Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Postanesthetic delirium is a type of postoperative emotional response occurring immediately after emergence from general anesthesia. Associated with excitement and confusion, the alternative terms emergence delirium or postanesthetic excitement are frequently used. Historically, the more encompassing term postoperative psychosis is used interchangeably but more frequently refers to those conditions occurring after a lucid interval of 24 to 48 hours. Either phenomenon may arise from a variety of disturbances, with drug reactions, hypoxemia, or reaction to pain being common, or it may arise from psychological causes. Reported is a case of postanesthetic delirium in a healthy young man. An historical overview of this potentially harmful condition, with specific recommendations for diagnosis and treatment, also is presented.
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PMID:Postanesthetic delirium: historical perspectives. 200 46

A recent report suggested that more than 50% of terminal cancer patients have physical suffering that requires sedation in the last days of life. To evaluate this finding on our 14-bed palliative care unit, a retrospective analysis of 100 consecutive patients admitted for 6 days or more was carried out. Information was collected on major symptoms requiring treatment, symptom control at admission and during each of the last 7 days of life, medications used, and changes that may have contributed to sedation. Of the 100 patients, 99 had pain, 46 had dyspnea, 71 had nausea, and 39 experienced delirium. Visual Analogue Scores (VAS) were done twice a day in all patients; mean pain showed a change from 31 +/- 24 on Day 6 to 24 +/- 19 on day of death (DOD) (p less than 0.05); nausea from 19 +/- 18 on Day 6 to 13 +/- 9 on DOD (p less than 0.01); drowsiness from 51 +/- 28 on Day 6 to 85 +/- 45 on DOD (p less than 0.001); symptom distress score from 49 +/- 11 on Day 6 to 52 +/- 9 on DOD (p less than 0.01). On the day of admission (DOA), 69% of VAS were done by the patient and 28% by the nurse as compared to 8% by the patient and 90% by the nurse on DOD. Level of consciousness on DOA was alert (72%), drowsy (28%), unresponsive (0%) and by DOD was alert (2%), drowsy (41%), unresponsive (57%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Symptom control during the last week of life on a palliative care unit. 204 96

As many as 180 children aged 4 to 14 years with depression and pain were examined. According to psychopathology senesthopathic pains, pains with vital depersonalization, hallucinatory pains, and pains marked by elements of delirious perception, and undifferentiated pains were distinguished. The authors review some typological varieties of depression and pain: somatoalgic crises associated with somatized depression and pains associated with depression and depersonalization, somatoalgic crises in depression associated with pseudoneurological disorders, somatoalgic crises in the structure of nocturnal fears in the presence of anxious depression, somatoalgic crises in the presence of short-term well-defined episodes of psychomotor excitation or stupor with fear, distress, dysphoria, hallucinations, senesthohypochondriac conditions in the presence of anxiety, somatoalgia in the structure of the depressive and delirious syndrome. Discuss problems of the disease entities, pathogenesis and therapy.
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PMID:[Pain syndrome in children with depression]. 217 25

Hip surgery is the most common major orthopedic procedure performed in the elderly. The indications are fracture and pain secondary to degenerative arthritis. Patients undergoing hip replacement for arthritis have excellent outcomes with decreased pain, increased mobility, and a low mortality. Age should not be a contraindication to hip replacement, with patient selection being made on the basis of symptomatology and overall health. In hip fracture, the prognosis is more guarded. Poor functional outcome results from complications of the fracture, such as avascular necrosis of the femoral head and fracture nonunion in femoral neck fractures and instability with delayed weight bearing in intertrochanteric fractures. In addition, patients sustaining hip fracture are more likely to have significant comorbidity and subsequent perioperative complications. Pressure ulcers, delirium, deep venous thrombosis, urinary retention and urinary tract infection, and cardiac events are the most frequent complications seen. These complications can be anticipated and prevented with careful preoperative assessment and post-operative prophylactic management. A team approach including the orthopedic surgeon, primary care physician, nursing staff, and physical therapists is essential for optimal outcome.
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PMID:Surgical management of the hip in the elderly patient. 219 20

Thirty children scheduled for elective orchiopexy or herniotomy were consecutively assigned at random to premedication with methohexital 80 mg/ml, 20 mg/kg rectally, 15 min before transportation to the operating room, or pentobarbital 28 mg/ml, 7 mg/kg rectally, 45 min before transportation. The quality of premedication was recorded at induction with halothane 1-2% and 60% N2O in O2 by mask. All patients received a caudal injection of bupivacaine 1.9 mg/ml, 1.25 ml/kg before surgery. Following completion of anaesthesia, the postoperative wake-up time and the duration of stay in the post-operative recovery room were recorded. The degree and quality of recovery were assessed using the Aldrete score every 30 min until discharge from the recovery room. The group of children receiving methohexital showed a highly significantly shorter awakening time, and a highly significantly shorter stay in the recovery room compared to the pentobarbital group. The children in both groups had a quiet, easy recovery without significant signs of confusion or agitation, and no difference in quality of recovery could be shown. Emergence delirium or agitation in connection with pentobarbital premedication and a possible relation to postoperative pain is discussed.
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PMID:Comparison of methohexital and pentobarbital for premedication in children. 223 20

Pain has been managed aggressively by hospice programs. However, other problems, particularly neuropsychiatric problems, such as confusion, can go unrecognized and untreated even in a hospice setting. The resulting disturbing, violent or disruptive behavior will severely detract from the quality of life the patient and family can share together. Dementia and delirium can be diagnosed using a mental status exam. Care-givers can then be informed about the special needs of the patients and prepared for potential problems. Identification of reversible causes for delirium can continue while agitated behavior is managed with behavioral and pharmacologic approaches. Confusion is a common problem in the terminally ill and prompt recognition and management of the potentially disruptive symptom can do a great deal to maximize the quality of the patient's life.
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PMID:Confusion in the terminally ill: recognition and management. 236 Nov 8

More than 2,000 medically ill patients with delirium have been treated by intravenous administration of a combination of haloperidol and lorazepam. The protocol was developed over 8 years at two major cancer centers in the United States and Canada. The addition of the potent benzodiazepine to the neuroleptic produces rapid and safe symptomatic sedation in emergency conditions and allows the use of lower doses of haloperidol. The combination was first attempted when doses of haloperidol as high as 350 mg failed to provide rapid emergency neurobehavioral control. All patients treated to date had cancer, and all were suffering multisystem organ failure. Hourly doses of each drug as high as 10 mg for as long as 15 days have been shown to be safe and effective in the most critically ill patient with delirium. Patients generally respond to the first one or two doses and, in most cases, less than 100 mg/day of each drug is required. The addition of the opioid hydromorphone makes the combination ideal for the treatment of intractable pain in terminally ill cancer patients. This polypharmacological approach is advocated as the method of choice for emergency sedation of the delirious patient as well as for palliative care.
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PMID:Emergency intravenous sedation of the delirious, medically ill patient. 246 29

A 39-year-old female with several past psychiatric hospitalization for schizophrenia was admitted to our hospital because of severe pain and swelling of her legs. A few days before onset, she had often sat down upon her heels in water closet, agitated and talking to herself for many hours. Two days before the admission, she had suffered from severe pain and swelling of her bilateral calf-muscles, and her urine became brownish. On admission, neurological findings revealed delirious state, moderate rigidity of limbs, hyporeflexia of legs, marked swelling and severe spontaneous pain in bilateral legs. She was afebrile with body temperature of 36.4 degrees C. Laboratory data showed marked increase of levels of serum CK to 163,000 U/1, myoglobin to 9,860 ng/ml and aldolase to 42.8 IU/1, and the diagnosis of rhabdomyolysis was made. Although she fell into acute renal failure, the renal function recovered after repeated hemodialysis. Several days after admission, swelling and pain of calf-muscles began to improve, and serum CK, myoglobin and aldolase decreased rapidly. One month later, she was able to walk on her own legs. In the literature, rhabdomyolysis associated with immobile posture caused by schizophrenia is extremely rare, and this is the first case reported in Japan. The relationship between rhabdomyolysis and schizophrenia was discussed.
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PMID:[A case of rhabdomyolysis following long time immobile posture caused by schizophrenia]. 259 45

The addition of corticosteroids in the early 1950s to the treatment armamentarium provided cure of some diseases and control of many. They have become an integral part of many cancer treatment regimens. Early reports of severe affective disorders appear less frequent today in patients receiving steroids, though controlled studies are rare. Minor mood changes are common, ranging from the euphoria of initial treatment to depressive symptoms on withdrawal. The most common severe disturbances seen clinically in cancer patients are the organic mood disorders and delirium. Studies are needed, especially in cancer, which control for prior psychiatric history, cancer site, cancer treatment, pain regimen, coexisting cancer complications, especially central nervous system complications, and physical performance status. DSM-III-R terminology must be used as the diagnostic classification for reliable investigation. A more careful clinical delineation of the mental changes with steroids is desirable not only for the clinical relevance, but for the potential understanding of the etiology of mood disorders and mental changes seen in delirium.
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PMID:Corticosteroids in cancer: neuropsychiatric complications. 269 30

Narcotic analgesics are the mainstay of pharmacological interventions for cancer pain. There is however growing awareness that psychotropic drugs, in particular the antidepressants, are useful adjuvant analgesic agents in the management of cancer pain. In addition many of these drugs are important in the treatment of psychiatric complications of cancer. Unfortunately cancer patients with pain are most vulnerable to such problems as depression, anxiety and delirium. For the clinician who wants to provide comprehensive management of cancer pain, familiarity with the indications and usefulness of psychotropic drugs will be most rewarding.
J Pain Symptom Manage 1989 Sep
PMID:Psychotropic adjuvant analgesic drugs for cancer pain. 277 53


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