Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0026838 (spasticity)
 6,471 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Mitochondrial myopathies make up a group of rare disorders whose onset is in childhood or adolescence. Muscle and central nervous system involvement is variable. Mitochondrial respiratory chain complex III deficiency (coenzyme Q - cytochrome C reductase) can manifest as exercise intolerance, myopathy, encephalopathy, and myocardial disease. Approximately 38 patients with complex III deficiency have been described since 1966, yet only a single anesthetic experience (epidural analgesia for cesarean delivery) has been reported. We describe the case of an 11-year-old boy with mitochondrial respiratory chain complex III deficiency, severe myopathy, and moderate encephalopathy who underwent surgery to improve right ischiotibial muscle spasticity. Monitoring included electrocardiography, noninvasive blood pressure, oxygen saturation by pulse oximetry, end-tidal carbon dioxide pressure, esophageal temperature, spirometry, and neuromuscular block (Relaxograph Datex). Midazolam, fentanyl, and propofol were used for anesthetic induction; mivacurium was used during intubation. Anesthetic maintenance was with propofol in continuous infusion and fractionated doses of fentanyl and mivacurium on demand in a mixture of oxygen and air. The boy's response to mivacurium was abnormal but he could nevertheless be extubated in the operating room at a train-of-four ratio of 75% and with no need to reverse the neuromuscular blockade. There were no problems during the anesthetic procedure, so it could be a good technique for these patients, despite of considering individually every case and extension of syntomatology, due to the little experience in anesthesia with deficiency of Complex III.
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PMID:[Anesthesia for a patient with mitochondrial respiratory chain complex III deficiency]. 1729 35

Nociceptive stimuli are modulated at the dorsal horn of the spinal cord. This modulation is performed by various systems working independently complementarily, additively or supra-additively. Non-opioid analgesics relieve pain without a motor blockade. In contrast to spinal opioids a reduced risk of respiratory depression is expected. In the therapy of chronic pain non-opioid analgesics may be an alternative, given alone or in combination with an opioid. Clinically relevant dosages for antinociception mediated by the alphaadrenoceptoragonistclonidine are >/=150 mug epidurally. Clonidine is effective in reducing acute and chronic pain. In combination with opioids the action of the opioids is intensified. Clonidine intensifies and prolongs the action of local anesthetics. If opioid tolerance occurs, epidural clonidine alone or in combination with an opioid has good antinociceptive action.Midazolam, a water-soluble benzodiazepine, was injected spinally for the reduction of pain for various indications (postoperative, malignancy, chronic back pain, spinal spasticity). Spinal benzodiazepine should not be injected into the spine in patients until it has been proven that there are no neurotoxic effects. Intrathecally injectedbaclofen is a well-known means of reducing spinal spasticity. Used in this way, it may have a secondary analgesic effect. No significant direct analgesic effect has so far been demonstrated. Spinalcalcitonin often leads to insufficient pain relief when given alone. Combination with an opioid may reduce the dosage of the opioid. Nausea and vomiting are frequent side effects of spinal calcitonin. Intrathecalsomatostatin produces antinociception. However, in animal studies neurotoxic action has been observed. Administration in man has not yet been proved to be safe. Spinalketamine has procluted controversial results in clinical studies, and has not yet been excluded that the substance is not neurotoxic.Lysine acetylsalicylic acid (L-ASA) has been given intrathecally for the therapy of severe cancer pain and chronic back pain. In most patients good analgesia was observed up to 2 months after a single injection. If neurotoxity can be excluded, L-ASA may be an alternative in the therapy of cancer pain before neurodestructive therapy is done.
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PMID:[Intrathecal and epidural administration of non-opioid analgesics in acute and chronic pain treatment.]. 1841 40