Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0030201 (Postoperative pain)
 1,085 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To study the significance of normalization of ventilatory or thermal homeostasis during naloxone reversal, 95 patients were given naloxone after thiopental-N2O-O2-relaxant anaesthesia supplemented with fentanyl (6 microgram/kg/h). If naloxone 0.16 mg was given to combat postoperative apnoea during hypercapnia (end tidal carbon dioxide concentration (ETco2)8%), minute ventilation and respiratory rate were significantly higher during the first minutes as compared to the normocapnic patients. Shivering occurred in 44% in the hypercapnic group, as compared to about 30% if naloxone was given during normocapnia (ETco2 5%). Postoperative pain and restlessness were significantly increased in the hypercapnic group. During normocapnia, untoward reactions were less frequent (40%) if naloxone was given in smaller increments (0.08 + 0.08 mg) rather than in one dose (0.16 mg) (72%). This was mainly due to nausea (8% compared to 32%). The incidence and severity of shivering showed a positive correlation to the duration of anaesthesia (r = 0.42) and to the total amount of fentanyl (r = 0.32), but not to the actual postoperative oesophageal temperature (r = -0.13). The results indicate that though untoward reactions after naloxone reversal are aggravated by naloxone-induced normalization of deranged homeostatic mechanisms, their aetiology probably should be sought in an acute abstinence syndrome.
 ...
PMID:Restlessness and shivering after naloxone reversal of fentanyl-supplemented anaesthesia. 42 15

In view of the increasing development of laparoscopic surgery and hoping to minimize thoracotomy's risks, we had the idea to perform pleurectomy as a treatment of Spontaneous Pneumothorax (S.P.) through video thoracoscopy. The operation was performed under general endobronchial anesthesia, the patient placed in the posterolateral thoracotomy position. Three trocars inserted through the 5th, 7th and 9th intercostal space, allowed the introduction of non specific thoracoscopic instruments similar to those used in laparoscopic surgery. The apical pleurectomy was delimited by the 6th rib, the internal thoracic vessels, the costovertebral sulcus and the first rib. Blebs and small bullae are now transected with application of the "EndoGIA 30". Pleural cavity was drained by F28 ans F32 tubes through the lower orifices. This procedure was performed in 18 patients presenting 20.S.P.. Operative indications were: persistent air link (7 cases), recurrence (9 cases), bullae with bridle and or anterior thoracotomy for S.P. (4 cases). One bleeding of 200 ml from a wounded intercostal vessel ligated with a clip was the sole operative hitch. Operative duration decreased from two to one hour. Average drainage duration was 3.5 dys and hospital stay 4.5 days. There was no death nor immediate complications. Post-operative pain was judged in all cases less intensive than that experienced after pleurectomy with thoracotomy. This original procedure is the first described as entirely performed through thoracoscopy with non specific instruments and hence economic impact.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Upper parietal pleurectomy with resection of bullae by thoracoscopy in spontaneous pneumothorax. New perspectives from preliminary results in 20 cases]. 130 25

From 1974 to 1988, 868 open palm and/or finger operations were carried out by a surgeon at the SOS Main emergent hand surgery unit in Strasbourg. Out of these, 107 patients making up 140 fingers were seen again after a period of more than 5 years. The essential advantage of the method is the low rate of postoperative complications relative to the other methods involving skin closure. All patients had an ambulatory treatment with regional anesthesia. The palm was opened in 85% of cases, and both the palm and the base of the fingers in 14%. The average healing time was 26 days, with an average sick leave of 28 days. Postoperative pain was noted in 20% of cases, requiring medication in 10% for an average of 3 days. Postoperative bleeding requiring new dressing occurred in one case, after the patient had already been discharged (0.7%), while 3.5% of all patients had anticoagulants. No hematoma and no flap necrosis were noted, and temporary dysesthesia was noted in 4.6% of cases, nerve involvement in 3.1%, and neurovascular dystrophy in 7%, including 4 only with a functional deficit (2.8%). On the other hand, results after 5-6 years are similar to those of selective aponeurectomies published in the literature, with frequent recurrence (40.6%, including 23% severe enough to require second surgery). Extension was noted in 39% of all cases, and the total activity of the disease was present in 55% of all studied hands.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:["Open palm" technique in Dupuytren's disease. Postoperative complications and results after more than 5 years]. 133 28

Prophylactic administration of analgesics before surgery can decrease the intraoperative anaesthetic requirement and decrease pain during the early postoperative period. In a double-blind, placebo-controlled study involving 90 healthy ASA physical status I or II children undergoing bilateral myringotomy, we compared the postoperative analgesic effects of oral acetaminophen and ketorolac, when administered 30 min before induction of anaesthesia. Patients were randomized to receive saline (0.1 ml.kg-1), acetaminophen (10 mg.kg-1) or ketorolac (1 mg.kg-1) diluted in cherry syrup to a total volume of 5 ml. Anaesthesia was induced and maintained with halothane and nitrous oxide via a face mask. Postoperative pain was assessed by a blinded observer using an objective pain scale. The three study groups were similar with respect to demographic data, duration of anaesthesia and surgery, induction behaviour, oxygen saturation, incidence of postoperative emesis and, recovery times. The ketorolac group had lower postoperative pain scores and required less frequent analgesic therapy in the early postoperative period compared with the acetaminophen and placebo groups. In contrast, there were no differences in pain scores or analgesic requirements between the acetaminophen and the placebo groups. We conclude that the preoperative administration of oral ketorolac, but not acetaminophen, provided better postoperative pain control than placebo in children undergoing bilateral myringotomy.
 ...
PMID:Perioperative effects of oral ketorolac and acetaminophen in children undergoing bilateral myringotomy. 139 50

Twenty-eight patients scheduled for lung resection with lateral thoracotomy and postoperative chest drains during combined thoracic epidural bupivacaine plus morphine and general anaesthesia were studied. Postoperative pain treatment was continuous epidural infusion of bupivacaine 0.25% 5 ml h-1 plus morphine 0.2 mg h-1 for 48 h and, in addition, the patients received rectal piroxicam 40 mg randomly and double-blind 12 h and 1 h before surgery and 20 mg 24 h-1 postoperatively or placebo. Pain was evaluated at rest, during cough and mobilisation, together with pulmonary function (FEV1, FVC, PEFR) and sensory level of analgesia repeatedly for 48 h. The results showed efficient pain relief, but without differences in pain scores or need for supplementary analgesics between the two groups. Pulmonary function decreased similarly in the two groups. Thus we were unable to show enhanced analgesia by supplementing an otherwise effective low-dose epidural bupivacaine and morphine treatment with piroxicam after thoracic surgery with chest drains.
 ...
PMID:Effect of piroxicam in addition to continuous thoracic epidural bupivacaine and morphine on postoperative pain and lung function after thoracotomy. 821 34

This study evaluates the reliability and validity of the Toddler-Preschooler Postoperative Pain Scale (TPPPS), an observational scale developed to be a clinically useful measure of postoperative pain in children aged 1-5 years. The TPPPS consists of 7 items divided among 3 pain behavior categories: (1) Vocal pain expression; (2) Facial pain expression; and (3) Bodily pain expression. These items were derived from preliminary studies by the authors and from other observational studies of children's pain behavior. Seventy-four children between the ages of 12 and 64 months seen for inguinal hernia or hydrocele repair were the subjects of the study. Subjects were observed postoperatively for six 5-min intervals, commencing with their awakening from anesthesia, using the TPPPS. Two raters independently observed 28 of the children to assess inter-rater reliability. Validity was assessed by relating TPPPS scores to the timing and type of analgesics used, visual analog and numerical scale pain ratings made by parents and nurses, and perioperative vital signs. The TPPPS was found to possess satisfactory internal reliability (Cronbach's alpha = 0.88). Inter-rater reliability was good, with kappas for the pain behavior items ranging from 0.53 to 0.78. Preliminary evidence of the scale's validity is provided by the sensitivity of the scale to analgesic regimen, the convergence between TPPPS scores and nurse and parent ratings of postoperative pain, and the associations found between TPPPS scores and perioperative vital signs.
 ...
PMID:The Toddler-Preschooler Postoperative Pain Scale: an observational scale for measuring postoperative pain in children aged 1-5. Preliminary report. 145 84

A study of the duration of analgesia and of the respiratory response to hypercapnia was carried out in 14 children who had had a caudal block with either bupivacaine alone (group B) or combined with fentanyl (Group B+F). Fourteen ASA I or II 5 to 10-year-old children undergoing genital and urinary surgery were included. They were not premedicated. At first, general anaesthesia was induced with halothane and nitrous oxide in oxygen. Thereafter, caudal anaesthesia was then carried out with 1 ml.kg-1 of 0.25% bupivacaine with adrenaline 1 in 200,000. Group B+F patients were also given 1 microgram.kg-1 of fentanyl in 1 ml of normal saline, and those in Group B 1 ml of normal saline. The level of sensory loss on leaving the operating theatre as well as the duration of motor paralysis were monitored. Postoperative pain was scored with Hannalah and Broadman's score (0 to 10) 2, 4, 8 and 24 h after the caudal block. Respiratory rate (fR), tidal volume (VT) and minute ventilation (VE) were assessed 10 min before induction of general anaesthesia, and 30, 60 and 120 min after the caudal anaesthesia. Petco2 was also measured before induction of general anaesthesia, and 60 and 120 min after caudal anaesthesia; at the same times, the ventilatory response to hypercapnia was assessed using Read's method with a Douglas bag containing 7% CO2 and 93% O2.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Caudal block in children: analgesia and respiratory effect of the combination bupivacaine-fentanyl]. 150 85

The analgesic efficacy, side effects, and satisfaction of patient-controlled analgesia (PCA) with intravenous and epidural morphine for postoperative pain were evaluated in this study. Twenty patients undergoing major joint replacement surgery were randomly allocated to intravenous PCA (IPCA) group or epidural PCA (EPCA) group. All patients had a standardized balanced anesthesia, and an epidural catheter was introduced after the operation in EPCA group. Postoperative pain relief was evaluated with verbal pain scale. The result showed that pain intensity and pain relief were similar in either group without significant difference (p greater than 0.05). Morphine consumption in IPCA group was 1.72 +/- 0.30 mg/h in the postoperative 0 - 12 h and 1.14 +/- 0.44 mg/h in 12 - 24 h. In EPCA group, relatively low doses of morphine were used, i.e., 0.20 +/- 0.07 mg/h in the postoperative 0 - 12 h and 0.17 +/- 0.07 mg/h in 12 - 24 h. Both groups showed an "incomplete" but satisfactory analgesia with relatively low doses of morphine. The "equianalgesic dose ratio" of IPCA to EPCA with morphine was approximately 8.5:1. Sedation was minimal in both groups. No respiratory depression developed in all patients. Nausea and vomiting were the most prominent side effects which might limit the usefulness of PCA. The incidence was 5 out of 10 patients in IPCA group and 4 out of 10 patients in EPCA group, despite under the treatment of droperidol (15 micrograms/kg, iv, prn) for most of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Patient-controlled intravenous versus epidural analgesia after major joint replacement]. 152 2

The aim of the present investigation was to study the effects of intraoperative and postoperative epidural pain management during and after coronary artery bypass grafting (CABG) on the recovery time, postoperative pulmonary and cardiac parameters, visual analog scale (VAS) scores, and sedation scores (SS) compared with patients anesthetized with general anesthesia (GA) whose postoperative pain was relieved with intermittent intravenous (IV) administration of nicomorphine. Fifty-four patients were studied postoperatively after uncomplicated CABG. In the thoracic epidural analgesia (TEA) group (n = 27), intraoperative analgesia was based on high TEA in combination with GA. In the GA group (n = 27), IV anesthesia with high-dose sufentanil and midazolam was used. Postoperative pain management in the GA group consisted of intermittent IV administration of nicomorphine, 0.1 mg/kg every 6 hours, whereas for the TEA group continuous high TEA with 0.125% bupivacaine plus sufentanil, 1:1,000,000 (0.05 mL/cm body length/hr) was used. Patients in the TEA group awakened earlier (148 [34] minutes vs 335 [51] minutes), resumed spontaneous respiration earlier (326 [79] minutes vs 982 [52] minutes), and were extubated earlier (463 [79] minutes vs 1140 [58] minutes). VAS score, SS, and postoperative PaO2 were significantly (P less than or equal to 0.01) better in the TEA group. The incidence of tachycardia (15 vs 2 patients) and postoperative myocardial ischemia (12 vs 4 patients) was higher in the GA group. It is concluded that intraoperative and postoperative pain treatment with epidurally administered bupivacaine plus sufentanil improved the recovery time, as well as pulmonary and cardiac outcome after CABG, when compared with IV postoperative pain treatment after intraoperative GA with sufentanil and midazolam.
 ...
PMID:Coronary artery bypass grafting using two different anesthetic techniques: Part 2: Postoperative outcome. 847 38

Laparoscopic cholecystectomy (LSC) is being performed increasingly often. The carbon dioxide cavity increases end-expiratory carbon dioxide (exCO2), which can be regulated by mechanical ventilation. Because about 20-40% carbon dioxide remains in the patient at the end of surgery, we were interested in its influence on spontaneous respiration. PATIENTS AND METHODS. Fifteen patients classed as ASA 1-2 and undergoing LSC were compared with 15 patients (also ASA 1-2) undergoing laparotomy for cholecystectomy (LAP). All patients had balanced anaesthesia with fentanyl, enflurane, nitrous oxide and vecuronium. After surgery they were extubated when spontaneous respiration and vigilance were adequate. In the next 3 h we continuously determined exCO2 in the expired air through an intranasal catheter, and oxygen saturation (SAT), respiratory rate (RR) and heart rate (HR) using Oscar (Datex) and Ohmeda (Braun) apparatus while the patients were breathing room air. The blood pressure (BP) was determined intermittently. Postoperative pain treatment was standardized. RESULTS. The groups were reduced comparable with respect of the anthropometric data, because the weight was significantly higher in the LAP group. Fentanyl consumption was also significantly higher in the LAP group, reflecting the more pronounced trauma than with LSC. Mean exCO2 was 46 mmHg after LSC and 36 mmHg after LAP (P less than or equal to 0.05), continuously decreasing in the LSC group and increasing in the LAP group to 40 mmHg after 3 h. Mean RR was 18-20.min-1 after LSC and 12-15.min-1 after LAP during this period (P less than or equal to 0.05). There were no differences in SAT (94-96%), HR (75.min-1) and BP (130/80 mmHg). DISCUSSION AND CONCLUSIONS. The remaining carbon dioxide after LSC has important implications for postoperative spontaneous respiration. Probably due to an activation of carbon dioxide receptors, RR is increased to eliminate residual carbon dioxide. This is confirmed by a significantly increased exCO2 compared with that in the LAP group. This effect lasts at least 3 h, exCO2 being comparable in both groups, but RR is still increased after LSC. This different respiratory pattern does not affect SAT, being normal without hypoxic episodes. Cardiovascular parameters were also normal without group differences. We conclude that the carbon dioxide peritoneal cavity has important consequences for postoperative ventilation. Using our anaesthetic technique and postoperative treatment exCO2 reaches normal values after about 3 h due to an increased RR. If other methods, e.g., stronger opioids, which decrease carbon dioxide response are used, this effect may even be prolonged and more pronounced. We are now performing an investigation to evaluate this effect.
 ...
PMID:[The effects of the carbon dioxide pneumoperitoneum in laparoscopic cholecystectomy on postoperative spontaneous respiration]. 848 1


1 2 3 4 5 6 7 8 9 10 Next >>