular Tissue Oxygen Saturation and Posthysterectomy Nausea and Vomiting.

    abstract:BACKGROUND:Suboptimal tissue perfusion and oxygenation during surgery may be responsible for postoperative nausea and vomiting in some patients. This trial tested the hypothesis that muscular tissue oxygen saturation-guided intraoperative care reduces postoperative nausea and vomiting. METHODS:This multicenter, pragma...

    journal_title:Anesthesiology

    pub_type: 杂志文章,多中心研究

    doi:10.1097/ALN.0000000000003305

    authors: Li G,Tian DD,Wang X,Feng X,Zhang W,Bao J,Wang DX,Ai YQ,Liu Y,Zhang M,Xu M,Mu DL,Zhao X,Dai F,Yang JJ,Che X,Yanez D,Guo X,Meng L,iMODIPONV Research Group.

    更新日期:2020-08-01 00:00:00

  • Effects of clonidine on postoperative nausea and vomiting in breast cancer surgery.

    abstract:BACKGROUND:Postoperative nausea and vomiting (PONV) is still common, especially among female patients. Our hypothesis is that coinduction with clonidine reduces the incidence of PONV in adult patients undergoing breast cancer surgery. METHODS:Sixty-eight women premedicated with midazolam were randomly allocated to coi...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000542-200205000-00013

    authors: Oddby-Muhrbeck E,Eksborg S,Bergendahl HT,Muhrbeck O,Lönnqvist PA

    更新日期:2002-05-01 00:00:00

  • Sensitization of spinal neurons by non-noxious stimuli in the awake but not anesthetized state.

    abstract:BACKGROUND:The observation that peripheral trauma causes enhanced spinal neuronal excitability has provided the scientific rationale for the concept of "pre-emptive analgesia." The premise has been that only noxious stimuli cause sensitization in sensory pathways, but this premise has not been tested in the conscious s...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199501000-00032

    authors: Herrero JF,Headley PM

    更新日期:1995-01-01 00:00:00

  • Effect of renal failure and cirrhosis on the pharmacokinetics and neuromuscular effects of rapacuronium administered by bolus followed by infusion.

    abstract:BACKGROUND:Recent trials indicate that rapacuronium's pharmacokinetic characteristics are influenced by both renal failure and cirrhosis but the time course of a single bolus dose of 1.5 mg/kg is affected minimally. The authors reassessed these pharmacokinetic findings and examined the time course of the same bolus dos...

    journal_title:Anesthesiology

    pub_type: 杂志文章,多中心研究

    doi:10.1097/00000542-200012000-00007

    authors: Fisher DM,Dempsey GA,Atherton DP,Brown R,Abengochea A,Hunter JM

    更新日期:2000-12-01 00:00:00

  • Isoflurane anesthesia and circadian temperature cycles in humans.

    abstract::Cognitive performance in postsurgical patients may be impaired by disturbances of normal circadian rhythm analogous to those produced by rapid transmeridian travel ("jet lag"). We therefore tested the hypothesis that isoflurane anesthesia alone produces a phase-delay in the human circadian temperature rhythm. We monit...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199112000-00010

    authors: Sessler DI,Lee KA,McGuire J

    更新日期:1991-12-01 00:00:00