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101. Intrathecal meperidine reduces intraoperative shivering during transurethral prostatectomy in elderly patients. (Full text)

Intrathecal meperidine reduces intraoperative shivering during transurethral prostatectomy in elderly patients. Shivering is a frequent event during the perioperative period. We performed a prospective, randomized, double-blind study to determine whether intrathecal meperidine (0.2 mg/kg) decreases the incidence and intensity of shivering after spinal anesthesia for transurethral operations.Fifty patients scheduled for elective transurethral resection operations under spinal anesthesia were (...) randomly allocated to two groups. Spinal anesthesia consisted of 0.5% hyperbaric bupivacaine 8 mg and, mperidine (0.2 mg/kg) (meperidine group) or, normal saline (saline group). Data collection, including sensory block level (by pinprick), blood pressure, heart rate, sublingual temperature, incidence and intensity of shivering, pruritus, nausea, and vomiting was performed at 10 minute intervals.The incidence and intensity of shivering was significantly less in the meperidine group than saline group (P

2011 Korean journal of anesthesiology Controlled trial quality: uncertain PubMed abstract

102. The relative efficacy of meperidine for the treatment of acute migraine: a meta-analysis of randomized controlled trials (Full text)

The relative efficacy of meperidine for the treatment of acute migraine: a meta-analysis of randomized controlled trials Despite guidelines recommending against opioids as first-line treatment for acute migraine, meperidine is the agent used most commonly in North American emergency departments. Clinical trials performed to date have been small and have not arrived at consistent conclusions about the efficacy of meperidine. We performed a systematic review and meta-analysis to determine (...) identified, of which 11 were appropriate and had available data. Four trials involving 254 patients compared meperidine to dihydroergotamine, 4 trials involving 248 patients compared meperidine to an antiemetic, and 3 trials involving 123 patients compared meperidine to ketorolac. Meperidine was less effective than dihydroergotamine at providing headache relief (OR=0.30; 95% confidence interval [CI] 0.09 to 0.97) and trended toward less efficacy than the antiemetics (OR=0.46; 95% CI 0.19 to 1.11

2009 EvidenceUpdates PubMed abstract

103. Remifentanil vs. meperidine for patient-controlled analgesia during colonoscopy: a randomized double-blind trial (Abstract)

Remifentanil vs. meperidine for patient-controlled analgesia during colonoscopy: a randomized double-blind trial The aim was to compare patients' and endoscopists' satisfaction in terms of efficacy and safety of remifentanil patient-controlled analgesia (PCA) during colonoscopy with that of a combination of midazolam and meperidine.Sixty patients undergoing colonoscopy were randomly assigned to two groups. All of the patients received midazolam 0.03 mg/kg intravenously for premedication (...) . In the remifentanil group, a bolus dose of remifentanil was given, and a patient-controlled sedation analgesia (PCSA) pump was set to inject further bolus doses with no "lockout" time. Patients in the meperidine group received a bolus of meperidine and sham PCSA. Non-invasive arterial blood pressure, electrocardiography, and pulse oximetry were monitored throughout the study. The Observer's Assessment of Alertness and Sedation Scale (OAA/S) was performed at baseline, every 5 min during, and after colonoscopy

2009 EvidenceUpdates Controlled trial quality: predicted high

104. Canadian guidelines on opioid use disorder among older adults

, oxycodone, meperidine, tapentadol, fentanyl, remifentanil, sufentanil, methadone, and buprenorphine . Opioids with mixed kappa receptor agonism and mu receptor antagonism that are available to treat pain include pentazocine, butorphanol, and nalbuphine . Medications to treat OUD encompass both opioid agonists and antagonists . Several opioid agonist treatments are authorized for OUD in Canada . Liquid methadone is most common and has the longest history of use . Sublingual buprenorphine is also approved

2019 CPG Infobase

105. Managing opioid use disorder in primary care: PEER simplified guideline

creating recommen- dations on their use. 22 Management of comorbid conditions in patients with OUD Management of comorbidities in patients taking OAT can be challenging. Unfortunately, randomized con- trolled evidence in this area is severely lacking. With regard to the management of acute pain in patients taking OAT, 1 RCT reported morphine was superior to meperidine in an emergency setting. 22 This is not always applicable in an ambulatory setting, and nonopioid options were not explored. Similarly

2019 CPG Infobase

106. Management of Cancer Medication-Related Infusion Reactions

, urticaria • 1st generation H1-receptor antagonist (e.g. diphenhydramine 25-50 mg IV) x 1 2,95,96,98-101 • Ranitidine 50 mg IV 95,96,101 or Famotidine 20 mg IV x1 98 • Hydrocortisone 100 mg IV x 1 98-100 Fever • Antipyretic (e.g. acetaminophen 650 mg PO x 1 98-100 ) Rigors/chills † • Meperidine 25-50 mg IV x 1 97,98 Nausea and/or vomiting • Dimenhydrinate 25-50 mg IV x 1 99,100 Hypotension • Normal saline as per hospital policy Wheezing/SOB • Salbutamol 2.5-5 mg nebules inh q 20 min x 3 doses, then q1-4h

2019 Cancer Care Ontario

107. Trastuzumab (Ogivri) - breast cancer or stomach cancer

be used to reduce risk of occurrence of these events. The majority of these events occur during or within 2.5 hours of the start of the first infusion. Should an infusion reaction occur the infusion should be discontinued or the rate of infusion slowed and the patient should be monitored until resolution of all observed symptoms (see section 4.2). These symptoms can be treated with an analgesic/antipyretic such as meperidine or paracetamol, or an antihistamine such as diphenhydramine. The majority

2019 European Medicines Agency - EPARs

108. Promethazine

received either placebo or midazolam or promethazine 5 minutes before appendectomy. All episodes of vomiting and nausea within 24 hours after surgery were 2011 19. Ketorolac versus meperidine-plus- promethazine treatment of migraine headache: evaluations by patients. 7893296 1995 04 27 1995 04 27 2013 11 21 0735-6757 13 2 1995 Mar The American journal of emergency medicine Am J Emerg Med Ketorolac versus meperidine-plus- promethazine treatment of migraine headache: evaluations by patients. 146-50 (...) This study was designed to compare and contrast the speed and efficacy of meperidine (75 mg)/ promethazine (25 mg) intramuscularly to ketorolac (60 mg (...) ketorolac (60 mg) or meperidine (75 mg)/ promethazine (25 mg). Sixty-eight percent of patients given meperidine/ promethazine responded whereas 55% of patients given ketorolac responded. The responder group showed a statistically significant reduction in headache within 30 minutes with both drug regimens. There was no statistically significant

2018 Trip Latest and Greatest

110. Diazepam

). Behavior during local anesthesia, application of rubber dam, cavity preparation, restorative procedures was evaluated, considering the degree of sleep, body movement, crying 2007 12. Intra-articular lidocaine versus intravenous meperidine/ diazepam in anterior shoulder dislocation: a randomised clinical trial. 18434457 2008 04 24 2008 05 19 2013 11 21 1472-0213 25 5 2008 May Emergency medicine journal : EMJ Emerg Med J Intra-articular lidocaine versus intravenous meperidine/ diazepam in anterior (...) shoulder dislocation: a randomised clinical trial. 262-4 10.1136/emj.2007.051060 Anterior shoulder dislocation is one of the most common complaints of patients referred to emergency (...) departments. Intravenous opiates and benzodiazepines are traditionally prescribed in order to relieve the pain in this group of patients; however, complications always pose a problem. To compare the pain relief and complications following intra-articular lidocaine and intravenous meperidine/ diazepam in patients

2018 Trip Latest and Greatest

111. Peripartum Analgesia and Anesthesia for the Breastfeeding Mother

and neo- natal neurobehavioral organization is also controversial and inconclusive in its long-term effects on breast- feeding outcomes. There may be depressed hand mas- sage and suckling behavior in neonates exposed to neuraxial analgesia, but some of the neonates studied were also exposed to oxytocin and/or meperidine/ pethidine during the course of labor, which were not accounted for in statistical analysis. There were no long-term differences in breastfeeding outcomes or these outcomes were (...) . Remifentanil is potent and has rapid onset and offset, but can be associated with a high incidence of maternal apnea, requiring in- creased monitoring 26 (IIB-III). Remifentanil has also been shown to result in a number of cases of neonatal depression in a recent survey in academic centers across the United States. 27 Evidence on breastfeeding outcomes is lacking. • Longer-acting opioids with active metabolites such as meperidine/pethidine or morphine should be used with caution and administered less than

2019 Academy of Breastfeeding Medicine

114. Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Headache

%) and in the hydromorphone arm by 26 of 64 patients (41%) 398 (difference 19%, 95% CI 2% to 36%; number needed to treat 6, 95% CI 3 to 52). The authors concluded that 399 intravenous hydromorphone is substantially less effective than intravenous prochlorperazine for the treatment of 400 acute migraine in the ED and should not be used as first-line therapy. 401 In a 2008 Class II systematic review, Friedman et al 34 performed a meta-analysis of randomized controlled 402 trials comparing meperidine versus several other (...) regimens (dihydroergotamine [DHE], ketorolac, or an antiemetic) 403 in the treatment of headache. In this study the authors looked at 899 citations and identified 19 trials for inclusion. 404 Within the review’s analysis, 11 studies were determined to have appropriate and available data. Four trials 405 compared meperidine with DHE, 4 compared meperidine with an antiemetic, and 3 compared meperidine with 406 ketorolac. The authors showed that meperidine was not superior to the other regimens

2019 American College of Emergency Physicians

118. CRACKCast E162 – Opioids

, methadone, and meperidine. Opioids are a major cause for concern today – in overdose they cause respiratory depression and death. In 2010 alone, enough prescription opioids were prescribed to medicate every American adult with 5 mg of hydrocodone every 4 hours for 1 month. Consequently, the United States has seen a widespread rise in prescription opioid abuse, overdoses, and deaths. In 2010, approximately 12 million Americans, or 1 in 20, reported use of opioids without a prescription. Nearly 15,000 (...) overdose or overdose of unknown substance! 1) List 6 commonly abused opioids (Table 156:1) Heroin (semisynthetic) Codeine (in its various forms e.g. Tylenol #3) Fentanyl Hydromorphone Morphine Methadone Oxycodone Meperidine 2) Describe the opioid toxidrome (list opioid effects on Neuro, Resp, Ophtho, CV, GI, Derm) Opioids act on receptors in the central nervous, cardiovascular, pulmonary, and gastrointestinal systems and can also be used therapeutically for their antitussive and antidiarrheal effects

2018 CandiEM

119. Guidelines for sedation and anesthesia in GI endoscopy

sedation (ie, a benzodiazepine plus narcotic), with respect to safety, patient and provider satisfaction, and induction and recovery times. Two randomized controlled trials compared NAPS for colonoscopy with a combination regimen of midazolam and fentanyl 57 and midazolam plus meperidine. 58 All studies found that NAPS exhibited signi?cantly shorter recovery times. There were no signi?cant differences across sedation regimens in the incidence of bradycardia, hypotension, hypoxemia, physician (...) . 50. Cohen LB, Hightower CD, Wood DA, et al. Moderate level sedation during endoscopy: a prospective study using low-dose propofol, meperidine/fentanyl, and midazolam. Gastrointest Endosc 2004;59: 795-803. 51. Rex DK, Overley C, Kinser K, et al. Safety of propofol administered by registered nurses with gastroenterologist supervision in 2000 endo- scopic cases. Am J Gastroenterol 2002;97:1159-63. 52. HeussLT,SchnieperP,DreweJ,etal.Riskstratificationandsafeadmin- istration of propofol by registered

2018 American Society for Gastrointestinal Endoscopy

120. Practice Guidelines for Moderate Procedural Sedation and Analgesia

benzodiazepines ( e.g. , midazolam, diazepam, flunitrazepam, lorazepam, or temazapam) and dexmedetomidine. Analgesics administered with sedatives include opioids such as fentanyl, alfentanil, remifentanil, meperidine, morphine, and nalbuphine. This section of the guidelines addresses the following topics: (1) benzodiazepines and dexmedetomidine, (2) sedative/opioid combinations, (3) intravenous versus nonintravenous sedatives/analgesics not intended for general anesthesia, and (4) titration of sedatives (...) dexmedetomidine is combined with an opioid analgesic compared with midazolam combined with an opioid analgesic (category A3-B evidence). One RCT reports deeper sedation ( i.e. , higher sedation scores) and a lower frequency of hypoxemia when dexmedetomidine combined with midazolam and meperidine is compared with midazolam combined with meperidine (category A3-B evidence). One RCT comparing intravenous midazolam with intramuscular midazolam reports equivocal findings for oxygen saturation levels, respiratory

2018 American Society of Anesthesiologists

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