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Biomedical subjects

W W Zuurmond

Publications and source records attributed to W W Zuurmond.

At least 19 recordsLinked to original sources
PubMed2002

Partial versus full agonists for opioid-mediated analgesia--focus on fentanyl and buprenorphine.

In contrast to other opioids, fentanyl and buprenorphine share a number of physicochemical properties that render both agents potentially suitable for transdermal delivery. However, there are significant differences between them in terms of their pharmacological profiles, as fentanyl is a full mu opioid receptor agonist capable of exerting a maximal response in certain tissues, while buprenorphine is a partial agonist unable to exert this maximum effect even at high doses. This review examines the hypothesis that partial opioid agonists would confer a number of benefits over full agonists, namely effective analgesia with a better tolerability and a lower propensity for addiction, with respect to fentanyl and buprenorphine. An attempt is also made to correlate clinical differences between these drugs with their respective agonist profiles and other differential pharmacokinetic/pharmacodynamic properties. Despite a dearth of directly comparative trials, the pharmacology of fentanyl and buprenorphine is well documented. Considerable data concerning buprenorphine suggest that the advantages initially espoused for partial opioid agonists are not borne out in clinical practice. Indeed, it may be postulated that full mu opioid agonists, particularly those with high selectivity and potency such as fentanyl, have a superior clinical profile and fulfill the above criteria more closely. Relative receptor binding, selectivity, potency and intrinsic efficacy of the opioids appear to be key determinants of their individual pharmacological profiles, contributing significantly to the heterogeneity of this class of analgesics.

Analgesics, Opioid↗
PubMed2001

Pain treatment with NSAIDs, primary focus on ibuprofen.

For the past 30 years ibuprofen has been known as one of the safest NSAIDs and in some countries, including The Netherlands, it is available as an over-the-counter medicine. Nevertheless, all NSAIDS may show adverse effects, such as gastrointestinal toxicity, sodium/water retention, reduced kidney perfusion and allergic responses. In developing safer NSAIDs two new types of drug have been introduced: the COX-2 inhibitors and the single enantiomer NSAIDs, in particular S(+)-ibuprofen. S(+) ibuprofen shows an equipotency with half of the racemic ibuprofen dose , and the introduction of S(+) ibuprofen (dexibuprofen, Seractil) permits the prescription of lower doses. The new COX-2 inhibitors have recently been compared to the racemic ibuprofen. Day et al. found no significant difference between rofecoxib and racemic ibuprofen concerning overall incidence rates of clinical adverse experiences. In the study by Silverstein et al. the annualised incidence rates of upper GI ulcer complications alone and combined with symptomatic ulcers for celecoxib vs ibuprofen showed no statistical difference (P = 0.09), but for patients not taking aspirin, a difference was found in favour of celecoxib (P = 0.04). Studies comparing the COX-2 inhibitors and dexibuprofen need to be performed.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2001

Treatment of reflex sympathetic dystrophy (CRPS type 1): a research synthesis of 21 randomized clinical trials.

A blinded meta analysis was performed on randomized clinical trials (RCT) on the medicinal treatment of reflex sympathetic dystrophy (complex regional pain syndrome type I) to assess the methodological quality and quantify the analgesic effect of treatments by calculating individual and summary effect sizes. The internal validity of 21 RCTs was investigated and the quality weighted summary effect size was calculated using a fixed effect model (Glass Delta). The methodological quality ranged from moderate to good (average 46%). Differences were found between the trials in inclusion/exclusion criteria, treatment methods, duration of treatments and trials, and measurement instruments. Statistical analysis was possible for four subgroups; one evaluating the analgesic effects of sympathetic suppressors in general (n = 12), one subgroup concerning the analgesic effects of guanethidine (n = 6), one investigating the analgesic effect of intravenous regional sympathetic blocks (n = 9), and one subgroup (n = 5) evaluating the analgesic effect of calcitonin. Except for the calcitonin subgroup (P = 0.002), the quality-weighted summary effect size of these subgroups were not significant. No significant analgesic effect by sympathetic suppressing agents could be established. Calcitonin seems to provide effective pain relief in reflex sympathetic dystrophy patients. The results of the present study show that weighting methodological quality influences the magnitude of the effect sizes of specific treatment methods. Future studies should control for methodological quality.

Analgesics↗
PubMed2001

Increasing the efficacy of a celiac plexus block in patients with severe pancreatic cancer pain.

The purpose of this study was to evaluate the technical possibilities of placing a catheter near the celiac plexus for performance of a celiac plexus block, and to study the efficacy of repeated neurolytic celiac plexus blocks with alcohol in patients with advanced pancreatic cancer pain resistant to opioid treatment. In 12 patients, a neurolytic celiac plexus block with alcohol, administered via an indwelling celiac catheter, was performed. To evaluate the efficacy, visual analog scale scores were recorded every day. Quality of life scores were registered before and 4 weeks following the procedure. Alterations in opioid consumption, and the time between the diagnosis of pancreatic cancer and the performance of the block, were registered. All patients were followed until they died. Two patients remained without pain after the first neurolytic celiac plexus block. In all other patients a second block was administered which provided only temporary relief. Additional intermittent administration of bupivacaine through the catheter was necessary to provide adequate pain relief in these patients. Quality of life increased significantly during the treatment. Opioid consumption decreased significantly in all patients. Our study indicates that a neurolytic celiac plexus blockade with alcohol results in a significant but short-lasting analgesic effect. The use of a celiac catheter improves the long-term management of pancreatic cancer pain.

Autonomic Nerve Block↗
PubMed2000

A comparison of the incidence of the oculocardiac and oculorespiratory reflexes during sevoflurane or halothane anesthesia for strabismus surgery in children.

UNLABELLED: We examined changes in the cardiorespiratory system of small children during surgical correction of strabismus with a laryngeal mask airway and spontaneous respiration with sevoflurane or halothane inhaled anesthesia. Fifty-one children, 1-7 yr old, having outpatient strabismus correction were randomized to sevoflurane (S) or halothane (H) in 66% nitrous oxide at 1.3 minimum alveolar concentration. Children breathed spontaneously through a laryngeal mask airway and were not pretreated with anticholinergics. The oculocardiac reflex (OCR), defined as a 20% decrease in heart rate (HR) from baseline, dysrhythmias, or sinoatrial arrest concomitant with ocular muscle traction occurred less frequently with sevoflurane than with halothane (S 38%, H79%, P = 0.009). The baseline HR was higher with sevoflurane (S 114 +/- 13 bpm, H 101 +/- 15 bpm, P = 0.002). The lowest HR occurred with halothane (S 95 +/- 22 bpm, H 73 +/- 19 bpm, P = 0.001). The incidence of dysrhythmias was higher in the halothane group (S 4%, H 42%, P = 0.004). Reductions in minute ventilation and PETCO(2) accompanied OCRs. Airway irritability was present with halothane only (S 0, H 3). Eleven children, of whom the majority had received halothane, required measures to correct SpO(2) < 95% or PETCO(2) > 60 mm Hg during maintenance anesthesia (S 11%, H 32%). Sevoflurane may be a more suitable anesthetic than halothane for operations involving traction on the ocular muscles with spontaneous respiration in children because of reduced incidence of OCR, airway irritability, and ventilatory disturbances. IMPLICATIONS: Some children experience a sudden slowing of the heart and impaired breathing when the surgeon pulls on the eye muscles during squint operations under anesthesia. Sevoflurane, a recently developed anesthetic vapor, may reduce this problem when compared with the established vapor halothane.

Anesthesia, Inhalation↗
PubMed2000

Continuous brachial plexus block as treatment for the Pancoast syndrome.

BACKGROUND: Six patients with severe neuropathic pain caused by a Pancoast tumor were treated with the continuous administration of local anesthetics. These patients had not responded to any other treatment, including nonsteroidal anti-inflammatory drugs, opioids, dexamethasone, tricyclic antidepressants, anticonvulsants, ketamine, and transcutaneous electric nerve stimulation. INTERVENTIONS: An axillary catheter was placed in the brachial plexus using a posterior approach that has not been described previously. A continuous infusion system of local anesthetics was delivered via a catheter. In two patients, the main purpose was to evaluate the technical possibilities and implications of this new approach. In all patients, the visual analogue scale score was evaluated until the patient died. In four additional patients, the quality of life and performance skills were recorded. RESULTS: In all patients, there was a significant reduction in the visual analog scale score, and there was an increase in performance skills and quality of life in four patients. No side effects occurred from this technique or from the continuous administration of local anesthetics. CONCLUSIONS: We conclude that neuropathic pain may be treated by local anesthetics administered through an axillary catheter placed in the brachial plexus. This technique is reversible and is preferable to destructive procedures such as cordotomy.

Aged↗
PubMed1998

[Perioperative mortality and the role of anesthesiologic activity at the Vrije University Hospital in Amsterdam].

OBJECTIVE: To determine the perioperative mortality and the share of anaesthesiological activity in it. DESIGN: Retrospective, descriptive. SETTING: VU University Hospital, Amsterdam. METHOD: Patients who in the period 1989-1994 had died within 7 days after a clinical surgical intervention were identified using the database of the hospital information system. The following data concerning these patients were collected from the database of the department of Anaesthesiology: age, sex, classification according to the American Society of Anesthesiologists (ASA), urgency (elective or emergency operation), type of operation (12 categories), duration of the operation, time and place of death. Four independent investigators classified the deceased patients with the aid of their medical files as to the degree of connection between the anaesthesiological activity and the death according to the Edwards classification. RESULTS: A total of 62,969 operations had been performed. following which 314 patients (0.5%) had died within 7 days. Death was connected with the anaesthesiological activity in 16 cases (2.5 per 10,000 operations): there was a connection with the anaesthesiological activity exclusively in two patients (0.3 per 10,000 operations) and with both anaesthesiological and surgical factors in 14 patients (2.2 per 10,000 operations). Advanced age, male sex, a higher ASA category, traumatological operations and emergency operations were associated with a higher mortality rate. CONCLUSION: The mortality rate within 7 days after a clinical surgical intervention was 0.5%. A connection with anaesthesiological activity was present in 2.5 per 10,000 operations.

Adolescent↗
PubMed1997

Patients' refusal to participate in clinical research.

The number of protocol-eligible patients, refusing to participate in a clinical trial is often not mentioned. The aim of this study is to report the number of refusers and to evaluate the reasons for not participating in a clinical study concerning post-operative pain relief and to assess the potential influence on the final study results. Patients refusing to participate in the study were recorded and evaluated for reasons of refusal. The post-operative pain relief techniques applied in this trial are commonly used, but nevertheless the refusal rate was higher than expected. When it was mentioned that an epidural technique was a part of the trial, 16.7% of the total protocol-eligible group refused. The responses of those offered an epidural could be divided into two groups: the adamant pros and cons to this technique. It can be concluded that in order to be able to judge the validity of results and thus for good clinical practice, the number of patients refusing to participate in a clinical trial and their reasons, should be mentioned in all publications.

Analgesia, Epidural↗
PubMed1997

Compliance in administration of prescribed analgesics.

In this noninterventional study, the implementation of 'modern' pain management in clinical practice was investigated by recording the regular prescription, administration and efficacy of analgesic drugs. This resulted in a reproducible and superficial quality control design for hospitals. One hundred and fifty surgical patients were followed during 5 days postoperatively. For every patient, pain, mood and sedation were measured using visual analogue and verbal descriptive scores; the prescription of analgesics at set times and administered doses of analgesics were also recorded. Only paracodeine and naproxen were administered regularly as prescribed, unlike paracetamol and morphine. The prescribed daily dose of morphine was only received by 4.2% of all patients. Although the postoperative pain treatment pathway was considered to be improved after better education and communication, in fact the opposite was found. This is probably caused by traditional thinking, lack of control and time pressure on the hospital staff and the subservient attitude of the patient.

Acetaminophen↗
PubMed1997

Neurohistopathological findings after continuous intrathecal administration of morphine or a morphine/bupivacaine mixture in cancer pain patients.

BACKGROUND: As the number of terminal cancer patients receiving continuous intrathecal infusion of opioids and local anesthetics for relief of pain increases, we decided to investigate the post-mortem findings of the spinal cord, meninges and nerve roots of patients after continuous intrathecal administration of morphine and combined with bupivacaine. METHODS: Neurohistopathological findings were obtained from 10 cancer patients [2 men and 8 women, 29-69 (median 52) yrs old] and 4 controls [4 men, 46-75 (median 64) yrs old]. The cancer patients had been treated for a mean of 98 (range 8-452) d with morphine/NaCl 0.9% or morphine/bupivacaine, administered through a polyamide lumbar catheter. Concomitant radiation therapy and chemotherapeutic drugs had been given to 5 and 6 patients, respectively. Cumulative doses of morphine ranged from 22 to 3895 mg, those of bupivacaine from 0 to 3250 mg and of sodium metabisulfite (antioxidant) from 0.6 to 97.4 mg. RESULTS: No macroscopic abnormalities of the catheter tract, dura, leptomeninges, nerve roots or spinal cord were found. Microscopically, focal foreign body giant cells were seen in 2 cases in the area of the catheter pathway both without any sign of inflammation. In one case treated for 103 d, an intrathecal reaction was found. This consisted of small aggregates of lymphocytes predominantly in the leptomeninges and focally in the cord parenchyma. No abnormalities were found in the other cases when using hematoxylin-eosin and Kluver or Bodian stained specimens, indicating neither myelin nor axonal damage. Microglial reactions were similar in both cancer patients and controls. CONCLUSION: The discrete and limited neurohistopathological findings in both catheter patients and controls suggest that intrathecal infusion of morphine and bupivacaine via a polyamide catheter is devoid of significant neurotoxic effects in cancer patients.

Adult↗
PubMed1997

Efficacy of sphenopalatine ganglion blockade in 66 patients suffering from cluster headache: a 12- to 70-month follow-up evaluation.

This study was conducted to evaluate the efficacy, based on 12- to 70-month follow-up data, of radiofrequency (RF) lesions of the sphenopalatine ganglion made in patients suffering from cluster headache. Sixty-six patients suffering from either episodic (Group A, 56 patients) or chronic (Group B, 10 patients) cluster headache who were not responsive to pharmacological management were treated by RF lesioning in the sphenopalatine ganglion. Complete relief of pain was achieved in 34 (60.7%) of 56 patients in Group A and in three (30%) of 10 patients in Group B. No relief was found in eight patients (14.3%) in Group A and in four (40%) in Group B. The mean time of follow up was 29.1 +/- 10.6 months in Group A and 24 +/- 9.7 months in Group B, ranging from 12 to 70 months. With regard to side effects and complications, temporary postoperative epistaxis was observed in eight patients and a cheek hematoma in 11 patients; a partial RF lesion of the maxillary nerve was inadvertently made in four patients. Nine patients complained of hypesthesia of the palate, which disappeared in all cases within 3 months. The authors conclude that RF lesioning in the sphenopalatine ganglion via the infrazygomatic approach may be performed in patients suffering from cluster headache that does not respond to pharmacological therapy.

Acute Disease↗
PubMed1996

[Phantom pain following leg amputation: retrospective study of incidence, therapy and the effect of preoperative analgesia].

OBJECTIVE: Evaluation of (a) the incidence of phantom limb pain after a lower limb amputation, (b) the influence of either general or epidural anaesthesia on the incidence, and (c) the different kinds of therapies applied. DESIGN: Retrospective. SETTING: Department of Anaesthesiology, Academic Hospital, Vrije Universiteit, Amsterdam, the Netherlands. METHOD: All 45 patients who had undergone a lower limb amputation in the period 1985-1994, and whose amputation had taken place at least 6 months earlier received a questionnaire. The level of the phantom limb pain was measured using a Visual Analogue Scale. RESULTS: 33 Patients returned the questionnaire. 85% suffered from phantom limb pain; 20 patients were still suffering at the time of replying to the questionnaire. The pain sensation was mostly characterized as "cramping'. The physicians told 42% of the patients that nothing could be done to relieve the pain. Other patients were given all different kinds of therapies. The type of anaesthesia, general or regional anaesthesia, did not influence the incidence of phantom limb pain. CONCLUSION: After lower limb amputations there was a high incidence of long lasting phantom limb pain. Therapy showed a large variability and a considerable failure rate. Further research into prevention and treatment of phantom pain is urgently needed.

Adult↗
PubMed1996

Treatment of acute reflex sympathetic dystrophy with DMSO 50% in a fatty cream.

Acute Reflex Sympathetic Dystrophy (acute RSD) was defined using a reproducible classification. Elevated temperature of the affected extremity ("calor"), measured by the dorsal side of the observer's hand and mentioned by the patient, pain ("dolor") measured by the Visual Analogue Scale (VAS), redness ("rubor"), edema ("tumor") and limited active range of motion ("functio laesa"), all contributed to the classification system. Patients scoring 4 to 5 positive symptoms were considered to have acute RSD. A prospective, randomized and double blind study was performed in 32 patients, all suffering from acute RSD. In all of these patients the primary injury was the result of a previous accident. One patient was taken out of the study because of his surgery. The study involved treatment with a fatty cream with 50% dimethyl sulfoxide (DMSO, group A), or without DMSO (placebo, group B), both for 2 months. All patients received physiotherapy applied within pain limits. Application of the creams resulted in both groups in an improvement of RSD-scores and VAS-scores after 2 months. However, the improvement of the RSD score in patients of group A (DMSO-group) was significantly (P < 0.01) better compared to group B. The results suggest a certain activity of DMSO 50% cream in patients suffering from RSD and is, therefore, recommendable.

Acute Disease↗
PubMed1996

[Neuroanatomy and anaesthesiology].

The pathways of nociception, concerning dentogenic pain, are followed from the peripheral nociceptors to the cortex. The branches of the trigeminal nerve supply the semilunar ganglion. From this ganglion the trigeminal nuclei are reached, extending from the bottom of the third ventricle to the upper cervical segments. The thalamus and subsequently the cortex are receiving nociceptive information from trigeminal nuclei. Either ascendent or descendent pathways are involved concerning nociception.

Afferent Pathways↗
PubMed1996

[Conduction anesthesia in and around the mouth].

Local infiltration anaesthesia is generally used in dentistry. The so-called nerve block anaesthesia is only routinely used for the mandible. The purpose of this article is to discuss the variety of blocks that can be used by dentists, oral and maxillofacial surgeons and anaesthesiologists. Furthermore, local reactions caused by anaesthetic solutions are described.

Anesthesia, Dental↗
PubMed1994

Sufentanil pharmacokinetics in young adult and elderly surgical patients.

Sufentanil 3 microgram kg-1 was administered as an intravenous (i.v.) bolus to 12 elderly patients, aged 65-87 years and 12 young adults, 17-43 years of age, all ASA class I-II, scheduled for orthopaedic surgery. Plasma sufentanil concentrations were measured by a specific radioimmunoassay. Plasma concentration time-curves for the young adult and the elderly groups were superimposible. Pharmacokinetic parameters were calculated from the derived compartmental models. Elimination half-lives, clearance and total volumes of distribution were calculated with non-compartment methods. The major pharmacokinetic parameters, elimination half-life, clearance and volume of distribution did not differ between both groups. The age-related differences in the action of sufentanil cannot be explained by its pharmacokinetic properties.

Adolescent↗
PubMed1993

[Continuous intrathecal analgesia in terminal cancer patients within transmural health care].

OBJECTIVE: To record the daily morphine doses, the influence of the treatment on quality of life and the incidence of side-effects and complications of continuous intrathecal morphine administration. SETTING: Academic Hospital, Free University, Amsterdam. DESIGN: Prospective. METHODS: Forty terminal patients with intractable cancer pain, who had either insufficient pain relief or severe side effects from systemic analgesics were selected for continuous intrathecal administration of morphine. An intrathecal catheter was implanted, tunnelled and connected with a portable infusion pump delivering morphine constantly and if needed on demand. In a pain diary the patients recorded: the number of daily doses of morphine, concomitant medication, pain scores on a visual analogue scale (VAS), extra doses and activities. RESULTS: The total number of catheter days was 1486. Patients were treated for a mean of 37.2 (range 2-183) days. The mean dose of daily administered morphine was in 30 patients (75%) less than 20 mg. Sufficient pain relief (VAS score < 5) was achieved in 37 patients (92.5%). Three patients had pain due to spinal cord compression, hardly responding to intrathecal morphine. Withdrawal symptoms, post-puncture headache and leakage of fluid could been treated conservatively. The catheter was removed inadvertently 6 times and could be replaced on outpatient basis. Meningitis occurred in 2 patients, who were adequately treated with antibiotics. The catheter could be re-inserted within 10 days. CONCLUSION: In terminally ill cancer patients, the continuous intrathecal administration of morphine may be recommended if conventional pain relief fails.

Adult↗