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)

In a prospective double blind study the efficacy and safety of nalbuphine as an analgesic in balanced anesthesia has been compared to fentanyl. In 63 patients, ASA class I-III, major gynecological or urological surgical procedures were performed under balanced anesthesia. Analgesia could be satisfactory maintained in all cases, but in cases of nalbuphine more hypnotics were necessary to keep the patients unconscious. The ratio of fentanyl and nalbuphine consumption was 1:200 (by weight). The nalbuphine cases can be distinguished by: more stable but higher arterial pressures and absence of arrythmia; lower incidence of nausea and vomiting in the postoperative period; less respiratory depression at the end of anesthesia, not needing antagonists, as compared to 11 patients needing antagonization in the fentanyl group; and a larger incidence of minor local allergic reactions at the injection site. Awareness was not observed in any patient of either group. Although nalbuphine has a weaker analgesic and hypnotic effect, it is perfectly possible to provide balanced anesthesia in combination with a hypnotic and a muscle relaxant. Advantages are the absence of respiratory depression as well as nausea and vomiting in the postoperative period.
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PMID:The efficacy and safety of nalbuphine (NUBAIN) in balanced anesthesia. A double blind comparison with fentanyl in gynecological and urological surgery. 226 Apr 32

Epidural narcotics has been shown to produce profound and long-lasting analgesia. It has been suggested that lipid-soluble narcotics such as fentanyl, because of their short transit time in the CSF, are less likely to be associated with delayed respiratory depression and side effects. We tried to combine low concentrations of fentanyl with bupivacaine to minimize side effects and to see if synergistic effect existed. Forty ASA physical status I or II patients who present for cholecystectomy were included in the trial. Before surgery a thoracic epidural catheter was inserted and pain control began when patients became fully awake and complained of pain in the recovery room after surgery. Patients were randomized in a double-blind fashion to one of four groups. Patients in group I were given epidural infusions of fentanyl 0.001%; patients in group 2 received fentanyl 0.001% mixed with bupivacaine 0.1%; patients in group 3 received fentanyl 0.0005%; patients in group 4 received fentanyl 0.0005% mixed with bupivacaine 0.1%. A continuous epidural infusion of these drugs began at a rate of 10 mL/h after a 5-mL bolus of the solution. Pain relief was assessed with visual analogue pain scale. Respiratory rates, vital signs, and mental status were assessed hourly. Except the group 3, the degree of analgesia achieved was similarly satisfactory in all other groups. There was no respiratory depression developed in either group. Motor block was minimal or absent in all groups. The incidence of nausea and pruritus was significant less in group 3 and group 4. In conclusion, the continuous infusion of dilute bupivacaine with fentanyl provides synergistic analgesia with minimal side effects.
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PMID:Comparison of continuous epidural infusion of fentanyl and fentanyl-bupivacaine for post cholecystectomy pain control. 235 68

Medical records of 81 older patients (65 years of age and over) who underwent electroconvulsive therapy (ECT) at a university-affiliated private geriatric hospital were reviewed to evaluate the safety and efficacy of this treatment for depression in the "young-old" (65 to 80 years) compared with the "old-old" age group (over 80 years), a group that has not yet been adequately studied. Information was obtained regarding demographics, medical and psychiatric diagnosis, medications, indications for ECT, number and laterality of treatments, outcome, and complications. Thirty-nine patients 80+ years of age (mean age, 85 +/- 3.2) were compared with 42 patients 65 to 80 years of age (mean age, 74 +/- 5.2). Statistical analysis was performed using confidence intervals of the difference in proportions of patients in each group. There were no significant differences in the demographics, number and laterality of ECT treatments, indications for ECT treatment, medical diagnosis, medications, or prior history of falls, but psychiatric diagnoses differed slightly. Patients over 80 years had significantly more cardiovascular complications and falls (95% confidence interval) and tended to have a worse ASA (American Society of Anesthesiologists) scale rating and a somewhat less successful outcome. This study confirms the role of ECT as a relatively safe and effective treatment, which may be lifesaving in selected depressed older patients. Prospective studies are needed to understand better the long-term outcome and to prevent the morbidity and mortality associated with ECT in this frail, high-risk older group.
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PMID:Electroconvulsive therapy in octogenarians. 237 Mar 95

This study aimed to compare the efficacy and side-effects of sublingual buprenorphine, a synthetic opioid agonist antagonist, with those of subcutaneous morphine. Fifty ASA class 1 patients were included in the study after having given their informed consent. Caesarean section was carried out under epidural block with 0.5% bupivacaine; no opioids were used during the procedure. The first dose of opioid was given 2 h after the first dose of bupivacaine. Patients were randomly given either 10 mg morphine (n = 25) or 0.4 mg buprenorphine (n = 25), followed by the same dose every 6 h for 36 h. When analgesia was insufficient, tablets containing dextropropoxyphene and paracetamol were given. No attempt was made to blind the study to the patient, but the investigator assessing pain was unaware of the drug given to the patient. Pain intensity was assessed before, and 2 h after each dose of opioid with a 100 mm visual scale, as well as systolic, diastolic and mean arterial blood pressures, heart and breathing rates, and SpO2. Side-effects (pruritus, nausea, vomiting, drowsiness) were also noted. In 2 patients in each group, the protocol was stopped before the 36th h, but after the fourth dose, either because of side-effects, or at the patient's request. Results were similar in both groups of patients, whether for degree of pain relief, or physiological effects. There was no clinically detectable respiratory depression. Duration and intensity of episodes of arterial oxygen desaturation, and the incidence of nausea, were similar in the 2 groups; pruritus was more common in the morphine group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Postoperative analgesia after cesarean section: sublingual buprenorphine versus subcutaneous morphine]. 237 54

The clinical effects of a propofol-alfentanil association were studied in fifteen patients ASA II (mean age 50.1 +/- 14.1) anaesthetized for E.N.T. endoscopy after informed consent. All the patients received an intramuscular premedication with 0.10 to 0.15 mg.kg-1 midazolam. Propofol 2.5 mg.kg-1 was injected in a peripheral venous line with alfentanil 10 micrograms.kg-1, followed by continuous automatic injection of propofol at a dose of 5 to 10 mg.kg.h-1 and alfentanil 5 micrograms.kg-1 given just before suspension. After induction and during maintenance of anaesthesia, the patients were allowed to breathe oxygen spontaneously O2 assisted when apneic. The following variables were studied before induction (to), after induction (t1), during suspension (t2) and when stopping the infusion (t3): haemodynamic parameters using an invasive method and blood gases. Statistical analysis was performed using the Student's test for paired samples. Surgical conditions and anaesthetic quality were good with early recovery of consciousness and return of all reflexes. After an initial period of cardio vascular depression, the haemodynamic parameters did not vary much during the anaesthesia and propofol-alfentanil appeared to limit considerably the hypertension due to laryngoscopy. However, there was a moderate degree of hypercapnia (p less than 0.001) in most patients, giving evidence of some respiratory depression and possibly a greater depth of anaesthesia than desirable. Indeed, the doses of alfentanil required seemed to be more important with propofol because of a probably interference between the two drugs; the doses of these drugs should therefore be modified according to the length of surgery.
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PMID:[Circulatory and respiratory repercussions to direct suspension laryngoscopy in the adult: value of a propofol-alfentanil combination]. 249 72

To determine in adults and children the dose-response relationship and the duration of action of pipecuronium bromide during fentanyl-nitrous oxide (N2O), isoflurane, and halothane anesthesia, the authors studied 30 ASA Physical Status 1-2 adults (age: 16-55 yr) and 30 ASA Physical Status 1-2 children (age: 1.7-11.5 yr) during minor elective surgery. Patients were anesthetized with N2O/O2 (60:40) supplemented with either fentanyl (4 micrograms/kg), or isoflurane (adults, 0.9%; children, 1.2%), or halothane (adults, 0.6%; children, 0.7%). Neuromuscular (NM) blockade was measured by electromyography. Incremental iv doses of pipecuronium were administered to determine the cumulative dose-response relationship of pipecuronium until a 95% twitch depression (ED95) had been obtained. In adults, ED50 was 31.7 +/- 2.9 micrograms/kg (mean +/- SE) during fentanyl-N2O/O2, reduced by isoflurane (18.0 +/- 4.8 micrograms/kg, P less than 0.05) but not by halothane (25.0 +/- 2.6 micrograms/kg, NS). ED95 was 59.4 +/- 5.4 micrograms/kg during fentanyl-N2O/O2, reduced by isoflurane (42.3 +/- 2.5 micrograms/kg, P less than 0.05), but not by halothane (49.7 +/- 3.1 micrograms/kg, NS). In children, ED50 was 43.9 +/- 4.7 micrograms/kg during fentanyl-N2O/O2, reduced by isoflurane (23.1 +/- 1.6 micrograms/kg, P less than 0.05), and halothane (33.2 +/- 3.2 micrograms/kg, P less than 0.05). ED95 was 79.3 +/- 9.8 micrograms/kg during fentanyl-N2O/O2, and reduced by isoflurane (49.1 +/- 3.1 micrograms/kg, P less than 0.05), but not by halothane (62.5 +/- 7.3 micrograms/kg, NS). Comparison between adults and children reveals no statistically significant differences, except for ED50 during fentanyl-N2O/O2 anesthesia which was increased in children.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pipecuronium-induced neuromuscular blockade during nitrous oxide-fentanyl, isoflurane, and halothane anesthesia in adults and children. 254 25

Many drugs potentiate the action of non depolarizing relaxants. These interactions are of clinical importance if such drugs are administered during the perioperative period. H2 Antagonists are increasingly often used for premedication. Cimetidine inhibits the elimination of a number of drugs used in the perioperative period. We therefore investigated whether H2 antagonists enhanced neuromuscular blockade by vecuronium, a medium short acting non depolarizing muscle relaxant. METHODS. The study was carried out in 24 female patients (ASA class I or II) scheduled for microsurgical procedures. Neuromuscular transmission was recorded electromyographically using four stimulations every 20 s to the ulnar nerve. After induction with thiopentone, anesthesia was maintained with fixed concentrations of volatile anesthetics. Fentanyl was administered for additional analgesia. Vecuronium was used as the sole muscle relaxant. Fixed repetitive doses of vecuronium (0.8-1.2 mg) were injected whenever the T1 returned to 25%. This time interval was defined as the T1-25 period. The study proper started when the T1-25 period had stabilized. After two control periods, six patients in each group received either 200 or 400 mg cimetidine or 100 mg ranitidine. The fourth group was the control group. The T1-25 periods and the maximal EMG depression were recorded automatically for at least two further periods. The first measured period was recorded as 100% and the length of each other periods was calculated as a percentage of the control period. This method enables an intraindividual comparison of the length of the T1-25 period and the maximal EMG depression before and after administration of the H2 antagonists. A two-tailed Student's t-test was used to test statistical significance, P less than 0.05 being accepted as significant. RESULTS. In the control group and in the group with 200 mg cimetidine or 100 mg ranitidine no statistical significant prolongation of the T1-25 period or of the maximal EMG depression could be observed, while after 400 mg cimetidine there was significant prolongation (mean 161 +/- 14.8%) of the T1-25 period and significantly greater EMG depression compared with the pre-cimetidine values. In the groups with 200 mg cimetidine or 100 mg ranitidine few patients showed prolongation of the T1-25 period up to 130%. DISCUSSION. Our results confirm experimental studies that have shown cimetidine to enhance aminoglycoside--relaxant interactions. Because we found an immediate response to the administration of the H2 antagonists, the interaction cannot be on the elimination side; it must be at the neuromuscular junction. Experimental investigation has shown that calcium reverses the cimetidine effects. It is therefore probable that the cimetidine--relaxant interaction occurs at the presynaptic level. Careful observation seems to be necessary if H2 antagonists, especially cimetidine, are administered intraoperatively at the same time as drugs that also enhance
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PMID:[Interactions of H2 antagonists and non-depolarizing muscle relaxants]. 256 80

To quantify the neuromuscular blocking effect of vecuronium on the diaphragm and the adductor pollicis, single twitch stimuli were applied to the phrenic nerves at the neck and the ulnar nerve at the wrist in anaesthetized patients. The evoked responses were measured simultaneously by recording the transdiaphragmatic pressure with a differential pressure transducer and the adductor pollicis strength with a force displacement transducer. Cumulative vecuronium dose-response curves were determined for both muscles in 11 ASA class I adult patients. The mean (SD) doses required to depress adductor pollicis and diaphragm responses to 50% (ED50) were 30 (9) micrograms kg-1 and 37 (12) micrograms kg-1, respectively. Corresponding values for 95% depression of the twitch response (ED95) were 48 (13) micrograms kg-1 and 67 (23) micrograms kg-1 (P less than 0.02), indicating that the diaphragm required approximately 40% more vecuronium for subtotal abolition of the single twitch response.
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PMID:Relative potency of vecuronium on the diaphragm and the adductor pollicis. 257 86

We evaluate the postoperative pain relief using continuous epidural fentanyl infusion in two different dosages for thoracic and upper abdominal surgeries. A total of 21 ASA class III patients were studied. A thoracic epidural catheter was placed before surgery but pain control was begun when the patients became fully awake and complained of pain in the recovery room. Patients were divided into group A (n = 9) and group B (n = 12). Those in group A were given fentanyl 1.5 micrograms/kg in saline solution as initial dose followed by continuous infusion at a rate of 1 microgram/kg/h for 23 hours. In group B the initial dose and the maintenance dose were respectively 1.0 microgram/kg and 0.5 micrograms/kg/h. Following the initial dose, the intensity of pain was assessed hourly for a total of 24 hours using a visual analogue pain scale with scores from 0 to 10. In group A, the pain scale fell from the baseline level of 7.7 +/- 2.6 to 2.3 +/- 2.0 at the first hour while in group B it fell from 8.9 +/- 1.4 to 4.3 +/- 2.1. The pain scores following continuous infusion in groups A and B were respectively 1.3 +/- 1.5 and 2.9 +/- 1.7. Although the analgesic effect appeared to be better in group A, pain relief was satisfactory in both groups (p less than 0.01). Regarding respiratory depression, there was a greater degree of rise in PaCO2 in group A and some of the patients even had a PaCO2 value above 50 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Continuous thoracic epidural fentanyl in postoperative pain control--a comparison of two different dosages]. 260 11

The morphological and functional aspects of the left ventricle (LV) were assessed by echocardiography and cardiac catheterization performed simultaneously in 41 patients. Eleven were normal (N), 14 had aortic stenosis (AS) and 16 had aortic regurgitation (AR). Of the 14 patients with AS, eight were in New York Heart Association (NYHA) functional class I and II (ASA group) and six were in NYHA functional class III and IV (ASB group). Of the 16 patients with AR, seven were in NYHA functional class I and II (ARA group) and nine in functional class III and IV (ARB group). In the ASA group normal values of the LV function were obtained because of the development of an adequate hypertrophy that in normalizing the systolic stroke was able to keep a suitable function. In the ASB group there was a reduction of the LV function due to an increase of the systolic stroke and to the reduction of the contractile muscle state. Thus, in the whole AS group we found an inversed relation between the ejection fraction and the systolic stroke. In the ARA group we found a normal cardiac function as consequence of an adequate development of the LV dilation and hypertrophy. Despite the find of reduction of the contractile state, the systolic stroke normalizing was capable to keep the cardiac function at normal values. The ARB group presented an important depression of the cardiac function due the increase of the systolic stroke and to the decrease of the contractile state of the cardiac muscle.
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PMID:[Analysis of the mechanical properties of the left ventricle in patients with aortic valve disease]. 263 9


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