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)

Twelve systemically healthy patients each (ASA risk groups 1-2) who required oral surgery under local anesthesia received the short-acting benzodiazepin Midazolam for analgosedation as well as the analgesics Pentazocin or Piritramid. Both i.v. medications are suitable as adjuvants for local anesthesia since neither clinically relevant respiratory and circular depression nor major sleepiness were observed.
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PMID:[Analgosedation as an adjuvant during surgery under local anesthesia]. 263 69

Succinylcholine was injected at different speeds to 60 men in halothane anesthesia, to see whether the rate of injection influenced the effects. METHODS. Sixty men (ASA I and II, mean age 28.6 years) undergoing surgery without muscle trauma were studied. They were treated uniformly with respect to premedication, anesthesia, venipuncture (cubital), and concentration (1%) and dosage (1 mg/kg) of succinylcholine (SCh). The only difference lay in the speed of injection of the relaxant: 20 mg/s, 8 mg/s, 4 mg/s, 2 mg/s and 1 mg/s, 12 patients being randomly allocated to each. The injection rate was controlled by a preprogrammed microprocessor pump system (XD 5500, HC Ulrich, D-7900 Ulm, Donau). The neuromuscular transmission was monitored by the adductor pollicis twitch technique using indirect supramaximal stimulation (Accelograph, biometer, DK-5120 Odense). The recorded twitch response allowed determination of the total onset time (TOT) from the beginning of the injection to the maximal twitch depression, its components, latent and manifest onset times (LOT and MOT), and the twitch depression factor ki. Blood samples for measurement of potassium and myoglobin levels (RIA, sensitive to 5 ng/ml) were taken before and 5, 15, and 30 min after SCh administration. For determination of the course (difference between two values before and after SCh), the maximum level up to 30 min was recorded. RESULTS. The twitch depression amounted to 100% in 57 patients and to 93% or 98% in the remaining 3. Reducing the speed of injection led to significant prolongation of TOT and LOT (Table 3) and significant differences in the onset characteristic in regard to twitch depression factor ki (Table 4). No significant influence on the increase in potassium (Table 7) and myoglobin (Table 8) was observed. CONCLUSION. These findings give no cause to inject SCh more slowly than usual in healthy adults.
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PMID:[The rate of injection of succinylcholine and onset of neuromuscular action, serum potassium or myoglobin levels. Studies in men during halothane anesthesia]. 267 68

60 patients (ASA class I-II) undergoing knee arthrotomy received in a double blind fashion, a transdermal drug delivery system, containing either fentanyl (delivery rate of 75 micrograms/hour)--Fentanyl TTS--or placebo. The system remained in place for 24 hours. Even when piritramid was added as escape analgesia, all respiratory and hemodynamic parameters, as well as blood gas analysis showed no statistical significant difference between both groups (fentanyl or placebo). One patient had evidence of a beginning respiratory depression, but no specific therapy was needed. No significant side effects were seen. Concerning escape medication, a highly statistically significant difference in favour of Fentanyl TTS was found (p less than 0.001).
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PMID:Transdermal fentanyl against postoperative pain. 267 77

A randomized, prospective, comparative study was performed to evaluate induction characteristics, haemodynamic changes and recovery in 60 ASA I-II patients undergoing mainly gynaecological laparotomies with either propofol or thiopentone-enflurane anaesthesia. The propofol group (n = 30) received 2 mg.kg-1 propofol for induction of anaesthesia followed by propofol infusion. The thiopentone-enflurane group (n = 30) received thiopentone 4 mg.kg-1 for induction followed by enflurane (0.5-2 per cent). All patients received nitrous oxide (66 per cent] in oxygen begun one minute after tracheal intubation, and fentanyl (1.5 micrograms.kg-1) four minutes prior to induction. Other drugs administered during or after anaesthesia were similar among the groups. Haemodynamic measurements were similar between propofol and enflurane groups except after tracheal intubation when the mean arterial pressure was lower in the propofol group (P less than 0.05). The propofol group had significantly less (P less than 0.01) emesis in the recovery room than the enflurane group. The propofol group experienced significantly less (P less than 0.05) dizziness, depression/sadness and hunger than the enflurane group in the postoperative period as assessed with a visual analogue questionnaire. We conclude that propofol provided better outcome than enflurane in terms of these nonvital but annoying outcome measures after relatively long intra-abdominal operations.
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PMID:Randomized comparison of outcome after propofol-nitrous oxide or enflurane-nitrous oxide anaesthesia in operations of long duration. 268 41

Stressful surgical stimuli, such as endotracheal intubation, surgical incision, organ manipulation and emergence from anesthesia, elicit adrenergic responses that precipitate transient but intense increases in heart rate and blood pressure. Although this response is well tolerated in healthy patients, patients with ischemic heart disease are at significant risk of myocardial ischemia and infarction owing to the sudden increase in myocardial oxygen demand. Parenteral beta blockers are effective in blunting this adrenergic response, but the duration of action of these agents is long-lasting and the degree of beta blockade is often difficult to predict. Further, long-acting parenteral beta blockers may cause adverse effects, the reversal of which presents a difficult clinical problem in patients with ischemic heart disease. The availability of esmolol, an ultrashort-acting parenteral beta-adrenergic antagonist with a half-life of 9 minutes, brings obvious advantages to the perioperative management of hypertension and tachycardia. With esmolol treatment, the difficulties of therapy with long-lasting beta blockers are avoided. Also, to blunt the adrenergic response, the anesthesiologist will have an alternative to increasing the depth of anesthesia, which can accentuate cardiovascular depression and prolong awakening and postoperative respiratory depression. Clinical studies performed during the perioperative period reveal that esmolol is safe and effective in this setting. Esmolol has been shown to be safe and efficacious in patients in ASA classifications I through IV and patients undergoing carotid endarterectomy and coronary artery bypass surgery. The pharmacokinetic profile, rapid onset and elimination half-life make this agent particularly well suited to treat the very intense but transient adrenergic responses to surgical stress in patients undergoing cardiac and noncardiac surgery.
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PMID:Perioperative use of esmolol. 286 50

The short elimination half-life of vecuronium suggests it may be delivered more efficiently by continuous infusion than by traditional bolus injections. The objective of this study was to compare manual administration with computer-controlled administration. Anesthesia was induced in 22 patients (American Society of Anesthesiologists [ASA] physical status I and II) with fentanyl and sodium thiopental and maintained with halothane and nitrous oxide in oxygen. Neuromuscular function was assessed at the hypothenar eminence and the adductor pollicis (train-of-four stimulation). A bolus of 0.1 mg/kg of vecuronium was given to obtain 100% twitch depression for tracheal intubation. After twitch height returned to 25% of control, relaxation was maintained by traditional bolus injections (group 1, n = 7), manually controlled continuous infusion (group 2, n = 7), or computer-controlled continuous infusion (group 3, n = 8). In all three groups the desired level of relaxation was 90% twitch depression. Variability of relaxation differed significantly among the three groups (group 1: 10.5%, group 2: 12.4%, group 3: 7.1%). Twitch height was more constant with computer control than with either bolus injections or manual infusion (P less than 0.05). There was no statistically significant difference in the drug requirement (group 1: 1.60 microgram/kg/min, group 2: 1.51 microgram/kg/min, group 3: 1.45 microgram/kg/min). Variability in the mechanomyogram (n = 12) was much higher than in the electromyogram (n = 10). Computer-controlled infusion may be a useful adjunct for the anesthesiologist who desires a stable level of patient relaxation when using short-acting, non-depolarizing relaxants.
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PMID:A comparison of computer-controlled versus manual administration of vecuronium in humans. 289 Jul 19

Two anaesthetic techniques were compared in a randomized trial of 60 ASA I and II women admitted for diagnostic dilatation and curettage of the uterus. Group I had fentanyl 2.5 micrograms/kg and thiopentone 2 mg/kg i.v. Supplementary thiopentone 50 mg was given every 15 s until loss of the eyelid reflex. Anaesthesia was maintained with nitrous oxide in oxygen 2/1 together with supplementary thiopentone 50 mg as required. Group II had midazolam 0.1 mg/kg i.v. and a supplementary 0.025 mg/kg every second min until sleep or dysarthria, followed by paracervical blockade with 1% mepivacaine 10 ml on each side of the portio. There was no significant depression of the cardiovascular system. The working conditions for the gynaecologist were good in both groups. The midazolam technique gave just as good amnesia as did general anaesthesia, and there was a high degree of patient satisfaction in both groups. In the thiopentone group there was a significant depression of the respiratory rate and a significantly higher frequency of adverse effects (nausea and vomiting) as compared to the midazolam group. It is concluded that paracervical blockade combined with midazolam, titrated i.v., until sleep or dysarthria, is a recommendable anaesthetic technique for diagnostic dilatation and curettage.
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PMID:Midazolam combined with paracervical blockade compared to general anaesthesia for curettage of the uterus. 306 45

The effect of nalbuphine on the respiratory depression, pruritus and analgesia induced by epidural morphine was determined in a randomized, prospective, double-blind, placebo-controlled fashion. Twenty ASA physical status I women received 0.1 mg.kg-1 epidural morphine at induction of general anaesthesia for elective total abdominal hysterectomy. Group 1 (n = 14) received 0.3 mg.kg-1 nalbuphine intravenously six hours after the epidural morphine administration. Group 2 (n = 6) received saline. Prior to agent administration, six patients from the nalbuphine group and four patients from the saline group had respiratory depression indicated by a PaCO2 greater than 45 mmHg. After nalbuphine administration the PaCO2 (mean +/- SE) decreased from 49.5 +/- 1.2 mmHg to 42.5 +/- 0.7 mmHg (p less than 0.005) while there was no significant change after saline administration. Nine of the 14 patients receiving nalbuphine appeared to become more sedated, despite an improvement in ventilation. Pruritus was antagonized by 0.1 mg.kg-1 nalbuphine (p less than 0.006). There was no reversal of analgesia after administration of 0.3 mg.kg-1 nalbuphine.
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PMID:Reversal of epidural morphine-induced respiratory depression and pruritus with nalbuphine. 314 43

This study evaluated the effects of propofol on somatosensory evoked cortical potentials in 20 ASA grade 1 or 2 patients who underwent spinal surgery. Anaesthesia consisted of propofol, dextromoramide, 50% nitrous oxide and oxygen mixture. The induction dose of propofol was 2 mg/kg and was followed by an infusion of 6 mg/kg for the first hour and 3 mg/kg subsequently. Somatosensory evoked cortical potentials were recorded on the scalp and compared to pre-operative values using Student's paired t-test. We observed a significant depression of evoked potential 10 minutes after induction, which continued until the early phase of recovery. Because of its short and quickly reversible action, propofol is an acceptable agent when clinical monitoring of the spinal cord is indicated but is not satisfactory when monitoring has to be based on somatosensory cortical evoked potentials.
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PMID:Propofol anaesthesia alters somatosensory evoked cortical potentials. 325 96

It has been suggested in various studies that the opiate agonist/antagonist nalbuphine (Nubain) provides for effective reversal of the respiratory depression after fentanyl while maintaining postoperative analgesia. We tested this hypothesis in a relatively large number of patients. The study consisted of two parts: one randomized open, the other randomized double-blind, each with 150 ASA I or II patients aged 18 to 65 years. After premedication with atropine 0.5 mg and flunitrazepam 0.5 mg, anaesthesia was induced with flunitrazepam 0.5 mg, fentanyl 0.1 mg, and etomidate 10 mg and maintained with N2O/O2, 2/1, and additional increments of 0.1 mg fentanyl as required. Relaxation for intubation and surgery was obtained with vecuronium, atracurium, or pancuronium depending on the expected duration of anesthesia. After the operation the patients were extubated and the residual effects of fentanyl antagonized with naloxone 0.05 mg or nalbuphine 10 mg or 20 mg i.v. (randomized open or double-blind). The patient data and fentanyl dosages are given in Table 1. Postoperative pain was assessed by the time interval between administration of the opiate antagonist and the requirement for the first analgesic medication. Figures 1a and b and Table 2 indicate that after nalbuphine 20 mg the first analgesic was required significantly later than after naloxone 0.05 mg (median 115 or 123 min after nalbuphine 20 mg vs 56 or 52 min after naloxone 0.05 mg; P less than 0.02). There was no significant difference between nalbuphine 10 mg and naloxone 0.05 mg. The open and double-blind studies gave virtually identical results. Sixty minutes after administration of 20 mg nalbuphine, vigilance was significantly reduced.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Nalbuphine following fentanyl. Postoperative analgesia]. 330 Apr 8


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