Phenytoin zero order elimination dose of 10 mg/kg). In our study, the highest dose of phenytoin for total dose-proportion analysis was 10 mg/kg and the second highest total dose of phenytoin was 20 mg/kg.
Based on the mean difference between groups in the total number of days with any abnormal clinical signs, mean daily dose of hydromorphone was significantly lower in the phenytoin group compared with placebo group.
The present study shows that in patients undergoing surgery, hydromorphone is associated with increased hospitalization and mortality due to the development of opiate and respiratory depression associated with the administration of phenytoin. In addition, the increased mortality was also associated with the development of hepatic impairment.
The results of this study were surprising and unexpected. Although it is known that the administration of hydromorphone may cause a variety of adverse effects, these experiences are usually confined to the terminal phase of surgery and are generally mild at the time of administration. results this study are very different. In this study, significant adverse effects were noted including increased mortality, hospitalization, decreased quality of life, and increased adverse events from the surgical procedures. In addition to this, the increased morbidity and mortality was also associated with a significant reduction in functional impairment. The results of this study suggest that the administration of hydromorphone during surgical procedures may be associated with significant complications and adverse effects that can significantly impact clinical outcomes.
A common misconception regarding hydromorphone is that the drug known by a generic name of hydromorphone. This drug is a long acting analgesic which, therefore, results in a short half-life. However, although hydromorphone is a long acting analgesic, it has the capacity to be absorbed by the gastrointestinal tract and central nervous system. In this study, the increased mortality was observed primarily in the last few days of surgery. This is largely due to the rapid effects of hydromorphone on the central nervous system. Because hepatic function is important during the surgical phase of surgery, results this study are important to the patients and their families physicians.
The present study also demonstrated that the duration of administration hydromorphone increased during surgery. This is important because the administration of hydromorphone is generally longer than that of morphine. It is generally believed that patients receive hydromorphone slowly over a period of 2 to 5 days achieve its therapeutic effects. In this study, hydromorphone was administered over a period of 24 to 48 hours. Patients who had been on morphine, at one week, continued to receive the same morphine dose and were not switched to hydromorphone. Therefore, if the time interval between morphine and hydromorphone was short, then the time interval between injection of hydromorphone and the onset opiate withdrawal symptoms was the same. Therefore, it has been suggested that patients who are switchable from morphine to hydromorphone would be in an improved position to cope with the effects of drug than patients who have been on morphine for a long time. This is in reference to some of the adverse effects described in this study that were observed in some of the patients who were switchable from morphine to hydromorphone. However, it has not been determined whether this change in the clinical condition of patients was from long-term morphine use or a drug-induced withdrawal.
Despite hydromorphone being a long acting analgesic, no evidence at this time is available to demonstrate that long-term hydromorphone use is associated with adverse effects. Nevertheless, this investigation is promising and important to the patients who are undergoing surgery and to physicians who are responsible for their care.
Our study demonstrated that the administration of hydromorphone was associated with significant morbidity and mortality in our patients that the number of days hospitalization and mortality was significantly increased in the patients who were switchable from morphine to hydromorphone. It is important for surgeons to understand that patients who are switchable from morphine to hydromorphone are now receiving more rapidly than previously, and the duration of administration is phenytoin dose oral increasing. Therefore, it important that physicians consider the need to discontinue hydromorphone if the number of days hospitalization and mortality increases during the last few days after surgery has reached a level that is beyond the capacity of patient to cope with.
The results of this study are consistent with that of the recent study by Leong et al7 which showed that the frequency of opiate-related adverse events is higher in patients who have been switched from morphine to hydromorphone. This study also demonstrated that patients who have been switched from morphine to hydromorphone had a higher incidence of opiate-related adverse events than those who were not switched. In addition, the incidence of respiratory depression and the use of vasopressors was.
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