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

The routine use of cholinesterase inhibitors to antagonize residual neuromuscular block may be associated with increased postoperative emesis. Rapid spontaneous recovery from mivacurium may obviate the need for these drugs. In this randomized, double-blind, placebo-controlled study of 113 healthy children who had received mivacurium as part of a standardized anesthetic regimen, we compared the incidence of postoperative complications after spontaneous recovery and after the use of neostigmine-glycopyrrolate or edrophonium-atropine. The anesthetic regimen consisted of halothane, nitrous oxide, fentanyl, 2 micrograms/kg intravenous (i.v.), mivacurium in an initial dose of 0.2 mg/kg, followed by an infusion, adjusted to maintain > or = 1 evoked contraction response to a supramaximum train-of-four stimulus. At the end of the procedure, patients received by random assignment one of three drug combinations: 1) neostigmine 70 micrograms/kg + glycopyrrolate 10 micrograms/kg, i.v., 2) edrophonium 1 mg/kg + atropine 10 micrograms/kg, i.v., and 3) saline. The trachea was extubated when evoked responses to peripheral nerve stimulation and clinical signs of adequate neuromuscular recovery were present. Postoperative pain was treated with morphine and emesis with metoclopramide. There were no significant differences between the three groups with respect to age, surgery, intraoperative fentanyl, and mivacurium use, time from the end of surgery to tracheal extubation, postanesthesia care unit (PACU) arrival and discharge, or in postoperative oxygen saturation values and analgesic requirements. Compared to the placebo group, emesis occurred more often in the PACU in patients receiving the neostigmine-glycopyrrolate combination, but not after edrophonium-atropine.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effect of antagonism of mivacurium-induced neuromuscular block on postoperative emesis in children. 970 58

We report a 75-year-old man with the liver cirrhosis of Child-Pugh B who underwent nephrectomy. Preoperative serum examination revealed increases in GOT, GPT, LDH and total bilirubin, decreases in cholinesterase and albumin, and prolongation of prothrombin time. We selected spinal anesthesia using bupivacaine and fentanyl rather than epidural anesthesia in combination with isoflurane inhalation anesthesia to supplement intra-operative anesthesia and post-operative pain relief. We explained the risks of blood coagulopathy and the predictable venous dilatation in the epidural space to the patient and relatives on obtaining informed consent. The surgery was completed uneventfully in 2.5 hours. Post-operative pain control was satisfactory and hepatic dysfunction did not deteriorate in the postoperative period.
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PMID:[Combination of spinal and inhalation anesthesia for nephrectomy in a cirrhotic patient]. 1724 50