Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0220723 (PCA)
 4,687 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Isolated porcine coronary arteries contracted transiently when exposed to 20 mM Na salts of organic acids (acetate, propionate, butyrate and lactate) at constant external pH (pH0 = 7.4). The peak of these phasic contractions, completely inhibited by 1 mM amiloride, amounted to about 10% of that elicited by depolarization with 50 mM K0. The slope of the relaxing branch of the phasic contractions induced by 20 mM acetate in HEPES buffered physiological salt solution decreased from 1.05 +/- 0.12 to 0.49 +/- 0.07 mN/min (S.E.M.; n = 14), when Na0 was reduced from 137 to 20 mM. In Na free HEPES-buffered PSS only sustained contractions were obtained. The EC50 values for the concentration-response curves for contractions induced by K-propionate (2-20 mM) in Tris-PSS were 8.2 +/- 0.5 mM, n = 6. After total isoosmotic replacement of external Na+ by sucrose in bicarbonate-buffered PSS, contractions induced by 20 mM K-propionate had the same height as those induced with 50 mM K0+. Longlasting exposure to 0 Ca0 PSS did not affect significantly contractions induced by 20 mM propionate. During an exposure to procaine (10(-4) M) acetate-induced contractions were transiently and significantly enhanced, when induced in bicarbonate buffered PSS, but not in HEPES buffered PSS. In normally polarized PCA preparations 20 mM NH4+ induced both sustained relaxations and polyphasic responses; in depolarized PCA preparations only polyphasic responses were evoked. The time course of the polyphasic responses to application and removal of weak bases (NH(4+)-pulse technique) or to removal and reintroduction of CO2/HCO3- paralleled exactly the expected pHi perturbations, as they have been described in a great variety of cells and tissues, alkalinization leading however to relaxation, acidification to contraction. In presence of NH4+, a transient relaxation (phase 1) was immediately followed by an overshooting contraction (phase 2); at removal of NH4+ a rebound contraction (phase 3) was observed, reaching a peak and changing thereafter to a relaxation (phase 4), the slope of which was sensitive to variation of the external Na0 concentration. These mechanical effects were abolished by 1 hr exposure to 0 Ca PSS. Phase 2 was enhanced 2-5 fold in presence of TEA, Ba ions, Na3 VO4 or beta-methyldigoxin. Contractile responses of PCA preparations activated by various agonists (acetylcholine, histamine and serotonin) to pHi manipulations were similar and generally amplified when compared to unactivated preparations.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Effects of manipulations of cytoplasmic pH on the mechanical responses of isolated porcine coronary arteries. 769 Dec 15

We compared the efficacy of intravenous patient controlled analgesia of buprenorphine plus continuous thoracic epidural infusion of bupivacaine (IV-PCA group) with the efficacy of continuous thoracic epidural infusion of bupivacaine and buprenorphine (the TEA group). No patient in IV-PCA group required supplemental analgesics, while 90% of TEA group required supplemental intramuscular buprenorphine to relieve post-thoracotomy pain. In TEA group, 94% of the supplemental drugs were administered during night shifts. These results indicate that IV-PCA of buprenorphine combined with continuous thoracic epidural infusion of bupivacaine is more effective analgesic management than continuous TEA with buprenorphine and bupivacaine.
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PMID:[Intravenous patient controlled analgesia combined with continuous thoracic epidural analgesia for post-thoracotomy pain]. 1121 28

Pain is one of the most important considerations in the care of thoracic surgical patients. Failure in pain management is associated with increased mortality and morbidity. Acute pain management aspires to stop the painful stimuli before it is transferred to the CNS. The authors recommend (1) a thorough explanation of the operation and the expected outcome to the patient, (2) preoperative pulmonary rehabilitation for those with marginal lung function, (3) choosing the least painful surgical approach with acceptable exposure, (4) minimizing tissue trauma during surgery, (5) preemptive analgesia, and (6) early ambulation as prophylactic measures that should be employed during hospitalization. Good acute pain control should reduce the incidence of chronic pain. Mediansternotomy and VATS seem to be less acutely painful approaches than thoracotomy for most thoracic surgery. One should rule out recurrent malignancy as the etiology for chronic or recurrent pain. Opioids and NSAIDs are sufficient to produce optimal pain control in patients who undergo VATS and sternotomv. TEA is typically reserved for patients who have a thoracotomy. Opioid PCA can be used instead of-or after the discontinuation of-the epidural catheter. Chronic pain can be treated in many ways, and input from a pain clinic might be beneficial. The single best approach to chronic pain is to prevent it. This can be achieved by selecting the right incisional approach, instituting early physical therapy, and achieving optimal postoperative pain control.
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PMID:Acute and chronic pain syndromes after thoracic surgery. 1247 33