Kratom and General Anesthesia: A Case Report and Review of the Literature.

Kratom is a botanical substance derived from the Mitragyna speciosa plant, which grows naturally in Southeast Asia. Its active compounds include alkaloids with psychoactive and opioid properties. Low doses act as a stimulant, while higher doses cause analgesia and euphoria. As a drug of abuse, there are reports of seizure, acute psychosis, and death. Both the US Food and Drug Administration and the Drug Enforcement Agency warn against the use of kratom. Here is the first reported case of an anesthetic in a patient using kratom for chronic pain.

Quality improvement project to reduce perioperative opioid oversedation events in a paediatric hospital.

BACKGROUND: Narcotics are responsible for many adverse drug events in children and there has been an increase in opioid oversedation events in hospitalised patients. OBJECTIVES: To use improvement methods to prevent perioperative opioid oversedation adverse events while continuing to provide appropriate pain control. METHODS: Interventions included revising the post-anaesthesia order form so that prescribers could choose only one narcotic and one dose for moderate pain and one narcotic and one dose for severe pain, modifying a nursing tool to provide more objective criteria for assessing patient sedation level, and restructuring the pain service. Clinicians on the Acute Pain Service saw all postoperative patients receiving intravenous patient-controlled analgesia or neuraxial narcotics in the mornings and afternoons and a nurse saw them on weekday evenings. RESULTS: The rate of opioid-related oversedation events decreased from 0.15 per 1000 patient days at baseline to 0.111 during the intervention period to 0.074 in the post-intervention period. The days between events increased from 21.0 to 27.5 to 48.8 during the same periods. The number of opioid-related oversedation events decreased from 22 to 17 to 5 during these periods, respectively. CONCLUSIONS: Opioid-related oversedation events decreased over the course of the study. Because the perioperative period is an especially likely time for opioid oversedation events, strict opioid prescribing practices, while maintaining adequate pain control and improved sedation assessment during the perioperative period, were emphasised. The restructured pain service and increased visits by pain team experts were also associated with the reduction in oversedation events.