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 precision of the compact Mini-Accelograph (M-A) was compared with the Myograph 2000 (MYO). Neuromuscular block resulting from atracurium was measured simultaneously by the MYO and the M-A applied to contralateral thumbs. During onset, the M-A frequently underestimated the extent of block (maximal at approximately 50% twitch depression). The M-A control train-of-four (TOF) ratio was characteristically > 1.0 and remained greater than the MYO ratio during the onset of atracurium. During recovery, the difference between the MYO and the M-A was maximal at approximately 50% twitch depression, but the M-A frequently overestimated the extent of block. The mean differences between the MYO and the M-A were small in respect of the recovery index (RI) and the TOF. However, the limits of agreement were unacceptably wide for both TOF and RI. When the MYO TOF was 0.7, the corresponding M-A TOF varied between 0.4 and 1.0. The M-A was more susceptible to drift than the MYO.
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PMID:Monitoring neuromuscular block by acceleromyography: comparison of the Mini-Accelograph with the Myograph 2000. 815 41

Neuromuscular block can cause anxiety. These known experimental results lead to the expectation of conditioned phobic reactions in myasthenia gravis. A sample of 240 patients with the disease do not show the theoretically expected results in the Fear-Survey-Schedule. But interindividual variation of anxiety corresponds to some clinical parameters, relevant for the disease. Patients with facial muscular symptoms have higher values on social phobia but no higher scores on a depression-scale. Opposite to the facial-feedback theory, this result supports the hypothesis, that intersubjective feedback is more significant to the development of the emotional reaction than proprioceptive (facial) feedback. Social anxiety also covariates with defensive coping-strategies. Implications for supportive psycho(behaviour)therapy are discussed.
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PMID:[Situational anxiety in myasthenia gravis]. 846 68

Neuromuscular blockade is controlled during anesthesia by administering either bolus doses or a continuous infusion of a blocking agent. To test whether a constant infusion technique requires less attention and provides better control we used a computer to simulate neuromuscular blockade. Using the model we maintained 95% blockade with mivacurium, atracurium, and vecuronium. It required 1.2 changes per hour to maintain the blockade by continuous infusion; an average of 4.5 bolus per hour were required to maintain blockade by the bolus technique. When the bolus and continuous infusion techniques were combined, only 0.16 changes per hour were required. Atracurium was then given to ten patients during anesthesia, following the bolus plus continuous infusion protocol. After a bolus was given to obtain 100% twitch depression, for tracheal intubation, neuromuscular function was assessed by train-of-four stimulation of the ulnar or facial nerves by observing the resultant muscle movement. When the first twitch of the train-of-four returned, relaxation was maintained by continuous infusion. A bolus was given and the drug infusion rate was changed whenever the level of relaxation changed from the desired one twitch of the train-of-four. The infusion rate was adjusted only 1.12 +/- 0.79 times per hour. The desired level of muscle relaxation was easily controlled using the bolus plus continuous infusion protocol. The infusion scheme might be implemented in future drug infusion pumps.
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PMID:A bolus plus continuous infusion protocol for controlling neuromuscular blockade during anesthesia. 884 71

We assessed the neuromuscular blocking effects of, and intubation conditions following, rocuronium in 81 children aged 2-12 years. The study was conducted in three parts. Parts 1 and 2 were undertaken during anaesthesia with thiopentone, alfentanil and nitrous oxide. Neuromuscular blockade was evaluated by recording the force of contraction of the adductor pollicis in response to train-of-four stimulation at 2 Hz repeated every 10s. In Part 1 the potency of rocuronium was determined in 15 children using a single dose-response technique; in Part 2 onset and recovery times were determined in six children following rocuronium 0.6 mg.kg-1. In Part 3 of the study, intubation conditions were assessed in five groups of 12 children whose tracheas were intubated 30, 40, 50, 60 and 70s after rocuronium 0.6 mg.kg-1 during anaesthesia with thiopentone. The times to satisfactory intubation conditions in 50% and 90% of children were determined by probit analysis. The effective doses of rocuronium to produce 50% and 95% twitch depression were 151 micrograms.kg-1 (95% confidence intervals: 129-173 micrograms.kg-1) and 331 micrograms.kg-1 (95% confidence intervals: 249-543 micrograms.kg-1), respectively. The mean times (SD) to 90% and 100% depression of control twitch following rocuronium 0.6 mg.kg-1 were 42 (11.8) s and 60.3 (19.3) s, respectively. The times to 5%, 25%, 75% and 90% recovery were 20.5 (3.1) min, 26.1 (4.1) min, 35.1 (5.4) min, and 39.5 (6.4) min, respectively. Intubation conditions were satisfactory in 4/12 children at 30 s, 6/12 at 40 s, 8/12 at 50 s, 11/12 at 60 s and 12/12 at 70 s. The times to satisfactory intubation conditions in 50% and 90% of children after rocuronium 0.6 mg.kg-1 were 38 s (95% confidence intervals: 30-44 s) and 61 s (95% confidence intervals: 55-70 s), respectively.
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PMID:Dose-response relationship and effective time to satisfactory intubation conditions after rocuronium in children. 916 60

Intraoperative monitoring of myogenic transcranial motor evoked responses (tc-MERs) requires an anesthetic technique that minimally depresses response amplitudes. Acceptable results have been obtained during opioid/N2O anesthesia, provided that the concentration of N2O does not exceed 50%. However, this technique may necessitate supplementation with additional agents to achieve adequate depth of anesthesia. Etomidate and ketamine have been reported anecdotally or in nonsurgical situations to produce little tc-MER depression. We investigated the effects on tc-MER amplitude and latency of supplementation of a sufentanil/N2O anesthetic with etomidate or ketamine in patients undergoing spinal instrumentation. Anesthesia was induced with etomidate 0.3 mg/kg and sufentanil 1.5 mg/kg and maintained with sufentanil 0.5 mg/kg/h and N2O 50%. Muscle relaxation was kept at 25% of control. Paired transcranial electrical stimulation was performed. Each patient randomly received either ketamine (0.5 mg/kg) or etomidate (0.1 mg/kg) as a single bolus intravenously, during stable surgical conditions. Triplicate tc-MERs were recorded from the tibialis anterior muscles before and 2, 5, 10, and 15 min after drug administration. Administration of ketamine did not significantly change tc-MER amplitudes, whereas etomidate resulted in a transient amplitude depression to 72% of control (p < 0.05) at 2 min after injection. Latency remained unchanged with both drugs. In conclusion, the data suggest that both ketamine (0.5 mg/kg) and etomidate (0.1 mg/kg) can be used to supplement sufentanil/N2O anesthetic without disrupting tc-MER monitoring.
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PMID:The use of ketamine or etomidate to supplement sufentanil/N2O anesthesia does not disrupt monitoring of myogenic transcranial motor evoked responses. 923 84

We have compared the pharmacokinetics of cisatracurium with atracurium when given by bolus dose followed by continuous infusion. Twenty healthy patients were anaesthetised with thiopentone, midazolam, fentanyl and 70% nitrous oxide in oxygen. Ten patients (Group C) were randomly allocated to receive cisatracurium 0.1 mg.kg-1 and 10 patients (Group A) were given atracurium 0.5 mg.kg-1. Neuromuscular block was monitored using a mechanomyograph. When the first twitch of the train-of-four had recovered to 5% of control, an infusion of cisatracurium 3 micrograms.kg-1.min-1 was started in Group C and an infusion of atracurium 10 micrograms.kg-1.min-1 was started in Group A. The infusion rates were adjusted to maintain the first twitch of the train-of-four at 5% of control. The times to 90% and maximum depression of the first twitch of the train-of-four were significantly longer after cisatracurium than atracurium (2.2 and 3.4 min compared with 1.3 and 1.8 min, respectively; p < 0.01 in each instance). No significant differences were found in recovery parameters between the two groups. Blood samples were taken at regular intervals following the bolus, during the infusion and for 8 h thereafter. The plasma samples were analysed using high-performance liquid chromatography for cisatracurium and atracurium (using a method which distinguishes between the three geometric isomer groups), laudanosine and monoquaternary alcohol. The results were analysed using the Non-linear Mixed Effects Model program. A two-compartment model was fitted to the data. The different isomer groups of atracurium have different pharmacokinetics, the trans-trans group having the highest clearance (1440 ml.min-1) and the cis-cis group the lowest (499 ml.min-1). The clearance of cisatracurium (425 ml.min-1) is less than that of cis-cis atracurium and its elimination half-life is longer (34.9 min and 21.9 min, respectively). The plasma concentration of laudanosine after cisatracurium was one-fifth of that after atracurium.
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PMID:A comparison of the infusion pharmacokinetics and pharmacodynamics of cisatracurium, the 1R-cis 1'R-cis isomer of atracurium, with atracurium besylate in healthy patients. 934 62

Rocuronium is a non-depolarizing neuromuscular blocking agent which has a rapid onset and intermediate duration of action. The goal of this study was to compare the neuromuscular blocking actions of rocuronium with and without a priming dose of pancuronium or rocuronium in children. Thirty patients were randomly allocated into 3 groups. Ten patients received a single dose of 0.6 mg/kg rocuronium (Group I). The others received either 0.015 mg/kg pancuronium (Group II) or 0.06 mg/kg rocuronium (Group III) 3 minutes before an intubating dose of 0.54 mg/kg rocuronium was given. Neuromuscular blockade was measured via accelerographic response to single stimulations (1 Hz) of the ulnar nerve until maximal twitch depression was reached followed by train-of-four (TOF) stimuli (2 Hz) at 15 second intervals for the remainder of recovery. Groups were compared with regard to onset time, duration and recovery indices. The onset time and duration of block did not differ significantly between groups. However, the time to recovery in group II (24.5 +/- 9.9 min) was significantly prolonged compared to that in group I (12.7 +/- 3.1 min) or group III (12.7 +/- 3.9 min). We concluded that the use of rocuronium with a preceding dose of either pancuronium or rocuronium provided no advantage for intubation in children.
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PMID:Effects of priming with pancuronium or rocuronium on intubation with rocuronium in children. 1048 34

Eight buffalo calves (8-12 months, 70-100 kg) were randomly assigned to two groups of four animals each. Animals of group I were given detomidine (100 micrograms/kg), whereas animals of group II received a mixture of detomidine (100 micrograms/kg), diazepam (100 micrograms/kg) and ketamine (3 mg/kg) (DDK) intravenously. Various clinical parameters, such as weak time, down time, pedal and pinprick reflexes, muscle relaxation and extent of sedation, as well as heart and respiratory rates and electrocardiograms were measured before (time 0) and 15, 30, 45, 60, 75 and 90 min after treatment. In all the animals of group II (DDK), the pedal reflex was completely abolished (score: 3.00 +/- 0.00) within 5 min, the pinprick response was either very weak or it was completely abolished at this interval. Muscle relaxation and sedation were excellent within 5 min of DDK administration. The depth of sedation and analgesia was maximum from 5 to 15 min postinjection. Detomidine alone, however, failed to produce appropriate depression of the pedal and pinprick reflexes, sedation was mild and muscle relaxation was inadequate. Heart rate showed a significant (P < 0.05) decrease in group I, but the decrease was non-significant in group II. A more pronounced increase in respiratory rate was observed in group I as compared to group II. Animals of both groups recovered within 90 min without any complication. Minimal changes in the cardiovascular system in the group given the DDK combination were an advantage over the group given detomidine. The results indicated that DDK combination is safe and suitable for 15 min of anaesthesia with excellent muscle relaxation and has only limited cardiorespiratory effects in buffaloes.
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PMID:Detomidine-diazepam-ketamine anaesthesia in buffalo (Bubalus bubalis) calves. 1084 67

OBJECTIVE: The authors report what they believe is the first reported use of etomidate to assist in the reduction of a major joint in an outpatient setting. METHODS: The authors review the case of an elderly woman with a total hip arthroplasty who experienced four spontaneous posterior hip dislocations in a 5-month period. Etomidate was successfully used in two dislocations where previous methods had failed. RESULTS: A 68-year-old woman, who 13 months earlier had an uncomplicated total left hip replacement, was transported to the same ED on four separate occasions for a spontaneous left hip dislocation. Radiographs in each instance were significant only for a posterior dislocation of the implant articulation. The first reduction in the ED was unsuccessful and required a closed reduction in the operating theater. Seventy-two hours later the second dislocation and subsequent reduction occurred in the ED using etomidate to facilitate muscle relaxation. The patient was subsequently discharged home. Similar scenarios were replayed in the next few months. CONCLUSIONS: Muscle relaxation is the key characteristic for the reduction of dislocated major joints. The risks of respiratory depression and hemodynamic alterations with sedation are not insignificant, especially at the extremes of age. In the present case, intravenous narcotics and sedative-amnestic agents did not result in sufficient muscle relaxation. Larger or repeated doses may have resulted in undesirable or dangerous side effects. Etomidate is a useful adjunct when cardiopulmonary disease is present. The rapid onset and recovery from etomidate make it an excellent choice for facilitating the reduction of hip dislocations in elderly patients with prior total hip replacements.
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PMID:Etomidate-facilitated hip reduction in the emergency department 1101 54

We compared the potency and duration of action of rocuronium in Chinese and Caucasian patients during general anesthesia. Thirty-six women (18 Caucasian and 18 Chinese) and 36 children (18 Caucasian and 18 Chinese) were evaluated during the administration of propofol/fentanyl anesthesia. Patients in each age group were randomized into three subgroups to receive single doses of 0.06, 0. 12, or 0.18 mg/kg rocuronium (adults) or 0.12, 0.18, or 0.24 mg/kg rocuronium (children). Neuromuscular blockade was assessed by electromyography of the adductor pollicis after train-of-four (TOF) stimulation of the ulnar nerve. Dose response curves were constructed when maximum neuromuscular depression of the first twitch of the train (T(1)) was obtained. A second bolus dose of rocuronium was then administered to a total dose of 0.6 mg/kg. The times of spontaneous recovery to T(1) 10%, 25%, and 90% of control and to TOF 0.25, 0.50, and 0.70 were recorded. For both adults and children, recovery occurred later in Chinese than in Caucasian patients (P<0.05 for T(1) of 10%, 25%, 75%, and 90% and TOF to 0.7). The 50% effective dose was smaller in Chinese adults (125+/-63 vs. 159+/-66 microg/kg) and Chinese children (171+/-43 vs. 191+/-46 microg/kg) than in Caucasian adults and children, but the difference was not statistically significant. In adults, time to 25% T(1) recovery was 43+/-13 min in Chinese patients and 33+/-10 min in Caucasian patients (P<0.05). The corresponding values were more rapid for children: 30+/-10 and 24+/-6 min (P<0.05). We conclude that the recovery from rocuronium neuromuscular blockade was longer in Chinese compared with Caucasian patients and in adults compared with children.
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PMID:The prolonged duration of rocuronium in Chinese patients. 1109 12


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