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  1. Article: Subanesthetic ketamine for pain management in hospitalized children, adolescents, and young adults: a single-center cohort study.

    Sheehy, Kathy A / Lippold, Caroline / Rice, Amy L / Nobrega, Raissa / Finkel, Julia C / Quezado, Zenaide Mn

    Journal of pain research

    2017  Volume 10, Page(s) 787–795

    Abstract: Background: Subanesthetic doses of ketamine, an : Purpose: We examined the effects of subanesthetic ketamine on pain intensity and opioid intake in children, adolescents, and young adults with acute and chronic pain syndromes treated in an inpatient ... ...

    Abstract Background: Subanesthetic doses of ketamine, an
    Purpose: We examined the effects of subanesthetic ketamine on pain intensity and opioid intake in children, adolescents, and young adults with acute and chronic pain syndromes treated in an inpatient setting.
    Methods: This is a longitudinal cohort study of patients treated with subanesthetic ketamine infusions in regular patient care units in a tertiary pediatric hospital. Primary outcomes included changes in pain scores and morphine-equivalent intake.
    Results: The study cohort included 230 different patients who during 360 separate hospital admissions received subanesthetic ketamine infusions for pain management. Overall, ketamine infusions were associated with significant reductions in mean pain scores from baseline (mean pain scores 6.64 [95% CI: 6.38-6.90]) to those recorded on the day after discontinuation of ketamine (mean pain scores 4.38 [95% CI: 4.06-4.69]),
    Conclusion: These data suggest that administration of subanesthetic ketamine for pain management is feasible and safe in regular inpatient care units and may benefit children, adolescents, and young adults with acute and chronic pain. This study is informative and can be helpful in determining sample and effect sizes when planning clinical trials to determine the role of subanesthetic ketamine infusions for pain management in pediatric patients.
    Language English
    Publishing date 2017-04-05
    Publishing country New Zealand
    Document type Journal Article
    ZDB-ID 2495284-9
    ISSN 1178-7090
    ISSN 1178-7090
    DOI 10.2147/JPR.S131156
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: The Use of Dexmedetomidine in Pediatric Palliative Care: A Preliminary Study.

    Burns, Jamie / Jackson, Kevin / Sheehy, Kathy A / Finkel, Julia C / Quezado, Zenaide M

    Journal of palliative medicine

    2017  Volume 20, Issue 7, Page(s) 779–783

    Abstract: Objective: To evaluate the effect of dexmedetomidine infusions in patients with advanced malignancies, advanced heart disease, or after stem cell transplantation (SCT), who during end-of-life care had pain and/or agitation unresponsive to conventional ... ...

    Abstract Objective: To evaluate the effect of dexmedetomidine infusions in patients with advanced malignancies, advanced heart disease, or after stem cell transplantation (SCT), who during end-of-life care had pain and/or agitation unresponsive to conventional therapies.
    Background: Pediatric patients with intractable advanced malignancies, end-stage congenital heart diseases, or after SCT can suffer a great deal during end of life. Pain, drowsiness, fatigue, irritability, and worrying are experienced frequently, considered distressing, and are strongly associated with reductions in health-related quality-of-life scores. While opioids are the mainstay of analgesic therapy, in some patients, increasing opioid use can be ineffective and can be associated with increasing pain during end of life. Dexmedetomidine, a α
    Methods: Observational cohort study of consecutive patients treated with dexmedetomidine during end of life in a pediatric hospital. Primary outcomes included pain scores and morphine-equivalent intake.
    Results: We identified nine patients [median age 8 (interquartile range; IQR 0.55-17 years)] who during end of life had received dexmedetomidine infusions. In these patients, dexmedetomidine infusions had a median duration of two days (IQR 1.5-12 days) and were associated with significant (p < 0.001) reductions in pain scores and a trend toward decreasing morphine-equivalent intake. There were no hemodynamic changes requiring vasoactive or anticholinergic agents.
    Conclusions: These preliminary findings of beneficial effects of dexmedetomidine support the hypothesis that dexmedetomidine has a role in palliative care of children and adolescents during end of life.
    MeSH term(s) Adolescent ; Analgesics, Non-Narcotic/therapeutic use ; Child ; Child, Preschool ; Cohort Studies ; Dexmedetomidine/therapeutic use ; Female ; Heart Diseases/complications ; Humans ; Hypnotics and Sedatives/therapeutic use ; Infant ; Male ; Pain/drug therapy ; Pain/etiology ; Palliative Care/methods
    Chemical Substances Analgesics, Non-Narcotic ; Hypnotics and Sedatives ; Dexmedetomidine (67VB76HONO)
    Language English
    Publishing date 2017-02-10
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1427361-5
    ISSN 1557-7740 ; 1096-6218
    ISSN (online) 1557-7740
    ISSN 1096-6218
    DOI 10.1089/jpm.2016.0419
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 5440: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  3. Article ; Online: Dexmedetomidine as an Adjuvant to Analgesic Strategy During Vaso-Occlusive Episodes in Adolescents with Sickle-Cell Disease.

    Sheehy, Kathy A / Finkel, Julia C / Darbari, Deepika S / Guerrera, Michael F / Quezado, Zenaide M N

    Pain practice : the official journal of World Institute of Pain

    2015  Volume 15, Issue 8, Page(s) E90–7

    Abstract: Patients with sickle-cell disease (SCD) can experience recurrent vaso-occlusive episodes (VOEs), which are associated with severe pain. While opioids are the mainstay of analgesic therapy, in some patients with SCD, increasing opioid use is associated ... ...

    Abstract Patients with sickle-cell disease (SCD) can experience recurrent vaso-occlusive episodes (VOEs), which are associated with severe pain. While opioids are the mainstay of analgesic therapy, in some patients with SCD, increasing opioid use is associated with continued and increasing pain. Dexmedetomidine, an α2 -adrenoreceptor agonist with sedative and analgesic properties, has been increasingly used in the perioperative and intensive care settings and has been shown to reduce opioid requirement and to facilitate opioid weaning. Therefore, there might be a role for dexmedetomidine in pain management during VOEs in patients with SCD. Here, we present the hospital course of 3 patients who during the course of VOEs had severe pain unresponsive to opioids and ketamine and were treated with dexmedetomidine. Dexmedetomidine infusions that lasted for 3 to 6 days were associated with marked reduction in daily oral morphine-equivalent intake and decreases in pain scores (numeric rating scale). There were no hemodynamic changes that required treatment with vasoactive or anticholinergic agents. These preliminary findings of possible beneficial effects of dexmedetomidine in decreasing opioid requirements support the hypothesis that dexmedetomidine may have a role as a possible analgesic adjuvant to mitigate VOE-associated pain in patients with SCD.
    MeSH term(s) Adolescent ; Analgesics, Non-Narcotic/administration & dosage ; Anemia, Sickle Cell/complications ; Dexmedetomidine/administration & dosage ; Female ; Humans ; Infusions, Intravenous ; Male ; Pain/drug therapy ; Pain/etiology ; Pain Management/methods ; Pain Measurement
    Chemical Substances Analgesics, Non-Narcotic ; Dexmedetomidine (67VB76HONO)
    Language English
    Publishing date 2015-11
    Publishing country United States
    Document type Case Reports ; Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2151272-3
    ISSN 1533-2500 ; 1530-7085
    ISSN (online) 1533-2500
    ISSN 1530-7085
    DOI 10.1111/papr.12336
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 5928: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  4. Article ; Online: Patient characteristics affect the response to ketamine and opioids during the treatment of vaso-occlusive episode-related pain in sickle cell disease.

    Nobrega, Raissa / Sheehy, Kathy A / Lippold, Caroline / Rice, Amy L / Finkel, Julia C / Quezado, Zenaide M N

    Pediatric research

    2017  Volume 83, Issue 2, Page(s) 445–454

    Abstract: BackgroundN-methyl-D-aspartate receptor activation has been implicated in the pathobiology of inflammatory, nociceptive and neuropathic pain, opioid tolerance, opioid-induced hyperalgesia, and central sensitization. Some of those mechanisms underlie ... ...

    Abstract BackgroundN-methyl-D-aspartate receptor activation has been implicated in the pathobiology of inflammatory, nociceptive and neuropathic pain, opioid tolerance, opioid-induced hyperalgesia, and central sensitization. Some of those mechanisms underlie sickle cell disease(SCD)-associated pain.MethodsWe conducted an exploratory cohort study of SCD patients who during vaso-occlusive episodes (VOEs) received subanesthetic doses of the N-methyl-D-aspartate receptor antagonist, ketamine, as an adjunct to opioids. We sought to identify predictors of changes in pain scores and of the percentage of ketamine infusions associated with meaningful changes (≥20% reduction) in pain and opioid consumption.ResultsEight-five patients received 181 ketamine infusions for VOE-associated pain. Combined with opioids, ketamine yielded significant decrease in pain scores and opioid consumption. Ketamine administered to males and to younger patients yielded greater pain score decrease compared with females (P=0.013) and older patients (P=0.018). Fifty-four percent of infusions yielded meaningful reductions in pain scores, and in multivariate analysis, sex, age group, pain location, and infusion duration independently predicted pain score changes.ConclusionThis study suggests that in SCD patients admitted with VOE-associated pain, ketamine has age- and sex-dependent effects. These data can inform sample and effect size calculations for controlled trials to determine which SCD patients would benefit most from ketamine.
    MeSH term(s) Adolescent ; Analgesics, Opioid/therapeutic use ; Anemia, Sickle Cell/complications ; Anemia, Sickle Cell/drug therapy ; Child ; Child, Preschool ; Cohort Studies ; Female ; Humans ; Infusions, Intravenous ; Ketamine/therapeutic use ; Male ; Nerve Tissue Proteins/metabolism ; Pain/drug therapy ; Pain Management/methods ; Pain Measurement ; Receptors, N-Methyl-D-Aspartate/metabolism ; Young Adult
    Chemical Substances Analgesics, Opioid ; GRIN1 protein, human ; Nerve Tissue Proteins ; Receptors, N-Methyl-D-Aspartate ; Ketamine (690G0D6V8H)
    Language English
    Publishing date 2017-09-13
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 4411-8
    ISSN 1530-0447 ; 0031-3998
    ISSN (online) 1530-0447
    ISSN 0031-3998
    DOI 10.1038/pr.2017.197
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 564: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)
    Zs.MO 373: Show issues

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  5. Article ; Online: Subanesthetic ketamine infusions for the treatment of children and adolescents with chronic pain: a longitudinal study.

    Sheehy, Kathy A / Muller, Elena A / Lippold, Caroline / Nouraie, Mehdi / Finkel, Julia C / Quezado, Zenaide M N

    BMC pediatrics

    2015  Volume 15, Page(s) 198

    Abstract: Background: Chronic pain is common in children and adolescents and is often associated with severe functional disability and mood disorders. The pharmacological treatment of chronic pain in children and adolescents can be challenging, ineffective, and ... ...

    Abstract Background: Chronic pain is common in children and adolescents and is often associated with severe functional disability and mood disorders. The pharmacological treatment of chronic pain in children and adolescents can be challenging, ineffective, and is mostly based on expert opinions and consensus. Ketamine, an N-methyl-D-aspartate receptor antagonist, has been used as an adjuvant for treatment of adult chronic pain and has been shown, in some instances, to improve pain and decrease opioid-requirement. We examined the effects of subanesthetic ketamine infusions on pain intensity and opioid use in children and adolescents with chronic pain syndromes treated in an outpatient setting.
    Methods: Longitudinal cohort study of consecutive pediatric patients treated with subanesthetic ketamine infusions in a tertiary outpatient center. Outcome measurements included self-reported pain scores (numeric rating scale) and morphine-equivalent intake.
    Results: Over a 15-month period, 63 children and adolescents (median age 15, interquartile range 12-17 years) with chronic pain received 277 ketamine infusions. Intravenous administration of subanesthetic doses of ketamine to children and adolescents on an outpatient basis was safe and not associated with psychotropic effects or hemodynamic perturbations. Overall, ketamine significantly reduced pain intensity (p < 0.001) and yielded greater pain reduction in patients with complex regional pain syndrome (CRPS) than in patients with other chronic pain syndromes (p = 0.029). Ketamine-associated reductions in pain scores were the largest in postural orthostatic tachycardia syndrome (POTS) and trauma patients and the smallest in patients with chronic headache (p = 0.007). In 37% of infusions, patients had a greater than 20 % reduction in pain score. Conversely, ketamine infusions did not change overall morphine-equivalent intake (p = 0.3).
    Conclusions: These data suggest that subanesthetic ketamine infusion is feasible in an outpatient setting and may benefit children and adolescents with chronic pain. Further, patients with CRPS, POTS, and a history of trauma-related chronic pain are more likely to benefit from this therapeutic modality.
    MeSH term(s) Adolescent ; Ambulatory Care/methods ; Anesthesia, Intravenous/methods ; Anesthetics, Dissociative/administration & dosage ; Child ; Chronic Pain/diagnosis ; Chronic Pain/therapy ; Feasibility Studies ; Female ; Follow-Up Studies ; Humans ; Infusions, Intravenous ; Ketamine/administration & dosage ; Male ; Pain Measurement ; Retrospective Studies ; Time Factors ; Treatment Outcome
    Chemical Substances Anesthetics, Dissociative ; Ketamine (690G0D6V8H)
    Language English
    Publishing date 2015-12-01
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2041342-7
    ISSN 1471-2431 ; 1471-2431
    ISSN (online) 1471-2431
    ISSN 1471-2431
    DOI 10.1186/s12887-015-0515-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: The effects of coxib formulary restrictions on analgesic use and cost: regional evidence from Canada.

    Marshall, Deborah A / Willison, Donald J / Grootendorst, Paul / LeLorier, Jacques / Maclure, Malcolm / Kulin, Nathalie A / Sheehy, Odile E / Warren, Leanne / Sykora, Kathy / Rahme, Elham

    Health policy (Amsterdam, Netherlands)

    2007  Volume 84, Issue 1, Page(s) 1–13

    Abstract: Background: Public insurance plans for pharmaceuticals in Canada differ substantially across provinces in the conditions under which pharmaceuticals are reimbursed. Coxibs provide a good example. Québec had no restrictions on reimbursement for these ... ...

    Abstract Background: Public insurance plans for pharmaceuticals in Canada differ substantially across provinces in the conditions under which pharmaceuticals are reimbursed. Coxibs provide a good example. Québec had no restrictions on reimbursement for these drugs. Ontario required physicians to submit the clinical indications for their use on the prescription. British Columbia required physicians to seek and receive prior authorisation from the drug plan.
    Objective: This study compares the effects of different reimbursement policies on coxib, non-selective non-steroidal anti-inflammatory drugs (nsNSAIDs), and gastro-protective agent (GPA) use and cost.
    Study design: Analysis of retrospective time series analysis of all NSAID and GPA administrative claims data from April 1997 through December 2002.
    Setting: Administrative claims data from April 1997 through December 2002 for each of the publicly funded drug plans in Québec, Ontario, and British Columbia. In addition, we obtained data from BC PharmaNet, which records all dispensed prescriptions in British Columbia.
    Patients or other participants: Senior beneficiaries (>or= 65 years).
    Main outcome measure: We compared the projected total NSAID utilisation in the absence of coxib reimbursement restriction with actual utilisation by province and drug category. Projected utilisation was based on ARIMA modelling and reported as the number of defined daily doses (DDDs) per 100 senior (>or=65 years) beneficiaries/month.
    Results: In Ontario, under its "limited use" policy, uptake and steady-state use of coxibs was similar to that in Québec, where there were no restrictions. In British Columbia, publicly funded use of coxibs was 6% of that in Ontario and Québec. Despite a shift to private reimbursement, total coxib use in BC was only 50% of use in Ontario and Québec. The use of all NSAIDS (nsNSAIDS plus coxibs) increased for all provincial drug plans except for BC. The increase and overall rate of total NSAID use was greatest in Ontario. Neither Ontario's nor BC's policies had an impact on use of nsNSAIDs or GPAs.
    Conclusion: Only BC's policy effectively limited publicly funded coxib use. However, there was substantial cost-shifting to out-of-pocket and third party insurance plans in BC.
    MeSH term(s) Analgesics ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Canada ; Cyclooxygenase 2 Inhibitors/economics ; Cyclooxygenase 2 Inhibitors/therapeutic use ; Evidence-Based Medicine ; Formularies as Topic ; Humans ; National Health Programs/organization & administration ; Organizational Policy ; Reimbursement Mechanisms/organization & administration ; Retrospective Studies
    Chemical Substances Analgesics ; Anti-Inflammatory Agents, Non-Steroidal ; Cyclooxygenase 2 Inhibitors
    Language English
    Publishing date 2007-11
    Publishing country Ireland
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 605805-x
    ISSN 1872-6054 ; 0168-8510
    ISSN (online) 1872-6054
    ISSN 0168-8510
    DOI 10.1016/j.healthpol.2007.04.010
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.B 2250: Show issues Location:
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