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)

An up-to-eight-hour lasting anterograde amnesia is achieved by "Rohypnol" i.v. causing no excitation before local anesthesia is given (prolongation by analgetics, anesthetics, neuroleptics). The cardiovascular functions remain stable with spontaneous breathing and preservation of the swallow and coughing reflexes. During the operation the patient is responsive and cooperative. The patient answers all questions, moves his body into any wanted position and when ordered he performs Valsalva's manoeuver without any remembrane. If not spoken to and having no pain he falls asleep right away. Postoperative vomiting is reduced. The patient feels relaxed after waking up. No complications have been noticed during more than 500 operations. The later questioning of all patients showed only 4 patients (with unsufficient preoperative sedation) who could remember part of the terminal phase of the operation.
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PMID:[Prolongated amnesia after "rohypnol" i.v. before local anesthesia and responsiveness during operation (author's transl)]. 1 38

The speed, side effects and cardiovascular changes associated with anaesthetic induction and endotracheal intubation following alfentanil (20 micrograms/kg/min, IV), thiopental (84 micrograms/kg/min, IV), etomidate (5 micrograms/kg/min, IV) and midazolam (20 micrograms/kg/min, IV) prior to halothane-nitrous oxide general anaesthesia were evaluated and compared in 80 patients undergoing elective general surgical operations. Anaesthetic induction was fastest with etomidate and thiopental (approximately one minute) and slowest with midazolam (about two minutes). Systolic arterial blood pressure (SBP) was decreased at the moment of unconsciousness with thiopental but unchanged with the other compounds. Heart rate (HR) was increased at unconsciousness with midazolam and thiopental but unchanged with etomidate and alfentanil. After intubation HR was increased in all groups except those induced with alfentanil. Arrhythmias were infrequent (5 per cent or less in all groups). Rigidity during induction only occurred with alfentanil (55 per cent) and pain on injection only with etomidate (35 per cent) and alfentanil (5 per cent). Postoperative vomiting was infrequent in all groups (15 per cent) except etomidate (55 per cent). No patient remembered any aspect of laryngoscopy or the operation and all rapidly regained consciousness at the end of operation. The results of this study demonstrate that with the exception of rigidity (which is easily overcome with succinylcholine) and a slightly slower onset of action, alfentanil compares favourably as an induction agent with thiopental and is better than midazolam and etomidate. Alfentanil is superior to all three other induction agents with respect to cardiovascular stability during induction and intubation.
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PMID:Anaesthetic induction with alfentanil: comparison with thiopental, midazolam, and etomidate. 640 82

Postoperative vomiting is induced by different mechanisms such as age, anaesthetic technique and medications, postoperative analgesia, and surgical traction on the extra-ocular muscles. The influence of anticholinergic premedication and the use of benzodiazepines as factors affecting the incidence of vomiting is controversial. In a prospective, randomised, single-blind study we examined two different treatments with regard to postoperative pain, vigilance, and vomiting in young children undergoing strabismus repair. METHODS. After institutional ethical committee approval, informed written consent was obtained from all parents. The children were randomly assigned to three groups: (1) paracetamol (P)--17 patients who received 250-500 mg paracetamol rectally (dependent on body weight) immediately after intubation of the trachea; (2) bupivacaine (B)--17 patients who received two drops 0.5% bupivacaine hydrochloride on the conjunctiva of the eye(s) being corrected following intubation of the trachea and again 10 min after intubation. After the surgeon had exposed the extra-ocular muscle and before readaptation of the conjunctiva, two drops of the same solution were applied again each time directly on the muscle; and (3) controls (C)--16 patients who received rectal paracetamol after completion of the operation but before extubation. The children were premedicated with 0.05 mg/kg flunitrazepam sublingually. After 0.25 mg atropine i.v., anaesthesia was induced with 0.1 mg/kg vecuronium, 5 mg/kg thiopentone, 1.5 vol% enflurane, and N2O/O2 50:50. When the trachea was intubated anaesthesia was maintained with enflurane as required and 70% N2O in oxygen. Extubation was performed only if the patient could touch or did not tolerate the tube. Oral diet was allowed 6 h after extubation at the earliest. EXAMINATION OF VIGILANCE AND ANALGESIA. The degrees of vigilance and pain were evaluated preoperatively and after extubation over 24 h using two different scales. Evaluation of the scales was performed during the first 3 postoperative h at 12 different time points (Figs. 1, 2) and 6, 12, and 24 h after extubation. The evaluation was conducted by nursing staff who were blinded to the treatment (single-blind study). Postoperative analgesia consisted of 250-500 mg rectal paracetamol (all patients). Parametric data were expressed as mean +/- SD, and comparisons were made with the one-way analysis of variance. Fisher's exact test was applied to ordinal data. P < 0.05 indicates a statistically significant difference. RESULTS. Two patients (P) were excluded from the study postoperatively because of refusing rectal paracetamol in spite of pain and postoperative infection of the upper airways, which had manifested on the afternoon of the operative day. No significant differences were found between the three groups in patient characteristics (Table 1). The quantity of enflurane administered, rate, postoperative consumption of rectal paracetamol, and postoperative emesis were highest in the control group (Tables 2, 3), but the incidence of postoperative vomiting ranged only between 13% and 24% (Table 3). Children with preoperative paracetamol needed more time to fulfill the criteria to "stick out the tongue" and "recognising the mother". VIGILANCE. The time to postoperative crying or screaming and restlessness was shorter in the control group. The values reached significant difference at 10 min (P) and 25 min (P and B) after extubation compared with the other groups (Fig. 1). ANALGESIE. At 5, 10, and 150 min after extubation pain was significantly higher in patients in the control group (Fig. 2). CONCLUSIONS. Intraoperative administration of rectal paracetamol or topical 0.5% bupivacaine was most effective in the treatment of postoperative pain for strabismus surgery in younger children. Sublingual flunitrazepam and i.v. atropine given as premedication probably decrease postoperative vomiting.
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PMID:[Strabismus surgery in children. The effect of paracetamol and bupivacaine]. 761 77

The purpose of this study was to compare the side effects and efficacy of equianalgesic doses of morphine (M) and butorphanol (B) in children undergoing similar surgical procedures associated with moderate postoperative pain. We studied 156 healthy children aged 1.5-13 yr who underwent elective inguinal herniorrhaphy or orchidopexy. After induction of anaesthesia subjects were given 150 micrograms.kg-1 M or 30 micrograms.kg-1 B following a randomized, stratified, blocked and double-blind design. A standardized anaesthetic was administered, which included 1.5% halothane, vecuronium, droperidol and mechanical ventilation. The postsurgical four-hour follow-up included assessment of pain, vomiting and respiratory depression. Pain was assessed with mCHEOPS and analgesics were administered when indicated in the recovery room. Each opioid was administered to a group of 78 patients. Within each group, 25 subjects had an iv induction, 21 children had an orchidopexy and 57 had inguinal hernia repairs. The groups were similar with respect to age, weight, and length of surgery. The choice of opioid did not affect recovery times from anaesthesia. Analgesic requirements were similar among the groups. Ten minutes after arrival in the recovery room the B-subjects had a lower pain score than the M-patients. Postoperative vomiting was less among the B-subjects: 14% vs 28%, P = 0.03. Two M-patients required an unscheduled admission to hospital because of vomiting. It is concluded that butorphanol has few advantages over morphine in the population studied.
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PMID:Butorphanol: an opioid for day-care paediatric surgery. 762 27

The past decade has witnessed the introduction of several significant innovations to combat POV, particularly the introduction of serotonin antagonists and the use of combinations of drugs for analgesia and control of POV. Based on current knowledge, the anaesthetic plan for a patient with a previous history of severe PONV and undergoing a procedure known to be associated with a high incidence of this problem should include premedication with a benzodiazepine and/or clonidine and the preferential use of regional anaesthetic techniques. If general anaesthesia is essential, anaesthetists should consider the use of propofol for both induction and maintenance of anaesthesia, together with avoidance of nitrous oxide, opioids and neuromuscular antagonists. Pain control is extremely important, and a peripheral regional block should be used if possible. A combination of prophylactic antiemetics such as dexamethasone, a 5-HT3 antagonist and an antiemetic of a different class (e.g. perphenazine or dimenhydrinate) should be administered. Non-pharmacological measures such as acupressure and suggestion should also be considered, together with nursing measures to avoid sudden movement from one position to another during the postoperative period. A quiet environment, adequate i.v. fluids and not forcing the patient to drink before discharge all contribute to decreased emesis. It is possible that the advent of a new class of antiemetic agents, the NKI antagonists, may have major effects on the incidence of this complication. Drugs in this group differ from other currently available drugs in having the ability to effectively block the emetic response to many stimuli in experimental animals. Postoperative vomiting remains a significant problem, resulting in patient suffering and prolonged recovery from anaesthesia. Our aim should be to eliminate this complication in all children who require surgery. It should not be considered merely as the 'big, little problem'.
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PMID:Postoperative nausea and vomiting in paediatric patients. 1061 38

Postoperative vomiting is a common and unpleasant complication. The purpose of the present study was to verify if dexamethasone reduces the incidence of vomiting when injected IV in children anaesthetized with halothane for common paediatric operations. We also studied the incidence of vomiting when sevoflurane was used instead. Five hundred and 69 boys, aged 2-12 years (ASA physical status I, II), scheduled for inguinal field surgery were randomly assigned to receive halothane, halothane and dexamethasone and sevoflurane in three groups: halothane (n=180), halothane and IV dexamethasone (n=188) and sevoflurane (n=201). Anaesthesia was induced by inhalation of halothane or sevoflurane in oxygen and nitrous oxide and was maintained at minimum alveolar concentration of each agent throughout the surgery. For intra- and postoperative pain control iliac crest block was used in all the boys. Vomiting was defined as any expulsion of liquid gastric contents. The incidence of postoperative vomiting was 23% in the halothane group, which was significantly greater than that in the other groups (halothane and dexamethasone group, 9%; sevoflurane group, 13%). In conclusion, dexamethasone reduces the incidence and frequency of multiple emetic episodes when administered intravenously after halothane anaesthesia; sevoflurane reduces the overall incidence of vomiting, but not multiple emetic episodes.
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PMID:Vomiting and common paediatric surgery. 1111 97

We evaluated the effectiveness of a multifaceted general anesthesia protocol designed to minimize postoperative vomiting after pediatric eye surgery. A convenience sample of 150 consecutive children, aged 2 weeks to 18 years, who received general anesthesia for pediatric ophthalmic surgery was studied. General anesthesia was administered with induction by mask for 82.7% of the children and intravenously using propofol in 17.3% of the children. Anesthesia was maintained using halothane or isoflurane, oxygen, and air mixture for all patients. Morphine sulfate was used for additional pain relief, up to 0.1 mg/kg. Gastric aspiration was performed after intubation for each child. Metoclopramide, 0.15 mg/kg, and 0.1 mg/kg of ondansetron were administered before the end of each operation. Postoperatively, patients were monitored for vomiting for 24 hours. Postoperative vomiting occurred in 11 (7.3%) of 150 cases. Acute elevation of intraocular pressure was found in 5 of the 11 children who vomited. This vomiting was unresponsive to intravenous rescue ondansetron, but responded to lowering the intraocular pressure. The incidence of postoperative vomiting after general anesthesia for pediatric eye surgery can be substantially decreased by adopting a protocol designed to lessen the emetic effects of general anesthesia. Limited use of nitrous oxide for mask induction only, gastric emptying, and administration of metoclopramide and ondansetron intravenously in combination proved effective in reducing the incidence of postoperative vomiting.
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PMID:Prevention of vomiting after general anesthesia for pediatric ophthalmic surgery. 1175 37

Nausea and vomiting is a relevant and common problem with unfavourable sequelae in children undergoing some plastic surgery procedures. There is a lack of anti-emetic trials performed in children, with only a few investigating the roles of the older anti-emetic agents such as cyclizine compared with newer ones such as ondansetron. This randomised, controlled, double-blind study examined the effectiveness of a single dose of ondansetron (0.1 mg x kg-1), cyclizine (20 mg) and placebo (normal saline) in the prevention of postoperative nausea and vomiting in 150 children (mean age 3.6 years) undergoing plastic genitourinary procedures. Rates of previous postoperative nausea and vomiting and motion sickness were comparable across the groups. Postoperative vomiting was significantly reduced with ondansetron prophylaxis (p = 0.006) but there was no detectable anti-emetic effect with cyclizine. Furthermore, cyclizine caused pain on injection (p < 0.001).
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PMID:A comparison of cyclizine, ondansetron and placebo as prophylaxis against postoperative nausea and vomiting in children. 1461 47

BACKGROUND Lidocaine is widely used as a general and local anesthetic in minor or major surgeries. The objective of the study was to compare postoperative pain relief and adverse events using different forms of lidocaine administration in patients following closed nasal bone reduction surgery. MATERIAL AND METHODS A total of 381 patients with a solitary nasal fracture that could be managed with closed reduction were included in this study and divided into 3 groups of 127 patients in each group. Patients had received 1% lidocaine HCl with epinephrine (LL group), inserted a mesh impregnated with lidocaine spray (TL group), or 1 mg/kg/h lidocaine infusion (GL group) before surgeries. Patients also received morphine when the pain was not controlled. The postoperative pain was assessed at 6 hours and 48 hours after surgery. Postoperative vomiting and nausea were evaluated. Repeated ANOVA/Tukey-Kramer multiple comparisons test was performed at 95% confidence level. RESULTS At 6 hours after surgery, patients in the general lidocaine (GL) group reported decreased postoperative pain compared with those in the topical lidocaine (TL) group (P<0.001, q=6.633) and LL group (P<0.001, q=8.056). The morphine consumption within 48 hours was least in GL group than TL group (P<0.001, q=172.9) and LL group (P<0.001, q=226.42). Lidocaine infusion caused nausea (P<0.001, q=6.742) and vomiting (P<0.001, q=4.306). CONCLUSIONS Topical lidocaine anesthesia had the same postoperative pain relief and the least adverse events as local and general lidocaine anesthesia.
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PMID:Comparison of Efficacy Outcomes of Lidocaine Spray, Topical Lidocaine Injection, and Lidocaine General Anesthesia in Nasal Bone Fractures Surgeries: A Randomized, Controlled Trial. 2994 61