雷米芬坦尼尔诱导的过敏症:目前的情况
Alexander A Vitin1, Talmage D Egan2
1Department of Anesthesiology, Perioperative & Pain Medicine.
Current opinion in anaesthesiology
|June 6, 2024
概括
在停止高剂量雷米芬坦尼尔输注后,可以出现雷米芬坦尼尔诱导的过敏症 (RIH). 了解其机制和预防策略对于患者护理至关重要.
科学领域:
- 麻醉学 麻醉学
- 药理学 药理学是指药理学的学科.
- 神经科学是一个神经科学.
背景情况:
- 阿片类药物诱导的过敏症 (OIH) 是一个复杂的临床现象.
- 雷米芬坦尼尔诱导的过敏症 (RIH) 是OIH的一种特定形式.
- RIH与高频率的雷米芬坦尼尔输注 (>0.3mcg/kg/min) 的突然停止有关.
研究的目的:
- 探索RIH的潜在机制.
- 审查潜在的预防和管理RIH的战略.
主要方法:
- 临床和动物研究的文献综述.
- 对拟议的病理生理机制的分析.
- 建议药理干预措施的评估.
主要成果:
- 拟议的机制包括N-甲基-D-酸盐受体过活化,脊柱促进和增强的dynorphin.
- 已经研究了缓慢戒断,普罗波福,胺,布普伦诺芬,NSAIDs,美沙和德克斯米德托米丁等干预措施.
- 这些策略的成功程度各不相同,需要进一步的研究.
结论:
- 在临床麻醉中,RIH是一个重要的关注点.
- 需要对RIH机制和有效的预防/管理进行进一步的研究.
相关概念视频
Analgesia and Pain Management
579
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
579
Opioid Analgesics: Synthetic and Semisynthetic Opioids
276
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
276
Parenteral Anesthetics: Overview
118
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
118
Nociception
27.8K
Nociception—the ability to feel pain—is essential for an organism’s survival and overall well-being. Noxious stimuli such as piercing pain from a sharp object, heat from an open flame, or contact with corrosive chemicals are first detected by sensory receptors, called nociceptors, located on nerve endings. Nociceptors express ion channels that convert noxious stimuli into electrical signals. When these signals reach the brain via sensory neurons, they are perceived as pain.
27.8K
Local Anesthetics: Clinical Application as Epidural Anesthesia
429
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
429


