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)

50 non-premedicated ASA class I or II patients were allocated randomly into two groups and received either a variable infusion of propofol or midazolam for sedation during orthopaedic surgery with regional blockade. To achieve a well-sedated patient with eyes closed and able to follow commands, the dose requirements for propofol were 1.25 mg/kg +/- 0.5 as a loading dose followed by a mean infusion rate of 3.17 mg kg-1 h-1 +/- 1.4 and for midazolam 0.073 mg/kg +/-0.02 and 0.074 mg kg-1 h-1 +/- 0.14. Steady-state plasma concentrations of propofol averaged 1.23 micrograms/kg +/- 0.75 and of midazolam 134 ng/ml +/- 62. Recovery was significantly shorter for propofol: 3.42 +/- 2.5 versus 8.05 min +/6.2 for midazolam. Perioperative cooperation was similar in both groups providing good or excellent conditions in 76% with propofol and in 52% with midazolam. 2h after discontinuation of the infusion 92% of the propofol patients were alert, while 36% of the midazolam were sleeping again. Cardiovascular effects of both drugs were minimal; however significant respiratory depression and/or airway obstruction developed in both groups (propofol 48%, midazolam 52%) requiring therapeutic intervention. Additional undesirable effects were: severe cough (propofol 40%, midazolam 20%), inadvertent movements (propofol 36%, midazolam 24%), confusion (propofol 24%, midazolam 20%), euphoria (propofol 44%), pain on injection (propofol 32%). The results of the study indicate that both drugs are useful and controllable sedative agents for surgery under regional anaesthesia, provided that measures for continuous monitoring of respiration and emergency care are guaranteed.
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PMID:[Propofol infusion for sedation in regional anesthesia. A comparison with midazolam]. 220 73

The admissions to Vancouver General Hospital from its Surgical Day Care Centre were reviewed for the period 1977 to 1987. The overall mean rate of admission for the period was 0.28 per cent, for surgically-related admissions 0.22 per cent and for anaesthesia-related admissions 0.07 per cent. The principal reasons for surgery-related admissions were postoperative bleeding, complications, the need for further surgery, the requirement for prolonged postoperative care, and pain. Urology had a particularly high percentage of admissions compared with its workload, because of the diagnostic nature of much of the work. Anaesthesia-related admissions included "syncope," lack of an accompanying adult, aspiration pneumonitis and coincident acute disease. Twelve of the 14 patients admitted with syncope had surgery in the afternoon and had received less than ideal amounts of intravenous fluid. Seven of the 12 ASA physical status II patients admitted had an admission diagnosis related to the coincident disease.
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PMID:Hospital admissions from the Surgical Day Care Centre of Vancouver General Hospital 1977-1987. 220 46

The hemodynamic responses to laryngoscopy and intubation were compared in forth patients of ASA class I-II undergoing various surgical procedures without premedication were randomly divided into two groups and given propofol (2.5 mg/kg) or thiopentone (5 mg/kg) for induction, and succinylcholine (1.5 mg/kg) for facilitating laryngoscopy and intubation. Each group consisted 20 patients. Baseline data has no significant difference between the two groups. After induction systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP) heart rate (HR), cardiac output (CO), cardiac index (CI) were all lower in the propofol group than thiopentone group. It indicate that propofol (2.5 mg/kg) has more cardiovascular depressive effects than thiopentone (5 mg/kg). Local injection pain was complained by every patient.
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PMID:Cardiovascular responses to tracheal intubation after thiopentone or propofol. 221 5

The hypothesis that the lipid emulsion of the emulsion formulation of propofol is responsible for the low frequency of nausea, retching, and vomiting after propofol anesthesia was tested. A randomized, prospective, and comparative study was performed to evaluate the antiemetic effect of 10% lipid solution in 60 women, ASA physical status I and II, scheduled for ambulatory laparoscopic procedures. Two groups of patients were studied. Induction of anesthesia (thiopental) and maintenance of anesthesia (enflurane, nitrous oxide) were similar in both groups. At induction the study group received 10% Intralipid (3 mL/min for 20 min). The control group received 5% dextrose in lactated Ringer's solution at the same rate. Other drugs administered during or after anesthesia were similar among the groups. The groups were similar with respect to duration of anesthesia, characteristics of early and intermediate recovery, as well as pain scores in the postanesthesia care unit. There were no differences in the amount of antiemetic medications administered or postoperative nausea, retching, or vomiting when the patients were evaluated objectively by a blinded observer or subjectively by patient self-evaluation. It is concluded that 10% Intralipid, the lipid in the emulsion formulation of propofol, does not possess significant antiemetic effects.
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PMID:Is the antiemetic effect of the emulsion formulation of propofol due to the lipid emulsion? 222 15

We compared postoperative pain and narcotic requirements, oxygen saturation (SaO2) and length of stay in the post-anesthesia care unit (PACU) in patients who received 30 ml of either 0.25% bupivacaine (B) or saline placebo (S) infiltrated into the operative incision. Twenty ASA I-III patients undergoing abdominal surgery were studied in a double-blinded randomized prospective trial. Study and control groups were not different in patient age, procedure, intra-operative narcotics administered or preoperative SaO2. In the PACU, patients receiving B had significantly lower analog pain scores (6.0 vs 8.3, P = 0.02). They had lower respiratory rates (15.6 b/min vs 19.1, P = to 0.02), required significantly less narcotic (4.5 mg morphine sulphate vs 11.0, P = to 0.03) and were discharged from the PACU almost an hour sooner than patients receiving S (P = 0.02). Patients receiving B had significantly higher minimum SaO2 than those receiving S (93.3% vs 89.9, P = 0.04). Discharge pain scores, SaO2 and respiratory rates were not significantly different between B and S groups. Finally, mean requirements for narcotics for the first 24 h were reduced by approximately 30% (from 406.9 mg meperidine to 255.5 mg, P = 0.006). This study demonstrates that infiltration of a long-acting local anesthetic lowers initial pain scores and requirements for narcotics in the PACU. The effect can be seen for at least the first 24 h. A lower requirement for postoperative narcotics is accompanished by faster wake-up, more alert patients, and, most importantly, higher SaO2 and shorter PACU stay. This may have a significant effect on pulmonary morbidity following abdominal operations.
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PMID:The effects of incisional bupivacaine on postoperative narcotic requirements, oxygen saturation and length of stay in the post-anesthesia care unit. 223 22

The purpose of this study is an investigation of two protocols using propofol as induction and maintenance agent in 100 children scheduled for strabismus surgery (4-8 year, ASA I, NYHA I). Protocol I; Propofol 6 mg.kg-1 in 60 s with fentanyl 2 micrograms.kg-1 and vecuronium bromide 0.08 mg.kg-1 for induction, followed by propofol 11 mg.kg-1 for maintenance; Protocol II; Propofol 3 mg.kg-1 in 20 s with fentanyl 3 micrograms.kg-1 for induction, followed by propofol 12 mg.kg-1.h-1 for maintenance. It appears that the use of protocol I offers significant advantages compared with protocol II: a better quality of induction with a lesser incidence of pain during injection of propofol; a better quality of maintenance with very infrequent bradycardia from oculocardiac reflectivity; and a better recovery with a greatly reduced frequency of nausea and vomiting.
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PMID:[Anesthesia using propofol during surgery of strabismus in children. A comparison of two different protocols of induction and maintenance]. 225 60

The analgesic effect of bilateral ilioinguinal nerve blockade with or without epinephrine after caesarean section with Pfannenstiel incision was investigated in 36 ASA class 1-2 parturients. They were randomly classified into 3 groups of 12 each. Before the patients were extubated from standard general anesthesia, bilateral ilioinguinal nerve blockade was performed. Group A patients were the control group. Group B patients received 0.375% plain marcaine 10 mL to each side. Group C patients received 0.375% plain marcaine with 1:200000 epinephrine 10 mL to each side. The pain scores and requirement for post operative analgesia of group B and C were compared with the control group A. The pain scores of group B and C were decreased 30% and 37% respectively during the first eight hours after operation. However, group C patients had lower pain scores during the first day after operation. There was an increased time from anesthesia to the first injection of pethidine in group B and C when compared with group A (4.57 +/- 2.94, 4.38 +/- 2.72 and 1.8 +/- 0.9 hr, respectively). However, no significant difference between group B and C. The total pethidine requirement were decreased in group B and C although the mean pethidine dose was not statistically significant. The results suggest that bilateral ilioinguinal nerve blockade improve the quality of postoperative analgesia. The adding epinephrine can prolong the duration of nerve blockade.
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PMID:[Ilioinguinal nerve blockade with or without epinephrine for analgesia after caesarean section]. 227 78

Patient-controlled analgesia is an increasingly popular method of postoperative pain relief. However, patients often worry about new therapies. Eighty ASA 1 and 2 patients aged 18-65 years were asked to list the advantages and disadvantages of using patient-controlled analgesia. The most important advantage as perceived by patients was the reduced time spent by nurses in giving medication, but there was concern that direct personal contact would also be lessened. Preservation of self control, autonomy, rapid onset of analgesia, ability to titrate analgesia and lack of injections were seen as an advantage. Addiction and machine faults were seen as minimal problems. Preservation of patient-nurse contact is of great importance to ensure success of postoperative analgesia.
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PMID:Patients' expectations of patient-controlled analgesia. 227 34

Continuous brachial plexus blockade achieved by repeated injections through an axillary catheter is used increasingly often for microsurgical procedures and for postoperative pain relief. Repetitive administration, especially of long-acting agents, can cause problems with local anesthetic toxicity. Based upon a pharmacokinetic analysis of prilocaine serum concentrations after single-dose axillary plexus blockade in 14 patients, a pharmacokinetic model was established from which to predict serum concentrations after successive doses. METHODS. Each of 14 patients (ASA I-II, age 42 +/- 20 years, height 171 +/- 10 cm, body weight 72 +/- 9 kg) undergoing minor hand surgery received a single dose of 600 mg (40 ml 1.5%) prilocaine for axillary plexus blockade. Serial samples were taken from the contralateral antecubital vein and serum local anesthetic concentrations were measured by gas chromatography. Least square, non-linear regression analysis was performed to fit a triexponential curve; standard formulas were applied to develop the corresponding open two-compartment model. Computer simulation was carried out to predict the accumulation of mean local anesthetic concentrations after repetitive dosages. The kinetic model was verified with another set of 5 patients receiving a repetitive dose of prilocaine. The initial dose was 400 mg (40 ml 1%), followed by insertion of a catheter which allowed repetition at 2 and 4 h. The repetition dose was 300 mg (20 ml 1.5%). RESULTS. Maximal prilocaine serum levels of 2.32 +/- 0.80 micrograms/ml were found after 34 +/- 13 min. Mean pharmacokinetic data of the open two-compartment model with first order absorption from extravascular sites were: t alpha 1/2 = 10 min; t beta 1/2 = 139 min; V1 = 661; V dss = 254 1; Cltot = 2310 ml/min; tabs 1/2 = 35 min. The comparison of predicted and observed serum concentrations after continuous anesthesia was excellent. DISCUSSION. Pharmacokinetic data after axillary plexus blockade are comparable to those found after i.v. injection. Low serum levels were found throughout the 8 h of investigation and accumulation in serum was minimal following repetitive doses. There was no loss of action on repetition. Predicted values after pharmacokinetic modeling showed good agreement with actual measured values. Prilocaine may be a reasonable choice for repetitive use, as is appears to be toxicologically safe. Methemoglobinemia resulting from metabolites of prilocaine did not lead to complications in our study. It may, however, be a problem with repetitive dosages. Further investigations concerning this question would be useful.
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PMID:[The blood level and a pharmacokinetic model of prilocaine during a continuous brachial plexus blockade]. 228 64

In a previous study it was proved impossible to evaluate the validity of a system modified according to McGrath et al. for measuring postoperative pain in children. Three reasons were postulated for this result. The analgesics used did not modulate the pain in such a manner that the statistical analysis was effective; or the postoperative pain had an acute onset or fluctuated and the regular observations did not allow detection of the pain peaks; or the system used did not measure pain. Therefore, a new and different approach was adopted to evaluate the reliability and validity of a scoring system for the measurement of postoperative pain in small children. MATERIAL. Sixty children classed as ASA I and II and aged between 1 and 5 years were randomly allocated to 2 groups: one group received Tramadol (0.5 mg/kg) after the induction of anesthesia and the other group received placebo. Premedication and anesthesia were standardized. All indications were accepted except for urgent operations and painful diseases. For 1 h after the operation the children were continuously observed by an experienced pediatric anesthetist who did not know what drugs had been given. Every 15 min and when the observer was convinced that the children were in pain and needed analgesics the following items were scaled: wakefulness, wake-up reaction, crying, facial expression, position of the trunk, position of the legs, muscle tone, making contact, verbal communication on being asked about pain, special defense against stimuli and consolability. The items were included in a factor analysis (principal components). The number of the factors was detected using the Scree test. The only items accepted as reliable were those that had a substantial load of at least 0.4 at each measurement. The reliability coefficient was computed with the split-half technique (odd-even). The validity was estimated with a multifactorial analysis of variance with repeated measurements. When the observer was convinced that any child was in pain, Metamizol (15 mg/kg) was administered. Significance was assumed at P less than 0.05. The study was accepted by the ethical committee of the Ruhr University, Bochum. RESULTS. A replication verified the results of the previous study: the factor analysis resulted in a one-factorial solution. Of the 8 items (wakefulness, wake-up reactions, crying, position of the trunk, position of the legs, verbal communications on being asked about pain, special defense against stimuli) only 4 had a sufficiently substantial load on all measurements (crying, facial expression, position of the trunk and position of the legs). (ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Initial results of the reliability and validity of a German-language scale for the quantitative measurement of postoperative pain in young children]. 228 8


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