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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sedation, anesthesia, protection of the airway during general anesthesia, and control of pain in the perioperative period are important considerations in the management of sheep, goats, and cattle. Though ruminants are classically considered farm animals and are often intended for the production of food and fiber, these species are used extensively in research and teaching and they are increasingly important as companion animals. Whatever their use may be, anesthetic and analgesic drugs and techniques should be used to ensure minimal stress and discomfort during the perioperative period.
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PMID:General anesthetic techniques in ruminants. 891 91

Sedation is currently administered to neonates experiencing pain and stress during intensive care for medical diseases, as well as postoperatively. Drugs commonly used for sedation in neonates include benzodiazepines (midazolam and lorazepam), chloral hydrate and opioids (fentanyl and morphine). Sedation protocols and dosage schedules are, in most cases, adapted from those which have been developed in children and even adults. The effectiveness and safety of the sedative agents remain underevaluated, however, due to the difficulties of quantifying pain and stress in neonates, and because of the limited use of validated scoring methods by practitioners. Among the benzodiazepines, midazolam is probably the drug of choice for continuous sedation. However, its elimination is delayed in the neonatal period and hypotension may occur when given as a bolus injection or when taken with opioids. Lorazepam requires further evaluation to exclude severe neurotoxicity. Chloral hydrate is administered orally, but because of its delayed elimination and risk of accumulation, a single administration for short term sedation is recommended. Among opioids, fentanyl (which was initially administered for postoperative analgesia) is now prescribed for sedation during mechanical ventilation. Tolerance and dependence may develop rapidly, limiting its usefulness for prolonged sedation. Although extensively studied in neonates, the efficacy and safety of morphine are not clearly determined, because of the limited number of patients included in individual studies. In addition, important interindividual differences in metabolism render dosage recommendations difficult. Alfentanil and sufentanil need further investigations to define their pharmacokinetic-pharmacodynamic properties in neonates. Although the choice of drug is important, the way the drug is used and monitored is equally important. All the drugs used for the sedation of neonates have large inter- and intraindividual differences in disposition, justifying specific pharmacological knowledge and individual dosage adjustments based on clinical evaluation of the patient and the monitoring of drug concentrations.
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PMID:Clinical pharmacokinetics of sedatives in neonates. 896 56

In this uncontrolled clinical study 12 investigators cooperated to evaluate the analgesic and sedative effect of detomidine (DORMOSEDAN; Farmos Group Ltd; Finland) in 234 horses with abdominal pain caused by colic. The study was designed to use each animal as its own control and to evaluate its response to the drug over a 60 min period. Detomidine was given intravenously (i.v.) once in 169 cases (167 horses, 1 mule, 1 donkey) at a dose of 20 micrograms/kg bodyweight (bwt), and to 65 horses at 40 micrograms/kg bwt. The higher dose was used predominantly in horses with severe pain which were more often in poor health and therefore given a poor prognosis. Sedation and analgesia, rated as satisfactory or highly satisfactory, was achieved in 96 per cent of cases, without obvious differences between doses, sex, breed and species. First clinical signs of sedation and analgesia were recorded within 2.5 and 3.2 mins, respectively, and deep sedation and analgesia were achieved by 4.2 and 5.1 mins. Objective evaluation of analgesia was based on clinical scores related to behaviour (eg sweating, kicking, pawing, head and body movement, stretching, lip curling, attitude and appetite). In five of seven of these parameters the 40 micrograms/kg bwt treatment scored higher initially (P < 0.001) and took longer to return to normal. Although most cases treated with 20 micrograms/kg bwt returned to almost normal levels by 15 mins, those treated with 40 micrograms/kg required 30 mins. Animals not responding to either dose of detomidine went to surgery and/or were destroyed. These involved intestinal strangulation, incarceration, and torsion or rotation of the intestinal tract. No differences were found between doses in the occurrence of side effects. As expected, heart rates and respiratory rates decreased and recovered slowly. Other side effects were recorded in approximately 37 per cent of cases and consisted of instability (27.1 per cent of all other side effects), sweating (14.5 per cent), cardiovascular abnormalities (arrhythmias: 15.1 per cent) and abnormal reactions to sensorial stimuli (6.6 per cent). Less than 20 per cent of the side effects were classified as 'strong' or 'very strong' and none was considered serious. No deaths were attributed to the drug.
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PMID:Field trial evaluation of detomidine as a sedative and analgesic in horses with colic. 911 92

Preoperatively administered midazolam may contribute to postoperative sedation and delayed recovery from brief outpatient general anesthesia, particularly in patients who receive significant postoperative opioid analgesics. We evaluated the effects of midazolam premedication (0.04 mg/kg) on postoperative sedation and recovery times after laparoscopic tubal sterilization (Falope rings) in 30 healthy women in a randomized, double-blind, placebo-controlled study. Patients received midazolam or saline-placebo intravenously 10 min before anesthesia. General anesthesia was induced with fentanyl, propofol, and mivacurium and was maintained with N2O and isoflurane. Sedation was quantified before and after premedication and 15, 30, and 60 min after emergence from anesthesia, using the digit-symbol substitution (DSST) and Trieger dot (TDT) tests. Management of postoperative pain and nausea and discharge criteria were standardized. Groups were similar with respect to age, weight, and duration of surgery and anesthesia. Midazolam was associated with impairment of performance on the TDT and DSST after premedication administration and 15 (TDT and DSST) and 30 (DSST) min after postanesthesia care unit (PACU) arrival. There were no differences in PACU time and time to discharge-readiness. In conclusion, midazolam premedication augments postoperative sedation in this population but does not prolong recovery times.
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PMID:Midazolam premedication increases sedation but does not prolong discharge times after brief outpatient general anesthesia for laparoscopic tubal sterilization. 924 4

The appropriate anesthesia for renal transplantation (RT) requires minimal toxicity for patient and transplant besides of sufficient pain relief and correction of vital functions. Since 1990 for this reason prolonged epidural anesthesia (PEA) was used for 42 RT. The catheterization of epidural space was performed on the spine level Th9-Th12. Lidocaine and Bupivacaine solutions were used for epidural block. Sedation during the operation was performed only with low doses of Diazepam and Sodium Oxybutyrate. After the operation epidural catheters were used for pain relief during 2-5 postoperative days. Less cardiodepressive effect, stable intraoperative hemodynamics and absence of serious post-operative pulmonary complications were observed in patients operated under PEA. Also less toxic action of PEA for recipient as well as for renal allograft was marked. Obtained results show that PEA might be the preferable method for RT due to its lower toxicity, significantly less number of postoperative complications.
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PMID:Renal transplantation--choice of anesthesia. 1279 Aug 18

The goal of this prospective, randomised and double-blind pilot-study was to investigate the analgesic potency and the side-effects of tramadol enantiomers in clinical practice. One hundred patients recovering from orthopaedic surgery with a postoperative pain intensity of more than 50 on a visual analogue scale 0-100 mm (Table 1) were recruited for the study. They were treated in a randomised, double-blind way with a maximal dose of 150 mg i.v.(+)-,(-)-tramadol, racemate, or 15 mg i.v. morphine or saline in the placebo group (5 groups, 20 patients each). The primary criterium of efficacy was the number of responders defined as patients with a pain reduction of at least 20 on VAS after 40 min. In case of pain, responders were allowed to continue with the double-blind drug up to six hours. The non-responders were treated with morphine as the rescue analgesic. The secondary criterium was the incidence and severity of side-effects. Six patients terminated the study prematurely. One patient was excluded because of an allergic reaction to morphine, one patient could not be treated sufficiently with morphine, four were excluded because of protocol violations. There were 8 responders in the (+)-tramadol-,6 in the (-)-tramadol- and 6 in the racemate group, 16* (P < 0.05) in the morphine group, and 5 in the placebo group. Pain intensity after 40 min was reduced by 20 (p < 0.05), 17 (p < 0.05), 17 (p < 0.05), 36 (p < 0.01 vs placebo, p < 0.05 vs (+)-,(-)-tramadol, and racemate group) and 5 mm on the VAS in the (+)-, (-)-, (+/-)-tramadol-, morphine- and placebo-group, respectively. Thirty eight adverse events like nausea, vomiting, PCO2-increase, and urinary retention occurred in 20 patients, most frequently in the (+)-tramadol- and morphine group. Sedation was significantly less profound in the (-)-tramadol group 1-4 h postoperatively. There were no side-effect in the tramadol racemate group. The enantiomers were equal to the racemate in analgesic potency, but inferior by far to morphine. They showed more adverse events and, hence, can not be preferred to the racemate in postoperative pain therapy.
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PMID:[Are tramadol enantiomers for postoperative pain therapy better suited than the racemate? A randomized, placebo- and morphine-controlled double blind study]. 964 78

Colonoscopy is routinely performed with conscious sedation. We wanted to determine if colonoscopy can be successfully completed without sedation and to assess patient tolerance and acceptance. One hundred nine consecutive patients undergoing colonoscopy were examined. The risks and benefits of colonoscopy with or without sedation were explained in a standard format. Patients were then given the option of having colonoscopy without premedication. After the procedure, as well as 2 to 5 days later, patients rated on an analog scale (0, no pain; 5, severe) the severity of pain and willingness to undergo colonoscopy in the future without sedation. Eighty patients underwent colonoscopy without prior sedation. Only 6% (n=5) required sedation to complete the examination. When questioned, 5% experienced no pain, 41% slight or mild pain, 34% moderate pain, and 20% severe pain. Seventy-three percent (n=58) were willing to undergo repeat colonoscopy without sedation, 10% (n=8) were undecided, and 18% (n=14) would request sedation. Pain severity was a strong predictor (p=0.001) of future sedation preference. Colonoscopy without sedation may be completed successfully in most patients and does not undermine many patients' willingness to undergo a similar procedure in the future. Sedation by choice is more cost-effective, may be safer, and should be offered as an alternative to routine intravenous sedation.
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PMID:Colonoscopy without sedation. 964 11

The outcome and costs of testicular sperm extraction under outpatient local analgesia or general anaesthesia were compared in men with non-obstructive azoospermia. Nineteen consecutive patients were allocated to receive general anaesthesia, while the subsequent 21 consecutive patients received outpatient analgesia in the form of i.v. midazolam sedation, lignocaine spray, scrotal infiltration with local anaesthetic and spermatic cord block. Blood pressure, pulse rate and respiratory rate were determined. Sedation and testicular pain were assessed by subjective scoring. Both groups showed haemodynamic stability with little alteration in blood pressure, pulse rate and oxygen saturation. Toxic symptoms of local anaesthetic were not encountered in the outpatient group. No relationship was found between testicular size and the duration of the operation. The median postoperative pain intensity, sedation scores and analgesic requirements were significantly less in the outpatient group (P < 0.05). These advantages led to a shorter recovery time (P < 0.0001), 3-fold cheaper care and greater patient satisfaction (P < 0.0001) in the outpatient group.
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PMID:Morbidity and cost-effectiveness analysis of outpatient analgesia versus general anaesthesia for testicular sperm extraction in men with azoospermia due to defects in spermatogenesis. 1009 72

Sedation in the intensive care unit (ICU) aims to improve patient comfort and facilitate treatment procedures. Most units still rely on a combination of opioid and benzodiazepines with the addition of other drugs for specific requirements. However, the effect of sedative agents in critically ill patients is often unpredictable, so frequent assessment of the depth of sedation is essential to match the depth to patient requirements. In the 1990s, heavy sedation and paralysis is not considered appropriate for many ICU patients; a minimum sedation approach limits cardiovascular or respiratory depression and enables earlier weaning and extubation of patients. Administering sedative agents by continuous infusion is convenient but, unless the level of sedation is reassessed regularly, many patients may become over-sedated. The use of propofol for short-term sedation in ICUs has allowed the maintenance of sedation to continue until just a few hours before extubation but the benefits of propofol for longer-term indications are more debatable. Closer titration of dose and desired effects could also be achieved by a patient-controlled system. The technique may not be suitable for a large number of patients, particularly early in their ICU stay but, for long-term sedation and in the weaning phase--of sedation as well as ventilation--the utility of a drug delivery system truly controlled by the patient should be further explored. The ICU has been succinctly described as an environment in which 'anxiety is prevalent, pain frequent, rest difficult and sleep impossible'. Sedation in the ICU has the double objective of relieving patient distress as well as facilitating treatment procedures.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Controlling sedation rather than sedation controlling you. 1015 May 52

Sedation in the critically ill patient is essential to ensure maximal quality of life in the high-stress environment of the intensive care unit. The main goals of sedation include augmentation of pain control, management of agitation and psychological distress, and improvement of patient tolerance and acceptance of the endotracheal tube and ventilatory support. Ideally, the sedated patient should be asleep yet easily rousable. This is most commonly achieved in practice with a combination of morphine and benzodiazepines although a variety of combinations of drugs have been utilized. Other agents which have been employed include, other opiates such as fentanyl and sufentanil, butyrophenones such as haloperidol, and anesthetics such as propofol. These agents will be reviewed with respect to their role in sedating the critically ill patient.
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PMID:Sedation in the intensive care unit: an overview. 1015 66


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