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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A major advantage of desflurane over currently available agents is that the blood-gas partition coefficient of desflurane is 0.42, lower than all available volatile anesthetics, and slightly lower than nitrous oxide. This property predicts rapid induction of and recovery from general anesthesia with desflurane. This review will summarize and compare results of studies that have examined various clinical characteristics of induction and emergence with desflurane in a variety of patient populations. Studies in pediatric patients, and in adults, have confirmed that inhalation induction with desflurane is rapid. However, there has been a high incidence of airway irritation and/or reactivity, including breath holding, coughing, excessive secretions, and laryngospasm. This incidence is significantly higher than that seen with halothane, making it unlikely that desflurane will supplant halothane for inhalation inductions. The hemodynamic effects of desflurane induction and maintenance with or without intravenous adjuvants appear similar to those seen with isoflurane. Several studies have compared emergence from anesthesia with desflurane with that from isoflurane-based anesthetics, and have demonstrated that initial emergence from a given depth of anesthesia, e.g., time to eye opening or response to verbal commands, is about twice as fast with desflurane. Similar results have been obtained in pediatric patients where emergence from desflurane is faster than that seen from halothane. Emergence from desflurane anesthesia appears similar in time-course to that from propofol-based anesthetics.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:An overview of induction and emergence characteristics of desflurane in pediatric, adult, and geriatric patients. 152 39

Thirty-six children (mean age 2.4 years) premedicated with oral chloral hydrate 70 mg kg-1 and atropine 0.03 mg kg-1 were anaesthetized with either 3.75% isoflurane or 2.5% halothane in 70% nitrous oxide in oxygen. The eyelash reflex disappeared in 39 +/- 7 s (mean +/- SD) with isoflurane and in 56 +/- 16 s with halothane (P less than 0.001). Tachypnoea was seen with both anaesthetics. Coughing, breath holding, stridorous breathing and respiratory depression were seen during isoflurane but not during halothane induction (P less than 0.01). In nine of 20 children anaesthetized with isoflurane, the ventilation had to be assisted before intubation. Endotracheal intubation was possible in 224 +/- 35 s with isoflurane and in 281 +/- 64 s with halothane (P less than 0.01). Intubating conditions were satisfactory in 80% of the children anaesthetized with either volatile agent. Cardiovascular responses to endotracheal intubation were minimal with both anaesthetics. No cardiac dysrhythmias were noted. Heart rate was higher during isoflurane than during halothane induction. Diastolic arterial pressure was lower during isoflurane than during halothane induction immediately and 5 min after intubation.
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PMID:Comparison of inhalation induction with isoflurane or halothane in children. 187

A new benzodiazepine-type drug, midazolam, was administered intramuscularly as a premedicant to 155 patients aged from 16 to 81 years with ASA status 1 or 2. The hypnotic action and the effect on the upper airway tract of midazolam were evaluated. Hypnosis appeared 5 minutes after the administration of midazolam, reached its plateau after 20 minutes and started to decline after 30 minutes. The hypnotic effect showed dose-dependent increase in doses ranging from 0.05 to 0.20 mg.kg-1. No age-dependent differences in hypnosis were observed except for teenage group which showed stronger hypnosis than the other age groups. There was no problem on the upper airway tract for all age groups at the dosage of 0.05 mg.kg-1, but in the patients over 40 years increasing dosage tended to obstruct the upper airway tract. Along with the appearance of hypnosis, cough and breath holding, suggesting retention and aspiration of saliva, were observed. The appropriate dosage of midazolam for premedication was considered to be 0.05 mg.kg-1.
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PMID:[Effect of midazolam as a premedicant]. 209 95

The reliability of lumbar intraspinal epidural pressure (ISEDP) as an index of intracranial pressure was investigated in seven patients with high intracranial pressure following neurosurgery. ISEDP and intracranial epidural pressure (ICEDP) were measured simultaneously, the latter by the conventional method. ISEDP was measured with a Gaeltec catheter-tip pressure transducer placed percutaneously in the lumbar epidural space via Touhy's needle. In five of seven patients, the ISEDP value was consistently 70 to 100% of the ICEDP value. In all patients, ISEDP always fluctuated in parallel with ICEDP, and the time courses of both were quite similar in response not only to normal cardiac pulsation but also to various manipulations, such as neck compression, coughing, breath holding, mannitol administration, and compression at the cranial defect. In one patient with communicating hydrocephalus following subarachnoid hemorrhage, the relationship between ISEDP and cerebrospinal fluid (CSF) pressure was studied. Upon gradual withdrawal of CSF, ISEDP decreased in parallel with CSF pressure until the latter reached 8 mmHg. Below 8 mmHg CSF pressure, ISEDP did not correlate with CSF pressure. This phenomenon was attributed to slackness of the dural sac due to lowering of CSF pressure, which severed contact between the spinal dural theca and the sensor. Although the discrepancy between ISEDP and ICEDP was prominent in some patients, especially those with low intracranial pressure or blockage of the subarachnoid space, in this study ISEDP reliably reflected ICEDP. The results suggest that ISEDP measurement is useful in monitoring intracranial pressure in patients with increased intracranial pressure. Also, the procedure is simple and relatively noninvasive.
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PMID:[The usefulness of lumbar epidural pressure as an index of intracranial pressure]. 247 50

Ninety unpremedicated patients undergoing mask anaesthesia were assigned to one of three groups according to the volatile anaesthetic and the acute intravenous premedication administered. Group I received saline placebo as premedication and halothane by inhalation. Group II received saline placebo and isoflurane by inhalation. Group III received nalbuphine 0.1 mg.kg-1 IV as premedication and isoflurance by inhalation. Mean time to loss of consciousness (71 sec) did not differ among groups. The dosage of thiopentone required to induce loss of consciousness was decreased by 15 per cent (from 3.9 to 3.3 mg.kg-1) by nalbuphine premedication (P less than 0.05), and time to induction of surgical anaesthesia using isoflurane was decreased by 15 per cent (P less than 0.05). The incidence of reflex actions (coughing, laryngospasm, breath holding, hiccoughs and movement) during induction was no different in the saline-premedicated halothane or isoflurane groups. Acute intravenous nalbuphine premedication decreased significantly the incidence of reflex actions during induction of isoflurane anaesthesia from 77 per cent to 37 per cent (P less than 0.02). Desaturation episodes (SaO2 less than 90 per cent) were more frequent with isoflurane inductions compared with halothane (55 per cent vs 17 per cent, P less than 0.01). Apnoeic episodes accounted for the majority of desaturations associated with nalbuphine premedication, while excitatory reflexes (coughing and laryngospasm) accounted for more desaturations with isoflurane alone.
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PMID:Induction reflex actions with intravenous nalbuphine as an adjunct to isoflurane. 266 79

Relative changes in cerebral blood volume and in the oxidation/reduction state of cytochrome aa3, the terminal member of the electron transport chain in oxidative metabolism, can be simultaneously observed with near infrared spectroscopy. Using this technique, we studied movement-associated blood pressure elevations in three nonparalyzed very low birth weight infants receiving mechanical ventilation. We defined hypertensive peaks as increases in systolic and diastolic blood pressures greater than or equal to 30% over baseline and lasting at least 2 seconds. Ninety percent of monitored time, an increase in tissue blood volume (tBV) immediately followed each blood pressure elevation, with deoxygenated hemoglobin providing the sole or predominant increase in tBV. A simultaneous shift of cytochrome aa3 to a more reduced state usually accompanied the rise in tBV, probably indicating a transient imbalance between oxygen delivery and cellular oxygen utilization and a failure of mechanisms that normally regulate cerebral oxygenation. The consistent association of hypertensive peaks with body movement, coughing, and breath holding, and the predominant increase in deoxygenated hemoglobin suggest that increased intrathoracic pressure transiently impedes cerebral venous return. The repeated fluctuations in intracerebral blood volume and associated shifts to greater cytochrome aa3 reduction with hypertensive peaks provide a possible explanation for the association of fluctuating blood pressure patterns and increased risk for intraventricular hemorrhage.
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PMID:Changes in cerebral blood volume and cytochrome aa3 during hypertensive peaks in preterm infants. 301 56

Sevoflurane allows a moderately rapid induction with only slight problems of induction. However, it has not been possible to conduct tests with more than 2.6 minimum alveolar concentration (MAC) of sevoflurane (4.5%) because of the limitations in the performance of the currently available vaporizer. We tested the performance of a new vaporizer and tried it with single breath induction. The new vaporizer could deliver a 4.3 MAC (7.5%) sevoflurane through oxygen of 8 liter/min. Twenty-one unpremedicated volunteers breathed 7.5% sevoflurane in oxygen. The mean time for induction of anesthesia was 48 +/- 16 seconds, reflecting its high concentration and low blood/gas solubility. Although coughing was observed in two subjects, laryngospasm, breath holding, and secretions did not occur during induction by this method. All subjects except one would be willing to undergo similar induction again. This study demonstrate that the new vaporizer can be used to administer 7.5% concentration of sevoflurane and to adequately perform smooth and rapid inhalation induction of anesthesia in young volunteers without premedication.
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PMID:Rapid inhalation induction with high concentration of sevoflurane using a new vaporizer. 792 78

To evaluate the usefulness of measuring lumbar intraspinal epidural pressure (ISEDP) measurements for the estimation of intracranial pressure, we studied the relationship between ISEDP and intracranial epidural pressure (ICEDP) in 12 patients with high intracranial pressure after neurosurgical procedures. ISEDP was measured with a Gaeltec catheter-tip pressure transducer placed percutaneously in the lumbar epidural space with a Touhy needle. ICEDP was determined by the conventional method. During the measurement, some manipulations were carried out. ISEDP and ICEDP measurements exhibited a linear correlation. In all but one patient with normal cerebrospinal fluid, ISEDP was 84 to 100% of ICEDP. In patients with mild subarachnoid hemorrhage, ISEDP was 82 to 86% of ICEDP. In patients with severe subarachnoid hemorrhage, ISEDP was 45 to 57% of ICEDP and always fluctuated in parallel with ICEDP. ISEDP accurately reflected ICEDP in response to manipulations such as breath holding, neck compression, compression at the cranial defect, mannitol administration, and coughing. These data suggest that ISEDP measurement is useful in monitoring intracranial pressure in patients with intracranial hypertension. In addition, the measurements can be obtained easily and safely.
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PMID:Clinical investigation of lumbar epidural pressure. 849 52

Leprosy has been shown to affect almost all systems of human body and abnormalities in functions of autonomic nerves innervating various parts have been observed in several studies. In the skin and its appendages, the common changes are anhidrosis and varying degree of impaired sweat response. Signs of denervation of iris and reduced intraocular pressure are permanent features of autonomic involvement in the eye. In the cardiac autonomic functions, rhythm disturbances have been documented by several investigators. Respiratory function test studies have shown impaired breath holding time and decreased response to cough as well as other changes indicating blockade of vagus nerves and sympathetic plexus. Abnormal testicular pain sensation and diminished nocturnal penile tumiscence provide evidence of afflication of autonomic nerves of male genital system. Other important autonomic nervous system involvements include the nerves innervating the capillaries of legs. These changes have been observed to be more in extensive and long standing disease which indicate the need to study all these aspects in prospective studies specially in the light of early institution of multidrug treatment.
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PMID:Autonomic nerve affection in leprosy. 872 14

Induction, emergence and recovery characteristics were compared during sevoflurane or halothane anaesthetic in a large (428) multicentre, international study of children undergoing elective inpatient surgical procedures. Two hundred and fourteen children in each group underwent inhalation induction with nitrous oxide/oxygen and sevoflurane or halothane. Incremental doses of either study drug were added until loss of eyelash reflex was achieved. Steady state concentrations of anaesthesia were maintained until the end of surgery when anaesthetic agents were terminated simultaneously. Time variables were recorded for induction, emergence and the first need for analgesia in the recovery room. In addition, in 86 of the children in both groups, venous blood samples were drawn for plasma fluoride levels during and after surgery. There was a trend toward smoother induction (induction of anaesthesia without coughing, breath holding, excitement laryngospasm, bronchospasm, increased secretion, and vomiting) in the sevoflurane group with faster induction (2.1 min vs 2.9 min, P = 0.037) and rapid emergence times (10.3 min vs 13.9 min, P = 0.003). Among the children given sevoflurane, 2% developed bradycardia compared with 11% in the halothane group. Postoperatively, 46% of the children in the halothane group developed nausea and or vomiting versus 31% in the sevoflurane group (P = 0.002). Two children in the halothane group developed cardiac dysrhythmia and were dropped from the study. In addition, a child in the halothane group developed malignant hyperthermia, received dantrolene, and had an uneventful recovery. Mean maximum inorganic fluoride concentration was 18.3 microM.l-1. The fluoride concentrations peaked within one h of termination of sevoflurane anaesthetic and returned rapidly to baseline within 48 h. This study suggests that sevoflurane may be the drug of choice for the anaesthetic management of children.
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PMID:A comparison of sevoflurance to halothane in paediatric surgical patients: results of a multicentre international study. 882 44


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