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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study was designed to investigate if propofol produced cardiovascular effects by direct actions or by indirect actions secondary to depression of the central nervous system. Experiments were performed on chloralose anaesthetized dogs in which all neurogenic cardiovascular reflexes were abolished by bilateral vagotomy and common carotid ligatures, in combination with i.v. bretylium and propranolol. Bolus doses of propofol followed by infusions at rates up to 160 mg kg-1 h-1 produced blood concentrations of propofol from 1.99 to 112 micrograms ml-1. Infusions of hydroxyethyl starch given to maintain central venous pressures and pulmonary artery occlusion pressures at control values were used as an index of changes in capacitance. Blood concentrations of propofol less than 10 micrograms ml-1 caused an increase in mean capacitance of 8.0 (SEM 1) ml kg-1 with no significant changes in systemic vascular resistance, pulmonary vascular resistance or inotropic state of the heart. We conclude that anaesthesia with propofol may be accompanied by decreased cardiac output secondary to reduction in preload by a direct venodilator effect. Our experiments indicate that cardiac output and arterial pressure are preserved well at normal anaesthetic blood concentrations of propofol if the preload is maintained.
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PMID:Cardiovascular effects of propofol in the anaesthetized dog. 278 50

A program was developed to improve independence, self-esteem, and glycemic control in patients with diabetes and blindness. Twenty-nine individuals with both insulin-dependent and noninsulin-dependent diabetes mellitus entered 12-week programs that included education focusing on diabetes self-management skills for the visually impaired, monitored exercise sessions, and group support. Glycated hemoglobin values fell from 13.0% +/- 0.6% (SEM) to 11.4% +/- 0.5% (P = .001). Exercise tolerance in a 12-minute walk test improved from 0.48 +/- 0.04 to 0.64 +/- 0.05 miles (P = .001). Marked improvements occurred in psychosocial indices, demonstrated through changes in the Rand Mental Health Index from 155 +/- 6 to 174 +/- 5 (P = .0001), the Rosenberg Self-Esteem Scale from 22 +/- 1 to 19 +/- 1 (P = .001), the Zung Depression Scale from 0.50 +/- 0.02 to 0.44 +/- 0.02 (P = .001), and the Diabetes Self-Reliance Test from 60 +/- 3 to 74 +/- 2 (P = .0001).
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PMID:A model clinical program for patients with diabetes and vision impairment. 279 59

Local blood flow was measured with radioactive microspheres in 9 near-term ewes 2 min into successive high and low voltage electrocortical activity states. In an additional 8 animals the umbilical blood flow was measured using an electromagnetic flow-probe on the common umbilical vein. The microsphere data indicated that the blood flow during low and high voltage electrocortical activity was 185 +/- 22 ml/min per kg of fetus (SEM) and 165 +/- 22 ml/min per kg of fetus (P less than 0.01) respectively. Using the electromagnetic flowprobe the average flow during low and high voltage electrocortical activity was 203 +/- 14 ml/min per kg of fetus and 196 +/- 13 ml/min per kg of fetus (P less than 0.05) respectively. We observed that the decrease in the umbilical blood flow preceded the change from low to high voltage electrocortical activity by approximately 1 min. In that time the flow is significantly lower than it was during the preceding measurements taken during the low voltage electrocortical activity periods. This depression was still significantly lower at 3 min into the high voltage electrocortical activity whereas at 5 min into the high voltage state it was elevated to near average values. We conclude that the umbilical blood flow, on the average, is lower in high voltage states than it is in low voltage states and that this change precedes the switch from low to high voltage electrocortical activity.
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PMID:Relationship between fetal electrocorticographic changes and umbilical blood flow in the near-term sheep fetus. 279 85

Postoperative cardiac patients frequently are mildly hypothermic, yet the influence of hypothermia on left ventricular (LV) contractility has received little attention. To study the possible effects of mild hypothermia on LV function, six pigs were placed on partial right ventricular bypass, the hearts were electrically paced to control heart rate, and myocardial temperature was varied between 34 degrees and 38 degrees C. Using two pairs of orthogonally oriented sonomicrometer crystals in the left anterior descending (LAD) and left circumflex (LCX) distributions, we estimated regional work (the area within LV pressure-area loops) over a range of LV preloads. Diastolic function was assessed by measurement of the time constant of LV pressure decay during isovolumic relaxation. Regional work data were expressed as percentages of baseline (38 degrees C and end-diastolic pressure of 10 mm Hg). To control for preload variations, regional work and time constants were calculated from beats with end-diastolic areas within 0.1% of baseline. Regional work (mean +/- SEM) declined from 85.1 +/- 6.7% at 38 degrees C to 31.9 +/- 4.4% at 34 degrees C. Time constants were prolonged from 44.8 +/- 2.5 msec at 38 degrees C to 61.6 +/- 2.7 msec at 34 degrees C. These data demonstrate a marked depression of LV contractility, even at mild levels of hypothermia that may be encountered clinically after cardiac operations.
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PMID:Systolic and diastolic left ventricular dysfunction due to mild hypothermia. 280 6

Epidurally administered clonidine has been reported to produce postoperative analgesia. To assess the efficacy, safety, and appropriate dose of epidural clonidine for postoperative analgesia, clonidine (range, 100-900 micrograms in 100-micrograms increments) was injected in 22 patients following abdominal surgery or total knee arthroplasty (TKA). Clonidine produced analgesia, as measured by change in verbal pain scores and supplemental iv morphine usage. The largest doses examined (700-900 micrograms) produced complete pain relief for 5.0 +/- 0.8 h (mean +/- SEM; range 2-11 h), without other sensory or motor blockade. Clonidine also produced dose dependent decreases in blood pressure, being less following small (100-300 micrograms) and large (700-900 micrograms) doses than following intermediate (400-600 micrograms) doses. Six patients required iv ephedrine for treatment of blood pressure decrease of greater than 30%. Clonidine decreased heart rate 10-30% and produced transient sedation. Oxyhemoglobin saturation, serum glucose, and arterial blood gas tensions were not altered by clonidine, whereas there was a small (28%) dose-independent decrease in serum cortisol following clonidine injection. Clonidine was absorbed in a dose-dependent manner into the systemic circulation, with plasma concentrations 0.1-3.3 ng/ml 1 h following injection. These results suggest that hemodynamic depression and short-lasting analgesia may limit the usefulness of bolus epidural clonidine analgesia in the postoperative setting.
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PMID:Epidural clonidine analgesia following surgery: phase I. 281 56

We have studied combinations of alfentanil and propofol for total i.v. anaesthesia in 24 severely burned patients. No inhalation agents were used. After a loading dose of alfentanil 100 micrograms kg-1, the intraoperative requirement was 1.24 (SEM 0.7) micrograms kg-1 min-1, and after a propofol induction dose of 2 mg kg-1 the maintenance rate was 100 micrograms kg-1 min-1. Initial hypotension occurred after induction of anaesthesia, but during the operation, cardiovascular variables were stable. After adequate antagonism of neuromuscular block, respiratory depression persisted in three patients when the two agents were discontinued simultaneously; this was not seen when alfentanil was discontinued 15 min before propofol. Quality of recovery was good, and satisfactory postoperative analgesia was present in the majority of patients 2 h after operation. This study indicates that total i.v. anaesthesia with a combination of alfentanil and propofol appears to be satisfactory in burned patients.
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PMID:Alfentanil and propofol infusions for surgery in the burned patient. 281 18

Bisoprolol is a new cardioselective beta-blocker with a long half-life. The efficacy of once daily bisoprolol (10 mg) and atenolol (100 mg) was assessed in 20 patients with stable angina using a placebo controlled double-blind randomized crossover protocol. Efficacy was assessed by computer assisted treadmill exercise testing with monitoring of leads CM5 and CC5, carried out 22-24 h after the last dose. The mean +/- SEM exercise time on placebo was 6.5 +/- 0.4 min increasing to 7.8 +/- 0.5 min on bisoprolol (P less than 0.001) and 8.6 +/- 0.6 mins on atenolol (P less than 0.001). The time to 1 mm ST depression in CM5 and CC5 was also prolonged significantly with both drugs. The mean basal resting heart rate of 84 +/- 4 bpm decreased to 63 +/- 2 bpm on bisoprolol (P less than 0.001) and 64 +/- 3 bpm on atenolol (P less than 0.001), with a significant decrease in the peak exercise heart rate seen with both drugs (P less than 0.001). The peak rate-pressure product was 175 +/- 8 after placebo, 146 +/- 7 (P less than 0.001) with bisoprolol and 149 +/- 5 (P less than 0.001) after atenolol. One patient was withdrawn because he suffered a myocardial infarction. Eighteen patients were prescribed bisoprolol 10 mg once a day for 6 weeks and an exercise test was performed at the end of this period. Bisoprolol retained its efficacy at the end of this period and was well tolerated.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Efficacy of once daily bisoprolol in stable angina pectoris: an objective comparison with atenolol and long term follow-up. 286 60

Train-of-four stimulation was applied to the ulnar and phrenic nerves in 18 adult patients anaesthetized with nitrous oxide and halothane in oxygen. The response of the adductor pollicis and the diaphragm were measured. Incremental doses of atracurium and vecuronium were given, with an infusion to replace drug lost by elimination or distribution. The mean (SEM) doses of atracurium associated with 50% and 90% depression of response to the first stimulation in the train-of-four (ED50 and ED90) were 90 (9) and 133 (10) micrograms kg-1 at the adductor pollicis, and 130 (9) and 245 (17) micrograms kg-1 at the diaphragm, respectively. The mean (SEM) ED50 and ED90 of vecuronium were 25 (2) and 38 (4) micrograms kg-1 at the adductor pollicis and 34 (3) and 58 (5) micrograms kg-1 at the diaphragm, respectively. The mean (SEM) ED50 ratios were 1.56 (0.16) for atracurium and 1.47 (0.16) for vecuronium. ED90 ratios were 1.93 (0.29) and 1.55 (0.17) for atracurium and vecuronium, respectively. It is concluded that both atracurium and vecuronium exhibit a similar degree of sparing of the diaphragm.
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PMID:Potency of atracurium and vecuronium at the diaphragm and the adductor pollicis muscle. 290 72

Mivacurium chloride (BW B1090U) is a new, short-acting non-depolarizing neuromuscular blocking agent. It is a synthetic bis-benzylisoquinolinium diester, which is hydrolysed rapidly by plasma cholinesterase. This study compares mivacurium, atracurium and vecuronium by continuous i.v. infusion. The duration of mivacurium infusion ranged from 29.5 to 286 min. The steady state infusion rates necessary to maintain 95 (SEM 4)% twitch suppression were: mivacurium 8.3 (0.7) micrograms kg-1 min-1; atracurium 7.9 (0.4) micrograms kg-1 min-1; vecuronium 1.2 (0.3) micrograms kg-1 min-1. Following infusions of mivacurium, various recovery times (for example: 25-75%, 6.9 (0.3) min; 25-95%, 11.0 (0.4) min; 5-95% 14.5 (0.4) min) did not differ significantly from those following single bolus doses. Recovery times following cessation of mivacarium infusions were approximately 50% of those for equivalent durations of infusion of atracurium (10.9 (0.3) min for 25-75% recovery and 26.6 (0.4) min for 5-95% recovery). For vecuronium, corresponding recovery times were 13.8 (0.9) and 32.0 (1.2) min, respectively. Comparative recovery times for mivacurium were 40-50% of those for vecuronium. There was a significant correlation between the infusion rate of mivacurium required to maintain 95% twitch depression and the plasma cholinesterase activity of individual subjects.
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PMID:Clinical pharmacology of mivacurium chloride (BW B1090U) infusion: comparison with vecuronium and atracurium. 290 43

We studied neutrophil activation in patients with burns by serial immunofluorescent measurement of neutrophil expression of the complement opsonin receptors CR1 and CR3. CR1-dependent fluorescence was initially (days 0 through 5 after the burn) elevated (mean +/- SEM, 294 +/- 42 vs. 63 +/- 6 in the controls; P less than 0.001) and gradually returned to normal (days 6 through 8, 270 +/- 62, P less than 0.001; days 9 through 13, 185 +/- 38, P less than 0.001; days 14 through 19, 143 +/- 27, P less than 0.001; and days 20 through 50, 93 +/- 5, P less than 0.04). CR3-dependent fluorescence paralleled that of CR1. Neutrophil chemotaxis in response to zymosan-activated serum, a source of C5a, was depressed (days 0 through 5, 77 +/- 4 percent of control, P less than 0.001; days 6 through 8, 70 +/- 4 percent, P less than 0.001; days 9 through 13, 74 +/- 3 percent, P less than 0.001; days 14 through 19, 90 +/- 4 percent, P less than 0.01; and days 20 through 50, 97 +/- 3 percent, P not significant) and inversely correlated with CR1- and CR3-dependent fluorescence (r = -0.559, P less than 0.001; and r = -0.709, P less than 0.001, respectively). Plasma C3a desArg levels were above normal (100 +/- 5 ng per milliliter) throughout (days 0 through 5, 305 +/- 42; days 6 through 8, 546 +/- 69; days 9 through 13, 490 +/- 72; days 14 through 19, 409 +/- 54; and days 20 through 50, 260 +/- 36; all P less than 0.005). Thus, neutrophils in burned patients were activated as indicated by increased expression of complement receptors. The correlation between this increase and the depression of chemotaxis in response to zymosan-activated serum suggests that C5a is responsible for systemic neutrophil activation, which may contribute to the increased susceptibility to infection of patients with burns.
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PMID:Neutrophil activation in thermal injury as assessed by increased expression of complement receptors. 293 5


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