Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A phase III, open label randomized study was conducted in 50 patients comparing halothane and sevoflurane for paediatric day case surgery. A graded inhalational induction resulted in only slightly more rapid induction with sevoflurane (3.34 +/- 0.92 versus 3.85 +/- 1.02 minutes; P > 0.05). In children receiving sevoflurane, systolic blood pressure decreased to a lesser extent during induction (143 +/- 19.2 versus 26.9 +/- 10.9 percent decrease from resting values; P < 0.01) and heart rate was maintained. Respiratory events (coughing, breath-holding, bronchospasm, laryngospasm) were more common during induction with halothane, and excitement more common in children receiving sevoflurane. Emergence times were significantly more rapid in children who had received sevoflurane (21.4 +/- 10.9 versus 33.1 +/- 13.7 minutes; P < 0.01). Objective pain/discomfort scores were higher in patients receiving sevoflurane at 10, 20, 30 and 40 minutes after arrival in the recovery room, and the incidence of excitement during emergence was higher in this group. It is concluded that sevoflurane is well tolerated for inhalational induction and has an improved cardiovascular profile compared to halothane. Emergence was significantly more rapid following sevoflurane.
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PMID:A comparison of sevoflurane with halothane for paediatric day case surgery. 945 47

Ninety patients were assigned randomly in a double-blind manner to receive 0.9% sodium chloride, mivacurium 0.04 mg.kg-1 or mivacurium 0.08 mg.kg-1 intravenously, followed by propofol 2.5 mg.kg-1. A laryngeal mask airway (LMA) was inserted 90 s later. The LMA was positioned correctly during the first attempt in 87% of patients and this was not significantly altered by the use of mivacurium. However, mivacurium decreased the incidence of swallowing, coughing, movement and laryngospasm (p < 0.05). LMA insertion was graded as easy in 88% of patients who had mivacurium, compared with 50% in patients who had propofol alone (p < 0.05). The conditions during LMA insertion were similar after 0.04 or 0.08 mg.kg-1 of mivacurium. Patients were apnoeic for a mean (SD) time of 0.67 (0.72) min after propofol alone, compared with 1.72 (1.06) min and 3.05 (1.36) min in patients who also received mivacurium 0.04 and 0.08 mg.kg-1, respectively (p < 0.01). Patients who received mivacurium had a lower incidence of postoperative sore throat (24-30% vs. 53%) (p < 0.05). In conclusion, low-dose mivacurium facilitates LMA insertion and decreases the incidence of postoperative sore throat.
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PMID:The use of low-dose mivacurium to facilitate insertion of the laryngeal mask airway. 965 25

We studied the efficacy of the cuffed oropharyngeal airway in 100 patients. Insertion of the airway after induction of anaesthesia with propofol was easy in 95 of 100 patients, moderately difficult in four patients and failed in one patient. Complications, such as coughing, gagging or body movement, occurred during induction and insertion in 15 patients. Insertion of the airway was not associated with tachycardia or hypertension. Manual ventilation through the airway was easy in less than 30% of patients immediately after insertion. Manual ventilation became easier after adjusting the position of the patient's head, neck or jaw. During spontaneous breathing, adjustment of the head, neck or jaw was required in 30% of patients. Complete airway obstruction occurred in one patient after insertion of the device and in two patients during maintenance of anaesthesia. The airway was left in place during emergence from anaesthesia in the remaining 97 patients. No complications occurred in 91 patients and coughing occurred in the remaining six patients before or during removal of the airway. No regurgitation, vomiting or laryngospasm occurred in any patient at any time. Therefore, the cuffed oropharyngeal airway has a potential use in anaesthetised patients who are breathing spontaneously.
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PMID:The cuffed oropharyngeal airway. Its clinical use in 100 patients. 1045 57

We studied 40 patients undergoing surgical removal of at least two third molar teeth under general anaesthesia. Patients were allocated randomly to one of two groups: group B (n = 20) received bupivacaine up to 2 mg kg-1, infiltrated around the inferior alveolar nerves bilaterally, and group K (n = 20) received ketorolac 10 mg i.v. at the start of surgery. There were no significant differences between the two groups in postoperative pain scores measured at 1 h using a visual analogue scale. Group K had a significantly lower incidence of side effects related to intraoral anaesthesia. Swallowing, speech and oral continence were significantly better. Group K scored higher for overall patient satisfaction, measured using a visual analogue scale. We failed to demonstrate any difference in early postoperative recovery (coughing, laryngospasm, stridor or arterial oxygen desaturation) between the groups. We conclude that the use of 0.5% bupivacaine infiltration was no more effective than a single 10-mg injection of ketorolac while giving rise to a higher rate of "minor" airway complications and lower patient acceptability.
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PMID:Local anaesthetic infiltration for surgical exodontia of third molar teeth: a double-blind study comparing bupivacaine infiltration with i.v. ketorolac. 992 22

A brief history of croup is presented. The forms of croup under examination are defined with emotional factors at one end of a continuum and viral and traumatic factors at the other. The complexity of the disorder and its peculiar clinical characteristics are explained. Some of these characteristics are: (1) the predominant 1-3-year age range, which corresponds to the anal stage of development; (2) the relief afforded by vomiting; (3) the occurrence of attacks at night and during sleep, (4) the relative dryness of the cough and its harsh metallic quality; (5) the frequent presence of a ticklish, irritating sensation in the throat; and (6) the presence of edema and/or laryngospasm. Three case vignettes are presented. These cases support a previously developed theory concerning the impulses and defenses underlying the croup attack. Croup is seen as a fixation at the oral level with a regression to that level in the face of conflicts of the anal or sometimes the oedipal stage. The psychosexual development of the larynx is discussed.
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PMID:Croup, a disorder of the anal phase of development. A contribution to our understanding of the psychosexual development of the larynx. 999 Aug 33

The cuffed oropharyngeal airway (COPA) was compared with the laryngeal mask airway (LMA) with respect to airway quality and respiratory adverse events in 140 spontaneously breathing patients undergoing procedures of duration more than 1 h. Patients were allocated randomly to receive either a COPA (n = 72) or a LMA (n = 68) for airway management during anaesthesia induced with propofol and maintained with sevoflurane, nitrous oxide and oxygen. Groups were similar when comparing the first-time successful insertion rates (COPA: 94.5%, LMA: 95.6%), but airway manipulations (head tilt, chin lift, jaw thrust) were reported more frequently in the COPA group, 27.8% vs. LMA, 4.4%; P = 0.0005. During the post-induction apnoeic period, all patients were ventilated manually and although, mean (SD) leak pressure was lower in the COPA group (18 (4) cm H2O vs. LMA, 22 (3) cm H2O; P < 0.0001), the tidal volumes achieved did not differ in both groups: COPA, 9.5 (4) mL kg-1 vs. LMA, 10.5 (4.5) mL kg-1. The incidences of intra-operative coughing, gagging, laryngospasm, oxygen desaturation and hypercarbia were similar in both groups. Although both devices are equivalent with respect to the overall respiratory problems during spontaneous breathing anaesthesia of intermediate or prolonged duration, the LMA was associated with fewer airway quality problems, suggesting that it is more efficacious in securing the airway.
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PMID:Comparative evaluation of the prolonged use of the cuffed oropharyngeal airway and the laryngeal mask airway in spontaneously breathing anaesthetized patients. 1043 64

Muscular tension dysphonia, episodic laryngospasm, globus, and cough may be considered to be hyperfunctional laryngeal symptoms. Suggested etiological factors for these symptoms include gastroesophageal reflux, psychological problems, and/or dystonia. We propose a unifying hypothesis that involves neural plastic change to brainstem laryngeal control networks through which each of the above etiologies, plus central nervous system viral illness, can play a role. We suggest that controlling neurons are held in a "spasm-ready" state and that symptoms may be triggered by various stimuli. Inclusion criteria for the irritable larynx syndrome are episodic laryngospasm and/or dysphonia with or without globus or chronic cough; visible or palpable evidence of tension or tenderness in laryngeal muscles; and a definite symptom-triggering stimulus. thirty-nine patients with irritable larynx syndrome were studied. Gastroesophageal reflux was felt or proven to play a major role in a large number of the group (>90%), and about one third were deemed to have psychological causative factors. Viral illness seemed quite prevalent, with one third of patients able to relate the onset of symptoms to a viral illness that we feel might lead to central nervous system changes. Our proposed hypothesis includes a mechanism whereby acquired plastic change to central brainstem nuclei may lead to this form of hyperkinetic laryngeal dysfunction. It gives structure and reason to an array of therapy measures and suggests direction for basic research.
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PMID:The irritable larynx syndrome. 1049 60

Sevoflurane has a non-pungent odour and provides smooth induction of anaesthesia. In contrast, isoflurane is irritating to the airway when used for induction, and this may also be evident during emergence from anaesthesia. We measured the end-tidal concentration of anaesthetic that prevented response to extubation in 50% of patients (MACEX) in adults receiving either sevoflurane or isoflurane. Airway complications during emergence from anaesthesia were also noted. We studied 51 adult patients, ASA 1, aged 36-59 yr. Patients received sevoflurane (n = 29) or isoflurane (n = 22) for elective intraocular surgery. The concentration at which extubation was attempted was determined by a modification of Dixon's up-and-down method. When tracheal extubation was accomplished without coughing and gross purposeful muscular movements within 1 min after extubation, it was considered a smooth tracheal extubation. Patients who developed breath-holding or laryngospasm immediately after tracheal extubation were regarded as not having been extubated smoothly. In addition, patients were observed for respiratory events during the remainder of the emergence period. MACEX values for sevoflurane and isoflurane were 1.07% and 0.83%, respectively. ED95 values of sevoflurane and isoflurane were 2.04% and 1.19%, respectively. In 12 patients in the isoflurane group, extubation was smooth but six patients had coughing episodes during the remainder of the emergence period. In contrast, one of 15 patients in the sevoflurane group in whom tracheal extubation was smooth coughed later (P = 0.035). Airway obstruction was frequent when tracheal extubation was performed at end-tidal concentrations exceeding 1 MACEX for each anaesthetic.
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PMID:End-tidal sevoflurane concentration for tracheal extubation (MACEX) in adults: comparison with isoflurane. 1056 78

Sevoflurane induction of anasthesia has been examined extensively, but little is known about the usefulness of other drugs as adjuncts to hasten and smooth the process. Sixty patients, undergoing surgery of a type suitable for a spontaneous respiration, laryngeal mask airway anasthetic technique, were randomly allocated to receive 1.0 microgram.kg-1 intravenous fentanyl or the equivalent volume of normal saline, 30 s prior to triple-breath induction with sevoflurane. The study was double-blind. There were no differences between the groups for the times to loss of eyelash reflex, jaw relaxation, insertion of the laryngeal mask airway or regular settled breathing. However, there was a difference in the incidence of adverse airway events (breath-holding, coughing and laryngospasm) between the two groups (16.5% in the fentanyl group and 40% in the placebo group); this did not reach statistical significance. Both groups were haemodynamically stable throughout induction, although the fentanyl group had a statistically significant decrease in systolic blood pressure at 4 min compared with the placebo group, which was not considered clinically relevant. We conclude that fentanyl has no significant influence over the speed and quality of sevoflurane induction.
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PMID:Fentanyl supplementation of sevoflurane induction of anaesthesia. 1079 42

The upper airway is a vital part of the respiratory tract. Although the upper airway serves several functions, protection of the airway and preservation of airway patency are the most essential functions subserved by upper airway reflexes. Various types of nerve endings have been identified in and under the epithelium of the upper airway, and afferent nerve endings are the natural starting of all reflex activity. The upper airway reflexes consist of many different types of reflex responses such as sneezing, apnea, swallowing, laryngeal closure, coughing, expiration reflex, and negative pressure reflex. Although the activation of upper airway reflexes does not necessarily occur at one particular site of the respiratory tract, individual reflex response is usually considered to be highly specific for the particular respiratory site which has been affected. The upper airway reflexes are modified by many factors such as sleep, anesthesia, and background chemical ventilatory drive. Both depression and exaggeration of upper airway reflexes cause clinical problems. Depression of upper airway reflexes enhances the chance of pulmonary aspiration and compromises the maintenance of the airway, whereas exaggeration of airway reflexes such as laryngospasm and prolonged paroxysm of cough can be harmful and dangerous. In this review, various aspects of upper airway reflexes are discussed focusing on the functions of upper airway reflexes in humans and some pathophysiological problems related to clinical medicine.
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PMID:Physiological and pathophysiological implications of upper airway reflexes in humans. 1086 92


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