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Query: UMLS:C0220723 (PCA)
 4,687 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Several situations arise in the PICU patient that require the administration of drugs for sedation and analgesia. A "cookbook" approach is impossible because of the diversity of patient and clinical scenarios. When amnesia is required, these authors prefer a continuous infusion of a benzodiazepine such as midazolam or lorazepam. Although the majority of clinical experience has been with midazolam, lorazepam either by bolus dose or continuous infusion offers a cost-effective alternative. When analgesia is required, the addition of a continuous infusion of narcotic or the use of a PCA device in the older patient should prove effective. Although fentanyl is frequently chosen, morphine is an effective and cost-effective alternative for patients with stable cardiovascular function. The synthetic narcotics are recommended for neonates, especially following cardiac surgical procedures and those at risk for pulmonary vasospasm. Narcotics may also be used for the treatment of agitation in those situations that do not necessarily require analgesia. Our clinical experience suggests that narcotics may be more effective for sedation than benzodiazepines in children less than 1 year of age. When the above agents fail to be effective or are associated with cardiovascular depression, alternatives may include ketamine or pentobarbital. Ketamine may be useful for the unstable patient or those with a bronchospastic component to their disease process. We have found pentobarbital to be effective when the combination of benzodiazepines and narcotics fails to provide the desired level of sedation. Aside from these techniques, regional anesthesia may offer a more effective means of controlling pain in the PICU patient. These techniques may be effective when parenteral narcotics are inadequate or lead to undesired effects. Although most commonly used for postoperative analgesia, their use in patients with pain from other causes (e.g., multiple trauma) may be indicated, especially when parenteral narcotics may interfere with respiratory function or the ongoing assessment of the patient's mental status.
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PMID:Pain management and sedation in the pediatric intensive care unit. 798 86

Although aggression research in general has been hampered by a lack of objective measurements of aggressive acts, two types of aggressive acts, impulsive vs. premeditated, have been studied extensively in recent years. These two types of aggression have been primarily measured by structured or semi-structured interviews. The current study was designed to assess the construct validity of these two types of aggression using a self-report questionnaire which included items gleaned from the content of interviews used in past studies. For this study, 216 college students assessed their own aggressive acts rather than answering general questions about aggression. The students were not significantly different from normative sample groups on self-report measures of impulsiveness, aggression, and anger/hostility. A PCA factor analysis with a promax rotation of the items on the self-report questionnaire identified four factors: impulsive aggression; mood on the day the act occurred; premeditated aggression; and agitation. Thus, impulsive and premeditated aggression are independent constructs which exist in varying degrees among these 'normal' persons in a non-clinical sample. Impulsive aggression was characterized in part by feelings of remorse following the acts and by thought confusion. Premeditated aggression was related to social gain and dominance.
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PMID:Impulsive and premeditated aggression: a factor analysis of self-reported acts. 1039 18

Beef cattle responses to handling depend partly on the genetic characteristics of the animals. However, the various methods used in order to assess these responses differ to a great extent. The purpose of this work is to study the relationship between two different situations extensively used to evaluate cattle reactions to handling. Moreover, the genetic variability of cattle responses to these two handling situations was investigated. Behavioural reactions of 245 Limousine heifers, from 10 sires, were evaluated both in a docility test and in a crush test. In the docility test, a human tried to lead and then to maintain the animal in the corner of a pen during 30 consecutive seconds, with a maximum duration of the test of 3.5min. A docility score summarised the animal's behavioural reactions to the test. The crush test procedure consisted of social isolation of the animal in a crush, with the head maintained in a head gate (5min), then exposure to a stationary human (30s), and finally stroking on the forehead (30s). An agitation index for each part of this test was computed from PCA analyses based on agitation behaviours. Sire effect was significant for every part of both tests (P<0.05). Heifers' behavioural responses to the docility test were significantly correlated with their responses to the crush test, when the animals were in isolation (r=0.29; P<0.001), when the human stood motionless in front of the animals (r=0.37; P<0.001), and when the human stroked them (r=0.28; P<0.001). Sires' behavioural reactions to the docility test (computed from their daughters' scores) were correlated with their reactions to the crush test only when the human was present, both when motionless (r=0.88; P<0.001) and when stroking the heifer (r=0.81; P<0.05). No relationship appeared between sires' behavioural reactions to the docility test and their responses to restraint in the crush when the human was absent (P=0.17). Furthermore, the crush test did not reveal the animals which presented aggressive reactions to handling in the docility test. The results exposed in this paper pointed out the existence of a general reactivity of beef cattle to handling, whether the animals are restrained or not, which appears influenced by the sire. Such reactivity is suggested to be mainly a consequence of the animals reactions to humans. The human environment needs to be precisely defined in the handling test procedures before using them as a selection criteria.
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PMID:Do beef cattle react consistently to different handling situations? 1124 77