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[Perioperative use of metamizole and other nonopioid analgesics in children : Results of a survey].
No full textMetamizol. Überlegungen zum Monitoring zur frühzeitigen Diagnose einer Agranulozytose
Full text linkBACKGROUND
Dipyrone (metamizole) is a non-opioid analgesic commonly used in Germany, which can, in very rare cases, cause life-threatening agranulocytosis. The prescribing information calls for regular monitoring of the differential blood count in cases of long-term treatment. However, there is uncertainty about how this testing should be handled in practice.
OBJECTIVES
Which recommendations can be derived from the published literature for evaluating blood cell counts during treatment with metamizole and which other options for monitoring exist?
METHODS
Data from recent epidemiological studies, reviews, and spontaneously reported cases were evaluated.
RESULTS
Agranulocytosis can emerge at highly variable intervals ranging from the first day of metamizole treatment to months after treatment has begun. As a result, there is no conclusive, evidence-based recommendation for the time intervals at which blood cell counts should be tested. Therefore, the onset of clinical symptoms should be used as trigger for monitoring blood cell counts to enable early diagnosis and avoid agranulocytosis-related complications. In addition to general symptoms like fever, sore throat, fatigue, and muscle pain, mucosal ulcerations, severe angina, and systemic infections leading to sepsis are typical of agranulocytosis.
CONCLUSIONS
Providing patients and medical staff with better information about early symptoms of agranulocytosis could be a sensible way to prevent complications. Any suspicion of agranulocytosis should immediately lead to a differential blood count and to the withdrawal of all drugs possibly associated with agranulocytosis. Patients should be monitored and treated according to the severity of their symptoms
Dipyrone is the preferred nonopioid analgesic for the treatment of acute and chronic pain. A survey of clinical practice in German-speaking countries.
No full textPURPOSE
Nonopioid analgesics are frequently used for the treatment of acute and chronic pain. Dipyrone is an alternative to NSAIDs and paracetamol, however, data on the frequency of its usage by anaesthesiologists in the perioperative and chronic pain setting are lacking and its adverse reactions are a matter of debate.
METHODS
The link to a questionnaire on the use of nonopioid analgesics (NSAIDs, COX-2 inhibitors, paracetamol, dipyrone) and the safety of dipyrone in the perioperative and chronic pain setting was mailed to anaesthesiologists and pain physicians.
RESULTS
A total of 2237 responses were analysed. About 97.4% of the respondents used nonopioid analgesics for the treatment of acute pain, with 93.8% administering dipyrone, 54.0% NSAIDs, 41.8% COX-2 inhibitors and 49.2% paracetamol. Nonopioid analgesics were administered preoperatively by 22.3%, intraoperatively by 86.1% and postoperatively by 73.0% of the respondents. For chronic pain management, 76.7% of the respondents prescribed oral dipyrone in combination with other nonopioid analgesics; 19.9% used dipyrone as sole nonopioid, whereas 2.9% denied its use. Cases of dipyrone-associated agranulocytosis were observed by 3.5% of the respondents of the acute and 1.5% of the chronic pain questionnaire, respectively. The majority of respondents (acute pain: 73.0%, chronic pain 59.3%) performed no blood cell counts to monitor dipyrone therapy. Patients were rarely informed about possible adverse drug reactions.
CONCLUSIONS
Dipyrone is the preferred nonopioid analgesic in the perioperative and chronic pain setting. Although cases of agranulocytosis occur, benefits apparently outweigh the risks according to anaesthesiologists. Measures like patient information may improve safety.
SIGNIFICANCE
A survey of anaesthesiologist in German-speaking countries revealed dipyrone as preferred nonopioid analgesic for the treatment of acute and chronic pain. Benefits seem to outweigh the risks, specifically the risk of agranulocytosis. Information of medical staff and patients on adverse drug reactions and symptoms of agranulocytosis should be implemented
Perioperative analgesia with nonopioid analgesics
No full textHintergrund: Nichtopioidanalgetika wer-
den bei vielen Patienten zur perioperativen
Analgesie eingesetzt. Zu einigen
praktischen Fragen beim Einsatz von
Nichtopioidanalgetika liegen z. T. nur
wenig Informationen aus Studien vor,
und in Krankenhäusern existieren häufig
keine Konzepte zum Vorgehen, z. B. zur
Patientenaufklärung und zum Zeitpunkt
der perioperativen Gabe.
Methodik: Eine Expertengruppe der
beteiligten Fachgesellschaften hat konsensbasierte
Empfehlungen zum perioperativen
Einsatz und in einem strukturierten
formalen Konsensusprozess
verabschiedet.
Ergebnisse: Die Arbeitsgruppe stimmt
überein, dass Nichtopioidanalgetika Bestandteil
eines perioperativen multimodalen
Analgesiekonzepts sein sollen
und Patienten präoperativ über Nutzen,
Risiken und alternative Behandlungsmöglichkeiten
aufgeklärt werden sollen.
Die präoperative Patienteninformation
und -edukation soll auch eine Schmerzund
Analgetikaanamnese umfassen und
Patienten mit Risikofaktoren für starke
Schmerzen und eine Schmerzchronifizierung
sollen identifiziert werden.
Unter Berücksichtigung von Kontraindikationen
können Nichtopioidanalgetika
abhängig von der Operationsdauer auch
schon prä- oder intraoperativ gegeben
werden, um nach Beendigung der
Anästhesie ausreichende Plasmakonzentrationen
zu erzielen. Nichtopioidanalgetika
oder Kombinationen von (Nichtopioid-)
Analgetika sollen nur für einen
begrenzten Zeitraum gegeben werden.
Ein gemeinsam erarbeiteter abteilungsübergreifender
Behandlungsstandard mit
dem Nichtopioidanalgetikum erster Wahl,
weiteren Therapieoptionen sowie ad-
äquaten Dosierungen, ergänzt durch ein-
griffsspezifische Konzepte, soll schriftlich
hinterlegt werden. Bei Entlassung
aus dem Krankenhaus soll der nachbehandelnde
Arzt zu perioperativ gegebenen
und aktuell noch eingenommenen
Analgetika schriftliche Informationen
erhalten. Patienten sollen zu möglichen
Nebenwirkungen der Analgetika und
ihrer Symptome, die auch nach Krankenhausentlassung
auftreten können, und
die befristete Einnahmedauer informiert
werden.
Schlussfolgerung: Die Anwendung von
Nichtopioidanalgetika soll als Bestandteil
eines perioperativen multimodalen
Analgesiekonzepts mit klaren Vorgaben
zu Indikationen, Kontraindikationen,
Dosierungen
und Behandlungsdauer
in einem abteilungsübergreifenden
Behandlungsstandard
schriftlich hinterlegt
werden.Background: Nonopioid analgesics are
frequently used for perioperative analgesia;
however, insuffcient research is
available on several practical issues.
Often hospitals have no strategy for
how to proceed, e.g., when informing
patients or timing the perioperative administration
of nonopioid analgesics.
346 Sonderbeiträge
Special Articles
Leitlinien und Empfehlungen
Guidelines and Recommendations
© Anästh Intensivmed 2021;62:345–361 Aktiv Druck & Verlag GmbH
Methods: An expert panel representing
the German national societies of pain,
anaesthesiology and intensive care
medicine and surgery developed recommendations
for the perioperative use of
nonopioid analgesics within a formal,
structured consensus process.
Results: The panel agreed that nonopioid
analgesics should be part of a multimodal
analgesia concept and that pa-
tients have to be informed preoperatively
about possible complications and
alternative treatment options. Patients’
history of pain and analgesic intake
should be evaluated. Patients at risk of
severe postoperative
pain and possible
chronification of postsurgical pain should
be identified. Depending on the duration
of surgery, nonopioid analgesics can
already be administered preoperatively
or intraoperatively so that plasma concentrations
are sufficient after emergence
from anaesthesia. Nonopioid analgesics
or combinations of analgesics should
be administered for a limited time only.
An interdisciplinary written standard of
care, comprising the nonopioid analgesic
of choice, possible alternatives,
adequate dosing and timing of administration
as well as surgery specific po-
licies, have to be agreed upon by all
departments involved. At discharge, the
patient’s physician should be informed
of analgesics given and those necessary
after discharge. Patients should be informed
of possible side effects and
symptoms and timely discontinuation of
analgesic drugs.
Conclusion: The use of nonopioid an-
algesics as part of a perioperative multimodal
concept should be approved and
established as an interdisciplinary and
interprofessional
concept for the adequate
treatment of postoperative pain
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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