Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

At the beginning, the way intrathecal morphine was used for postoperative pain relief was quite unfortunate, because the doses derived from experience with morphine-tolerant cancer patients were considerably too high and respiratory depression occurred frequently. Subsequent dose-finding studies showed that the doses of morphine used initially could be reduced by a factor of ten without loss of the analgesic effect and with a marked reduction in side-effects. No respiratory depression has been reported when doses below 0.1 mg morphine are used. METHOD. In this prospective study the effect of 0.06 to 0.08 mg intrathecal morphine, mixed with the local anaesthetic for spinal anesthesia, was investigated in surgical patients aged 21 to 81 years, ASA grade I or II, scheduled for orthopaedic operations or herniorraphies. Thirty unpremedicated patients were enrolled in the study and were, after informed consent, randomly allocated to a control group without morphine or to a morphine group. The analgesic effect was assessed by the time interval between the administration of the spinal anaesthesia and the first demand for an analgesic medication. The mood state was evaluated with the adjective checklist of Janke and Debus 6 h after the spinal anaesthesia. RESULTS AND DISCUSSION. In the control group half of the patients asked for an analgesic medication within 275 min (median) after the spinal anaesthesia, and all patients within 420 min, whereas in the morphine group half of the patients asked for an analgesic within 1170 min (median). Seven patients had not required an analgesic at the termination of the observation period 20 h after the spinal anaesthesia. The mood status showed no difference between the two groups, in particular, no dizziness or drowsiness after morphine. There was no difference in the incidence of side-effects such as nausea or urinary retention between the two groups. Pruritus was not reported spontaneously but was found upon questioning in five patients. It was in no case disturbing. CONCLUSIONS. Morphine (0.06 to 0.08 mg) mixed with the local anaesthetic for spinal anaesthesia provided for an analgesia of more than 20 h duration in half of the patients. This technique is safe, simple, reliable and virtually free of side-effects. No particular supervision due to the administration of intrathecal morphine is necessary in this dose range if systemic opiates are avoided. If the analgesia is unsatisfactory, a non-opioid analgesic is recommended.
 ...
PMID:[Intrathecal morphine for postoperative pain]. 146 57

Administering intravenous sedation in conjunction with intraoperative monitoring to cataract surgery patients is a widely accepted technique. Numerous articles report local sedation techniques for cataract surgery that are, in essence, abbreviated general anesthetic techniques for insertion of the retrobulbar block (RBB). Because of variations in levels of consciousness, a number of complications have been encountered with this specific patient population, ie, movement upon insertion of the RBB, intraoperative patient movement, confusion, hypotension, respiratory depression, and respiratory arrest. In an attempt to meet the specific needs of this patient population, a study comparing propofol-fentanyl with midazolam-fentanyl was initiated. Seventy-five (ASA 1 to 3) patients were randomly assigned to two groups: propofol-fentanyl (P/F) or midazolam-fentanyl (M/F). The mean age of patients in the P/F group was 71.1 +/- 13 SD, and the mean age in the M/F group was 74.4 +/- 8.8 SD. All patients entered the operating room unpremedicated. Before the RBB, patients in both groups were given a single intravenous dose of 50 micrograms fentanyl. Propofol (mean dose, 24.7 mg) or midazolam (mean dose, 1.58 mg) was then titrated to slurred speech or nystagmus. Patients' responses to the RBB were evaluated and recorded by an objective observer. The amnestic properties of both agents were evaluated by patient questioning at 10 minutes and 24 hours. Levels of discomfort were evaluated on a scale of 1 to 5, with 1 being extremely uncomfortable and 5 being noticeable without pain. Respiratory depressant effects of both techniques was assessed via continuous pulse oximetry. Results were analyzed using the chi 2 test, rank t test, and SD.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Propofol-fentanyl versus midazolam-fentanyl: a comparative study of local sedation techniques for cataract surgery. 147 88

Epidural clonidine produces regional anesthesia as well as sedation and a decrease in anesthetic requirements. To assess these effects, the electroencephalogram (EEG) was recorded after epidural or intravenous (iv) injection of clonidine during enflurane/N2O anesthesia. Eighteen ASA physical status 1 women undergoing vaginal hysterectomy were allocated randomly to receive epidural clonidine (8 micrograms.kg-1 in 4 ml over 2 min) and iv saline (10 ml over 14 min); or epidural saline (4 ml over 2 min) and iv clonidine (8 micrograms.kg-1 in 10 ml over 14 min); or epidural saline (4 ml over 2 min) and iv saline (10 ml over 14 min). The level of anesthesia was kept constant beginning 10 min before and until 44 min after epidural injection. EEG power spectral analysis was performed throughout the study period using a 2-min average of 8-9-s epochs. Clonidine significantly reduced EEG total power only after epidural administration (P less than 0.05). Relative power increased in the delta band in both the epidural and iv clonidine groups (P less than 0.001). The depression of the total EEG power after epidural injection could be explained neither by systemic absorption alone nor by hemodynamic variations. It may represent the contribution of the direct spinal action of this alpha 2-adrenergic agonist to general anesthesia.
 ...
PMID:Central effects of epidural and intravenous clonidine in patients anesthetized with enflurane/nitrous oxide. An electroencephalographic analysis. 151 83

The purpose of this investigation was to compare the analgesic actions and side-effects of a 50 micrograms epidural bolus of sufentanil and 50 micrograms epinephrine, with a control group receiving saline and epinephrine. The method employed was a prospective, randomised, double-blind trial involving 40 ASA I or II patients for total abdominal hysterectomy. All received 1.5% lidocaine with 1/200,000 epinephrine epidurally before operation, until a block to T4 was established. Patients were anaesthetised, their tracheas were intubated, and they were allowed to breathe spontaneously before administration of the test drug. Results showed that sufentanil prolonged the duration of local anaesthesia (198 +/- 35 min vs 174 +/- 29 min; P less than 0.05), and of analgesia (288 +/- 85 min vs 188 +/- 42 min; P less than 0.01). There was an increase in somnolence in the sufentanil group (9/20 vs 2/20; P less than 0.05). Glycopyrollate was given to 11/20 patients in the sufentanil group vs 1/20 in the control group (P less than 0.01) following bradycardia and hypotension. Clinical respiratory depression occurred in the sufentanil group; 5/20 patients required controlled ventilation following apnoea greater than 20 sec. It is concluded that epidural sufentanil causes considerable cardiorespiratory depression in the setting of general anaesthesia, and should be used with caution in the spontaneously breathing, anaesthetised patient.
 ...
PMID:Epidural lidocaine with sufentanil and epinephrine for abdominal hysterectomy under general anaesthesia: respiratory depression and postoperative analgesia. 153 50

Dose-response relationships for doxacurium and neostigmine were established in 24 young (18-40 yr) and 24 elderly (70-85 yr) patients, ASA physical status I or II, anesthetized with thiopental, fentanyl, nitrous oxide, and isoflurane. Mechanomyographic response of the adductor pollicis muscle to the train-of-four stimulation of the ulnar nerve was recorded. Doxacurium (5, 10, 15, or 20 micrograms/kg IV) was administered by random allocation. After maximal blockade, and additional dose, for a total of 30 micrograms/kg, was administered. When first twitch height recovered to 25%, incremental doses of 5 micrograms/kg were administered for maintenance of relaxation. Neostigmine (5, 10, 20, or 40 micrograms/kg) was injected at 25% first twitch recovery, and neuromuscular monitoring was continued for 10 min. The doses of doxacurium (+/- SEM) required to produce a 50%, 90%, and 95% depression of twitch tension in the young patients were, respectively, 13.3 +/- 1.6, 23.6 +/- 2.8, and 28.6 +/- 3.4 micrograms/kg, not statistically different from corresponding values in the elderly, 11.8 +/- 1.3, 21.2 +/- 2.3, and 25.9 +/- 2.9 micrograms/kg, respectively. Time to 25% recovery after 30 micrograms/kg was 80.2 +/- 12.2 min in the young versus 133.0 +/- 17.1 min in the elderly (P less than 0.05). Neostigmine-assisted recovery was not significantly different in both groups. The estimated doses of neostigmine to obtain 70% train-of-four recovery after 10 min were 53.6 +/- 7.5 micrograms/kg in the young and 41.6 +/- 5.8 micrograms/kg in the elderly (P = NS).(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Dose-response relations of doxacurium and its reversal with neostigmine in young adults and healthy elderly patients. 153 72

The effects of sedative-hypnotic doses of propofol on respiratory drive and pattern have not yet been extensively described. Repeated small boluses of propofol (0.6-0.3 mg.kg-1) were administered to ten ASA I patients undergoing carpal tunnel release using regional anaesthesia. Airway pressure, capnography and pneumotachography were continuously recorded. With respect to basal values, no significant variations of respiratory rate, minute volume, tidal volume, inspiratory and expiratory time, total expiratory cycle, Ti/Ttot, TV/Ti, P0.1, EtCO2 and blood gas analysis were observed. Low doses of propofol, to maintain conscious sedation of light sleep, have not been shown to cause respiratory depression.
 ...
PMID:Effects of low-dose propofol administration on central respiratory drive, gas exchanges and respiratory pattern. 154 31

Eighty patients undergoing abdominal surgery were studied to evaluate ECG changes in perioperative period and also identify the factors influencing the incidence and the severity of postoperative ventricular arrhythmia. Holter ECG was recorded with CM5 and NASA leads from the night before operation to the night of the 2nd postoperative day. Tachycardia (greater than or equal to 100 beats.min-1) was found in 46.3% of the patients preoperatively and in 55% postoperatively. Bradycardia (less than or equal to 50 beats.min-1) was found in 30% of the patients mostly in the night prior to the operation, while only 1 patient (1.3%) demonstrated bradycardia postoperatively. SVPCs were observed in high incidence ranging from 75% preoperatively to 85% postoperatively. Two patients had paroxysmal supraventricular tachycardia postoperatively. VPCs were observed in 42.5% of the patients preoperatively and in 53.8% postoperatively. Warning arrhythmias which were ranked as more dangerous than Lown 2 were observed in 15% of the patients preoperatively, in 11.3% intraoperatively and in 23.8% postoperatively. Serious arrhythmias which needed immediate treatment were found in 6.3% of the patients preoperatively, in 10% intraoperatively and in 11.3% postoperatively. ST depression was recorded in 11 patients at CM5 and 2 patients at NASA leads. Chi-square and Hayashi's multidimensional quantification analyses were applied to determine the relationship between postoperative VPCs and pre- and intra-operative clinical factors. Factors such as age, type of surgery, intraoperative VPCs, ASA classification, ischemic changes in preoperative ECG, intraoperative blood loss, operation time, Goldman score, untreated hypertension as well as ischemic heart disease and abnormal findings of Master ECG were considered to be contributing to the high incidence and the severity of post-operative VPCs. When multidimensional quantification analysis is applied to the data, the occurrences of no VPCs, occasional VPCs, warning VPCs and serious VPCs could be predicted in postoperative patients.
 ...
PMID:[Holter electrocardiographic findings in surgical patients during the perioperative period]. 156 May 81

The intravenous anaesthetic agent propofol has become more and more popular not only for induction but also for the maintenance of anaesthesia in all fields of surgery. For this purpose, different infusion rates and also combinations of propofol with opioids, nitrous oxide and volatile anaesthetic agents have been described. The present study was designed to find the best dosage regimen for short operations and rapid changes. The necessity for the frequently recommended standardized combination of propofol with opioids should be checked with respect to the cardiovascular effects. METHODS. A series of 60 patients (ASA I and II, age range 22-79 years) selected for discectomy were prospectively randomized to three groups. Half an hour before operation all patient received 0.5 mg atropine, 50 mg promethazine and 50 mg pethidine as i.m. premedication. In all groups anaesthesia was induced with propofol in a bolus dose of 2.5 mg/kg body weight over a period of approximately 45 s. After 5 mg atracurium the patients were intubated under 100 mg succinylcholine and normoventilated with 70% nitrous oxide and 30% oxygen. For relaxation 25 mg of atracurium were given. In group I propofol was administered in a dosage of 15 mg/kg body weight per hour for 10 min after induction. After this time the propofol infusion was reduced to 6 mg/kg body weight per hour. Group II received 0.1 mg fentanyl before induction. The dosage of propofol was similar to group I. In group III 0.1 mg of fentanyl was administered before induction and propofol was given with an infusion rate of 6 mg/kg body weight from the beginning. The following parameters were controlled and documented: systolic and diastolic blood pressure (SAP and DAP), heart rate (HF), end-expiratory carbon dioxide (eeCO2), inspiratory oxygen concentration (FiO2) and peripheral oxygen saturation (sO2). Recovery time was determined as the time from the end of the propofol infusion until eye-opening on command. RESULTS. In all groups anaesthesia could be induced and maintained without complications. There was a slight increase in SAP in group I after intubation, while in the groups with fentanyl a pronounced decrease of SAP was found simultaneously with induction of anaesthesia (Fig. 1). In group I HF showed significantly higher values after intubation and for the next 15 min than in group II and group III. A rapid and pronounced increase of end-tidal carbon dioxide occurred in the fentanyl groups with the beginning of spontaneous ventilation at the end of anaesthesia. There was a significantly longer recovery time in group II with fentanyl and initial higher propofol infusion rate. A correlation between dosage of propofol and recovery time could not be found. DISCUSSION. The results of this study demonstrate that a routine combination of propofol with opioids is not necessary even for painful surgical procedures if the propofol dosage is initially increased. There are differences in cardiovascular reactions between group I without and groups II and III with fentanyl, but in our patients these changes were of no clinical importance. An additional administration of fentanyl can prevent hypertensive reactions or tachycardia with intubation, but on the other hand fentanyl can also increase the cardial depression of propofol with a dangerous decrease in blood pressure and heart rate. Therefore in combination with opioids lower doses of propofol should be used for induction and maintenance of anaesthesia. If opioids are administered, signs of a residual postoperative respiratory depression have to be taken seriously.
 ...
PMID:[The use of propofol during diskectomy in neurosurgery]. 159 May 74

It was aimed to assess if intrathecal (i.t.) injections of acetylsalicylic acid and salicylic acid depress C fibre-evoked activity in the sensory part of the nociceptive system. In rats under urethane anaesthesia, activity was elicited in single neurones in the dorsomedial part of the ventral nucleus (VDM) of the thalamus and in ascending axons of the spinal cord by supramaximal electrical stimulation of the sural nerve. Acetylsalicylic acid and salicylic acid injected i.t. significantly reduced the activity evoked in thalamic neurones. The maximum depression amounted to about 50% of the activity evoked in the controls and was produced by acetylsalicylic acid at a dose of 50 micrograms (0.28 mumol)/rat and by salicylic acid at a dose of 37.5 micrograms (0.27 mumol)/rat. Indomethacin injected i.t. also reduced C fibre-evoked activity in the thalamus in a dose-dependent fashion, 100 micrograms producing a 50% depression. Salicylic acid (37.5 micrograms/rat, i.e.) depressed C fibre-evoked activity in ascending axons but had no effect on A beta fibre-evoked activity. It is concluded that i.t. injection of acetylsalicylic acid selectively inhibits nociceptive impulse transmission in the spinal cord by an action of the salicylic acid moiety. It is possible that prostaglandins are involved in the central action of salicylic acid.
 ...
PMID:Intrathecal injection of acetylsalicylic acid, salicylic acid and indomethacin depresses C fibre-evoked activity in the rat thalamus and spinal cord. 1183 30

This case report describes a general anesthetic where ketorolac tromethamine was used instead of a narcotic. The patient was a 37-year-old male, ASA II category, who underwent general anesthesia for a cholecystectomy. The drug is discussed in terms of preoperative, intraoperative, and immediate postoperative effects. During the preoperative phase, no effect was demonstrated. Intraoperatively, the drug performed poorly to attenuate responses to intense stimulation as noted by an increase in pulse and blood pressure of greater than 20% during intubation, incision, and abdominal wall retraction. During the immediate postoperative phase, the drug performed well to provide analgesia related to incisional pain. Ketorolac has not been previously discussed in terms of intraoperative uses. The mechanism of action by which it provides analgesia is through the inhibition of prostaglandin synthesis. It is similar in structure to the other nonsteroidal anti-inflammatory drugs and may offer certain advantages over traditional agents used to provide analgesia, including the absence of respiratory depression, addictive potential, euphoria, a decrease in gastric motility, and cardiovascular effects. These properties may help in the management of certain types of patients who are at risk for respiratory depression or in those who have a contraindication to narcotics.
 ...
PMID:Ketorolac tromethamine: a nonsteroidal anti-inflammatory analgesic used as an adjunct for general anesthesia. 163 59


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>