scholarly journals The effect of breakthrough pain on heart and lung function during the cancer pain treatment in palliative care

2011 ◽  
Vol 1 (2) ◽  
pp. 103-109
Author(s):  
Samir Husić ◽  
Dženita Ljuca ◽  
Senad Izić ◽  
Hasan Karahasan
Keyword(s):  
Blood Pressure ◽  
Palliative Care ◽  
Lung Function ◽  
Cancer Pain ◽  
Respiratory Function ◽  
Pain Treatment ◽  
Breakthrough Pain ◽  
Systolic Pressure ◽  
Oral Morphine ◽  
The Mean

Introduction: The aim of the research was to determine the effect of breakthrough pain (BTP) on heart and lung function in patients whose cancer pain had been treated with strong opiates.Methods: A prospective study was conducted on 80 patients who were treated in recumbent patients’ hospice of Palliative Care Centre (hospice) University Clinical Centre Tuzla. The effect of pain breakthrough onheart function was monitored by blood pressure and pulse measuring outside. The effect on respiratory function was monitored by measuring the respiration number with SpO2 and pCO2 and pO2 capillary blood valuesoutside, during and after relieving pain breakthrough.Results: Mean value for Karnofsky score for patients upon admission was 47.13 ± 11.05 and on discharge 51.25 ± 11.73. The total number of pain breakthroughs for patients within the 10 days of the treatment was1396. During the pain breakthrough the mean of systolic pressure was 133.1 mmHg and it was statistically significantly higher than the mean of systolic pressure measured after BTP relief with oral morphine. Themean of diastolic pressure measured outside of pain breakthrough was 75.9 mmHg and after the BTP relief it was 72.9 mmHg. The mean pulse outside of pain breakthrough was 92.7 heartbeats per minute and afterthe BTP relief 8 9.1 heartbeats per minute.Conclusion: Pain breakthrough leads to pulse acceleration, increased systolic and diastolic blood pressure and it also affects respiratory function by accelerating the respiration

scholarly journals The Prevalence and Characteristics of Breakthrough Cancer Pain in Patients Receiving Low Doses of Opioids for Background Pain

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1058
Author(s):  
Sebastiano Mercadante ◽  
Marco Maltoni ◽  
Domenico Russo ◽  
Claudio Adile ◽  
Patrizia Ferrera ◽  
...  
Keyword(s):  
Pain Relief ◽  
Cancer Pain ◽  
Oral Morphine ◽  
Epidemiological Data ◽  
Low Doses ◽  
Advanced Cancer Patients ◽  
Breakthrough Cancer Pain ◽  
Background Pain ◽  
The Mean ◽  
Oral Morphine Equivalent

The aim of this study was to assess the prevalence and characteristics of breakthrough cancer pain (BTcP) in patients receiving low doses of opioids for background pain. A consecutive sample of advanced cancer patients receiving less than 60 mg/day of oral morphine equivalent (OME) was selected. Epidemiological data, background pain intensity, and current analgesic therapy were recorded. The presence of BTcP was diagnosed according to a standard algorithm. The number of BTcP episodes, intensity of BTcP, its predictability and triggers, onset duration, interference with daily activities, BTcP medications, satisfaction with BTcP medication, and time to meaningful pain relief were collected. A total of 126 patients were screened. The mean intensity of background pain was 2.71 (1.57), and the mean OME was 28.5 mg/day (SD15.8). BTP episodes were recorded in 88 patients (69.8%). The mean number/day of BTP episodes was 4.1 (SD 7.1, range 1–30). In a significant percentage of patients, BTcP was both predictable and unpredictable (23%). The BTcP onset was less than 20 min in the majority of patients. The mean duration of untreated episodes was 47.5 (SD 47.6) minutes. The mean time to meaningful pain relief after taking a BTcP medication was >20 min in 44.5% of patients. The efficacy of BTcP medication was not considered good in more than 63% of patients. Gender (females) (OR = 4.16) and lower Karnofsky (OR = 0.92) were independently associated with BTcP. A higher number of BTcP episodes/day was associated with gender (females) (p = 0.036), short duration of BTcP (p = 0.005), poorer efficacy of BTcP medication (none or mild) (p = 0.001), and late meaningful pain relief (p = 0.024). The poor efficacy of BTcP medication was independently associated with a higher number of episodes/day (OR = 0.22). In patients who were receiving low doses of opioids, BTcP prevalence was 69.8%. Many patients did not achieve a sufficient level of satisfaction with BTcP medications, particularly with oral morphine. Data also suggest that better optimization of background analgesia, though apparently acceptable, may limit the number of BTcP episodes.

scholarly journals Etorphine-halothane anaesthesia in two five-year-old African elephants (Loxodonta africana) : clinical communication

1999 ◽  
Vol 70 (4) ◽  
Author(s):  
G.F. Stegmann
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Systolic Pressure ◽  
Loxodonta Africana ◽  
African Elephants ◽  
Clinical Communication ◽  
Dental Surgery ◽  
Blood Pressures ◽  
The Mean ◽  
Mean Heart Rate

Anaesthesia of 2 five-year-old femaleAfrican elephants (Loxodonta africana) was required for dental surgery. The animals were each premedicated with 120 mg of azaperone 60 min before transportation to the hospital. Before offloading, 1 mg etorphine was administered intramuscularly (i.m.) to each elephant to facilitate walking them to the equine induction / recovery room. For induction, 2 mg etorphine was administered i.m. to each animal. Induction was complete within 6 min. Surgical anaesthesia was induced with halothane-in-oxygen after intubation of the trunk. During surgery the mean heart rate was 61 and 45 beats / min respectively. Systolic blood pressures increased to 27.5 and 25.6 kPa respectively, and were treated with intravenous azaperone. Blood pressure decreased thereafter to a mean systolic pressure of 18.1 and 19.8 kPa, respectively. Rectal temperature was 35.6 and 33.9 oC at the onset of surgery, and decreased to 35.3 and 33.5 oC, respectively, at the end of anaesthesia. Etorphine anaesthesia was reversed with 5mg diprenorphine at the completion of 90 min of surgery.

scholarly journals Intrathecal Analgesia Via a Percutaneous Port For the Management of Movement-Evoked Breakthrough Cancer Pain of Refractory Lower Extremity Cancer Pain: A Retrospective Review and Commentary

2021 ◽  
Author(s):  
Liang Zhou ◽  
Zhenggang Guo
Keyword(s):  
Lower Extremity ◽  
Cancer Pain ◽  
Pain Intensity ◽  
Breakthrough Pain ◽  
Infusion Therapy ◽  
The Mean ◽  
Intractable Cancer Pain ◽  
Time To Onset ◽  
Morphine Equivalent ◽  
Intrathecal Analgesia

Abstract Background and Objectives: Intrathecal analgesia (ITA) is a trusty treatment option for refractory and intractable cancer pain. However, there is still no general consensus on the analgesic effect of movement-evoked breakthrough pain (MEBTP) in the ITA setting. This study examined the effect of patient-controlled intrathecal analgesia (PCIA) on analgesic efficacy, emphasizing movement evoked breakthrough pain (MEBTP) in patients with refractory lower extremity cancer pain. Methods: A retrospective chart review included all patients with refractory lower extremity cancer pain who received Intrathecal morphine infusion therapy via percutaneous port (IMITPP) at our hospital between January 2017 and December 2020. Data on the numerical pain rating scales (NRS) scores, opioid doses, and complications were collected from medical records prior to IMITPP and at a one-month postimplant visit.Results: A total of 16 patients were included in the study group. Mean SRPI (spontaneous resting pain intensity) decreased from 8.75 pre- IMITPP to 3.75 post- IMITPP, (P < 0.001); mean MEPI (movement-evoked breakthrough pain intensity) fell from 8.83 pre- IMITPP to 4.25 post- IMITPP (P < 0.001); mean daily morphine equivalent dosing decreased from 360 mg/d to 48mg/d (P< 0.001); mean daily morphine equivalent dosing for MEBTP decreased from 87 mg/d to 6 mg/d (P< 0.001). Both total and breakthrough dosing of conventional opioid medications significantly decreased following the initiation of ITT with PCIA. The mean perceived time to onset with conventional movement evoked breakthrough medications was 38 minutes, and the mean perceived time to onset with PCIA was 8 minutes (P < 0.001). Conclusions: IMITPP was associated with improved pain control in patients with refractory lower extremity cancer pain. Compared with conventional MEBTP medication, appropriate PCIA provided superior analgesia and a much faster onset of action.

scholarly journals Assessment of safety and effectiveness of oral morphine on patients attending pain and palliative care: a study on Indian population

2020 ◽  
Vol 33 (4) ◽  
pp. 184-190
Author(s):  
Sreelakshmi Jayan ◽  
Stephy Stephen ◽  
Kevin Tom Koshy ◽  
Nikhil John Abraham ◽  
Sunitha Daniel ◽  
...  
Keyword(s):  
Palliative Care ◽  
Pain Score ◽  
Indian Population ◽  
Oral Morphine ◽  
Immediate Release ◽  
Study Groups ◽  
Sample Population ◽  
Prescribing Pattern ◽  
Cancer Group ◽  
The Mean

Abstract Opioid analgesics remain the corner stone of effective management of moderate to severe pain. Morphine in its oral and parenteral form is one of the most affordable options left to treat severe cancer pain in most Palliative centres in India. The main objective of our study was to assess the safety and effectiveness, as well as the prescribing pattern of immediate release oral morphine on the Indian population attending Pain and Palliative Care in a multi-speciality hospital. Within the sample population, 74.8% of all patients achieved a pain score reduction of less than or equal to 3 within the 72nd hour. Although the mean baseline pain score was similar in the cancer (8.23±0.75) and the non-cancer (8.26±0.98) group, the mean pain score at the 24th and 72nd hours were significantly different (5.6±1.29 in cancer and 5.09±1.26 in the non-cancer group within the 24th hour, followed by 3.66±1.479 and 3.12±0.88 after the 72nd hour, respectively). The majority of the patients (58.3%) were prescribed at a frequency of 5 mg every 4th hourly, with double dose at bedtime. A similar prescribing trend was seen in both the cancer and non-cancer groups. Moreover, 14 patients underwent dose escalation – with 12 belonging to the cancer group, while 11 patients falling under the cancer group required a switch to different therapy. The major adverse drug reactions (ADR) observed in both study groups were constipation (89.2%), fatigue (37.4%), dry mouth (36%) and nausea/vomiting (23%). The severity of nausea/vomiting and sleepiness was higher in the cancer group whereas itching was more predominant among the non-cancer group.

scholarly journals Oral morphine versus transmucosal diamorphine for breakthrough pain in children: methods and outcomes: UK (DIPPER study) consensus

2021 ◽  
pp. bmjspcare-2021-003278
Author(s):  
Emily Harrop ◽  
Christina Liossi ◽  
Liz Jamieson ◽  
Silke Gastine ◽  
Kate Oulton ◽  
...  
Keyword(s):  
Palliative Care ◽  
Randomised Controlled Trial ◽  
Breakthrough Pain ◽  
Controlled Trial ◽  
Nominal Group Technique ◽  
Oral Morphine ◽  
Nominal Group ◽  
Small Scale ◽  
Paediatric Palliative Care ◽  
Randomised Controlled

ObjectivesNo randomised controlled trials have been conducted for breakthrough pain in paediatric palliative care and there are currently no standardised outcome measures. The DIPPER study aims to establish the feasibility of conducting a prospective randomised controlled trial comparing oral and transmucosal administration of opioids for breakthrough pain. The aim of the current study was to achieve consensus on design aspects for a small-scale prospective study to inform a future randomised controlled trial of oral morphine, the current first-line treatment, versus transmucosal diamorphine.MethodsThe nominal group technique was used to achieve consensus on best practice for mode of administration, dose regimen and a range of suitable pain intensity outcome measures for transmucosal diamorphine in children and young people with breakthrough pain. An expert panel of ten clinicians in paediatric palliative care and three parent representatives participated. Consensus was achieved when agreement was reached and no further comments from participants were forthcoming.ResultsThe panel favoured the buccal route of administration, with dosing according to the recommendations in the Association for Paediatric Palliative Medicine formulary (fifth Edition, 2020). The verbal Numerical Rating Scale was selected to measure pain in children 8 years old and older, the Faces Pain Scale-Revised for children between 4 and 8 years old, and Face, Legs, Activity, Cry and Consolability (FLACC)/FLACC-Revised as the observational tools.ConclusionsThe nominal group technique allowed consensus to be reached for a small-scale, prospective, cohort study and provided information to inform the design of a randomised controlled trial.

scholarly journals Associations between metabolic syndrome and reduced lung function in young people

2017 ◽  
Vol 89 (10) ◽  
pp. 54-61
Author(s):  
N A Kovalkova ◽  
Yu I Ragino ◽  
N Yu Travnikova ◽  
D V Denisova ◽  
L V Shcherbakova ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Lung Function ◽  
Respiratory Function ◽  
Hdl Cholesterol ◽  
Research Society ◽  
High Density Lipoproteins ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Russian Research

Aim. To reveal possible associations between metabolic syndrome (MS) and reduced lung function. Subjects and methods. In 2013—016, a cross-sectional survey was conducted in 908 Novosibirsk dwellers, which included spirometry to evaluate external respiratory function (ERF). For the detection of MS, the investigators used the 2009 All-Russian Research Society of Cardiologists criteria: waist circumference (WC) > 80 cm for women and >94 cm for men in combination with two of the following criteria: blood pressure (BP) ≥130/85 mm Hg, triglycerides (TG) ≥1.7 mmol/l, high-density lipoproteins (HDL) cholesterol

scholarly journals Lifestyle changes counseling reduces central blood pressure in pre-hypertensive individuals: an intervention study

2019 ◽  
Vol 88 (3) ◽  
Author(s):  
Luiz Tadeu Giollo Junior ◽  
Luciana Neves Cosenso-Martin ◽  
Days Oliveira de Andrade ◽  
Letícia Aparecida Fernandes-Baruffi ◽  
Juan Carlos Yugar-Toledo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Mild Hypertension ◽  
Systolic Pressure ◽  
Lifestyle Changes ◽  
The Body ◽  
Central Blood Pressure ◽  
Before And After ◽  
Study Population ◽  
The Mean ◽  
Peripheral Blood Pressure

Introduction: Lifestyle changes (LC) influence peripheral blood pressure (BP) in pre-hypertensive (PH) individuals; the behavior of central systolic BP (CBP) in respect to LC is not fully known. However, pre-hypertension cardiovascular risk is similar to mild hypertension and can be associated with changes in the endothelial function thereby altering the CBP. Objective: Thus, to demonstrate the influence of LC on the peripheral and the central blood pressure in PH individuals.Methods: Fifty-six PH patients were studied before and after three months of LC (Dash diet and aerobic exercises). The CBP was measured by tonometry of the radial artery before and after LC.Results: The mean age of the study population was 48 ± 10.8 years. There were significant reductions in peripheral systolic pressure (127±8.1 vs. 122 ± 9.2, P=0.003), in the body mass index (29.0±4.6 vs. 28.5±4.6, P=0.001) and the waist-hip ratio(0.91 ± 0.07 vs. 0.89 ± 0.06, P=0.0007) and also in the central systolic pressure (113±10.7 vs. 107±10.9, P=0.0001) after three months of LC.Conclusion: Lifestyle changes promote improvement in peripheral and central BP in PH individuals.Aconselhamento sobre mudanças no estilo de vida reduz a pressão arterial central em indivíduos pré-hipertensos: um estudo de intervençãoIntrodução: Aconcselhamento para Modificação no estilo de vida (MEV) influencia diretamente a pressão arterial periférica em indivíduos pré-hipertensos. O comportamento da pressão sistólica central (PSC) em relação à MEV não está plenamente conhecido. Além disso, a pré-hipertensão (PH) oferece risco cardiovascular semelhante ao de um hipertenso leve e pode estar associado com alterações da função endotelial alterando a PSC.Objetivo: Demonstrar a influência da MEV com exercício físico e dieta alimentar em parâmetros antropométricos e hemodinâmicos, incluindo a PSC, em indivíduos pré-hipertensos.Métodos: Foram estudados 56 pacientes com PH antes e após 3 meses de MEV. A PSC foi avaliada utilizando-se um sistema de tonometria da artéria radial antes e após a MEV.Resultados: A média de idade da população estudada foi 48±10,8 anos. Houve redução significativa na PAS (127±8,1 para 122±9,2; p=0,003), PAD (75±7,4 para 72±7,7; p=0,003), PAM (92±7,0 para 89±7,6; p=0,002), IMC (29,0±4,6 para 28,5±4,6; p=0,001) e na relação C/Q (0,91±0,07 para 0,89±0,06; p=0,0007) após 03 meses de MEV. Também se observou redução da PSC (113±10,7 para 107±10,9; p=0,0001) após três meses de MEV.Conclusão: A MEV promoveu melhora pressão arterial periférica e central de indivíduos pré-hipertensos.

Abstract 2961: Ventricular Stiffness Contributes to Hypertension in Patients with Clinical Science Repaired Coarctation of the Aorta

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Hideaki Senzaki ◽  
Hirotaka Ishido ◽  
Satoshi Masutani
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Systolic Pressure ◽  
Regulatory System ◽  
Left Ventricular Pressure ◽  
Coarctation Of The Aorta ◽  
Left Ventricular ◽  
Pressure Area ◽  
The Mean ◽  
Preload Reduction

Background Despite successful repair, patients with coarctation of the aorta (CoA) often show persistent hypertension at rest and/or during exercise. Previous studies indicated that this phenomenon is mainly due to abnormality in arterial bed and its regulatory system. However, blood pressure is determined not only by the state of arterial bed but also by cardiac function to which the blood vessels are coupled. We hypothesized that ventricular stiffness contributes to the hypertensive state in patients with repaired CoA, in addition to increased vascular stiffness. Methods and Results The left ventricular pressure-area relationship was measured invasively in 37 patients (2–14 years of age) with successfully repaired CoA (defined as 0 mmHg pressure gradient) and compared with that of 41 age-matched control subjects who had small ventricular septal defect with an estimated shunt ratio <5%. Data recorded at rest and during transient preload reduction by inferior vena caval obstruction yielded left ventricular chamber stiffness (Ees) and effective arterial stiffness (Ea). The mean systolic blood pressure (SBP) was significantly higher in CoA patients (118±24 mmHg) than in the control (98±9 mmHg, p<0.01). Ees (45±19 mmHg/mlm 2 ) and Ea (36±19 mmHg/mlm 2 ) of CoA patients were significantly higher than those of the controls (18±7 and 20±7 mmHg/mlm 2 , respectively, P<0.001). To quantify the contribution of increased ventricular stiffness to the high SBP in CoA patients, SBP was estimated by assuming that Ees of CoA patients was equal to the mean Ees value of the control. The results showed a significant decrease in blood pressure by 12±5 mmHg, indicating that ventricular stiffness accounts for about 60% of the elevated blood pressure in CoA patients. Conclusions Increased ventricular stiffness greatly contributes to elevated systolic pressure in patients with repaired CoA. Thus, in addition to the recognized arterial stiffness, abnormal neurohumoral activity and autonomic dysfunction, ventricular stiffness could be a viable target for reduction of blood pressure and improvement of prognosis of patients with this disease.

INDIRECT ESTIMATION OF SYSTOLIC AND DIASTOLIC BLOOD PRESSURE IN THE NEWBORN

PEDIATRICS ◽  
1972 ◽  
Vol 50 (3) ◽  
pp. 387-394
Author(s):  
Colin H. M. Walker ◽  
Phillip J. West ◽  
Sanford L. Simons ◽  
Anthony R. Whytock
Keyword(s):  
Blood Pressure ◽  
Diastolic Pressure ◽  
Blood Pressure Monitoring ◽  
Systolic Pressure ◽  
Correlation Coefficients ◽  
Mean Value ◽  
Arithmetic Mean ◽  
Pressure Monitoring ◽  
Blood Pressures ◽  
The Mean

An impedance plethysmographic method for measuring systolic and diastolic blood pressures in small infants using standard electro-cardiogram recorders has been studied. The overall 95% confidence limit of the mean of five estimations was found to be ±3.74 mm Hg for the systolic and ±3.72 mm Hg for the diastolic value. Comparing this method with intra-arterial measurements gave correlation coefficients (r) of 0.95 (bias 10.09 mm Hg) for systolic pressure and 0.89 (Bias 10.09 mm Hg) for diastolic pressure. Values for the comparison with auscultation were 0.98 (bias 19.29 mm Hg) systolic and 0.86 (bias 10.17 mm Hg) diastolic, and for the comparison of the arithmetic mean value with the flush method 0.84 (bias 30.17 mm Hg). These results reveal a good correlation with the intra-arterial measurements and indicate that this technique can be used for the periodic or continuous blood pressure monitoring of infants.

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