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Suffocation during/after Anaesthesia or due to Medical Malpractice
Published in Burkhard Madea, Asphyxiation, Suffocation,and Neck Pressure Deaths, 2020
Burkhard Madea, Elke Doberentz, Frank Musshoff
Piritramide (1-(3-cyano-3,3-diphenyl-propyl)-4-(1-piperidyl)piperidin-4-carboxamid) is a synthetic opioid indicated primarily for the management of postoperative pain (Figure 35.6). The drug is commonly applied via portable pumps in a PCA regime, providing safe self-administration of analgesics [60]. The steady-state plasma concentration of piritramide necessary for 50 per cent of maximum analgesia (ED50) is between 2.9 and 29.8 ng/ml (mean 12.1 ng/ml) [56]. In comparison to other opioids, it has a quite slow onset of action (10−60 minutes) [51,73] and a long terminal elimination half-life of about 8 hours with a considerable variability with respect to the patient's age [38]. Therefore, piritramide has to be dosed carefully during long-term treatment to avoid accumulation that may lead to adverse effects [57].
Total Hip in a Day: Setup and Early Experiences in Outpatient Hip Surgery
Published in K. Mohan Iyer, Hip Joint in Adults: Advances and Developments, 2018
In the recovery unit we frequently do IV administration of 2 mg of piritramide up to three times that day, as well as 500 mg metamizole oral in the late afternoon. Immediately following the patient’s return out of the operating room, the second mobilisation is conducted about 90 minutes postop by a physical therapist, followed by two further mobilisations with an increasing radius of motion, walking down the room or hallway (Fig. 18.5).
Post-tonsillectomy hemorrhage: cost-benefit analysis of prolonged hospitalization
Published in Acta Oto-Laryngologica, 2020
Erich Vyskocil, Wolf-Dieter Baumgartner, Matthaeus Ch. Grasl, Stephan Grasl, Christoph Arnoldner, Johannes Steyrer, Boban M. Erovic
Preoperative examinations included full blood count, clotting screen (prothrombin time, partial thromoboplastin time). Treatment was adapted to minimize bleeding risk if patients received medication which had an effect on blood coagulation due to their comorbidities. All interventions were performed under general anesthesia, using cold-steel dissection with bipolar diathermy. Adenoidectomy was performed with adenotoms. Patients were hospitalized for three nights. One week after surgery a routine follow-up appointment in the outpatient clinic. Some patients required prolonged postoperative observation (e.g. pain, poor general condition, long travel time to the next emergency department, postoperative bleeding, severe nausea or pain). Pain control was accomplished by paracetamol, mefenamic acid and diclofenac in the standard dosages. Patients with severe pain, which could not be sufficiently treated with above-mentioned drugs, also received Metamizole given intravenously. In some cases of persisting pain, adults received synthetic opioid analgesic (Piritramide). Fever, vomiting and dehydration were treated symptomatically. Postoperative care also included monitoring during two surgeon rounds per day and permanent observation by the nursing staff.
Pain-diminishing effects of Kinesio® taping after median sternotomy
Published in Physiotherapy Theory and Practice, 2018
Rabea Brockmann, Hans-Michael Klein
-Patients of the treatment group needed significantly less daily piritramide suspension (15 mg Dipidolor on 10 ml of NaCl) (1.2 ml ± 0.4 ml, CI: 0.4 ml; 2.1 ml) versus (3.1 ml ± 0.5 ml, CI: 2.0 ml; 4.2 ml) (p = 0.01) particularly on day 1 (p = 0.007) and on day 4 (p = 0.015) (control group: day 1: 16.2 ml ± 2.3 ml; day 2: 4.9 ml ± 1.3 ml; day 3: 2.9 ml ± 2.0 ml; day 4: 2.9 ml ± 1.2 ml; day 5: 0.1 ml ± 0.1 ml; day 6: 0.0 ml ± 0.0 ml; day 7: 0.1 ml ± 0.1 ml; day 8: 0.0 ml ± 0.0 ml; treatment group: day 1: 8.1 ml ± 1.6 ml; day 2: 2.6 ml ± 0.8 ml; day 3: 0.8 ml ± 0.4 ml; day 4: 0.5 ml ± 0.2 ml; day 5: 0.0 ml ± 0.0 ml; day 6: 0.0 ml ± 0.0 ml; day 7: 0.0 ml ± 0.0 ml; day 8: 0.0 ml ± 0.0 ml). Analgesic treatment outcomes for piritramide are shown in Figure 4.
Sedation in cardiac arrhythmias management
Published in Expert Review of Cardiovascular Therapy, 2018
Federico Guerra, Giulia Stronati, Alessandro Capucci
Wutzler and colleagues reported the outcomes of 42 patients undergoing VT ablation under minimal sedation and 78 patients undergoing VT ablation under deep sedation [63]. Both strategies used midazolam and piritramide. Deep sedation was associated with longer procedure duration and radiofrequency delivery time, while no differences were seen in terms of hypotension, hypoxia, and bradycardia [63]. Nof and colleagues reported that GA was associated with more use of hemodynamic support but this did not adversely affect VT stability or procedural outcomes [64]. More recently, another observational study demonstrated that a CDS strategy of propofol alone with the occasional addition of fentanyl could be a safe option for VT ablation, albeit propofol had to be discontinued in 11.7% of the procedures due to low systolic blood pressure [65].