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)

Lorazepam, a new benzodiazepine, was compared with morphine for premedication. Ten patients received morphine 10 mg/70 kg i.m. and 10 received lorazepam 4 mg/70 kg i.m. Respiratory effects were assessed from the change in slope (S) and intercept (B) of the carbon dioxide response line, using a development of Read's rebreathing method. Morphine depressed S by 47% (P less than 0.01), but after lorazepam S increased by 27% (P less than 0.05), neither drug altering B significantly. In two volunteers lorazepam was assessed by both the rebreathing and the steady-state methods; after lorazepam S was smaller by the steady-state than by the rebreathing technique. The findings for lorazepam are consistent with the known effects of sleep on carbon dioxide sensitivity. Amnesia lasting 4-8 h occurred in all patients who received lorazepam so that pain and nausea during this period were not recalled, but no patient who received morphine experienced amnesia. We conclude that lorazepam merits further study, particularly where sedation without respiratory depression is needed, as in obstetrics, and where amnesia for uncomfortable procedures is required.
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PMID:Respiratory effects and amnesia after premedication with morphine or lorazepam. 1 25

For centuries, surgical technics have included sharp metal instruments for incisions and dissections together with time-consuming clamping and tying of vessels with associated blood loss. The CO2 laser presents the first major change in these basic technics. Our brief experience with the Sharplan 791 indicates consistently marked reduced blood loss, less postoperative edema, and less postoperative pain with no increased risk to the patient and no compromise in the end results. Admittedly, much more investigation is necessary to determine its full potential, and perhaps its contraindications. However, it would appear at this time that the proper use of this new modality should be incorporated into our armamentarium of tools for plastic surgical advantages consistent with sound surgical judgment.
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PMID:The use of the carbon dioxide laser in plastic surgery. 32 7

1. Radiant-heat stimuli of different intensities were delivered every 28 s to the thenar eminence of the hand of human subjects and to the receptive fields (RFs) of 58 "mechanothermal nociceptive" and 16 "warm" C-fibers, most of which innervated the glabrous skin of the monkey hand. A CO2 infrared laser under control via a radiometer provided a step increase in skin temperature to a level maintained within +/- 0.1 degrees C over a 7.5-mm-diameter spot. 2. Human subjects categorized the magnitude of warmth and pain sensations evoked by stimuli that ranged in temperature from 40 to 50 degrees C. The scale of subjective thermal intensity constructed from these category estimates showed a monotonically increasing relation between stimulus temperature and the magnitude of warmth and pain sensations. 3. The mechanothermal fibers had a mean RF size of 18.9 +/- 3.2 mm2 (SE), a mean conduction velocity of 0.8 +/- 0.1 m/s, mean thresholds of 43.6 +/- 0.6 degrees C for radiant heat and 5.95 +/- 0.59 bars for mechanical stimulation, and no spontaneous activity. In contrast, warm fibers had punctate RFs, a mean conduction velocity of 1.1 +/- 0.1 m/s, heat thresholds of less than 1 degrees C above skin temperature, no response to mechanical stimulation, and a resting level of activity in warm skin that was suppressed by cooling. 4. The cumulative number of impulses evoked during each stimulation in the nociceptive afferents increased monotonically as a function of stimulus temperature over the range described by humans as increasingly painful (45-50 degrees C). Nociceptive fibers showed little or no response to stimulus temperatures less than 45 degrees C that elicited in humans sensations primarily of warmth but not pain. In contrast, the cumulative impulse count during stimulation of each warm fiber increased monotonically with stimulus temperature over the range of 39-43 degrees C. However, for stimuli of 41-49 degrees C the cumulative impulse count in warm fibers was nonmonotonic with stimulus temperature. Warm-fiber response to stimuli of 45 degrees C or greater usually consisted of a short burst of impulses followed by cessation of activity. 5. The subjective magnitude of warmth and pain sensations in humans and the cumulative impulse count evoked by each stimulus in warm and nociceptive afferents varied inversely with the number, delivery rate, and intensity of preceding stimulations. 6. The results of these experiments suggest the following: a) that activity in the mechanothermal nociceptive C-fibers signals the occurrence of pain evoked by radiant heat, and that the frequency of discharge in these fibers may encode the intensity of painful stimulation; b) that activity in warm fibers may encode the intensity of warmth at lower stimulus temperatures, but is unlikely to provide a peripheral mechanism for encoding the intensity of painful stimulation at higher stimulus temperatures.
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PMID:Comparison of responses of warm and nociceptive C-fiber afferents in monkey with human judgments of thermal pain. 41 56

O2 and CO2 tensions were measured in the gastrocnemius muscles of patients submitted for reconstructive arterial surgery due to obstructive arteriosclerosis (37) or abdominal aortic aneurysm (5). Four patients without signs of arterial ischaemia served as controls. Measurements were carried out by means of implanted silastic tonometers during breathing of air and 100% O2 and immediately after walking on a treadmill. Peripheral blood pressures in the ankles were recorded with a Doppler apparatus. Baseline tissue gas tensions showed no essential differences between the various groups of patients: intermittent claudication, pain at rest, praegangrene, abdominal aortic aneurysm and controls. In contrast, baseline ankle pressures correlated well with the severity of the disease. During breathing of oxygen, the smallest increases of muscle PO2 were observed in extremities with pain at rest or praegangrene and the highest responses were recorded in controls and aneurysm patients. Muscle PCO2 values showed no alterations during oxygen breathing. In physical exercise, muscle PO2 and PCO2 levels as well as ankle blood pressures remained unchanged in controls and patients with aneurysm but no claudication. However, in all groups with arterial ischaemia, the exercise test resulted in a profound fall of muscle PO2 and ankle blood pressure and an increase of muscle PCO2.
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PMID:Tissue gas tensions in the calf muscles of patients with lower limb arterial ischaemia. 43 76

Content and biosynthesis of glycogen in rat liver tissue as well as transition of 14C from main substrates of tricarboxylic acid cycle to CO2, examined in liver slices, were studied under conditions of stress caused by pain and emotion. The stress was accompanied by mobilization of the glycogen deposits; glycogen synthesis in liver tissue and oxidation of pyruvate, asparate succinate or alpha-ketoglutarate in tricarboxylic acid cycle were inhibited. At the same time, the stress was accompanied by ulcerous impairments of gastric mucosa. The phenomena observed appear to be due to increased activity of adrenergic and sympathoadrenal systems. Prior to the stress administration of sodium gamma-hydroxybutyrate, which activates the inhibitory GHB-ergic system of brain, prevented distinctly the impairments found.
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PMID:[Hepatic energy metabolism disorders in emotionally-painful stress and prevention of these disorders with sodium gamma-hydroxybutyrate]. 56 22

Experiences with 70 CO2-laser procedures are reported. 39 operations were performed in the larynx, 7 in the pharynx, 4 in the oral cavity; 19 were tonsillectomies and 1 the excision of an exophytic skin tumor. The advantages of the CO2-laser-surgery are: minimal hemorrhage during surgery, excellent visibility in the operative field, slight postoperative edema and reduced postoperative pain. Surgery with the CO-2-laser beam is best performed for the following indications: endolaryngeal microsurgery, procedures in highly vascularized organs (tongue) or on well vascularized tumors (hemangioma), operations in hemophiliacs.
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PMID:[Experiences with CO2-laser-surgery in otorhinolaryngology (author's transl)]. 57 58

To investigate the antagonistic effect of naloxone on fentanyl-induced respiratory depression, 55 patients (randomly divided into various study and control groups were studied during nitrous-oxide-oxygen-halothane anaesthesia. Respiratory depression after 0.1 mg of fentanyl was totally reversed by 10 microgram/kg of naloxone, measured as 100% restoration of spontaneous respiration, normal minute volume and end-tidal CO2, while 15 microgram/kg of naloxone was needed to antagonize 0.2 mg of fentanyl. The respective control groups remained apnoeic. If no fentanyl had previously been administered, there was no difference in the respiratory behaviour of naloxone-treated and control patients, which indicates that no unspecific analeptic effect of naloxone could be demonstrated. The circulatory changes after fentanyl were nearly reversed by naloxone, as has been found earlier with other narcotics. Recovery from anaesthesia was scored from 0 to 10 (using a modification of Apgar scores for newborns), and somewhat higher mean scores were obtained with the naloxone-treated patients than with their controls. However, higher postoperative pain scores were recorded in these patients as well as a higher incidence of nausea and vomiting. The study demonstrates the dose-relationships of fetanyl and naloxone for estimation of total antagonism; however, the use of naloxone for partial antagonism at the termination of anaesthesia cannot be based on these findings.
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PMID:Antagonism of fentanyl with naloxone during N2O+O2+ halothane anaesthesia. 60 61

Different modes of naloxone administration were studied in 100 patients following N2O-O2-relaxant anaesthesia, where fentanyl was administered for analgesia according to a standardized dose schedule (mean 4.3 microgram/kg/h). After reversal of muscular relaxation, the patients were randomly given naloxone--either 1.0 or 2.5 microgram/kg i.v. or 2.5 or 5.0 microgram/kg i.m., or none (control). Each group consisted of 20 patients. Awakening was fastest after 2.5 microgram/kg i.v. of naloxone (1.8 +/- 0.1 min), the time being significantly shorter (P less than 0.025) than in the control group (2.7 +/- 0.4 min). After 15 min, the minute volume and frequency of respiration were significantly higher (P less than 0.05) in all naloxone groups than in the control group. However, the arterialized venous PCO2 did not show significant differences during the recovery. It is therefore suggested that naloxone reversal may cause an increase in CO2 production. The immediate postoperative pain (score 0-3) was mildest in the control group (1.0 mean) and severest after 2.5 microgram/kg i.v. of naloxone (1.8 mean); the difference was statistically significant (P less than 0.05). The groups receiving 1.0 microgram/kg i.v. and 2.5 microgram/kg i.m. did not differ from each other (1.2 mean). Nausea and vomiting were reported more often after 5.0 microgram/kg im. of naloxone than in other groups. After moderate doses of fentanyl during balanced anaesthesia, routine use of naloxone does not seem to be necessary, but if rapid recovery is essential, 1.0 microgram/kg i.v. or 2.5 microgram/kg i.m. of naloxone may be recommended and these doses do not cause a higher incidence of side effects.
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PMID:Naloxone as narcotic antagonist after balanced anaesthesia. 60 62

Artifacts in CO2 tension measurements owing to heparin dilution are eliminated by use of a sampling device employing crystalline heparin. The absence of a plunger and the low resistance to filling allows the use of small, 23- or 25-guage needles, thus reducing pain during arterial puncture and hematoma formation.
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PMID:A new device for arterial blood gas sampling. 64 34

Twenty patients with a mean age of 79 years were followed over a period of 6 months after intra-arterial insufflation of CO2 in the lower extremity. All patients had severe peripheral occlusive arterial disease caused by atherosclerosis and were scheduled for amputation. A significant increase of the distal perfusion pressure was obtained in the majority of the cases resulting in pain relief and healing of ulcers and gangrenes.
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PMID:Effect of intra-arterial CO2 insuffflation on occlusive arterial disease in the lower leg. 73 39


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