七氟醚或丙泊酚复合瑞芬太尼用于小儿经喉罩纤维支气管镜检查的比较

目的观察和比较七氟醚或丙泊酚复合瑞芬太尼麻醉在小儿经喉罩纤维支气管镜(FOB)检查中的临床效果。方法 60例拟行FOB检查的患儿随机分为两组,每组30例:七氟醚复合瑞芬太尼组(S组)和丙泊酚复合瑞芬太尼组(P组)。S组采用七氟醚复合瑞芬太尼的静吸复合麻醉方式,P组采用丙泊酚复合瑞芬太尼的全凭静脉麻醉方式。两组均置入喉罩并保留自主呼吸,经喉罩行FOB检查。记录入室后安静时(T0:基础值)、镜检前(T1)、镜检进行2 min(T2)时平均动脉压(MAP)、心率(HR)、脉氧饱和度(Sp O)2、呼气末二氧化碳(PETCO2)和脑电双频指数(BIS),评估麻醉效果,并记录镜检时间、苏醒时间和不良反应发生情况。结果 P组T1时HR、MAP和Sp O2明显低于S组、PETCO2明显高于S组;T2时MAP、HR和PETCO2明显高于S组、Sp O2明显低于S组(P0.05)。S组麻醉效果优良率明显高于P组(P0.05)。S组短暂呼吸抑制、检查中断率明显低于P组(P0.05)。结论经喉罩吸入七氟醚复合静脉瑞芬太尼用于小儿FOB检查,较丙泊酚复合瑞芬太尼的全凭静脉麻醉方式更为安全、有效。     

七氟醚复合瑞芬太尼麻醉对宫颈癌术后应激反应的影响

目的:探究七氟醚复合瑞芬太尼麻醉对宫颈癌患者行腹腔镜下子宫全切术后应激反应的影响。方法:选取2015年10月~2017年4月我院收治的74例宫颈癌患者作为研究对象,依照随机数字表法分为观察组和对照组,每组37例。两组均行腹腔镜下子宫全切术,对照组采用丙泊酚联合瑞芬太尼麻醉,观察组采用七氟醚联合瑞芬太尼麻醉。对比两组的自主呼吸恢复时间、定向力恢复时间、言语应答时间、麻醉前及建立气腹后10 min心率(HR)、平均动脉压(MAP)、血糖(GLU)水平和肾上腺素(NE)水平。结果:观察组的自主呼吸恢复时间、定向力恢复时间和言语应答时间均短于对照组,差异均有统计学意义,P<0.05;建立气腹后10 min,观察组的HR、MAP、GLU和NE均低于对照组,差异均有统计学意义,P<0.05。结论:宫颈癌患者行腹腔镜下子宫全切术时,给予其七氟醚复合瑞芬太尼麻醉,能有效促进麻醉后恢复,减轻应激反应。     

七氟醚与瑞芬太尼联用对困难气道患者应激反应、肺功能及血气指标的影响

目的探讨七氟醚与瑞芬太尼联用对困难气道患者应激反应、肺功能及血气分析的影响。方法选择2014年6月至2016年7月该院收治的麻醉预计困难气道患者90例,随机分为试验组和对照组,每组45例。试验组使用七氟醚联合瑞芬太尼,对照组使用丙泊酚联合瑞芬太尼进行麻醉。比较两组T0、T1、T2时间点应激反应指标[包括血糖(GLU)、皮质醇(CRO)、去甲肾上腺素(NE)、肾上腺素(NA)、心率(HR)、平均动脉压(MAP)及血氧饱和度(SpO_2)]、肺功能指标[包括QS/QT、肺动态顺应性、P_(peak)、P_(ET)CO_2]、血气指标[包括PaCO_2、PaO_2、pH值]的波动情况。结果两组患者在T0、T1、T2时间点各个指标均存在不同程度的波动。T0时间点两组的GLU、CRO、NA、HR、MAP、SpO_2、NE、QS/QT、肺动态顺应性、P_(peak)、P_(ET)CO_2、PaCO_2、PaO_2、pH值均无明显波动,差异无统计学意义(P0.05)。T1时间点试验组的PaO_2波动优于对照组,两组比较差异有统计学意义(P0.05)。T2时间点试验组的SpO_2波动优于对照组,两组比较差异有统计学意义(P0.05)。T1、T2时间点试验组GLU、CRO、NA、HR、MAP、NE、肺动态顺应性、P_(peak)波动均优于对照组,两组比较差异有统计学意义(P0.05)。结论七氟醚与瑞芬太尼联用可明显改善困难气道患者应激反应、肺功能,对患者血气分析影响较轻,值得推广。     

老年急性胆囊炎腹腔镜胆囊切除术中七氟醚联合瑞芬太尼麻醉效果分析

目的:探讨七氟醚联合瑞芬太尼麻醉对老年急性胆囊炎(AC)患者行腹腔镜胆囊切除术中镇静效果及术后自主呼吸恢复的影响。方法:选取2013年12月~2017年1月我院老年AC患者98例,按照随机数字表法分为对照组和观察组各49例。对照组给予丙泊酚联合瑞芬太尼麻醉,观察组给予七氟醚联合瑞芬太尼麻醉。比较两组不同时间段(T0、T1、T2、T3)血流动力学指标(HR、MAP、Sp O2)及Ramsay镇静评分;记录两组自主呼吸恢复时间、呼唤睁眼时间及拔管时间;比较两组苏醒期不良反应发生率。结果 :两组的Sp O2在各时间段无明显变化,组间、组内比较差异无统计学意义(P>0.05);观察组T1、T2、T3时HR、MAP较T0时无明显变化,差异无统计学意义(P>0.05);对照组T1、T2、T3时HR、MAP较T0时出现明显变化,差异具有统计学意义(P<0.05);观察组T1时Ramsay评分低于对照组(P<0.05);观察组自主呼吸恢复时间、呼唤睁眼时间、拔管时间及苏醒期不良反应发生率均低于对照组(P<0.05)。结论:AC老年患者在腹腔镜胆囊切除术中采用七氟醚联合瑞芬太尼麻醉,术中循环平稳,术毕苏醒迅速,并发症少,值得临床推广应用。     

Narcotrend监测下七氟醚对脊柱侧弯矫正术中唤醒的影响

目的:观察Narcotrend麻醉深度监测在脊柱侧弯矫正术中唤醒试验的应用,评价七氟醚对脊柱侧弯矫正术中唤醒试验的影响.方法:60例择期行脊柱侧弯矫正术患者,ASA Ⅰ～Ⅱ级,随机分为七氟醚复合瑞芬太尼静吸复合组(S组)和丙泊酚复合瑞芬太尼静脉麻醉组(P),每组30例.以丙泊酚复合瑞芬太尼靶控输注诱导,诱导插管成功后S组吸入低流量七氟醚(1L/min),P组靶控输注丙泊酚维持麻醉.两组术中均靶控输注瑞芬太尼.根据Narcotrend麻醉深度监测把NI值维持在30 ～ 45调整麻醉深度.记录两组患者手术开始至唤醒试验的时间、手术时间、唤醒时间(从开始唤醒至唤醒成功时间)及苏醒时间(唤醒后清醒时间);观察唤醒试验期间有无不良反应发生,记录两组麻醉前(TO)、术中唤醒前停药时(T1)、唤醒时(T2)、唤醒后10 min (T3)、术毕拔管(T4)时平均动脉压(MAP)、心率(HR)、NI值及呼吸末七氟醚的浓度(ETsev).术后1d,随访患者对唤醒试验及术中其他事件的记忆情况及术中有无疼痛等.结果:两组两组患者均成功完成唤醒试验.两组患者手术开始至唤醒试验的时间、手术时间、唤醒时间和苏醒时间比较差别均无统计学意义(P＞0.05).唤醒期间丙泊酚组有2例发生呛咳,七氟醚组无发生呛咳患者.术后随访两组患者无神经损伤表现,对术中其他事件无记忆.术中两组患者唤醒试验唤醒时(T2)及术毕拔管时(T4)的MAP和HR值较其他时间点均明显升高(P＜0.05);两组患者在唤醒前停药时(T1)及唤醒后10 min(T3)的NI值较其他时间点均明显降低(P＜0.05);七氟醚组在唤醒前停药时(T1)及唤醒后10 min(T3)的ETsev值较其他时间点升高(P＜0.05);两组各时间点的MAP、HR及NI值比较差别无统计学意义(P＞0.05).结论:在Narcotrend麻醉深度监测指导下吸入七氟醚同丙泊酚一样适用于脊柱侧弯矫正术中唤醒麻醉,Narcotrend麻醉深度监测对脊柱矫形术中唤醒时间有预测和指导作用.     

靶控输注瑞芬太尼伍用丙泊酚或七氟醚在妇科腹腔镜手术中的麻醉效果比较

[目的]比较靶控输注瑞芬太尼与丙泊酚全凭静脉麻醉和靶控输注瑞芬太尼与七氟醚静吸复合麻醉在妇科腹腔镜术中的麻醉效果.[方法]选择ASAⅠ或Ⅱ级择期行妇科腹腔镜手术患者52例,随机均分为瑞芬太尼-丙泊酚全凭静脉麻醉组（RP组）与瑞芬太尼-七氟醚静吸复合麻醉组（RS组）.RP组麻醉维持用瑞芬太尼与丙泊酚靶控输注,RS组采用靶控输注瑞芬太尼及吸入七氟醚维持麻醉.观察和测定麻醉前10 min（T0）、插管后1 min（T1）、气腹后15 min（T2）及停气腹后15 min（T3）4个时间点的平均动脉压（MAP）、心率（HR）、血糖（BG）、皮质醇（Cor）,并记录两组患者术毕停药后自主呼吸恢复时间、呼之睁眼时间、拔管时间及定向力恢复时间.术后24 h 随访恶心、呕吐、躁动发生率,有无术中知晓以及患者满意度.[结果]两组4个时间点的MAP、HR、Cor、BG组间比较差异无统计学意义（P〉0.05）;组内比较,两组MAP、HR在T1、T2两时点与T0比较均下降（P〈0.05）,两组Cor在T2、T3与T0时点比较均明显下降（P0.05）.两组均无术中知晓,RS组的恶心、呕吐例数多于RP组（P〈0.05）.患者术后满意度均为100%.[结论]靶控输注瑞芬太尼复合丙泊酚或七氟醚用于妇科腹腔镜手术,均能维持术中血流动力学稳定以及较好的抑制插管和气腹造成的应激反应,术后苏醒迅速,尽管RS组术后恶心、呕吐多于RP组,但两种方法均能被病人较好的接受.     

瑞芬太尼复合丙泊酚或七氟烷全身麻醉维持效果比较分析

目的:分析比较瑞芬太尼复合丙泊酚或七氟烷全身麻醉维持临床应用效果。方法:选取2015年5月~2017年2月我院接诊的84例行腹腔镜胆囊切除术患者为研究对象,随机分为七氟烷组和丙泊酚组各42例。七氟烷组给予瑞芬太尼和七氟烷麻醉,丙泊酚组瑞芬太尼复合丙泊酚麻醉。比较两组患者麻醉诱导时(T1)、手术刺激最强时(T2)、拔管时(T3)、出手术室时(T4)心率(HR)及平均动脉压(MAP)情况;两组自主呼吸恢复、睁眼、拔管时间及患者拔管15 min后的VAS评分。结果 :七氟烷组和丙泊酚组患者T1、T2、T3和T4不同时间点的HR和MAP无显著性差异(P>0.05);七氟烷组自主呼吸恢复、睁眼及拔管时间、VAS评分均显著低于丙泊酚组(P<0.05)。结论:瑞芬太尼复合七氟烷全身麻醉维持效果优于丙泊酚。     

复合丙泊酚和瑞芬太尼麻醉维持对腹部手术患者血氧指标的影响

目的探讨复合异丙酚和瑞芬太尼麻醉维持对腹部手术患者血氧指标的影响。方法择期拟行腹部手术的患者80例,随机分为观察组(A组)和对照组(B组),每组40例。A组患者麻醉诱导后采用丙泊酚复合瑞芬太尼进行麻醉维持,B组患者麻醉诱导后采用七氟醚吸入,芬太尼静脉输注维持麻醉。观察入室时(T0)、气管插管时(T1)、手术开始时(T2)、手术开始30min(T3)、拔管后(T4)的平均动脉血压(MAP)、心率(HR)、氧分压(Sp O2)、呼气末二氧化碳分压(PETCO2)并记录。分别记录手术时间、清醒时间、拔管时间以及麻醉用药量。观察并比较A、B两组患者术后恶心呕吐(PONV)发生率。结果与T0时比较,T1~T4时A组MAP明显低于B组(P0.05);T3、T4时A组的MAP明显降低(P0.05);与B组比较,A组T1~T4时MAP明显降低;T2~T4时HR明显减慢(P0.05)。T0时,两组患者Sp O2差异比较无统计学意义;与B组比较,A组T1~T4时Sp O2明显高于B组(P0.05)。两组患者PETCO2差异比较无统计学意义。两组患者的手术时间、清醒时间、拔管时间差异均无统计学意义(P0.05)。A组PONV发生率(15.0%)明显低于B组(32.5%),差异有统计学意义(P0.05)。结论复合丙泊酚和瑞芬太尼应用于腹部手术患者麻醉维持可有效维持术中血流动力学及血氧指标稳定。     

七氟醚-瑞芬太尼静吸复合麻醉对创伤患者应激反应及术后认知功能的影响

目的探讨七氟醚-瑞芬太尼静吸复合麻醉对创伤患者应激反应及术后认知功能的影响。方法选择该院2015年6月至2016年6月创伤患者124例,根据随机数字表法将患者分为观察组(n=62)及对照组(n=62),对照组患者应用丙泊酚-瑞芬太尼静脉复合麻醉,观察组患者使用七氟醚-瑞芬太尼静吸复合麻醉,记录2组麻醉前5min(T_0)、麻醉后10min(T_1)、手术开始时(T_2)、麻醉完成后1h(T_3)、手术结束时(T_4)的平均动脉压(MAP)、心率(HR)、血氧饱和度(SPO_2)、呼吸末二氧化碳(PETCO_2)。分别于麻醉前1d及术后1d应用简易精神状态量表(MMSE)及连线试验(TMT)对2组认知功能进行评价,并比较2组并发症发生情况。结果 2组患者T1~T4时间段MAP、HR、SPO_2、PETCO_2水平显著高于T0时间段,观察组T1~T4时间段MAP、HR、SPO_2、PETCO_2水平显著低于对照组(P0.05)。观察组患者术后1dMMSE评分低于对照组(P0.05),且与术前1d比较差异无统计学意义(P0.05)。对照组术后1dMMSE评分高于术前1d(P0.05),2组术前1dTMT完成时间比较差异无统计学意义(P0.05),观察组术后TMT完成时间短于对照组(P0.05)。观察组认知功能障碍、恶心呕吐、头昏、嗜睡、躁动、呼吸抑制发生率低于对照组(P0.05)。结论七氟醚-瑞芬太尼静吸复合麻醉能有效稳定创伤患者血流动力学,术后认知功能及相关并发症较小,是较为理想的麻醉方式,值得临床推广应用。     

地佐辛复合七氟醚在膀胱黏膜白斑电切术中的应用

目的观察地佐辛复合七氟醚吸入行膀胱黏膜白斑电切术的麻醉效果。方法择期行膀胱黏膜白斑电切术患者90例随机分成地佐辛复合七氟醚组(D组),芬太尼复合七氟醚组(F组)和单纯七氟醚组(Q组),每组30例。记录麻醉开始前(T0)、手术开始前(T1)、电切开始后(T2)、手术结束时(T3)和患者清醒后5 min(T4)各时点的平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(Sp O2)和呼吸频率(RR);记录麻醉起效时间、意识恢复时间、术中体动和呼吸抑制情况及术后下腹部胀痛不适情况。结果 D组和F组各时点MAP、HR、RR和Sp O2无显著差异(P0.05);在T2和T3时点,Q组的MAP、HR和RR与D组和F组比较差异有统计学意义(P0.0 5);在T4时点,Q组的MAP、HR与D组和F组比较差异有统计学意义(P0.05);Q组麻醉起效时间较D组和F组长(P0.05);Q组术中体动及术后尿胀不适患者明显较D组和F组多(P0.05)。结论地佐辛和芬太尼复合七氟醚吸入均可以用于膀胱黏膜白斑电切术,但地佐辛复合七氟醚吸入用于膀胱黏膜白斑电切术的麻醉效果更佳。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.