The safety of deep sedation without intubation for abortion in the outpatient setting.

STUDY OBJECTIVE: To determine the rate of perioperative pulmonary aspiration in patients undergoing first and second-trimester surgical abortion during deep sedation with propofol, without intubation. DESIGN: Retrospective review of cases of surgical and anesthetic complications reported to the Office of Quality Management of the surgical facility between August 1, 2001 and April 30, 2008. SETTING: Large urban surgical abortion outpatient facility. MEASUREMENTS: The medical records of all surgical abortion patients who underwent hospital transfer were reviewed. From billing records, all patients who underwent abortion during deep sedation were identified. The primary outcome was the rate of perioperative pulmonary aspiration. Secondary outcomes included the rates of other anesthesia-related adverse events resulting in hospital transfer. MAIN RESULTS: During the 81-month study period, the facility performed 62,125 surgical abortions during deep sedation, including 11,039 second-trimester abortions. Only one patient received endotracheal intubation. No cases of perioperative pulmonary aspiration occurred. CONCLUSIONS: Deep sedation without intubation is a viable method of anesthesia for both first and second-trimester surgical abortions in the outpatient setting.

Anesthesia for patients on buprenorphine.

Opioid abuse is a devastating, costly, and growing problem in the United States, and one for which treatment can be complicated by barriers such as access to care and legal issues. Only 12% to 15% of the opioid-dependent population is enrolled in methadone maintenance programs. A significant breakthrough occurred with passage of the Drug Addiction Treatment Act of 2000 (DATA 2000). For the first time in approximately 80 years, physicians could legally prescribe opioid medications for the treatment of opioid addiction. The opiate, so designated, was buprenorphine (Subutex).

Medications of abuse in pain management.

PURPOSE OF REVIEW: Chronic pain leads to a reduction in the quality of life for those who suffer it. Due also to high medical costs and lost productivity, chronic pain is a significant burden on society. One contributor to the burden of pain is the fear that medications used in pain management produce dependency, leading to diversion and addiction. Certain medications used in practice, although not abused by the patient, seem to be favored and these are frequently reported to be used recreationally by the nonpatient population. This report identifies medications that most frequently present a problem in pain practices, why they are a problem, and possible alternatives to their use. RECENT FINDINGS: Problem medications used in analgesic regimens tend to be those that have rapid onset due to their lipophilic nature or route of administration, short duration, and a sedating or energizing effect. These medications are generally more affordable than alternatives with less abuse potential. These medications are more often covered by insurance and more frequently prescribed. Changes in prescribing habits have resulted in predictable shifts in abuse. SUMMARY: Addiction and diversion of prescription medications is a multidimensional problem. Its multifactorial solution will require efforts at many regulatory levels.

Ultrarapid opiate detoxification: a review.

PURPOSE: This review on ultrarapid detoxification examines the pharmacology, techniques, and efficacy of this potentially promising technique and contrasts it with conventional treatment modalities. SOURCE: The information found here is derived from experiences at the Texas Tech University, government reports, and peer reviewed journals. PRINCIPLE FINDINGS: Incidence and prevalence of heroin use is on the rise. Social and treatment costs suggest that this problem is staggering. Approximately 400,000 patients are enrolled in or are actively seeking methadone therapy. While many of these individuals want to undergo detoxification, traditional techniques, including methadone tapering are usually unsuccessful. The withdrawal syndrome is extremely unpleasant, may be fatal, and deters patients from completing the detoxification process. Ultrarapid detoxification entails general anesthesia in conjunction with large boluses of narcotic antagonists. This combination allows the individual to completely withdraw from the opiate without suffering the discomfort of the withdrawal syndrome. Unless performed properly, this procedure can be dangerous due to the sympathetic outflow. However, with proper support, this danger can be mitigated. CONCLUSION: Ultrarapid opiate detoxification, performed under the proper circumstances, is associated with few adverse events and is relatively comfortable for patients who seek treatment for their addition.