Buprenorphine Facilitates Rapid Weaning From Very-High-Dose Intrathecal Hydromorphone.

Pain management in patients on chronic opioid therapy is a common clinical challenge. The phenomena of opioid-induced hyperalgesia and tolerance are important contributors to that challenge. There are multiple strategies described to wean opioid doses and/or transition patients off opioids altogether. However, there is very little data to guide transitions off chronic intrathecal opioids. Here, we report on two patients with intractable post-laminectomy pain syndrome, resulting in severe functional limitation in the setting of opioid escalation culminating in the intrathecal delivery of hydromorphone to daily doses as high as 20 mg/day. We describe their rapid successful weaning off opioids using low-dose buprenorphine, which resulted in a dramatic improvement in pain and function.

Unusual Cause of Intraoperative Asystole During Thoracotomy: A Case Report.

Thoracotomies are classified as moderate to high-risk surgeries due to the preponderance of complex anatomic structures, cardiac dysrhythmias, and respiratory insufficiency. The right vagus nerve innervates the sinoatrial node and controls the heart rate. The parasympathetic activation of the sinoatrial node can lead to bradyarrhythmias. The anatomic aortopulmonary window contains lymph nodes and the left vagus nerve. The occurrence of sudden asystole due to left vagus nerve stimulation is extremely rare. We report an unusual case of intraoperative asystole related to electrosurgical stimulation of the left vagus nerve that required cardiopulmonary resuscitation and cardiac massage.

Reversible, electrochemically controlled binding of phosphine to iron and cobalt bis(dithiolene) complexes.

The homoleptic bis(dithiolene) complexes [M(S(2)C(2)R(2))(2)](2) (M = Fe, Co; R = p-anisyl) undergo two successive reductions to form anions that display [M(S(2)C(2)R(2))(2)](2)(2-) <--> 2[M(S(2)C(2)R(2))(2)](1-) solution equilibria. The neutral dimers react with Ph3P to form square pyramidal [M(Ph(3)P)(S(2)C(2)R(2))(2)](0). Voltammetric measurements upon [M(Ph(3)P)(S(2)C(2)R(2))(2)](0) in CH(2)Cl(2) reveal only irreversible features at negative potentials, consistent with Ph(3)P dissociation upon reduction. Dissociation and reassociation of Ph(3)P from and to [Fe(Ph(3)P)(S(2)C(2)R(2))(2)](0) is demonstrated by spectroelectrochemical measurements. These collective observations form the basis for a cycle of reversible, electrochemically controlled binding of Ph(3)P to [M(S(2)C(2)R(2))(2)](2) (M = Fe, Co; R = p-anisyl). All members of the cycle ([M(S(2)C(2)R(2))(2)](2)(0), [M(S(2)C(2)R(2))(2)](2)(1-), [MM(S(2)C(2)R(2))(2)](2)(2-), [M(S(2)C(2)R(2))(2)](1-), [M(Ph(3)P)(S(2)C(2)R(2))(2)]) for M = Fe, Co have been characterized by crystallography. Square planar [Fe(S(2)C(2)R(2))(2)](1-) is the first such iron dithiolene species to be structurally identified and reveals Fe-S bond distances of 2.172(1) and 2.179(1) Angstrom, which are appreciably shorter than those in corresponding square planar dianions.