Global oxycodone consumption has increased sharply during the last two decades, and, in 2008, oxycodone consumption surpassed that of morphine. As oxycodone was synthesized in 1916 and taken to clinical use a year later, it has not undergone the same approval process required by today’s standards. Most of the basic oxycodone pharmacokinetic (PK) data are from the 1990s and from academic research; however, a lot of additional data have been published over the last 10 years. In this review, we describe the latest oxycodone data on special populations, including neonates, children, pregnant and lactating women, and the elderly. A lot of important drug interaction data have been published that must also be taken into account when oxycodone is used concomitantly with cytochrome P450 (CYP) 3A inducers and inhibitors and/or CYP2D6 inhibitors. In addition, we gathered data on abuse-deterrent oxycodone formulations, and the PK of alternate administration routes, i.e. transmucosal and epidural, are also described.

Background and objective: Non-obstetric surgery is fairly common in pregnant women. We performed a systematic review to update data on non-obstetric surgery in pregnant women. The aim of this review was to evaluate the effects of non-obstetric surgery during pregnancy on pregnancy, fetal and maternal outcomes. Methods: A systematic literature search of MEDLINE and Scopus was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search span was from January 2000 to November 2022. Thirty-six studies matched the inclusion criteria, and 24 publications were identified through reference mining; 60 studies were included in this review. Outcome measures were miscarriage, stillbirth, preterm birth, low birth weight, low Apgar score, and infant and maternal morbidity and mortality rates. Results: We obtained data for 80,205 women who underwent non-obstetric surgery and data for 16,655,486 women who did not undergo surgery during pregnancy. Prevalence of non-obstetric surgery was between 0.23% and 0.74% (median 0.37%). Appendectomy was the most common procedure with median prevalence of 0.10%. Near half (43%) of the procedures were performed during the second trimester, 32% during the first trimester, and 25% during the third trimester. Half of surgeries were scheduled, and half were emergent. Laparoscopic and open techniques were used equally for abdominal cavity. Women who underwent non-obstetric surgery during pregnancy had increased rate of stillbirth (odds ratio (OR) 2.0) and preterm birth (OR 2.1) compared to women without surgery. Surgery during pregnancy did not increase rate of miscarriage (OR 1.1), low 5 min Apgar scores (OR 1.1), the fetus being small for gestational age (OR 1.1) or congenital anomalies (OR 1.0). Conclusions: The prevalence of non-obstetric surgery has decreased during last decades, but still two out of 1000 pregnant women have scheduled surgery during pregnancy. Surgery during pregnancy increases the risk of stillbirth, and preterm birth. For abdominal cavity surgery, both laparoscopic and open approaches are feasible.

Background: Procalcitonin is a biomarker that can be used to diagnose bacterial infection and monitor treatment. Clinical practice guidelines are evidence-based recommendations by experts that aim to aid decision-making. In this systematic review, we searched for clinical practice guidelines and evaluated recommendations given regarding use of procalcitonin. Methods: Four biomedical databases (PubMed, Scopus, Cochrane Database and Web of Science) and various national medical sites were searched for clinical practice guidelines. Guidelines that mentioned procalcitonin were included in the review. Results: Seventeen guidelines were included. The earliest were published in 2009 and the latest in 2018. A majority (12/17) recommended use of procalcitonin or stated that it can be useful. One national guideline did not recommend procalcitonin, stating that there is no need for any biomarkers in diagnostics of community-acquired pneumonia in adults. Four guidelines stated no evidence to recommend or not recommend procalcitonin use. Thirteen of the guidelines commented on other concomitant or alternate biomarkers, mainly C-reactive protein. Five guidelines suggested decision limits for procalcitonin. None took a stand on how often procalcitonin should be analysed, and if it should be used as a single or as multiple measurements. Conclusions: One international and 11 national clinical practice guidelines endorse the use of procalcitonin in differential diagnosis of bacterial infections and/or to monitor antibiotic therapy. However, the evidence for or against the use of procalcitonin is weak.