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

Nalbuphine hydrochloride 0.2 mg/kg was compared with meperidine 0.5 mg/kg in a double-blind study in 20 patients undergoing elective inguinal hernia repair while breathing spontaneously under general anesthesia. The respiratory effects of the two drugs studied were continuously and accurately recorded with a wet wedge spirometer throughout the procedure. The acute respiratory effects of these analgesic drugs could therefore be assessed. The measurements recorded before any surgical stimulation showed that both nalbuphine and meperidine produce a similar degree of respiratory depression. These results are at variance with earlier studies that drew conclusions from measurements that were neither continuous nor accurate. Nalbuphine was found to be a satisfactory analgesic adjuvant in this anesthetic technique.
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PMID:A double-blind study of the respiratory effects of nalbuphine hydrochloride in spontaneously breathing anesthetized patients. 335 65

Six male patients were studied on the morning following upper abdominal surgery for highly selective vagotomy. Nalbuphine hydrochloride was infused i.v. at different rates that increased progressively in each hour over a 4-h period. In the last 15 min of each hour, the plasma nalbuphine concentrations were almost steady (73-68, 71-82, 116-113 and 201-208 ng ml-1). Patients and an observer made hourly assessments of pain and sedation. Although the changes in the pain and sedation scores were not significant, the patients' mean pain scores increased when the mean plasma nalbuphine concentrations were greater (greater than 82 ng ml-1), which suggested that nalbuphine analgesia had been reversed. Nalbuphine caused sedation and possibly induced amnesia which could invalidate retrospective assessment, since the patients' assessment of analgesic efficacy at the end of the study was good. No cardiovascular depression or significant decrease in the ventilatory rate was recorded.
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PMID:A dose-response study with nalbuphine hydrochloride for pain in patients after upper abdominal surgery. 368 10

Nalbuphine hydrochloride (Nubain; Du Pont Pharmaceuticals), a synthetic agonist-antagonist analgesic, in a dose of 20 mg was compared with pethidine 100 mg in 60 patients after elective surgery in a random double-blind study. Both drugs were given intramuscularly on the first day after surgery. The pain intensity and visual analogue scales would seem to indicate that nalbuphine has a longer duration of action than pethidine (P less than 0,05). The respiration rates in the pethidine group were significantly more depressed 30 minutes after the injection than in the nalbuphine group (P less than 0,05). Nalbuphine caused less depression of both systolic and diastolic blood pressure at both 30 and 60 minutes (P less than 0,001). The results of the study show that nalbuphine, in the dose used here, may prove to be a useful substitute for pethidine.
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PMID:A comparison of nalbuphine and pethidine for postoperative pain relief after orthopaedic surgery. 389 18

Due to the short duration of action of naloxone, late respiratory impairment may be anticipated when given for the reversal of opioid anesthesia. Nalbuphine, a mixed agonist-antagonist chemically related to naloxone has a longer duration of action. It therefore was considered to be of clinical interest in reversing fentanyl anesthesia related depression of respiratory drive. In an open study 15 patients (mean age 40 years) undergoing orthopedic surgery received nalbuphine (0.1 mg/kg) after fentanyl (median dose 1.4 mg over a mean length of operation time of 95 min) - N2O/O2-anesthesia. 5, 15, 30, 45 and 60 min after nalbuphine, the ventilatory response to CO2-stimulation (rebreathing technique), was assessed and compared to control pre-anesthetic values. Nalbuphine reversed total apnoea due to fentanyl anesthesia. The slope of the CO2-response curve (sensitivity of the respiratory center to CO2) was -8% below control at the 5th and +13.5% and +22.6% at the 30th respectively 45th minute post nalbuphine. The ventilatory response to an increased end-tidal pCO2 of 60 mm Hg (level of response of the respiratory center to CO2) remained below control (-23.5% to -21%) over the following 60 minutes. A return of respiratory depression was not observed as the slope of the CO2-response curve remained above control values. From this study it was concluded that nalbuphine seemed to be a suitable compound for the reversal of opioid-anesthesia induced respiratory depression.
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PMID:Reversal of fentanyl related respiratory depression with nalbuphine. Effects on the CO2-response curve in man. 393 74

Nalbuphine is an agonist/antagonist analgesic. After parenteral administration of 'usual' doses it is approximately equipotent in analgesic activity to morphine on a weight basis. In studies in patients with moderate to severe pain, usually following surgery, the characteristics of analgesia with nalbuphine were comparable to those seen with equianalgesic doses of morphine or pentazocine. It also appears to produce satisfactory anaesthesia when used as a component of a 'balanced' anaesthesia technique, although a relatively low 'ceiling' effect for reduction of anaesthetic requirements with nalbuphine may limit its usefulness in this regard. As with other agonist/antagonist analgesics, a 'ceiling' effect to nalbuphine-induced respiratory depression is also seen, beyond which further depression does not readily occur. However, with usual analgesic doses, respiratory depression seen with nalbuphine is comparable to that with morphine. Important haemodynamic changes have not occurred after usual doses of nalbuphine, even in patients with cardiac disease. Like other agonist/antagonist analgesic drugs, the abuse potential of nalbuphine seems relatively low, but only wider clinical use for longer periods can establish this with certainty. Thus, nalbuphine appears to offer a useful alternative to morphine in patients with moderate to severe pain.
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PMID:Nalbuphine. A preliminary review of its pharmacological properties and therapeutic efficacy. 613 54

Premedication for cardiac surgical patients attempts to achieve relief of anxiety with minimal or no cardiorespiratory changes. Nalbuphine (NUBAIN) and morphine produced similar decreases in respiratory rate (1-3 breaths per min) and PaO2 (averaging 1.34 kPa), and increases in arterial PaCO2 (averaging 0.56 kPa). Cardiovascular changes were not seen with either agent. A similar degree of sedation and relief of anxiety was achieved with both drugs. Side effects were minimal and infrequent. Nalbuphine produces respiratory depression and sedation without cardiovascular changes which is comparable to an equivalent dose of morphine in patients with either valvular or coronary artery disease.
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PMID:Cardiorespiratory effects of nalbuphine and morphine premedication in adult cardiac surgical patients. 643 10

Nalbuphine, chemically related to naloxone however, with mixed agonist-antagonist activity, was considered to be of clinical interest in reversing opioid anesthesia. In an open-end study 15 patients (mean age 40 years) undergoing orthopedic surgery received nalbuphine (0.1 mg/kg) after fentanyl (total dose 17.4 micrograms/kg over a mean of 95 min). In order to establish the state of vigilance, continuous EEG-recording of the posterior region of the cortex (P3-O1) was done with the aid of power spectral analysis using fast Fourier transformation (FFT). Additionally blood pressure and heart rate were measured. The observed effects were compared with the awake unpremedicated preoperative state. In the EEG nalbuphine reversed the anesthesia-related increase in power in the delta (0.25-4 Hz) and decrease in alpha (8-12 Hz), beta 3 (20-25 Hz) and beta 4 (25-32 Hz) domain. After the 45th minute delta significantly increased while power in the beta-band unsignificantly dropped. Power in the alpha-band remained elevated throughout the whole postoperative period. In regard to blood pressure measurements nalbuphine induced an increase in systolic, diastolic pressure and heart rate 15% above control. These parameters declined towards the 30th minute; only heart rate reached predrug values at the 45th minute. With the aid of EEG-power spectral analysis it was demonstrated that nalbuphine seems a valuable tool for the reversal of opioid-induced cortical depression.
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PMID:Nalbuphine reverses fentanyl-related EEG-changes in man. 646 30

To compare the respiratory depressant and analgesic effects of nalbuphine and morphine, six healthy male subjects were given the drugs as single 0.15-mg/kg doses, and as four successive doses of 0.15 mg/kg. Respiratory depression was monitored by ventilatory and mouth occlusion pressure responses during CO2 rebreathing, while analgesia to experimental pain was tested with the submaximal effort tourniquet ischemia test. When given as single 0.15 mg/kg doses, both drugs significantly increases the threshold and tolerance for experimental pain. The analgesic effect was similar for both drugs at this dosage, as was depression of the ventilatory and occlusion pressure responses to CO2. Morphine administered in multiple doses progressively increased pain tolerance from 30 +/- 13% above control with the first dose of 0.15 mg/kg to 107 +/- 13% above control after the fourth dose (cumulative total 0.60 mg/kg). Nalbuphine produced a 40 +/- 12% increase in pain tolerance with an initial dose of 0.15 mg/kg, but additional increments of nalbuphine did not result in significantly greater analgesia. The increasing morphine dosage was associated with progressive rightward displacements and ultimately decreases in the slope of the CO2 response curves. Nalbuphine produced an initial rightward displacement of the CO2 response curves similar to morphine, but continued administration of the drug did not result in further displacement or changes in slope. These findings demonstrate that nalbuphine, in contrast to morphine, exhibits a ceiling effect for respiratory depression which is paralleled by its limited analgesic effect on experimental pain.
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PMID:Analgesic and respiratory depressant activity of nalbuphine: a comparison with morphine. 681 1

The chemical properties, animal and human pharmacology, analgesic efficacy, relative potency, administration, and adverse effects of nalbuphine, a recently marketed, parenteral, strong analgesic with narcotic antagonist properties, are reviewed. Acute, subacute, and chronic toxicity studies in animals revealed no unusual adverse effects. The abuse potential of nalbuphine in man is probably similar to pentazocine. Respiratory depression produced by usual therapeutic doses of nalbuphine is equivalent to that of morphine; at higher than usual doses, nalbuphine produces less respiratory depression. Nalbuphine has few effects on cardiovascular hemodynamics in patients without cardiac disease or with stable ischemic disease. In patients with acute myocardial infarction, nalbuphine has an advantage over morphine, pentazocine, and butorphanol of not producing hypotension. Nalbuphine is as effective and has the same potency as morphine as an analgesic, with about the same onset, peak, and duration of action. Sedation is the most common adverse effect and occurs about as often as with other strong analgesics. Nausea and vomiting occur less often. In contrast to pentazocine, the frequency of psychotomimetic reactions apparently is very low. On the basis of presently available evidence, nalbuphine appears to have fewer disadvantages than any other parenteral strong analgesic.
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PMID:Evaluation of nalbuphine hydrochloride. 699 99

1. Vomiting and restlessness following ENT and eye surgery are undesirable, and may be related to the emetic and analgesic effects of any analgesic given to augment anaesthesia during surgery. 2. To rationalise the choice of analgesic for routine ENT surgery we examined the intraoperative, recovery and postoperative effects following the administration of either buprenorphine (3.0 to 4.5 micrograms kg-1), diclofenac (1 mg kg-1), fentanyl (1.5 to 2.0 micrograms kg-1), morphine (0.1 to 0.15 mg kg-1), nalbuphine (0.1 to 0.15 mg kg-1), pethidine (1.0 to 1.5 mg kg-1) or saline (as control) given with the induction of anaesthesia in 374 patients. A standardised anaesthetic technique with controlled ventilation using 0.6-0.8% isoflurane in nitrous oxide and oxygen was employed. The study population constituted 7 similar groups of patients. 3. Intraoperatively, their effects on heart rate and blood pressure, airway pressure and intraocular pressure, were similar. This implies, most surprisingly, that neither their analgesic nor their histamine releasing effects were clinically evident during surgery. By prolonging the time to extubation at the end of anaesthesia, only buprenorphine, fentanyl, morphine and pethidine provided evidence of intraoperative respiratory depression. 4. Postoperatively, buprenorphine was associated with severe respiratory depression, prolonged somnolence, profound analgesia and the highest emesis rate. Diclofenac exhibited no sedative, analgesic, analgesic sparing, emetic or antipyretic effects. Fentanyl provided no sedative or analgesic effects, but was mildly emetic. Morphine provided poor sedation and analgesia, delayed the requirement for re-medication and was highly emetic. Nalbuphine and pethidine produced sedation with analgesia during recovery, a prolonged time to re-medication and a mild emetic effect. None provided evidence, from analysis of postoperative re-medication times and analgesic consumption, of any pre-emptive analgesic effect. 5. We conclude that nalbuphine (mean dose 0.13 mg kg-1) and pethidine (mean dose 1.35 mg kg-1), given individually as a single i.v. bolus during induction of anaesthesia, are the most efficacious analgesics for routine in-patient ENT surgery.
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PMID:Analgesics and ENT surgery. A clinical comparison of the intraoperative, recovery and postoperative effects of buprenorphine, diclofenac, fentanyl, morphine, nalbuphine, pethidine and placebo given intravenously with induction of anaesthesia. 788 92


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