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 effects of a continuous steady rate infusion of propofol on spontaneous ventilation were studied in eight unpremedicated ASA 1 male patients. All were non smokers, aged 29 +/- 8 years, and weighed 67 +/- 9 kg. After an initial 1 mg.kg-1 bolus, they received 10 mg.kg-1.h-1 propofol for 10 min, followed by 8 mg.kg-1.h-1 for a further 10 min, and then 6 mg.kg-1.h-1 during the whole study period. Endotracheal intubation was carried out using lidocaine for local anaesthesia. Spontaneous ventilation was assessed during three periods of five minutes: in the awake subject, using indirect spirometry (measurement of variations in chest circumference) and direct spirometry separately, and then, in the anaesthetized subject, using both methods simultaneously. This study aimed: a) to compare the results obtained with the two methods, b) to characterize the effects of propofol anaesthesia on chest wall mechanics using the partitioning of ventilation between rib cage and abdomen provided by the non-invasive method, and c) to assess abdominal compliance by means of a gastric balloon catheter. There was an increase in rib cage ventilation in the awake state, induced by the apparatus for direct spirometry (mouth piece, nose clip). This explained that the ventilatory depression induced by propofol anaesthesia was more pronounced when measured by the direct method. The major determinant of this depression was a shortened inspiratory time, and, to a lesser extent, a decreased mean inspiratory flow rate. By contrast to inhalational anaesthesia, rib cage ventilation was preserved during propofol anaesthesia. The decrease in abdominal ventilation was partly related to a lowered abdominal compliance, suggesting recruitment of the abdominal muscles.
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PMID:[Measurement of respiratory effects of propofol by indirect spirometry]. 200 68

Twenty-two patients of ASA physical status 1 or 2 undergoing surgery of the perineal region received intrathecal pethidine as the sole agent. The anesthetic effect of 0.5 mg.kg-1 (group 1) or 0.7 mg.kg-1 (group 2) of pethidine was evaluated and compared. Patients were randomly assigned to one of the two groups (12 in group 1 and 10 in group 2). Subarachnoid puncture was performed with the patient in the sitting position, using a 25 gauge spinal needle at the lumbar vertebral level of L4/5 or L5/S. The patients remained sitting for 5 min before being placed in the supine position. Two patients in the group 1 had inadequate sensory blockade and they were excluded from further study. The average segmental level of analgesia was S1 in group 1 and L2 in group 2. Motor blockade of the anal sphincter was seen in all patients. During the operation, the patients were stable hemodynamically and no respiratory depression was noticed. Prolonged postoperative analgesia was obtained and some patients did not require additional analgesics during postoperative period. Four patients complained of itching, two patients of nausea and two developed arrhythmias.
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PMID:[Spinal anesthesia with pethidine as the sole agent]. 207 94

Propofol (Diprivan), a modern intravenous hypnotic, produces a reduction in both cardiac index (CI) and mean arterial pressure (MAP). Ketamine (Ketanest), a potent analgesic, in contrast, causes an increase in MAP and CI. The aim of the present study was to investigate whether the combination of propofol and ketamine can give better hemodynamic stability during the induction and maintenance of general anesthesia than propofol used with fentanyl, whose cardiodepressant actions may cumulate. METHODS. For induction of general anesthesia 10 patients (ASA I and II) each received 3-5 boluses of propofol (0.5 mg.kg-1 during 35 s until predetermined level of anesthesia was reached (stage D2/E0 according to [20]) followed by a continuous propofol infusion (0.120 mg.kg-1.min). Fentanyl 0.1 mg was administered to each patient in group A for induction of anesthesia and again if evident pain was present. In group B ketamine was given following a pharmacokinetic model based on computer-simulated calculation. After an initial bolus of 38 mg injected within 2 min further doses of 42 mg, 35 mg, 32 mg and 28 mg ketamine were administered over 30 min at a time. Signs of evident pain were treated by means of supplementary doses of 0.5 mg.kg-1. RESULTS. In both groups a moderate drop of MAP was observed after the induction of general anesthesia. Two patients in each group showed a distinct decrease in MAP (-32%). The heart rate dropped slightly (-9%) in group A, but did not change in group B. Following intubation the MAP rose by less in group A (+8%) than in group B (+21%). After the beginning of the operation the group treated with propofol/fentanyl showed major hemodynamic changes; in particular, bradycardia with less than 40 bpm was observed in more patients than in the propofol/ketamine group. Postoperatively, fewer patients in group B required rescue doses of analgesics (1 of 10) than these in group A (7 of 10), though vigilance was better in group B. DISCUSSION. The dose of ketamine administered during the induction of general anesthesia may have been not high enough to neutralize the cardiodepressant effect of propofol. But during the maintenance of anesthesia there was in fact better hemodynamic stability in group B than in group A as a result of the neutralization of opposing actions. Fentanyl even intensified the fall in MAP after propofol. Patients in group B showed better vigilance as well as better pain relief postoperatively. The population of the fentanyl group was obviously more deeply sedated and analgesia was still inadequate. In our study general intravenous anesthesia with propofol and ketamine offered the advantages of better analgesia, a higher state of vigilance and the absence of respiratory depression during the postoperative phase compared with the combination of propofol and fentanyl.
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PMID:[The effect of propofol-ketamine anesthesia on hemodynamics and analgesia in comparison with propofol-fentanyl]. 207 45

The use of spinal opioids for postoperative analgesia has gained popularity in recent years. In this study, subarachnoid fentanyl 20 micrograms was evaluated to determine its efficacy for postoperative analgesia, its possible side effects and its effects on the newborn. Sixty ASA class I or II at-term parturients undergoing elective cesarean section were randomly divided into two groups. In one group fentanyl 20 micrograms (0.4 ml) with 0.5% heavy marcaine 2.0 ml was given intrathecally and in the other group only 0.5% heavy marcaine 2.0 ml with CSF 0.4 ml was given intrathecally. The average time for patients in the fentanyl group to demand the first dose of narcotic for pain was 6.8 +/- 3.2 h and in the control group it was 3.9 +/- 1.1 h. The incidences of postoperative nausea and vomiting were higher in the fentanyl group than in the control group. Pruritus was only found in the fentanyl group and amounted to 50%. Early or late respiratory depression was not found in the fentanyl group. During operation, all patients were wakeful and alert. Neonatal condition as determined by 1-min and 5-min Apgar score was satisfactory and showed no significant difference in both groups. Examination on neurobehavior and reflexes done at the baby room showed no abnormality in both groups.
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PMID:The evaluation of subarachnoid administration of fentanyl for surgery and postoperative analgesia in patients undergoing cesarean section. 209 85

During inhalation induction of the pediatric patient, laryngospasm can develop before intravenous access has been established. The intramuscular administration of succinylcholine is commonly used in such instances. This study was designed to determine if the injection of succinylcholine by an extraoral submental approach would be an acceptable method of terminating laryngospasm when compared to conventional intramuscular sites. Following induction with halothane and nitrous oxide in oxygen, a total of fifteen ASA 1 children were given 3.0 mg/kg intramuscular succinylcholine either intralingually by a submental approach, or using the upper leg musculature in order to electromyographically measure the time to maximum (or 90 percent depression from baseline) twitch depression. The intralingual submental injection had a mean twitch depression of 265 +/- 62.5 seconds compared to the quadriceps femoris at 295 +/- 42.6 seconds. A group with digital massage of the intralingual injection site produced a mean depression time of 133 +/- 11.9 seconds and was also the only group providing 100% success rate in reaching the desired twitch depression level. This may suggest that the operator should consider digital massage to produce a more predictable and desirable result.
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PMID:Submental administration of succinylcholine in children. 209 11

The new benzodiazepine antagonist flumazenil represents another approach to the ever-present problem of recurring respiratory depression after anesthesia with flunitrazepam and fentanyl. Objective and subjective side effects of flumazenil were studied in comparison with the opiate antagonists naloxone and nalbuphine. METHODS. One hundred fifty surgical patients, ASA I or II, aged 18-65 years were studied. After premedication with atropine 0.5 mg and flunitrazepam 0.5 mg anesthesia was induced with flunitrazepam 0.5 mg, fentanyl 0.1 mg and etomidate 10 mg and maintained with N2O/O2 2:1 and additional increments of 0.1 mg fentanyl as required. Relaxation for intubation and surgery was obtained with non depolarizing muscle relaxants. After the operation the patients were extubated and then flumazenil 0.4 mg, naloxone 0.05 mg, or nalbuphine 20 mg was given i.v. (randomized and double-blind). In 15 patients blood pressure and heart rate were monitored. In all patients postoperative pain was assessed by the time interval between administration of the antagonist and need for the first analgesic medication. On the 1st postoperative day recall of postoperative events and of pictures shown 5, 30, 60, 120, and 240 min after administration of the antagonist was tested. The patients were interviewed a second time for side effects on day 3-6 after the operation. RESULTS. The three antagonists produced no significant effects on arterial pressure and heart rate. There were no differences between the antagonists in the incidence of postoperative nausea and/or vomiting or postoperative pain. After flumazenil, a significant transient increase in vigilance and better recall of postoperative events was noted within 5 and 30 min after administration of the drug. CONCLUSION. On the basis of the objective clinical findings, there is no reason to prefer either benzodiazepine or opiate antagonists after flunitrazepam and fentanyl. However, postoperative amnesia can be reduced by flumazenil if this is desirable.
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PMID:[Antagonism of flunitrazepam and fentanyl by flumazenil, naloxone or nalbuphine]. 210 74

This study evaluates the respiratory effects of laparoscopy under epidural anesthesia in seven female patients (ASA physical status I) scheduled for a gamete intrafallopian transfer procedure. Epidural anesthesia was performed with 15-18 mL of 1.5% plain lidocaine using a catheter inserted at the L3-4 level. The upper level of analgesia to pinprick was measured 20 min after lidocaine injection. Ventilatory measurements and arterial blood gas analyses were performed (a) preoperatively, in the horizontal supine position with a T7-9 level of analgesia; (b) in the 20 degrees Trendelenburg position with a T2-5 level of analgesia; (c) during intraabdominal insufflation of CO2 through the laparoscope; and (d) after CO2 exsufflation by manual compression of the abdomen before removal of the laparoscope while in the horizontal position. On-line measurements of VO2, VCO2, VE, VT, F, and PETCO2 were made using a Beckman metabolic cart, while the patients breathed room air through an anesthetic face mask. No significant changes in the ventilatory variables were observed in the Trendelenburg position. In contrast, CO2 insufflation significantly increased VE (from 9.1 +/- 1.0 L/min to 11.8 +/- 2.6 L/min, mean +/- SD), and F (from 16.9 +/- 1.9 breaths/min to 23.1 +/- 3.3 breaths/min, mean +/- SD), whereas VCO2 remained unchanged. PaCO2 remained constant throughout the study. These results suggest that epidural anesthesia may be a safe alternative to general anesthesia for outpatient laparoscopy, as it is not associated with ventilatory depression.
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PMID:Ventilatory effects of laparoscopy under epidural anesthesia. 213 37

Preliminary disposition studies of the investigational, long-acting muscle relaxant doxacurium chloride (Nuromax) have demonstrated dual elimination by renal and hepatobiliary pathways, as well as slow hydrolysis by plasma cholinesterase. The present study compares the kinetics and dynamics of doxacurium in eight ASA physical status I or II elderly patients (67-72 yr of age) and eight ASA I or II young patients (22-49 yr of age). After institutionally approved written informed consent, kinetic and dynamic measurements were made after a 25-micrograms/kg bolus injection of doxacurium during 1.25 MAC nitrous oxide/oxygen/isoflurane anesthesia. Maximum twitch depression was similar in older patients (96.4% +/- 1.3%) to that in the young patients (96.6% +/- 1.8%). The time to achieve this level of block was significantly longer in the elderly than in the young (11.2 +/- 1.1 min versus 7.7 +/- 1.0 min, respectively). Recovery times to twitch heights of 5% and 25% of control tended to be prolonged and were more variable in the elderly (82.6 +/- 17.2 and 97.1 +/- 20.1 min, respectively) than in the young (54.8 +/- 9 and 67.5 +/- 8.2 min, respectively). Elimination half-life (96 +/- 20 min) and clearance (2.47 +/- 0.69 mL.kg-1.min-1) in the elderly patients were not statistically different from values found in the younger group. Volume of distribution at steady state in the elderly (220 +/- 80.2 mL/kg) was significantly larger than in the young (150 +/- 40.0 mL/kg).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pharmacokinetics and pharmacodynamics of doxacurium in young and elderly patients during isoflurane anesthesia. 214 83

Preliminary studies have shown that polymorphonuclear neutrophil (PMN) activity is decreased in a state-dependent manner in patients with endogenous depression. The present study investigates this finding in a larger group of psychiatric patients and attempts to determine the identification of the factor responsible for the abnormal neutrophil function. Chemiluminescence responses of PMNs from patients with diagnoses of endogenous depression, panic disorder, anxiety, schizophrenia and alcoholism were assessed concurrently with age- and sex-matched control subjects. The reduction in PMN activity was observed in panic disorder patients as well as during depression but remained normal in schizophrenia, alcoholism and generalised anxiety. The defect in PMN function appears to be related to an abnormal factor in the serum of the patient which is corrected on clinical recovery. Aspirin-inhibited prostaglandin synthesis resulted in an enhancement of PMN activity in healthy subjects, suggesting a possible role for prostaglandins in the abnormal PMN response.
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PMID:Abnormal zymosan-induced neutrophil chemiluminescence as a marker of depression. 214 3

We sought to compare epidural lidocaine to several short-acting epidural narcotics for their efficacy in controlling pain during extracorporeal shock wave lithotripsy (ESWL), hemodynamic changes, side effects and patient acceptance. To determine what contribution, if any, the local anesthetic test dose makes to the above factors, we also compared epidural sufentanil with and without a preceding test dose of local anesthetic with epinephrine. One hundred ASA I-III patients scheduled for elective ESWL were divided equally into five groups to receive one of the following epidural drugs through an epidural catheter: 2% lidocaine with 1:200,000 epinephrine (Group L), 1000 micrograms alfentanil (Group A), 200 micrograms fentanyl (Group F) or 60 micrograms sufentanil (Groups S and S-). Group S- differed from all other groups in omission of the test dose and direct injection of the opioid through the epidural needle. Significant hypotension occurred in 20% of patients in Group L compared to 0% in the narcotic groups (p less than 0.01). Clinically significant respiratory depression was not observed in any group. Mild pruritus was observed in up to 60% of patients in the narcotic groups (p less than 0.01). Sedation was observed in all of the narcotic groups, particularly in Group S-, in which more than half of patients were drowsy (p less than 0.05). Requirements for adjuvant analgesics during ESWL were highest in Group A. Patient acceptance was high throughout the study. We conclude that epidural alfentanil, fentanyl and sufentanil are as effective as epidural lidocaine plus epinephrine in providing analgesia during ESWL.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A comparison of epidural narcotics, with and without a test dose, to epidural lidocaine for extracorporeal shock wave lithotripsy. 214 29


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