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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Intra-operative monitoring practice during anaesthesia was studied in a randomised selection of hospitals in different categories. Questionnaires from 45 anaesthetists in 20 hospitals provided information on 973 cases. The study showed that in 11% of cases the patient was left at some stage during anaesthesia without the attention of a medical practitioner and that in 7% of cases no record was made of the anaesthetic or of the parameters monitored. Types of monitoring varied considerably between hospitals and often fell short of acceptable minimal standards. Pulse oximetry, which is considered essential, was used in only 53% of cases. One in 18 cases was associated with a peri-operative critical incident and in 7 cases a critical incident occurred where the monitoring was deemed to be inadequate. Pulse oximetry would have assisted the anaesthetist in 6 of these 7 cases. In 3% of cases the anaesthetist admitted to fatigue during the procedure. This study highlights deficits in anaesthetic practice and in available equipment, both of which require urgent attention.
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PMID:Standards of practice in anaesthesia--intra-operative monitoring. 156 11

We have studied the effect of halothane on diaphragmatic contractile function by measuring transdiaphragmatic pressure (Pdi) and electromyogram of the diaphragm (Edi) during various stimulation frequencies in 15 pentobarbitone-anaesthetized dogs undergoing mechanical ventilation. We have examined also the effect of halothane on the fatigued diaphragm by repeating the measurements 5, 10, 15, 30, 60 and 90 min after 30 min of tetanic stimulation applied to the phrenic nerves. Administration of 1-2 MAC of halothane did not affect Pdi at any given stimulation frequency. Changes in the depth of halothane anaesthesia (0, 1 and 2 MAC) did not alter the force-frequency relationship of the diaphragm during recovery from fatigue. Edi was unaffected by halothane, except for a small decline during 100-Hz stimulation with 2 MAC. In contrast with the changes in Pdi, Edi during recovery from fatigue was the same as that determined before fatigue. It is concluded that halothane, in clinical concentrations, did not depress the contractile function of fresh or fatigued diaphragm in vivo.
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PMID:Halothane does not depress contractile function of fresh or fatigued diaphragm in pentobarbitone-anaesthetized dogs. 161 Jun 28

In 1984, researchers analyzed data on 231 18-45 year old women with a spinal cord injury who underwent initial rehabilitation at Craig Hospital in Englewood, Colorado to examine sexual issues. More than 50% of the women reported that health workers did not provide them sufficient sexuality information during rehabilitation, but those who underwent rehabilitation after 1977 were more satisfied with it than those before 1977. They tended to be satisfied with the care they received from their physicians after the injury. Most women were comfortable talking about sexuality with family, friends, and/or other women with spinal cord injuries. Some women were concerned with increases in vaginal discharges (53%) and perspiration (27%) after the injury. Clinicians must realize that the needs of women with spinal cord injuries are different than those of men. Spasticity during sexual relations, pregnancy, childbirth, and the postpartum period troubled some women, e.g., it interfered with sexual intercourse in 21% of the women. Yet 2 newborns were addicted to valium which is used to control spasticity. Other issues were self-confidence and lack of spontaneity. Nevertheless 69% of all women were satisfied with sexual experiences. 60% of the women had amenorrhea after their injury and the mean time for menses resumption was 5 months. The preinjury pregnancy rate was 1.3/person compared with only .34 after the injury. Women with incomplete paraplegia had a higher postinjury pregnancy rate than those with complete quadriplegia (.63 vs. .15; p.001). 50% of the 47 women who had full-term infants delivered vaginally. 49% did not use any anesthesia. Pregnancy complications and complications during labor and delivery were bladder and bowel problems, autonomic hyperreflexia, decubitus ulcers, urinary tract infections, edema, anemia, spotting, fatigue, cardiac irregularity, and preeclampsia.
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PMID:Sexual issues of women with spinal cord injuries. 163 Aug 47

Postoperative complications such as myocardial infarction, pulmonary infection, thromboembolism and fatigue are probably related to increased demands, hypermetabolism, catabolism and other physiologic changes included in the global "surgical stress response." Strategies have been developed to suppress the detrimental components of the stress response so as to improve postoperative outcome. Of the various techniques to reduce the surgical stress response, afferent neural blockade with regional anesthesia to relieve pain is the most effective, although not optimal. Data from numerous controlled clinical trials have demonstrated a reduction in various aspects of postoperative morbidity by such a nociceptive blockade. Although a causal relationship has still to be demonstrated, these findings strongly argue the concept of "stress-free anesthesia and surgery" as an important instrument in improving surgical outcome.
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PMID:The surgical stress response: should it be prevented? 174 33

Sheep under general anesthesia had their left and right latissimus dorsi muscles mobilized for paraneuroelectrode and pulse generator implantation. After a 10-day recovery period, the left-side muscles were stimulated with a gradually increasing duration and rate over 3 months. At 4 months after operation, the tendinous end of each latissimus dorsi muscle was freed from its humeral insertion and attached to a strain gauge force transducer. Both left and right latissimus dorsi muscles, from each animal, were stimulated to contract for 2 hours for the fatigue study before being isolated, trimmed, and weighed. Frozen tissue biopsies were used to determine creatine phosphate, adenosine triphosphate, lactate, and glycogen content and muscle myosine ATPase, and succinate dehydrogenase activities. The arterial diameter in the conditioned muscle was 30% larger than that of the control muscle and had a 40% higher blood flow at rest. A three- to fivefold increase in blood flow during the fatigue test was observed. The force decreased 47% for the conditioned muscle and 91% for the control muscle. The mass and cross-sectional area of conditioned and unconditioned muscles were similar. Electric conditioning increased fatigue resistant fiber content from 33% to 92%, as evidenced by myosine ATPase activity. During the early phase of the fatigue test, higher glucose uptake but significantly lower lactate production were found for the conditioned muscle. This study indicates that it is possible to produce fatigue resistant muscle with preserved force and mass. In addition to skeletal muscle fiber transformation, metabolic adaptations appear to be important factors for fatigue resistance of skeletal muscle.
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PMID:Fatigue resistant muscle with preserved force and mass for cardiac assist. 180 6

The efficacy of acupuncture and transcutaneous stimulation analgesia, supplemented by small doses of fentanyl (mean 1.2 micrograms/kg, SD 1.7) was compared with moderate-dose fentanyl anaesthesia (mean 22.9 micrograms/kg, SD 2.8) in 29 patients who underwent surgery for retroperitoneal lymph node dissection. The present study describes the anaesthetic techniques and comparison of haemodynamics, demand for analgesics after surgery, recovery and blood gases, restoration of urinary and bowel functions, convalescence in terms of self-reliance and the postoperative course in respect of fatigue and morbidity. A more rapid return of consciousness, an absence of hypercapnia and a smaller decrease in pH were observed in patients who received acupuncture and transcutaneous stimulation (p less than 0.05). No clinically relevant disadvantages attributable to the method were demonstrated.
Anaesthesia 1991 Feb
PMID:Acupuncture and transcutaneous stimulation analgesia in comparison with moderate-dose fentanyl anaesthesia in major surgery. Clinical efficacy and influence on recovery and morbidity. 188 9

The potential capacity of aged motoneurons for the reconstruction of motor-units after nerve crush injury was studied in the medial gastrocnemius (MG) muscle of male Fischer rats. The MG nerve in middle-aged (8 months old) and aged (24 months) rats was aseptically crushed under pentobarbital anesthesia. After a 3-month recovery period, the animal was reanesthetized and physiological properties of individual motor-units were recorded. The three different types (fast twitch, fatigable: FF; fast twitch, fatigue resistant: FR and slow twitch: S) of normal motor-unit organization were restored in both middle-aged and aged reinnervated muscles as measured by their relative distributions, mean twitch contraction times and mean tetanic tensions. Some reinnervated units in both aged and middle-aged rats produced a large tetanic tension which exceeded the range for intact units. These findings indicate that aged motoneurons maintain their ability for axonal regenerating and muscle fiber innervation to reestablish normal function of motor-units.
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PMID:Recovery of motor-unit function after peripheral nerve injury in aged rats. 196 56

The effects of four different doses (0.167, 0.33, 0.67, and 1.0 microgram/kg) of dexmedetomidine, a novel alpha 2-adrenoceptor agonist, on anesthetic requirements, hemodynamics, and plasma catecholamine levels were investigated in a single-blind fashion in 20 healthy (ASA physical status I) women scheduled for uterine dilatation and curettage. The drug was administered intravenously 15 min before anesthesia induction with thiopental. Nitrous oxide/oxygen (70%/30%) was used for maintenance. Dexmedetomidine was well tolerated, and no serious drug-related subjective side effects or adverse events were observed. The most prominent subjective effects were tiredness and decreased salivation. The total amount of thiopental needed to perform uterine dilatation and curettage was decreased dose-dependently from 400 +/- 166 mg (mean +/- SD) after 0.167 microgram/kg of dexmedetomidine to 180 +/- 65 mg after 1.0 micrograms/kg of dexmedetomidine (P = 0.028). Blood pressure, heart rate, and plasma norepinephrine levels were reduced after dexmedetomidine. The optimal dose of dexmedetomidine for single-dose intravenous premedication studies in minor surgery appears to be in the range of 0.33-0.67 micrograms/kg.
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PMID:Dexmedetomidine premedication for minor gynecologic surgery. 196 52

The effects of dexmedetomidine, an alpha 2-adrenoceptor agonist, on vigilance, thiopental anesthetic requirements, and the hemodynamic, catecholamine, and hormonal responses to surgery were investigated in healthy (ASA physical status 1) women scheduled for dilatation and curettage (D & C) of the uterus. Fifteen minutes before induction they received single iv doses of either dexmedetomidine (0.5 micrograms/kg; n = 19) or saline (n = 20) in a double-blind fashion. Anesthesia was induced with thiopental and maintained with N2O/O2 (70/30%) and thiopental. Dexmedetomidine was well tolerated and no serious drug-related subjective side-effects or adverse events were observed. The most prominent subjective effects were fatigue and decreased salivation. The total amount of thiopental needed to perform D & C of the uterus was reduced approximately 30% (from 456 +/- 141 mg [mean +/- SD] after saline to 316 +/- 79 mg after dexmedetomidine). This was mostly due to a smaller induction dose in the group receiving dexmedetomidine. Dexmedetomidine appeared to improve the recovery from anesthesia as measured by visual analogue scales (VAS) on fatigue and nausea. The plasma concentration of norepinephrine was decreased by 56% after dexmedetomidine implying decreased sympathetic nervous activity. Systolic and diastolic blood pressure were moderately reduced after dexmedetomidine administration. The authors conclude that dexmedetomidine preanesthetic medication decreases thiopental anesthetic requirements and improves the recuperation from anesthesia with no serious hemodynamic or other adverse effects. Further studies in patients undergoing more stressful surgery are indicated.
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PMID:Dexmedetomidine, an alpha 2-adrenoceptor agonist, reduces anesthetic requirements for patients undergoing minor gynecologic surgery. 197 94

Thirty-eight healthy outpatients undergoing elective surgical procedures lasting 1-3 h were randomly assigned to receive either desflurane 3% (approximately 0.5 MAC) or isoflurane 0.6% (approximately 0.5 MAC) for maintenance of general anesthesia with nitrous oxide 60% in oxygen after a standardized induction sequence consisting of fentanyl 3 micrograms.kg-1, thiopental 4 mg.kg-1, and succinylcholine 1-1.5 mg.kg-1, intravenously. Although anesthetic conditions were similar during operations in the two treatment groups, significant differences were noted in the recovery profiles as measured by elimination kinetics, psychometric testing, and visual analog scales (to assess subjective feelings). The time required for the end-tidal concentration to decrease by 50% was 2.5 +/- 0.8 min for desflurane vs. 9.5 +/- 3.4 min for isoflurane (mean +/- standard deviation [SD]). Times to awakening and ability to follow simple commands were significantly shorter after desflurane than after isoflurane (5.1 +/- 2.4 vs. 10.2 +/- 7.7 min 6.5 +/- 2.3 min vs. 11.1 +/- 7.9 min, respectively). Postoperatively, patients who received desflurane exhibited less impairment of cognitive function (as measured using the Digit-Symbol Substitution Test) than did those who received isoflurane. Furthermore, visual analog scores indicated that patients receiving desflurane experienced significantly less discomfort (pain), drowsiness, fatigue, clumsiness, and confusion in the early postoperative period. We conclude that desflurane may offer clinical advantages over isoflurane when used for maintenance of anesthesia during outpatient surgical procedures.
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PMID:Recovery profile after desflurane-nitrous oxide versus isoflurane-nitrous oxide in outpatients. 200 Oct 18


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