The current status of bereavement follow-up in hospice and palliative care in Japan.

In order to explore the implementation of bereavement care in hospice/palliative care settings in Japan, a self-administered questionnaire was sent to all 54 government-approved hospice/palliative care units (PCUs) in May of 1999 (recovery rate 93%). Results showed that bereavement follow-up is performed in 37 institutes (74%) and memorial cards and services are most frequently provided. Memorial cards are provided mainly by nurses, and memorial services involve many health care professionals as well as volunteers. Religious workers tended to be involved in memorial services and social group meetings. Individually oriented interventions such as telephone contacts, personal visits and personal counselling were reportedly used less often. The need for individual-oriented programmes was recognized, and many institutes were considering the expansion of their programmes to include them. However, the difficulties of implementing such care at hospice/PCUs were also raised. Two socio-cultural factors possibly affecting bereavement care in Japan, namely, the roles of family and religious (Buddhist) ceremonies were discussed. It was pointed out that the spirit of bereavement care may be embodied in existing religious ceremonies. We conclude that it is necessary to develop bereavement care programmes based on common, basic hospice care tenets while making full use of existing local resources and taking into account regional values.

Kinetics of respiratory depression in rats induced by buprenorphine and its metabolite, norbuprenorphine.

The respiratory depression induced by buprenorphine and its active metabolite, norbuprenorphine (NBN), was evaluated in rats by measurement of changes in respiratory rate and arterial pCO2 levels. After i.v. bolus administration of buprenorphine no effects were noted over the dose range 0.008 to 3 mg/kg; by contrast, the respiratory rate after rapid i.v. administration of NBN decreased in a dose-dependent fashion within the dose range of 1 to 3 mg/kg, and the arterial pCO2 levels also varied in relation to the change in respiratory rate. The minimum respiratory rate was observed 15 min after NBN administration. Judging by the respiratory depressive effect after i.v. infusion, NBN was approximately 10 times more potent than the parent drug. In spite of the similarity of NBN concentrations in the brain after i.a. and after i.v. administration of NBN (3 mg/kg), neither the respiratory rate nor the arterial pCO2 levels after i.a. administration changed compared with the control levels. Moreover, the NBN concentration in the lungs after i.v. administration was approximately 4-fold higher than that after i.a. administration. NBN-induced depression was rapidly reduced after i.v. administration of naloxone and beta-funaltrexamine, but ICI 174864 was without effect. These results suggest that the respiratory depression induced by NBN may be mediated by opioid mu receptors in the lung rather than in the brain.

[Postoperative pain relief by patient controlled analgesia using intravenous pentazocine].

Patient controlled analgesia (PCA) by intravenous pentazocine was performed to determine its efficacy and the dose required for the pain relief after gynecological or obstetric operations. After obtaining informed consent, studies were performed on 28 female patients (ASA I, II: Mean age 38.1 years: Mean weight, 53.8 kg) who had received gynecological or obstetric operations with lower abdominal incision. Anesthesia given was nitrous oxide and isoflurane combined with epidural anesthesia with 1% mepivacaine used only during the operation. Six patients had cesarian section under spinal anesthesia. No patients received opioid during anesthesia. PCA was performed with a Graseby PCA pump. Lockout time was 8 minutes and the bolus dose was 3 mg. In all the patients, satisfactory pain relief was obtained and no other analgesic was necessary. Mean initial dose was 169.4 micrograms.kg-1 and the mean doses used for following each 6 hours until 24 hours were 409.7, 368.6, 279.3 and 211.1 micrograms.kg-1 respectively. Evaluation of PCA by the patients after the procedure showed excellent (13 patients) good (12) and passable (3) analgesia. No significant complication was observed except temporary nausea in two patients. Satisfactory postoperative pain relief could be obtained by relatively small doses of pentazocine and adverse reactions related especially to sigma receptor could be avoided.

Pharmacokinetics of d-tubocurarine in man: effect of an osmotic diuretic on urinary excretion.

The pharmacokinetics of d-tubocurarine (dTc) and the urinary excretion of dTc were studied in 18 neurosurgical patients with normal renal function, over a period of 96 hours. The effects of an osmotic diuretic (mannitol) on urinary elimination of dTc were determined. Following a single intravenous dose of d-tubocurarine (dTc, 0.3 mg/kg), serum levels and urinary excretion of the drug were measured. A specific radioimmunoassay was used for the analysis of dTc. Nine of the patients also received mannitol, 1 g/kg, after the injection of dTc for surgical indications. The study showed that only 45 per cent of the injected dose of dTc was excreted in 24 hours. Between 24 and 96 hours, an additional 7 per cent of the drug was excreted in the urine. The administration of mannitol, an osmotic diuretic, did not increase the excretion of dTc. The time-concentration relationship of serum concentration of dTc was analyzed. Using the four-exponential equation (data to 96 hours), the calculated volume of distribution (Vdarea) was 3.4 1/kg. This volume, which is greater than the volume of total body water, suggests that dTc is stored in certain tissues in the body and slowly released over a period of days to weeks.