Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The administration of intravenous dantrolene in a parturient susceptible to malignant hyperthermia has been associated with post partum uterine atony. We examined the effect of dantrolene sodium for injection (Dantrium Intravenous) on spontaneous contractility of uterine smooth muscle from women in term pregnancy in an isolated preparation. Dantrolene sodium for injection at 5 microg/ml and 10 microg/ml had no effect on the spontaneous contractility of the uterine muscle preparations. At a cumulative concentration of 20 microg/ml, a mild depression (16 +/- 14%) in the frequency of spontaneous contractions was noted. However, a similar depression in the muscle preparations treated with mannitol suggests that the depression observed with the dantrolene was likely due to the mannitol that was included in the dantrolene formulation rather than to dantrolene sodium itself. We conclude that dantrolene sodium has no effect on the spontaneous contractility of uterine smooth muscle. The depression of uterine muscle activity observed with dantrolene for injection appears attributable to the mannitol.
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PMID:Effect of dantrolene sodium on contractility of isolated human uterine muscle. 1563 10

A 44-year-old man presented for elective laparoscopic adrenalectomy. During the procedure his end-tidal carbon dioxide readings rose steadily. We assumed that this was due to a prolonged carbon dioxide pneumoperitoneum until he developed ST segment depression on his electrocardiogram and a rapid rise in temperature. A diagnosis of malignant hyperthermia was made in view of the rising temperature and carbon dioxide. He responded to cooling and intravenous dantrolene. He was later confirmed to be malignant hyperthermia-susceptible on in vitro contracture testing of a muscle biopsy. The diagnosis was delayed as the early signs of malignant hyperthermia are the same as the expected physiological changes in laparoscopic surgery. As laparoscopic surgery continues to expand we advocate vigilance to ensure early identification of this rare but potentially devastating condition.
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PMID:Malignant hyperthermia presenting during laparoscopic adrenalectomy. 1841 55

There are several problems in anesthetic management for patients with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS); susceptibility to malignant hyperthermia, metabolic disorders such as lactic acidosis and diabetes, and dysfunction of vital organs such as cardiomyopathy. Here we report an anesthetic management of emergency laparotomy in a 58-year-old woman with MELAS and systemic inflammatory response syndrome (SIRS). Pre-operative examinations revealed lactic acidosis, hyperglycemia, moderate cardiac depression, and slightly decreased renal function. We chose total intravenous anesthesia to avoid risks of malignant hyperthermia. Anesthesia was induced by rapid-sequence fashion and maintained using midazolam, propofol, ketamine, fentanyl and vecuronium. Based on arterial blood gas analyses, we adjusted ventilator settings, restored blood volume using acetated-Ringer's solution and alubumin preparation with transfusion, and administered sodium bicarbonate and catecholamines, to keep adequate oxygen demand/supply balance and improve acid-base balance. We applied a patient warming system to avoid the progression of hypothermia. After the surgery, the patient was transferred to the intensive care unit, and underwent the endotoxin absorption therapy as well as antibiotics therapy for the treatment of SIRS. The post-operative course was almost uneventful. We consider that careful anesthetic management was essential for the uneventful peri-operative course of this patient.
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PMID:[Anesthetic management of emergency total gastrectomy in a patient with mitochondrial encephalomyopathy: a case of gastric perforation accompanied by systemic inflammatory response syndrome]. 2056 Mar 85

A 49-year-old female with mitochondrial encephalomyopathy underwent laparoscopic cholecystotomy. She had some characteristic clinical symptoms, including muscle weakness, deafness, hemianopia and elevation of lactic acid level in the blood. It has been considered that problems of anesthesia for patient with mitochondrial encephalomyopathy are relevant to malignant hyperthermia, respiratory depression due to muscle weakness and probability of hyperlactacidemia. Anesthesia was induced with propofol, remifentanil and rocuronium, and maintained with continuous infusion of propofol and remifentanil, with administration of rocuronium under neuromuscular monitoring throughout the surgery. Arterial blood gases and pH were checked and acetated electrolyte solution was infused mainly during surgery. No complications occurred during anesthesia and this patient showed smooth recovery from anesthesia. Her postoperative course was uneventful.
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PMID:[Total intravenous anesthesia for a patient with mitochondrial encephalomyopathy who underwent laparoscopic cholecystotomy]. 2186 26

Malignant hyperthermia (MH) is a pharmacogenetic disorder most often linked to mutations in the type 1 ryanodine receptor (RyR1) or the skeletal L-type Ca(2+) channel (Ca(V)1.1). The only effective treatment for an MH crisis is administration of the hydantoin derivative Dantrolene. In addition to reducing voltage induced Ca(2+) release from the sarcoplasmic reticulum, Dantrolene was recently found to inhibit L-type currents in developing myotubes by shifting the voltage-dependence of Ca(V)1.1 channel activation to more depolarizing potentials. Thus, the purpose of this study was to obtain information regarding the mechanism of Dantrolene-induced inhibition of Ca(V)1.1. A mechanism involving a general depression of plasma membrane excitability was excluded because the biophysical properties of skeletal muscle Na(+) current in normal mouse myotubes were largely unaffected by exposure to Dantrolene. However, a role for RyR1 was evident as Dantrolene failed to alter the amplitude, voltage dependence and inactivation kinetics of L-type currents recorded from dyspedic (RyR1 null) myotubes. Taken together, these results suggest that the mechanism of Dantrolene-induced inhibition of the skeletal muscle L-type Ca(2+) current is related to altered communication between Ca(V)1.1 and RyR1.
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PMID:Dantrolene-induced inhibition of skeletal L-type Ca2+ current requires RyR1 expression. 2350 17

Simulation learning provides medical and nursing personnel with the opportunity to develop and refine their skills without putting patients at risk. Faced with ensuring the competence of a large number of new staff members, the management team at one facility implemented a simulation training program. Surgical team members are able to participate in an ongoing program of simulated scenarios involving surgical drape fires and airway fires, cardiac arrest of patients in the supine position and prone position, respiratory depression in the postanesthesia care unit, and malignant hyperthermia. The simulations help OR staff members identify problems that can happen during real emergencies and help them work as a team to prepare for events that may represent life-threatening situations for patients.
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PMID:Using simulation training to improve perioperative patient safety. 2353 8

General anesthesia and central neuraxial blockades in patients with severe Duchenne muscular dystrophy are associated with high risks of complications, including rhabdomyolysis, malignant hyperthermia, hemodynamic instability, and postoperative mechanical ventilation. Here, we describe peripheral nerve blocks as a safe approach to anesthesia in a patient with severe Duchenne muscular dystrophy who was scheduled to undergo surgery. A 22-year-old male patient was scheduled to undergo reduction and internal fixation of a left distal femur fracture. He had been diagnosed with Duchenne muscular dystrophy at 5 years of age, and had no locomotive capability except for that of the finger flexors and toe extensors. He had developed symptoms associated with dyspnea 5 years before and required intermittent ventilation. We blocked the femoral nerve, lateral femoral cutaneous nerve, and parasacral plexus under ultrasound on the left leg. The patient underwent a successful operation using peripheral nerve blocks with no complications. In conclusion general anesthesia and central neuraxial blockades in patients with severe Duchenne muscular dystrophy are unsafe approaches to anesthesia because of hemodynamic instability and respiratory depression. Peripheral nerve blocks are the best way to reduce the risks of critical complications, and are a safe and feasible approach to anesthesia in patients with severe Duchenne muscular dystrophy.
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PMID:Peripheral nerve blocks as the sole anesthetic technique in a patient with severe Duchenne muscular dystrophy. 2672 27

Comorbidity among the anxiety disorders is common and may negatively impact treatment outcome. Potentially, transdiagnostic cognitive-behavioral treatments (CBT) deal more effectively with comorbidity than standard CBT. The present study tested the effectiveness of The Unified Protocol (UP) applied to Mental Health Services. Pre-post-treatment effects were examined for psychiatric outpatients with anxiety disorders receiving UP treatment in groups. Forty-seven patients (mean-age = 34.1 (SD = 9.92), 77% females) with a principal diagnosis of anxiety were included. We found significant and clinically meaningful changes in the primary outcomes Clinical Global Impression Severity Scale (CGI-S; d = 1.36), Hamilton Anxiety Scale (HARS; d = .71), and WHO-5 Well-being Index (WHO-5; d = .54). Also, comorbid depressive symptoms and levels of positive and negative affect changed significantly after treatment. Patients with high levels of comorbidity profited as much as patients with less comorbidity; however, these patients had higher scores after treatment due to higher symptom burden at onset. Patients with comorbid depression profited more from treatment than patients without comorbid depression. The treatment effects found in the present study correspond to treatment effects of other TCBT studies, other UP group studies, and effectiveness studies on standard CBT for outpatients. The results indicate that the UP can be successfully applied to a MHS group setting, demonstrating positive effects on anxiety and depressive symptoms for even highly comorbid cases.
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PMID:Transdiagnostic group CBT for anxiety disorders: the unified protocol in mental health services. 2770 86

Merosin-deficient congenital muscular dystrophy (MD-CMD) is the most common and severe form of congenital muscular dystrophy and is characterized by progressive severe hypotonia due to the absence of the merosin chain around muscle fibers. The main anesthetic concerns include a possible association with malignant hyperthermia, the risk of anesthesia-induced rhabdomyolysis, a difficult airway and postoperative respiratory failure. We report the case of an uneventful general anesthesia (GA) in a two-year-old boy with MD-CMD for the placement of an implantable venous access system. The goal of our anesthetic management was to reduce the risk of respiratory depression. We considered the possibility of loss of spontaneous ventilation against the known, but rare, risk of rhabdomyolysis and we choose for a balanced GA with sevoflurane, short acting opioids and a pressure support ventilation mode instead of a trigger-free anesthesia. Our anesthetic management and the perioperative concerns for this particular syndrome are described.
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PMID:Pressure-support ventilation in a child with merosin-deficient congenital muscular dystrophy under sevoflurane anesthesia. 2987 69

Poland syndrome, which is characterized by an absence of pectoralis muscles and their innervated nerves, is marked by variable chest wall defects due to deficits of 2nd, 3rd, 4th, and 5th ribs and costal cartilage. Additionally, there are other reported combined anomalies of the heart, lung, kidney, ipsilateral hand and foot associated with the syndrome. The lung on the side with the thoracic deformity is more hypoplastic or smaller than the lung on the unaffected side, which can cause herniation of the lung or paradoxical ventilatory movement in severe cases, thereby increasing the risk of respiratory depression and hypoxemia. Patients may have profound lung complications due to depressed respiratory muscle function and exacerbation of the underlying chronic pulmonary disease during the perioperative period. These patients also show increased risk of malignant hyperthermia and therefore require careful attention during general anesthesia. We report here an anesthetic experience during reconstruction surgery of a chest wall defect in a male patient with Poland syndrome.
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PMID:Anesthetic experience during reconstruction surgery of a chest wall defect in a patient with Poland syndrome: A case report. 3062 42


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