Viney Kumar

Response of intractable pain to continuous intrathecal morphine: a retrospective study

&NA; We have treated 37 patients with intractable pain (35 with cancer‐related pain) by continuous intrathecal morphine infusion via implanted pump. These patients were carefully selected according to specific criteria, and each demonstrated a significant reduction in pain following a test dose of intrathecal morphine. All patients had good pain relief from intrathecal morphine infusion, even with pain located in cervical dermatomes. Systemic narcotics could be withdrawn from most patients. Significant side effects were rare and typically self‐limited. Many patients required gradually increasing doses, seemingly related to disease progression. Two patients with non‐malignant pain have had variable dose requirements over 28 and 44 months without clear tolerance. In these patients we observed a reduction in side effects associated with systemic opioids when continuous intrathecal opioid infusion was instituted. Intrathecal opioid administration may have fewer complications than ablative pain relief procedures. In properly selected patients, this method offers an effective alternative for pain relief.

Comparison of Psychologic and Cognitive Functions after General or Regional Anesthesia

The behavior of 105 patients randomly assigned to receive cither general or regional anesthesia and who underwent one of three types of surgery (hysterectomy, prostatectomy, or joint replacement) was assessed before, immediately after, and 3 mo after surgery. Psychologic status was assessed by the Sickness Impact Profile, the SCL-90-R, and a Metamemory Questionnaire. Cognitive functioning was measured by a battery of ten psychomotor, memory, and skilled performance tasks. Physical health was scored by the ASA classification of physical status, a health index, postoperative complications ratings, and a self-rated measure of the patients health. There were cognitive differences across surgery groups due to age and gender variability among the patients; however, the type of anesthesia produced no difference in behavior. Both the physical and mental health indices showed improvement from the preoperativc to the postoperative periods. General anesthesia appears to pose no risk to mental function and recovery beyond that associated with regional anesthesia and surgery.

An analysis of critical incidents in a teaching department for quality assurance A survey of mishaps during anaesthesia

A prospective survey was conducted from April 1984–January 1985 and April 1985–January 1986 to study the frequency of critical incidents and factors associated with them. Eighty‐six mishaps were reported in the first period, the majority of which were because of human error (80.3%);the must common were the transmission of gases and vapours and errors in drug administration. Factors frequently associated with these mishaps were failure to perform a normal check and lack of familiarity with equipment or technique. An anaesthesia equipment checklist was incorporated in the survey during the second period and 43 mishaps were reported. This decrease in incidence may have resulted from the anaesthesia apparatus checklist, awareness of mishaps since they were discussed regularly at departmental meetings, and new anaesthesia machines (eight older machines were replaced during the first period and 11 at the beginning of the second).

Effects of a subanesthetic concentration of nitrous oxide on overt and covert assessments of memory and associative processes

Drug effects on human memory are usually assessed by overt recall or recognition tests. Covert tests which do not explicitly assess memory but which indirectly elicit previously presented information may be more sensitive to low levels of learning than overt tests. Three covert tests and corresponding overt recall tests were given to 16 men and 16 women breathing 30% nitrous oxide in oxygen or 100% oxygen to see if the covert tests resisted the memory-impairing effects of nitrous oxide. Nitrous oxide impaired performance on the overt tests. Performance in two covert tests, Constrained Associations and Word Completion, showed resistance to memory impairment. In the least resistant covert test, Free Associations, nitrous oxide altered associative processes. Performance in an additional test involving recognition and preferences for nonsense words repeated with varying frequencies also showed some resistance to memory impairment. The results support the distinction between declarative and procedural memory. Constrained Associations, Word Completion, and Nonsense Words tests may be useful for assessing low levels of learning during drug states.

Intrathecal morphine for cancer related pain

Division of Neurosurgery and Department of Anesthesia, University of Iowa Bospitals and Clinics, Iowa City, Iowa 52240 USA Owing to improved anticancer therapy, patients afflicted with malignancies now survive longer, developing severe, incapacitating pain. Faced with pain that is often bilateral, involving the neck or upper extremites, other methods of pain control aside from cordotomy were deemed necessary. The authors resorted to the Infusaid pump to deliver intrathecal morphine in 9 patients; and hereby analyze their results in a retrospective manner. The ages of patients ranged from 24 to 66 years with 7 females and 2 males. The diagnosis was cancer of the lung in 2, cervix in 2, ependymoma in 1, breast in 1, esophagus in 1, and unknown in 1. One patient had a diagnosis of Behcets syndrome and had been on methadone and controlled release morphine for 2 years. The pain most commonly affected the spine and lower extremities in 5, shoulder and upper extremities in 3 and left lower quadrant in 1. Selection was on the basis of 50% reduction in pain following an intrathecal dose of morphine sulfate via lumbar puncture. Initial dosage was Sk1 mg, progressing to 14*9 mg per day. The mean survival of the 7 patients succumbing to their disease was 2.8+2.2 months. We believe that intrathecal delivery of morphine for the control of severe cancer related pain is effective even in those already on narcotic analgesics. Considering the cost of the device, in excess of

Effects of a subanaesthetic concentration of nitrous oxide on memory and subjective experience: Influence of assessment procedures and types of stimuli

4,000 excluding the surgery and hospitalization, an expected life span longer than 3 months at least should render implantation of morphine pumps worthwhile.