Background:

Mucositis pain can be very difficult to control in some patients despite the use of parenteral opioids. In our institution, we have started adding low-dose ketamine to the morphine NCA/PCA

in these children in an effort to improve analgesic efficacy.

Methods/materials:

The records of all children receiving a morphine/ketamine PCA or NCA for mucositis pain in our institution from 1999 to 2007 were reviewed. At the time of treatment, details of the analgesic management and consumption, pain scores and side effects were prospectively recorded and then selleck compound entered on to an electronic database. Ketamine was added at a concentration of 20 or 40 mu g center dot kg-1 per ml with our standard morphine NCA/PCA infusions and protocols being used.

Results:

In 28 patients, there was no difference between BEZ235 average morphine consumption in the 24 h pre and post the addition of ketamine (33.1 (+/- 10.7) vs 35.2 (+/- 14.3) mu g center dot kg-1 per hour, P = 0.45) but in those with recorded pain scores (n = 16), the median percentage of pain scores >= 4 was 48% (13-100%) preketamine versus 33% (0-82%) postketamine (P = 0.01). In all patients, there was no change in the rates of nausea and vomiting and pruritis pre and post the addition of ketamine and no other significant

side effects were reported. No difference was seen between those who had 20 or 40 mu g center dot kg-1 per ml of ketamine added.

Conclusion:

The addition of ketamine to a morphine NCA/PCA improves analgesic efficacy in children with mucositis pain with no increase in the incidence of side effects.”
“The toxicity of single and combined formulated herbicides (Mikado (R) and Viper (R)) was assessed on several endpoints in species from two trophic levels: algae growth-Pseudokirchneriella sub-capitata and Chlorella vulgaris-immobilization and life-history traits (only for single compound toxicity) of daphnids-Daphnia longispina and Daphnia magna. Viper was the most toxic formulated herbicide. It was hypothesized that the toxicity of both formulated herbicides could have been enhanced by adjuvants, especially PF-03084014 for Viper.

In most cases, the sublethal endpoints were the most sensitive and affected by both formulations, comparatively to their acute effects. Concentration addition (CA) and independent action (IA) models provided an accurate description of Mikado and Viper joint action on algae growth and immobilization of daphnids, although significant deviations were always detected. A low-dose antagonism and high-dose synergism were identified for P. subcapitata, whereas C. vulgaris response deviated antagonistically from CA and synergistically from IA. For both daphnids, however, synergistic effects were observed for higher mixture concentrations. Under a regulatory standpoint, CA provided the most conservative estimation either because the mixture effects were overestimated or less subestimated than IA.