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对于精神病学而言,哪种更好:滴定浓度还是固定浓度的一氧化二氮?

What is better for psychiatry: Titrated or fixed concentrations of nitrous oxide?

作者信息

Gillman Mark A

机构信息

Directorate, South African Brain Research Institute, Johannesburg, South Africa.

出版信息

Front Psychiatry. 2022 Aug 22;13:773190. doi: 10.3389/fpsyt.2022.773190. eCollection 2022.

Abstract

Medication dosages are crucial-no single dose fits all. My paper compares the safety, scientific and practical applicability of fixed 25-50% concentrations of nitrous oxide (NO) with the variable titrated concentrations of Psychotropic Analgesic NO (PAN), as used in dentistry, and neuropsychiatry. A crucial difference is that PAN is always titrated, an open circuit (nasal mask), to the concentration (dose), which ensures full consciousness, cooperation, comfort and relaxation. With PAN, the goal is subject comfort, not dose. In contrast, fixed goal concentrations are usually given relatively closed circuits (full facial mask/similar) without account for individual patient's dose-response. Hence, fixed concentrations, in NO sensitive subjects, could result in unconsciousness and other adverse effects (nausea, vomiting, anxiety, aspiration, might occur; requiring an anaesthesiologist for patient safety. PAN is titrated using each subject's subjective and objective responses as the guide to the ideal concentration. Thus, when PAN is used, there is no fixed concentration even for a single subject, nor is an anaesthesiologist required. Furthermore, there is a greater scientific rationale for using PAN, because the receptor systems involved are better known, whilst those for fixed concentrations are not. The PAN or dental titration method has been safely used in general dentistry for over 70 years and as an investigative, diagnostic and therapeutic tool for neuropsychiatry for over 40 years. Clinical applications include substance abuse detoxification, ameliorating depression, and investigations of schizophrenia, human orgasm, pain perception and basic neuroscience. By contrast, the experience with fixed doses in psychiatry is limited.

摘要

药物剂量至关重要——没有一种剂量适用于所有人。我的论文比较了牙科和神经精神病学中使用的固定25% - 50%浓度一氧化二氮(NO)与可变滴定浓度的精神镇痛性一氧化二氮(PAN)的安全性、科学性和实际适用性。一个关键区别在于,PAN总是通过开放式回路(鼻罩)滴定至所需浓度(剂量),这确保了完全清醒、配合、舒适和放松。使用PAN时,目标是让患者感到舒适,而非剂量。相比之下,固定目标浓度通常是通过相对封闭的回路(全面罩/类似装置)给予,而不考虑个体患者的剂量反应。因此,对于对NO敏感的患者,固定浓度可能导致意识丧失和其他不良反应(可能会出现恶心、呕吐、焦虑、误吸等情况;为确保患者安全需要麻醉师在场)。PAN是根据每个受试者的主观和客观反应进行滴定,以此作为确定理想浓度的指导。所以,使用PAN时,即使对于单个受试者也没有固定浓度,也不需要麻醉师。此外,使用PAN有更充分的科学依据,因为所涉及的受体系统更为人所知,而固定浓度的受体系统则不然。PAN或牙科滴定法已在普通牙科安全使用超过70年,并作为神经精神病学的一种研究、诊断和治疗工具使用超过40年。临床应用包括药物滥用解毒、改善抑郁症,以及对精神分裂症、人类性高潮、疼痛感知和基础神经科学的研究。相比之下,精神病学中使用固定剂量的经验有限。

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