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 double-blind study, 39 patients (ASA groups I-II,) were given either pancuronium or atracurium as an infusion during surgery. The drugs were given as an initial loading dose of 0.064 mg kg-1 or 0.30 mg kg-1, respectively, followed by an infusion, the rate of which was regulated to produce a constant 95% depression of the evoked twitch response throughout surgery. No significant difference in the number of corrections of the infusion rate per hour was found (4.6 v. 4.9). Mean infusion maintenance doses were 35 and 356 micrograms kg-1 h-1, respectively. The inter-individual variability of maintenance doses for the two drugs did not differ, the coefficients of variation being 0.32 and 0.24. On stopping the infusion, the patients given atracurium recovered to a 15% twitch faster than those given pancuronium. In addition neostigmine produced a quicker recovery in this group. Thus atracurium may be a more satisfactory drug for use by infusion.
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PMID:Maintenance of constant 95% neuromuscular blockade by adjustable infusion rates of pancuronium and atracurium. 337 23

We have investigated the use of constant-rate delivery of fentanyl by i.v. and transdermal routes for the treatment of pain after major surgery. Forty-five males, ASA I-III, received in a double-blinded fashion either placebo (n = 6) or fentanyl (n = 39) i.v. at one of four dose rates (25, 50, 100 or 125 micrograms h-1). Stable serum concentrations of fentanyl were produced by the end of surgery and were maintained for a total of 24 h. Calculated clearance of fentanyl was 1.05 +/- 0.38 litre min-1 and was not related to weight or age. Both the 100- and 125-micrograms h-1 dose rates produced significant analgesic efficacy as assessed by postoperative morphine requirements. Mean serum concentrations of fentanyl in these groups were 1.42 +/- 0.14 (SD) and 1.90 +/- 0.30 ng ml-1, respectively. One of 10 patients receiving fentanyl 100 micrograms h-1 and three of nine patients receiving 125 micrograms h-1 had evidence of respiratory depression. Eight additional patients were treated with a transdermal drug delivery system containing fentanyl (TTS-fentanyl). Steady-state serum concentrations in this group were 2.15 +/- 0.92 (SD) ng ml-1. Post-operative morphine requirements were minimal (less than 0.5 mg h-1) and PaCO2 remained acceptable in all patients. Serum concentrations of fentanyl increased slowly (15 h to plateau) and decreased slowly (apparent half-life, 21 h). We conclude that delivery of analgesic doses of fentanyl is feasible by the transdermal route.
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PMID:Postoperative analgesia with fentanyl: pharmacokinetics and pharmacodynamics of constant-rate i.v. and transdermal delivery. 337 42

The hemodynamic response to anesthesia with the aqueous emulsion formulation of propofol was studied in healthy patients (ASA I or II), aged 39-57 yr, premedicated with morphine, 0.15 mg/kg. Anesthesia was induced in all patients with propofol, 2 mg/kg. Subsequently, patients were randomly assigned to two groups and maintained by a continuous intravenous infusion (group 1 received 54 micrograms X kg-1 X min-1, group 2 received 108 micrograms X kg-1 X min-1) to supplement 67% nitrous oxide. Three minutes after induction, systolic arterial pressure (SAP) decreased 28% (P less than 0.01) and was associated with decreased (-12%) cardiac output (Q70) and decreased (-15%) systemic vascular resistance (SVR). The hemodynamic response to tracheal intubation was not obtunded, but peak values of arterial pressures and heart rate did not exceed those recorded awake. Thirty minutes elapsed before repeating measurements prior to the first surgical incision. In group 1, SAP and Q70 decreased to 65% and 68% of awake values and in group 2 to 55% and 74% (P less than 0.05). Mild ventilatory depression persisted for the duration of spontaneous ventilation and was not reduced by the stimulus of surgery, which caused no significant hemodynamic responses in either group. Decreasing arterial PCO2 to the awake value by controlled ventilation increased SVR (P less than 0.05), but the associated increased SAP and decreased Q70 did not reach statistical significance. No patient reported awareness. The infusion of the emulsion formulation of propofol was associated with satisfactory anesthesia and recovery and with hemodynamic effects similar to those recorded with other intravenous anesthetics.
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PMID:Hemodynamic effects of infusions of the emulsion formulation of propofol during nitrous oxide anesthesia in humans. 349 56

This was a randomized study of 180 ASA physical status I and II patients, 60 in each group who received propofol (PROP), 2.5 mg . kg-1, thiopentone (THIO), 4 mg . kg-1, or methohexitone (METH), 1.5 mg . kg-1. Control values, followed by changes after induction and during a 3-min delay before intubation were recorded for the following parameters: heart rate (HR), systolic and diastolic blood pressures (SBP, DBP), respiratory rate (RR), end-tidal CO2 (PETCO2), and induction time (IT). In addition, the incidence of adverse reactions and time for recovery from anaesthesia were noted. The IT (mean +/- SE) was 35 +/- 1 sec for propofol, 35 +/- 1.2 sec for thiopentone and 34 +/- 1.4 sec for methohexitone. Ninety-three per cent of the PROP group fell asleep with one dose and required no additional doses. Fifty per cent of each of the THIO and METH groups required additional agents (p less than 0.05). METH was associated with the highest elevation in HR, PROP the least (p less than 0.05). PROP was associated with the most decrease in SBP and DBP and in addition respiratory depression (p less than 0.05). The incidence of injection pain or excitatory activity was equal in the three groups with the exception that 14 patients who received METH developed hiccoughs while none did in the other groups. PROP was associated with the most rapid recovery, particularly with respect to the orientation time. We conclude that PROP is an effective alternative to barbiturate induction and that the published recommended doses of THIO and METH are often ineffective.
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PMID:A controlled investigation of propofol, thiopentone and methohexitone. 349 44

The anesthetic effect of 2 ml of 5% lidocaine in 7.5% glucose (LG) or 5% meperidine in water were evaluated and compared in 40 ASA class 1 or 2 patients. Patients were randomly assigned to one of the two groups (20 patients in each) according to the anesthetic agent, which was injected into the lumbar subarachnoid space in the sitting position. The patients remained sitting for 5 min before being placed in the supine position. Times of onset of sensory and complete motor blockade were significantly more rapid with LG. The extent of maximum cephalad spread of analgesia and the time to maximum height of analgesia in the two groups were not different. Duration of analgesia at the T-7 (48.96 +/- 6.64 min with LG, 44.74 +/- 6.14 min with meperidine; means +/- SEM) and L-1 (94.37 +/- 7.42 min with LG, 76.19 +/- 5.64 min with meperidine) dermatomes was not different in the two groups but was statistically longer at the T-10 dermatome with LG (66.83 +/- 6.72 min) than with meperidine (46.66 +/- 6.26 min). The duration of complete motor blockade was also significantly longer with LG (66.44 +/- 7.05 min) than with meperidine (42.67 +/- 4.47 min). Complications in both groups included decrease in blood pressure and nausea and vomiting intraoperatively, and urinary retention, nausea and vomiting, and mild headache postoperatively. Complications that occurred only in the meperidine group were intraoperative drowsiness, respiratory depression, bronchospasm, and itching. The frequency of complications was greater wit meperidine.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Meperidine as a spinal anesthetic agent: a comparison with lidocaine-glucose. 354 85

The effects of intravenous flunitrazepam (25 micrograms . kg-1) on the baroreflex control of heart rate and plasma catecholamine levels were determined in ten ASA 1 unpremedicated patients. Plasma concentrations of flunitrazepam were also measured. The data was obtained before and 5, 10 and 15 min after flunitrazepam administration. The baroreflex gain was significantly decreased at 5 min, the time of the highest flunitrazepam plasma concentration. Catecholamine plasma levels were decreased at each study time. It was concluded that flunitrazepam induced a transient depression in baroreflex function and a sustained decrease in adrenergic activity.
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PMID:[Effects of flunitrazepam on the baroreflex control of heart rate and on adrenergic activity]. 363 60

Blocking of sympathetic conduction aims at permanent or temporary elimination of those pain pathways conducted by the sympathetic nervous system. In order to provide an objective evaluation of sufficient blocking effect, earlier inquiries referred to parameters such as: (1) observation of clinical signs such as Horner's syndrome, Guttman's sign, anhidrosis, extended venous filling; (2) difference in skin temperature of at least 1.5 degrees C between blocked and unblocked side; (3) increase in amplitude of the pulse wave; and (4) depression of the psychogalvanic reflex (PGR) on the blocked side (Fig. 1). In clinical practice, these control parameters are effective because they are time-saving, technically simple, and highly evidential. Further parameters for evaluating sympathetic blockade are examination of hydrosis by means of color indicators such as bromocresol and ninhydrin, oscillometry, and plethysmography. The effectiveness of sympathetic blockade after stellate ganglion and sympathetic trunk blocks has been verified by various authors. In a clinical study, 16 patients were divided into four groups in order to test the effectiveness of sympathetic blockade after spinal anesthesia with 3 ml 0.75% bupivacaine (group I) and 4 ml 0.75% bupivacaine (group II) and after peridural anesthesia with 15 ml 0.75% bupivacaine (group III) and 20 ml 0.75% bupivacaine (group IV) by means of temperature difference, response of pulse wave amplitude and PGR between blocked lower and unblocked upper extremity, and sensory levels of block. The patients were classified as ASA I and II; their ages varied from 20 to 63 years.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Effectiveness of sympathetic block using various technics]. 365 38

The effect of age on the onset and duration of action of a d-tubocurarine (DTC) neuromuscular blockade with and without pancuronium priming in children was examined. Sixty ASA physical status I or II patients in three age ranges (0-1 yr, 1-3 yr and 3-10 yr) were anaesthetized with thiopentone, halothane and nitrous oxide. Each patient received either a single paralyzing dose of DTC 0.4 mg.kg-1, or DTC 0.36 mg.kg-1 preceded three minutes earlier by pancuronium 0.007 mg.kg-1. Evoked force of contraction of the adductor pollicis was measured using train-of-four stimulation applied every 12 sec. Time to 90 per cent first twitch depression after a single dose of DTC increased with increasing age (r = 0.65, p less than 0.01), and was 1.6 min (SEM +/- 0.3) in the 0-1 yr group, 1.9 +/- 0.3 min (1-3 yr), and 5.2 +/- 1.2 min (3-10 yr). Time to ten per cent spontaneous recovery after single dose DTC was shorter in older individuals (r = 0.40, p less than 0.05), being 36.4 +/- 5.1 min in infants 0-1 yr, 30.6 +/- 4.6 min (1-3 yr), and 24.0 +/- 2.7 min (3-10 yr). Priming with pancuronium accelerated the onset significantly in all age groups with 90 per cent T1 depression occurring at 0.7 +/- 0.1 min (0-1 yr), 0.9 +/- 0.1 min (1-3 yr), and 2.1 +/- 0.6 min (3-10 yr). However, priming delayed recovery, especially in infants.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Accelerated onset and delayed recovery of d-tubocurarine blockade with pancuronium in infants and children. 367 78

Thirty-four patients of ASA physical status I or II scheduled for gall bladder surgery were studied in a comparative prospective trial to evaluate the efficacy of epidural and intramuscular ketamine for postoperative pain relief. They were divided randomly into three groups. Group I (11 patients) received 30 mg intramuscular ketamine. Group II (10 patients) and Group III (13 patients) received 10 and 30 mg ketamine in 10 ml saline respectively, through epidural catheters. Pain was evaluated every two hours for the first 24 hours post-operatively by using a linear analogue pain scale from 0-10. Ketamine was given on the patient's request and whenever the pain score exceeded three. Ketamine produced analgesia in all patients studied. The reduction of pain score after two and four hours in Group I and III was significant when compared to Group II. Seven patients (54 per cent) in Group III did not require further analgesia after the initial injection. However, following 10 mg epidural ketamine or 30 mg IM ketamine, post-operative pain was more frequent. Four patients who received epidural ketamine complained of transient burning pain in the back during injection. No patient developed respiratory depression, psychic disturbance, cardiovascular instability, bladder dysfunction or neurologic deficit. It is concluded that 30 mg epidural ketamine is a safe and effective method for postoperative analgesia.
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PMID:Epidural ketamine for postoperative analgesia. 394 42

The hemodynamic and cardiovascular effects of isoflurane and halothane anesthesia were studied in 15 unpremedicated ASA I children using measurements of heart rate, blood pressure and M-mode echocardiography (echo). The children (ages 2 to 7.3 yr) were randomly assigned to receive either isoflurane (N = 8) or halothane (N = 7) with oxygen. End-tidal carbon dioxide concentrations (range 30-44 mmHg) were monitored throughout the study in each child. The experimental protocol was completed prior to intubation and the initiation of surgery. Within each anesthetic group, preinduction (control) hemodynamic and echo measurements were compared with measurements obtained at two sequential equipotent end-tidal anesthetic concentrations (0.74% and 2.22% isoflurane; or 0.5% and 1.5% halothane). We also compared the data of the isoflurane group with that of the halothane group at each equipotent end-tidal anesthetic concentration. Preinduction hemodynamic (heart rate, blood pressure) and echo measurements (left ventricular dimensions and function) were similar between the two anesthetic groups. With isoflurane or halothane administration, blood pressure decreased significantly, while heart rate remained essentially unchanged. The observed alterations in heart rate and blood pressure were similar in both study groups at each equipotent end-tidal anesthetic concentration. In contrast, there were marked differences in the echo measurements of the two anesthetic groups. Halothane was associated with a significant dose-dependent decrease in echo-measured left-ventricular shortening fraction and mean velocity of circumferential fiber shortening. These echo measurements were not significantly altered by isoflurane at either end-tidal anesthetic concentration. These alterations suggest halothane is associated with significant myocardial depression in normal children, while myocardial function is well preserved during isoflurane anesthesia.
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PMID:The hemodynamic and cardiovascular effects of isoflurane and halothane anesthesia in children. 395 27


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