Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0002622 (amnesia)
 5,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the last two decades, opioid analgesics have assumed an important place in general anesthetic practice in the United States. Part of the reason for this has been the introduction of the potent new agonists fentanyl, sufentanil, and alfentanil. Because of problems with morphine-oxygen anesthesia (incomplete amnesia, occasional histamine-related reaction, marked increases in intra- and postoperative respiratory depression), a suitable alternative was sought but not found among existing opioids. A breakthrough came in 1960, when fentanyl was synthesized, laying the foundation for a better understanding of the structure-activity relationships of narcotic analgesics and stimulating interest in developing compounds with even greater potency and safety margins. Investigators interested in opioid anesthesia began to study fentanyl in animals and then in humans. Fentanyl (50-100 micrograms/kg) with oxygen (100%) was evaluated as an anesthetic in patients undergoing mitral valve and coronary artery surgery. Changes in cardiovascular dynamics with induction doses ranging from 8 to 30 micrograms/kg consisted of small decreases in heart rate and arterial blood pressure. All other cardiovascular variables studied, including cardiac output, remained unchanged, even with additional doses up to 100 micrograms/kg. It was determined that fentanyl had use as a narcotic anesthetic, despite its potential for cardiovascular depression and stimulation, respiratory depression, muscle rigidity, and, occasionally, incomplete anesthesia. Since the introduction of fentanyl, two other potent synthetic opioids have been introduced into clinical practice--sufentanil and alfentanil.
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PMID:The history and development of the fentanyl series. 151 29

The pharmacokinetics, pharmacodynamics, and clinical uses of fentanyl, sufentanil, and alfentanil are reviewed. The fentanyl derivatives have reduced or eliminated many of the disadvantages of opioid anesthetics, such as incomplete amnesia and undesirable hemodynamic responses to surgery. Fentanyl is 50-100 times as potent as morphine and was the first of the three to be marketed. Sufentanil is even more potent than fentanyl. Alfentanil has the fastest onset of action, followed by sufentanil and then fentanyl. Alfentanil also has the shortest duration of action of the group. Most studies of these agents have been done to assess their role as anesthetics in cardiac surgery. All three provide cardiovascular stability when administered before noxious surgical stimuli, except when given as a single bolus during the induction of anesthesia. All seem to produce adequate anesthesia, particularly when used in combination with nitrous oxide. Because of its short duration of action, alfentanil is preferred for brief procedures or when rapid changes in the level of consciousness are desired. All three agents have also been used for analgesia; epidural administration provides adequate relief of pain. Fentanyl has been formulated as a transdermal patch that seems to provide the same degree of analgesia as a continuous i.v. infusion. Fentanyl has also been formulated as an investigational lozenge that has shown advantages as a preoperative sedative in children. As more is learned about these agents, their perioperative uses for anesthesia, analgesia, and sedation will continue to be refined.
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PMID:Clinical uses of fentanyl, sufentanil, and alfentanil. 183 93

Inhalational anesthetic agents, particularly nitrous oxide, are potentially hazardous to both the patient and operating room personnel. Recent efforts have been directed towards the development of intravenous anesthetic techniques using combinations of a hypnotic with an analgesic. The hypnotic used in such a combination should have a short elimination half-life, little or no influence on hemodynamics, and no side effects. Benzodiazepines are likely candidates for total intravenous anesthesia (TIVA) since they combine hemodynamic stability and paucity of unwanted effects with the ability to induce amnesia for the entire perioperative period. They do have long elimination half-lives; even midazolam, the shortest-acting benzodiazepine, has a half-life of 2 to 3 h. This disadvantage might be counteracted by the use of flumazenil, the recently introduced, specifically acting benzodiazepine antagonist. The aim of this study was to determine the effects of rapid awakening following flumazenil after major abdominal surgery with benzodiazepine-fentanyl TIVA. Six patients (4 male, 2 female) scheduled for elective laparotomies participated in this pilot study. The average duration of surgery was 2.2 +/- 0.9 h. The patients were given 2 mg flunitrazepam p.o. the evening before surgery and 1 h before being brought to the operating room. Baseline pre-induction values were obtained 15 min after inserting catheters and attaching the EEG electrodes. Fentanyl (0.005 mg/kg) was given as a bolus injection followed by a rapid midazolam infusion. The infusion rate was calculated using the method of Wagner et. al. from the data of Lauven et al. to give plasma concentrations of 500 ng/ml.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Hemodynamic effects of the benzodiazepine antagonist flumazenil following laparotomy under total intravenous anesthesia using midazolam]. 249 12

8-Chloro-6-(2-fluorophenyl)-1-methyl-4H-imidazol[1,5-a][1,4]benzodiazepine (midazolam maleate, Ro 21-3981, Dormicum) or thiopental were administered to 99 women undergoing short gynecological surgical procedures for induction and maintenance of anesthesia along with 67% nitrous oxide. Either fentanyl 1.5 microgram kg-1 or a saline placebo were given i.v. as acute premedication 5 min before induction. We measured the quality of induction and maintenance. Induction was more rapid after thiopental but thiopental produced more apnea especially when combined with fentanyl. Fentanyl premedication reduced the dose of hypnotics necessary to keep patients asleep. It was difficult to keep patients from moving during the procedure when only the hypnotics and nitrous oxide were used, so the use of these drugs for both induction and maintenance is recommended only when combined with narcotics or other analgesics. Although recovery after midazolam was slower than after thiopental, it was without untoward reactions such as hallucinations or excitement. Vomiting was less frequent after midazolam. Midazolam produced a profound period of amnesia for 1-2 h, so important instructions could not be given to patients during this time. All patients were awake enough to discharge from the hospital 200 min after the last dose of hypnotic was given. We would recommend a combination of midazolam, fentanyl and nitrous oxide for induction and maintenance of anesthesia for short surgical procedures except when a rapid induction is desired, then thiopental is preferred as the hypnotic.
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PMID:Awakening characteristics following anesthesia induction with midazolam for short surgical procedures. 719 31

Reporting our experience with etomidate infusion in 37 cases of endoscopic examinations of the larynx, we recommend a method of general anesthesia ensuring easy examination conditions and rapid recovery. After premedication with atropine, IV Thalamonal is administered till obtention of somnolence. A dose of 0.25 mg/kg of etomidate is used for induction and an infusion at a rate of 25 mcg/kg/min for maintenance of anesthesia. Succinylcholine is used for intubation and whenever complementary muscular relaxation is required. Ventilation is ensured by the jet mixing technique with a manual injector. Fentanyl is given when reactions of tachycardia or arterial hypertension due to nociceptive stimuli are observed. The method described is safe, provides good conditions of anesthesia with complete amnesia and rapid recovery.
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PMID:Etomidate infusion for laryngoscopy. 730 19