Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0016382 (flushing)
 6,387 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 64-year-old woman was scheduled for cholecystectomy. Her past history revealed that serious anaphylactic reactions including generalized flushing and urticaria, severe hypotension and unconsciousness which occurred after eating crab four years ago. Puncture and/or intradermal skin test and subsequent lymphocyte stimulation test to several drugs commonly used in perioperative period were performed prior to anesthesia. Positive reactions to intravenous anesthetics and muscle relaxants, and negative reactions to inhalational and local anesthetics were found. Famotidine and ketotifen fumarate were given to prevent histamine release for four days before operation. After premedication with scopolamine, a catheter was inserted into epidural space at Th9-T10 level and 2% lidocaine 2 ml was administered initially into the epidural space. Anesthesia was induced with inhalation of nitrous oxide and oxygen, and deepened gradually by the increments of sevoflurane. Tracheal intubation was performed smoothly without adjunct muscle relaxant. Anesthesia was maintained with sevoflurane and epidural anesthesia with intermittent lidocaine administration. No adverse responses were noted at the time of iopamidol injection for intraoperative cholangiography. The anesthesia and postoperative course of this patient were uneventful.
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PMID:[Anesthetic management of a multiallergic patient scheduled for cholecystectomy]. 783 7

We have compared arterial pressures measured by an indwelling radial cannula with those obtained non-invasively by the Finapres 2000 (Ohmeda) during spinal anaesthesia for lower segment Caesarean section. The digital outputs of both pressures were recorded using a computerized system. We studied 20 patients, yielding a total of 18,772 data points after elimination of data recorded during arterial flushing and erroneous results from each source. The data analysis demonstrated a normal distribution for differences between the two methods of measurement, and the correlations between invasive and Finapres readings for systolic, diastolic and mean pressures were 0.78, 0.72 and 0.79, respectively, indicating an overall poor reflection of intra-arterial pressure by the Finapres under these circumstances. Some patients and some periods of readings reflected a high degree of precision and little bias. However, unexplained large differences in pressure and trends of change that were out of phase over time occurred frequently. We conclude that the Finapres cannot be recommended as a monitor of arterial pressure in this group of patients in whom sudden hypotension may be a threat to maternal or fetal outcome.
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PMID:Comparison of invasive and non-invasive measurement of continuous arterial pressure using the Finapres in patients undergoing spinal anaesthesia for lower segment caesarean section. 788 Jun 55

The dose-response relationship and the time course of action of Org 7617, a short acting non-depolarizing neuromuscular blocking agent, were evaluated during thiopentone, fentanyl, halothane and N2O anaesthesia. Neuromuscular transmission was monitored mechanomyographically. The ED50 and ED90 were calculated after single bolus doses of the drug. Twelve, seven and three patients received 2.5, 3.75 or 5.0 mg.kg-1 Org 7617, respectively. Neuromuscular block was characterized by a short lag time (average 30 s) and rapid development of neuromuscular block (69-84 s). Maximum block approximated to 66%, 91% and 95%, and the duration until clinically adequate recovery (TOF ratio of 0.7) to 7.4, 12.1 and 12.2 min after 2.5, 3.75, 5 mg.kg-1 of Org 7617, respectively. The calculated ED50 and ED90 were 1.8 and 3.4 mg.kg-1. Adverse effects, including a moderate fall in systolic and diastolic arterial blood pressure and a concomitant increase in heart rate appeared to be dose-dependent. Some patients showed flushing. One patient given 5 mg/kg Org 7617 had serious adverse effects suggestive of histamine release, i.e. flushing, urticaria, tachycardia, hypotension and bronchospasm. Therefore further clinical investigations were terminated. Although its low potency and the adverse effects observed will prevent further clinical development of ORG 7617, the results do support the contention that it is feasible to develop short-acting non-depolarizing neuromuscular blocking agents from the steroidal series.
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PMID:Clinical pharmacology of ORG 7617, a short-acting non-depolarizing neuromuscular blocking agent. 791 36

Animal models for studying the developmental effects of maternal drug abuse are often based on chronic exposure of the pregnant rat. The suitability of animal models, however, has been constrained by the availability of an appropriate route of administration. The commonly employed SC and PO routes of administration fail to mimic the rapidly peaking pharmacokinetic profile observed in humans with licit (e.g., nicotine) and illicit (e.g., cocaine, methamphetamine) drugs abused via inhalation or i.v. injection. The present study provides a method for the routine use of an i.v. administration model in pregnant and/or group-housed rats. Prior to mating, young adult female Sprague-Dawley rats were anesthetized (ketamine/xylazine) for catheterization. A sterile Intracath i.v. catheter (22 ga., Becton/Dickinson) with a Luer-lock injection cap (Medex) was cut to approximately 8 cm and used as a SC dorsally implanted port for chronic i.v. injections. The distal end of the catheter was inserted into the jugular vein and threaded centrally. Catheter patency was maintained by daily flushing with 0.2 ml of heparinized saline. Following 1 week of surgical recovery, the mean (median)number of estrus cycles to impregnation was 2.5(2). The mean (+/- SEM) duration of catheter patency was 36.6 +/- 1.2 days and was in excess of 30 days for all animals (n = 22). Cocaine at a dose of 3 mg/kg (GD8-14 x 1/day, GD15-20 x 2/day) had no significant effect on dam weight gain, gestation length, litter size, sex ratio, or birth weight. In sum, a subcutaneously implanted port provides a procedure for the routine i.v. administration of drugs to pregnant and/or group-housed rats which avoids (a) the use of anesthesia/surgery during pregnancy, (b) the stress (restraint and/or thermal dilation) associated with tail vein injection, (c) the difficulties of mating and single housing associated with tethered i.v. catheters, and (d) in the case of cocaine, precludes the potential confounds of any drug-induced non-i.v. parenteral lesions.
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PMID:Chronic intravenous model for studies of drug (Ab)use in the pregnant and/or group-housed rat: an initial study with cocaine. 805 93

Duration of neuromuscular block may be prolonged by H1/H2 antagonists. This study was designed to determine the influence of H1/H2 antagonist treatment on onset, duration and recovery after mivacurium chloride (MIV), a new nondepolarizing neuromuscular blocking agent with a relatively short duration of action, which is metabolized by human plasma cholinesterase (PChE). METHODS. After approval from the hospital ethical committee and written informed consent, 48 ASA I-II patients of either sex (ages 18-65 years, weight 45-100 kg) were included in this double blind study and randomly allocated to four groups of 12 each: group A, 0.105 mg/kg MIV (1.5 x ED95) and H1/H2 antagonist; group B, 0.105 mg/kg MIV and placebo; group C, 0.21 mg/kg MIV (3 x ED95) and H1/H2 antagonist; Group D 0.21 mg/kg MIV and placebo. Premedication consisted of 2 mg lormetazepam p.o., 300 mg ranitidine and 0.1 mg/kg dimetindene, or placebo p.o. Anaesthesia was induced with thiopentone (5-7 mg/kg) and maintained with N2O/O2 at a 65/35 ratio, enflurane (0.8-1.5%) and supplements of fentanyl. The ulnar nerve was stimulated with supramaximal 2 Hz train-of-four (TOF) every 10 s. Neuromuscular twitch response was recorded with EMG. Onset time (time from end of injection to maximal or total block), maximal block (%), T125 (time from end of injection to 25% recovery) were recorded after each dose, and recovery index (T1 from 25% to 75% recovery) and TOF70 (time from end of injection to TOF ratio of 70%), after the last dose. RESULTS. The four groups did not differ with respect to age, weight or height. There was no difference in the pharmacodynamics of mivacurium between the groups receiving H1/H2 antagonists and those receiving placebo. Following 1.5 x ED95 the onset was at 3.7 +/- 1.2 (H1/H2) and 3.8 +/- 0.9 min (placebo), respectively. Clinical duration (T125) was 13.1 +/- 3.4 and 12.8 +/- 3.4 min. 3 x ED95 led to a significant faster onset and longer duration (P < or = 0.05). Onset was at 1.9 +/- 0.7 (H1/H2) and 2.1 +/- 0.5 min (placebo), respectively, and clinical duration 19.1 +/- 6.1 and 19.3 +/- 3.8 min. Duration of repetitive doses (10.1 +/- 5.3 min), recovery index (6.8 +/- 2.9 min) and interval from last dose to spontaneous recovery (22.4 +/- 7.0 min) did not differ between groups. Three patients in group D (placebo and 0.21 mg/kg MIV) had haemodynamic changes of over 20% from baseline. Flush and erythema were significantly less pronounced after H1/H2 premedication than after placebo (4 vs 12 pts). CONCLUSIONS. Our results suggest that time of onset and clinical duration of effects of MIV are not altered by dimetindene and ranitidine. The duration depends more heavily on the dose of MIV. The recovery of neuromuscular function, once it has begun, is prolonged neither by MIV nor by H1/H2 antagonists. As MIV is mainly broken down by PChE, it is evident that its duration of action is more prolonged by atypical PChE activity than by interaction with other drugs. Oral H1/H2 premedication may diminish haemodynamic side-effects and clinical signs of histamine release.
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PMID:[Pharmacodynamics and clinical adverse effects of mivacurium. The effect of oral premedication with H1/H2 antagonists]. 810 16

Morphine and tubocurarine may release histamine by direct mast cell degranulation which may result in systemic effects such as cutaneous flushing, local wheal and flare formation and hypotension. This randomised, double-blind study examined whether preoperative combined oral terfenadine (60 mg) and ranitidine (150 mg) attenuates the reduction in blood pressure and cutaneous flushing after the administration of tubocurarine and morphine in 60 patients undergoing elective gynaecological surgery. In addition, investigation was made of whether tubocurarine and morphine cause a significant decrease in gastric pH in comparison to the nonhistamine-releasing agents fentanyl and vecuronium. Patients were randomly assigned to one of three groups receiving either pre-operative terfenadine and ranitidine and intra-operative tubocurarine and morphine (group A); pre-operative placebo and intra-operative tubocurarine and morphine (group B); pre-operative placebo and intra-operative fentanyl and vecuronium (group C). Compared to group B, group A had less hypotension and tachycardia but no significant decrease in cutaneous flushing immediately following morphine and tubocurarine (p > 0.05). There were no significant differences in haemodynamic changes between the groups A and C. In those patients not pretreated with terfenadine and ranitidine (groups B and C), gastric pH decreased between 5 and 10 min following bolus administration of morphine and tubocurarine (group B), whereas patients receiving fentanyl and vecuronium (group C) had an increase in gastric pH. This suggests that histamine release following administration of morphine and tubocurarine is sufficient to increase gastric acidity.(ABSTRACT TRUNCATED AT 250 WORDS)
Anaesthesia 1993 Sep
PMID:The influence of the H1 and H2 receptor antagonists, terfenadine and ranitidine on the hypotensive and gastric pH effects of the histamine releasing drugs, morphine and tubocurarine. 821 91

A case of the inspired PCO2 increase secondary to the malfunction of expiratory valve due to a defected edge of creator is presented. In this case, we could not detect the malfunction of expiratory valve using the preanesthetic routine leak test but found it by observing the expiratory phase of the capnometric curve. Therefore, we devised a new leak test for checking the malfunction of inspiratory and expiratory valves. This test is simple and effective. The test consists of the following procedures.: 1. Connecting yokes to the oxygen piping system. 2. Connecting the breathing bag. 3. Occluding the inspiratory terminal. Closing the semiclosed valve completely. 4. Flushing the O2 gas and increasing the pressure of breathing circuit to 30 cmH2O. 5. Monitoring the pressure gauge of the anesthesia system. If the function of valves is normal, the system pressure decreases slowly. If either of the valves works wrong, it decreases rapidly. We checked anesthesia machines in our facilities using the new leak test, and found some cases of the expiratory valve malfunctions.
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PMID:[A new leak test of anesthetic machine]. 823 Jul 31

Mivacurium chloride has been assessed in respect of intubating conditions and neuromuscular effects. The influence of suxamethonium on the onset and duration of subsequently administered mivacurium was also studied. A dose of 0.15 mg.kg-1 of mivacurium was found to provide unacceptable intubating conditions at 2 min in 9/9 patients and further studies were conducted using 0.2 mg.kg-1. Intubating conditions with this dose were acceptable in 65% and 80% of patients at 2 min and 2.5 min respectively. In comparison, intubating conditions were acceptable in 100% of patients at 1 min following 1 mg.kg-1 of suxamethonium. The onset of block occurred in 96 s and 97 s after 0.15 mg.kg-1 and 0.2 mg.kg-1 respectively, and the durations of block in terms of recovery of the first twitch (T1) to 25% and 90% of control, and to recovery of train-of-four ratio to 0.7, were 16.1 and 17.9; 24.1 and 25.8; and 24.2 and 27.0 min respectively with the two doses. The time for the onset of complete block with suxamethonium 1.0 mg.kg-1 was 50 s and the times to 25% and 90% recovery were 9.8 min and 13.3 min. The differences between suxamethonium and both doses of mivacurium were significant (p < 0.05) but there were no significant differences between the two doses of mivacurium in any of the neuromuscular measurements. Prior administration of suxamethonium had no influence on the effects of mivacurium. Cutaneous flushing was observed in 30 out of 75 patients but this was associated with transient hypotension in only two patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Anaesthesia 1993 Nov
PMID:Neuromuscular effects and intubating conditions following mivacurium: a comparison with suxamethonium. 825 Jan 86

Pheochromocytoma is a catecholamine secreting tumor originating from the adrenal medulla (up to 90%), or from the chromaffin tissue along the paravertebral sympathetic chain. The hallmark of pheochromocytoma is paroxysmal hypertension associated with diaphoresis, headache, tremulousness, and palpitations. The triad of diaphoresis, tachycardia, and headache in hypertensive patients is highly suggestive of pheochromocytoma. Other symptoms like flushing, nausea, vomiting, personality changes, and visual disturbances may however cast doubt on the diagnosis of pheochromocytoma. Death resulting from pheochromocytoma is usually due to congestive heart failure, myocardial infarction, or intracerebral hemorrhage. Although less than 0.1 percent of patients with hypertension have a pheochromocytoma, nearly 50 percent of the mortality with unsuspected pheochromocytoma occurred during anesthesia and surgery or parturition. Patients of unsuspected pheochromocytoma have higher risk for surgery, because some mandatory pre-op medical treatments might have been ignored. It is also a challenge to anesthesiologists to handle unsuspected hypertensive crisis during anesthesia and surgery. We presented such a case of unexpected Pheochromocytoma which was mis-diagnosed by the surgeon and was treated as an ordinary adrenal gland tumor and was scheduled for surgical operation. When the patient was undergoing excision of the tumor, manipulations of the tumor initiated an tremendous elevation of the blood pressure. Upon reviewing her history of normotension with visual disturbance, nausea and restlessness, she was immediate treated as with a pheochromocytoma. Appropriate managements were applied to control her abnormally high fluctuating blood pressure with success and with no complications or adverse effect.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Anesthetic management of intraoperatively diagnosed pheochromocytoma--a case report]. 830 54

A new system for sampling from arterial cannulae has been designed which avoids the need to aspirate flushing solution before taking a sample and limits blood loss. The new system was compared with a standard sampling system and direct arterial sampling using in vitro models. A series of haemoglobin concentrations were prepared and sampled using the three sampling methods. There were no clinically significant differences in the values obtained with the different sampling techniques.
Anaesthesia 1993 Jun
PMID:Evaluation of an alternative method of blood sampling from arterial cannulae. 823 51


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