Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0278134 (anesthesia)
110,339 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Stress alters cellular immunity, affecting lymphocyte function, total lymphocyte count, and the frequency distribution of the lymphocyte subpopulations. Cortisol may mediate these stress-related changes, and drugs affecting cortisol levels might therefore alter lymphocyte patterns. Etomidate and midazolam both prevent the normal perioperative cortisol increase in minor surgery, but the mechanisms by which they do this are not identical: etomidate inhibits steroid synthesis in the adrenal cortex, leading to low cortisol and high ACTH levels, whereas midazolam primarily prevents ACTH increases. Methohexital has little or no influence on cortisol levels. By comparing the effects of these three drugs on the expression of lymphocyte surface markers and the interleukin-2 (Il-2) receptor, we hoped to gain further information on the effects of perioperative cortisol changes on cellular immunity. METHODS. Healthy, young male patients scheduled for routine body surface operations were premedicated with 2 mg flunitrazepam the evening before surgery and 50 mg promethazine and 15 mg piritramide i.m. 1 h before arrival in the operating room. Anaesthesia was induced with 0.2-0.3 mg fentanyl, 2 mg pancuronium, and either etomidate (0.3 mg/kg body wt.), midazolam (0.2 mg/kg body wt.), or methohexital (1.5 mg/kg body wt.). The induction bolus was followed by an infusion at the rate of 0.36 mg/kg/h for etomidate, 0.09 mg/kg/h for midazolam, and no infusion for methohexital. Intubation was facilitated with 100 mg succinylcholine. The patients were ventilated to normocapnia with 66% nitrous oxide in oxygen. Fentanyl was given as 0.1 mg bolus injections whenever necessary.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Changes in expression of lymphocyte surface markers following administration of etomidate, midazolam or methohexital]. 283 Aug 6

Nine premedicated patients, chronically maintained on beta-adrenergic blocking agents and demonstrating good ventricular function without significant valvular or left main coronary artery disease, were investigated to determine their haemodynamic responses to rapid induction of anaesthesia and tracheal intubation during elective coronary artery bypass surgery. Fentanyl 50 micrograms X kg-1 and pancuronium 0.15 mg X kg-1 were administered intravenously over 20 seconds followed by tracheal intubation 90 seconds thereafter. The rapid sequence of anaesthetic induction and tracheal intubation was well tolerated by all patients. Though statistically significant changes were detected in heart rate, pulmonary capillary wedge pressure and systemic vascular resistance, these changes were small and not considered clinically significant and no signs of ischaemia were detected on the ECG. The present study demonstrates that high-dose fentanyl is capable of inducing anaesthesia rapidly and protecting against the haemodynamic changes associated with tracheal intubation.
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PMID:High-dose fentanyl for rapid induction of anaesthesia in patients with coronary artery disease. 286 78

Pretreatment with small doses of fentanyl (100 micrograms) or alfentanil (300 micrograms) was found significantly to reduce the induction dose of thiopentone. Fentanyl 50 micrograms and alfentanil 150 micrograms also significantly reduced the onset time and increased the consistency of action of midazolam. Respiratory depression was not a problem when 50 micrograms fentanyl or 150 micrograms alfentanil were used.
Anaesthesia 1986 Feb
PMID:Pretreatment with opioids. The effect on thiopentone induction requirements and on the onset of action of midazolam. 286 11

Fentanyl, vecuronium and enflurane may cause bradyarrhythmias during anaesthesia. Lidocaine administered before endotracheal intubation may interact synergistically with these agents. In this randomized and double-blind study, lidocaine 1 mg kg-1 (24 patients) or saline (20 patients) was given, immediately after glycopyrrolate 5 micrograms kg-1, fentanyl 1.5 micrograms ml-1 and thiopentone 3-5 mg kg-1, together with vecuronium 0.1 mg kg-1 as a rapid i.v. injection to healthy (ASA 1) surgical patients. Enflurane 0.8% was included in the inhaled gases 10 min and enflurane 1.6% 25 min after lidocaine administration. The plasma concentrations of lidocaine rose to a mean level of 3.1 micrograms ml-1 (maximum 7.1 micrograms ml-1) which may affect the electrical conduction at various sites in the heart. There were no statistically significant differences in arterial blood pressures or heart rates during anaesthesia between the groups. The incidence of junctional rhythm was 7/24 patients in the lidocaine group and 5/20 patients in the saline group. Three patients in the lidocaine group, and two patients in the control group developed junctional rhythm immediately after intubation. The plasma concentrations of vecuronium were unaffected by lidocaine. The ratio of the unbound lidocaine to plasma protein bound lidocaine was at the expected level and did not differ significantly 2 and 10 min after the injection.
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PMID:Cardiovascular responses caused by the combination of lidocaine and vecuronium in the induction of general anaesthesia. 290 4

The pulmonary kinetics of fentanyl and alfentanil were studied quantitatively in two groups of five and six surgical patients, respectively, after the induction of anaesthesia. A mixture of one of the opioids and indocyanine green was administered as a bolus. From measurements of the concentrations of the dye in plasma and the opioids in blood, central blood volume and the amount of drug which passed through the pulmonary circulation were calculated. The pulmonary release of fentanyl and alfentanil was calculated from the arterial-mixed venous blood concentration differences. Fentanyl 43.0-86.9% (median 70.9%) and 35.9-79.8% of alfentanil (median 58.6%) were sequestered by the lung on first passage of the opioid-containing blood through the pulmonary capillaries. During the following 14 min, fentanyl was released, apparently from two binding sites (T1/2fast: 0.22 (0.16-0.27) min; T1/2slow: 5.78 (3.65-13.86) min). Initially, there was a rapid release of alfentanil (T1/2: 0.28 (0.08-0.51) min). However, 1-3 min after injection, the arterial-mixed venous blood concentration differences of alfentanil disappeared, although considerable amounts of drug were still present in the lung of five of the six patients studied. It may be expected that a temporary pulmonary sequestration of fentanyl and alfentanil has considerable impact on the time course of their pharmacological effects, on the time necessary to reach their maximum effect and on the intensity and (in case of fentanyl) the duration of these effects.
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PMID:Pulmonary kinetics of fentanyl and alfentanil in surgical patients. 290 58

To determine whether infants are more sensitive than older patients to the ventilatory-depressant effects of fentanyl, patients were anesthetized with fentanyl and nitrous oxide (N2O) and ventilatory depression was assessed following elimination of N2O and in the immediate postoperative period. Three groups of patients were studied: infants (1-12 mo old, n = 14), children (1-5 yr old, n = 14), and adults (23-38 yr old, n = 13). Skin-surface PCO2 was measured to determine the peak PCO2 occurring at the end of anesthesia when end-tidal N2O concentration was less than 6%. Naloxone was administered if PCO2 exceeded 70 mmHg. During recovery from anesthesia, ventilatory pattern was recorded using impedance pneumography to determine the longest breath-to-breath interval and the number of episodes of central apnea (defined as breath-to-breath intervals greater than or equal to 10 s in infants and children and greater than or equal to 20 s in adults). Elevation of PCO2 correlated with increasing plasma fentanyl concentrations but did not differ between groups. Four patients (two infants, one child, and one adult) required naloxone. The only subject who had a low plasma fentanyl concentration but required naloxone was a 6-wk-old infant; this was the only subject younger than 3 mo. For each range of fentanyl concentrations, the incidence of apnea increased with age, as did the number of episodes of apnea per subject. Fentanyl-induced ventilatory depression, as assessed by elevation of resting PCO2 during emergence from anesthesia and disruption of ventilatory pattern during recovery from anesthesia, is not greater in infants older than 3 mo than in children and adults.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Fentanyl-induced ventilatory depression: effects of age. 291 58

17 patients undergoing cholecystectomy in non-opiate general anaesthesia received tramadol (n = 7) or fentanyl (n = 10) for immediate postoperative pain relief using the on-demand analgesia computer (ODAC). Heart rate, blood pressure, and respiratory rate were monitored at half-hourly intervals during the 6-h trial period. Arterial blood was withdrawn at hourly intervals for blood gas analyses and beta-endorphin plasma level assays. Fentanyl and tramadol serum levels were determined prior to each on-demand bolus injection during the first 2 h of the study. At the end of the trial period, the quality of analgesia was assessed retrospectively using a visual analog scale. Mean opiate consumption was 0.53 +/- 0.1 mg for fentanyl and 412 +/- 11.6 mg for tramadol, resulting in an equipotency ratio of about 1:980 (relating to body wt., consumption/h, and pain score). No correlation was found between body wt.-based opiate requirements and pain score. Heart rate increased slightly but significantly under both opiates. Fentanyl produced a significant drop in mean arterial pressure by a maximum of 16%, while tramadol left mean arterial pressure unchanged. Respiratory rate, which was elevated initially, dropped significantly in both groups. Arterial pO2 and pCO2 were within the normal range throughout the observation period, reflecting the absence of respiratory side effects. Opiate blood levels showed major inter- and intraindividual variations (minimal and maximal levels for fentanyl ranged from 0.44-3.44 ng/ml, for tramadol from 272-1,900 ng/ml) and were thus poor predictors of the quality of analgesia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Comparison of fentanyl and tramadol in pain therapy with an on-demand analgesia computer in the early postoperative phase]. 294 72

Opioids remain the drugs of choice for the treatment of severe pain. In recent years several new potent opioids have become available for clinical use. These newer drugs are generally safer than the older morphine-like compounds and their differing pharmacological and pharmacokinetic properties allow the physician to choose an appropriate drug according to the clinical situation and need of an individual patient. These drugs are classified according to their activity at the opioid receptors. The opioid agonists produce their pharmacological effect by an almost exclusive action at mu-receptors. The agonist-antagonist group are kappa-receptor agonists and either competitive antagonists at the mu-receptor or weak mu-agonists. The use of the potent opioid agonists, because of their potential for causing respiratory depression, is restricted to hospitals. Fentanyl, the oldest drug of this class, is extensively used as a supplement to general anaesthesia, or in high doses as a 'complete' anaesthetic for patients undergoing cardiac surgery. Alfentanil and sufentanil are newer fentanyl derivatives. Alfentanil is unique in having a very short elimination half-life. This is a particular advantage during short operations and for day-case surgery. For longer operations alfentanil can be given as a continuous infusion to supplement nitrous oxide anaesthesia. Sufentanil is about 10 times more potent than fentanyl and is more rapidly eliminated. Initial reports suggest that it may be more effective than fentanyl as an anaesthetic supplement and that recovery may be more rapid. Both sufentanil and alfentanil are also used in cardiac anaesthesia. The newer agonist-antagonist opioids, butorphanol, nalbuphine and buprenorphine, have largely replaced pentazocine in clinical practice. Unlike pentazocine, they cause a low incidence of dysphoric side effects. Like the pure agonists, they cause respiratory depression; however, in contrast to the pure agonists this is not dose related, reaching a 'ceiling' as dose increases. The risk of dependence is also less, so that these drugs are safer for the treatment of chronic pain. Additionally, it is particularly worth noting that buprenorphine and nalbuphine cause minimal cardiovascular changes, and are safe and effective drugs for treatment of pain associated with myocardial infarction. Buprenorphine, which is effective parenterally, orally and sublingually, has a prolonged duration of action (up to 12 hours after a single dose).
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PMID:Which potent opioid? Important criteria for selection. 295 11

The effect of the supplementation of nitrous oxide-oxygen anaesthesia with either fentanyl 15 micrograms kg-1 or 0.5% halothane on the beta-endorphin, ACTH, glucoregulatory hormonal and metabolic response to pelvic surgery was investigated. Fentanyl inhibited the increases in circulating beta-endorphin, ACTH, growth hormone, cortisol and glucose concentrations found in the patients receiving halothane. Changes in circulating beta-endorphin concentrations during surgery probably reflect alterations in pituitary secretion and appear to have no major metabolic effects. The suppression of pituitary secretion persisted for at least 4 h after the start of surgery.
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PMID:Fentanyl and the beta-endorphin, ACTH and glucoregulatory hormonal response to surgery. 295 4

This is a report about five anaesthetic techniques for laparoscopy. Propofol and etomidate were used for total intravenous anaesthesia. Propofol, etomidate and thiopentone were used as induction agents prior to inhalational anaesthesia with isoflurane and nitrous oxide. Fentanyl was used for analgesia. Induction with propofol and thiopentone was rapid. Etomidate induction was characterised by myoclonus. Maintenance was smooth with inhalational anaesthesia. Of the groups that received total intravenous anaesthesia, propofol provided stable anaesthesia but required extra bolus doses. Recovery was the most rapid following total intravenous anaesthesia with propofol. Postoperative side effects were much lower after propofol. No difference was observed between the groups with regard to changes in arterial blood pressure and heart rate.
Anaesthesia 1987 Aug
PMID:Anaesthesia for laparoscopy. A comparison of five techniques including propofol, etomidate, thiopentone and isoflurane. 295 68


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