Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Ketamine is an NMDA receptors antagonist, with a potent anaesthetic effect. NMDA receptors are involved in nociceptive modulation, in the wind-up phenomenon, in peripheral receptive fields expansion, in primary and secondary hyperalgesia, in neuronal plasticity. Ketamine effects are well-known: it produces a state of "dissociative anaesthesia", amnesia, and, at the same time, it mantains the respiratory drive effective and supports the sistemic arterial blood pressure. Anaesthesiologists are also familiar with its side-effects, like the increase of salivar and bronchial secretions, the possible increase of intracranial and pulmonary pressures and the dysphoric effect that may produce vivid and sometimes unpleasant dreams. Reviewing scientific data and studies about the use of ketamine in children, many considerations come out: at first they considered the effects of the racemic ketamine, then they evaluated the S-enantiomer. Many surveys studied the effects (analgesia, sedation, side-effects) of different doses or different routes of administration. Other studies were designed to compare ketamine to clonidine or opioids as adjuvants in paediatric regional anaesthesia with local anesthetic drugs, in order to prolong analgesia. In our Children's Hospital, we use ketamine in the operating room, in intensive care unit and for any procedure in hospital wards. The suggested doses are: Epidural or caudal route (as an ajuvant for local anaesthetic agents, in the treatment of postoperative pain): 0.5 mg/kg. Sedative/analgesic effect (for algesic procedures): 1-2 mg/kg i.v. Continuous infusion (intensive care unit): 0.5 mg/kg/h, with a range from 20-30 microg/kg/min to 80 microg/kg/min, depending on the age of the patient.
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PMID:Ketamine: a new look to an old drug. 1276 86

As a result of increased use of risk-directed treatment regimes, there is a regular requirement for short-lasting but painful procedures to be performed on children to aid in diagnosis or treatment. The aim of any anaesthetic technique is to provide analgesia and amnesia with minimal side-effects and early return to former activity levels. We review the implications of haematological malignancy in children with regard to anaesthesia and the consequences arising from both the disease and ensuing treatment. We outline some of the current anaesthetic techniques in use and review the advantages and disadvantages of each.
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PMID:Considerations for anaesthesia in children with haematological malignancy undergoing short procedures. 1279 Nov 9

The frequency of occurrence of amnesia, analgesia and time distortion during hypnotic dental treatments (n = 60) was investigated on high dental anxiety patients. Hypnosis with and without standardised direct suggestions related to amnesia, analgesia and time distortion were compared. Treatment of alert patients without direct suggestions (n = 10) were also used for comparison. Amnesia and time distortion was higher (p < or = 0.05) with the use of suggestions under hypnotic conditions, but analgesia was not significantly different. Alert appearance of the events were in all cases less (p < or = 0.01) than under hypnotic conditions.
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PMID:[Effectiveness of standardized direct suggestions in dental hypnosis]. 1463 93

Somatosensorially evoked and auditorially evoked potentials (SSEP and AEP) were evaluated in 75 patients in different stages of general anesthesia during surgical procedures made on the lungs. N19-P23 latent increases of SSEP denoted an adequate level of analgesia. The AEP evaluation is recommended for monitoring the amnesia status during general anesthesia. N1 depression, long-latent N2 and P300 as well as disappearance of AEP and intracerebral asymmetry inversion with predominance of the bioelectric activity in the right cerebral hemisphere are regarded as objective signs of amnesia induction.
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PMID:[Monitoring of analgesia and amnesia during the general anesthesia in surgeries made on the lungs]. 1531 49

Attempts have been made to attribute the particular features of general anaesthesia such as hypnosis, analgesia, amnesia and autonomic stability to certain brain regions. In the present study, we examined the effects of the commonplace volatile anaesthetic isoflurane on synaptic transmission in an in vitro slice preparation of the murine amygdala. Despite the established role of this limbic structure in the formation of aversive memories, conditioned fear and anxiety, as well as pain processing and regulation of sympathetic tone, the influence of volatile anaesthetics on synaptic signalling has not yet been investigated in this region of the brain. Evoked postsynaptic currents were monitored from principal neurons in the basolateral nucleus of the amygdala by means of patch-clamp recording. The mixed postsynaptic currents were mediated by non-NMDA, NMDA, GABA A and GABA B receptors. Isoflurane added to the perfusion medium reduced the strength of synaptic signalling following the activation of non-NMDA, NMDA, and GABA B receptors, whereas the GABA A receptor-mediated responses were enhanced. The overall reduction of neuronal excitability was also reflected in a reduction of field potential amplitudes. Isoflurane neither changed the membrane resting potential nor the input resistance of principal neurons in the amygdala. The present results may contribute to the understanding of how stress reactions and long-lasting neuroplastic processes are suppressed under general anaesthesia.
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PMID:Isoflurane modulates glutamatergic and GABAergic neurotransmission in the amygdala. 1534 99

Laparoscopic surgery is a technique by which abdominal surgical treatments are performed in minimally invasive way. Many operations that once required long hospitalization are now being performed with laparoscopic technique. It has significantly reduced postoperative pain and the number of complications, shorter hospital stay, with faster recovery, and more rapid return to normal activities. These are only some of the advantages of laparoscopic surgery. The first laparoscopic cholecystectomy in Croatia was performed on May 14, 1992, at the University Department of Surgery of "Sveti Duh" General Hospital in Zagreb. By the introduction of this method as the "gold standard" in the treatment of cholelithiasis, laparoscopic surgery has been widely accepted, and today, ten years later, has become a recognized and routine surgical method. Because of its particular performance, laparoscopic surgery requires some specific anesthesiologic adjustments. Surgical treatments are usually performed in general endotracheal anesthesia, although regional or local one could be applied too. The choice of anestesiologic technique and anesthetics depends upon preoperative patient's condition, the kind of surgical treatment, anesthesiologist's evaluation, and at last upon the cooperation among patients, anesthesiologist and surgeon. The basic aim of anesthesia is respiratory and hemodynamic patient's stability, and the choice of anesthesiologic technique and anesthesia should enable satisfactory analgesia, amnesia, muscular relaxation, faster recovery and shorter hospital stay.
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PMID:[Specific anesthetic management in laparoscopic surgery]. 1552 48

Unrelieved pain may have a major impact on the care of children with cancer. The type and severity of pain experienced by children with cancer varies from acute, procedure-related pain to progressive chronic pain associated with the progression of the disease or sequelae of treatment. Drugs are the mainstay of treatment. Regular pain assessments combined with appropriate analgesic administration at regular dosing intervals, adjunctive drug therapy for control of adverse effects and associated symptoms, and nonpharmacological interventions are recommended. Although standard dosing of opioids adequately treats most cancer pain in children, more complex treatment is required by a significant group. Strategies to improve analgesia include the use of epidural or intrathecal infusions of a combination of opioids and other adjuvants, or other regional anaesthesia techniques. Procedure- and treatment-related pain is an even greater problem than cancer pain. Recommendations have been published with regard to the monitoring and personnel required when children are sedated which aim to set the standard of care and minimize both physical discomfort or pain and negative psychological responses, by providing analgesia; and to maximize the potential for amnesia; and to control behaviour.
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PMID:Cancer pain management in children. 1554 Jun 76

Current choices for sustained sedation in the critically ill include the benzodiazepines, the opiates, and propofol. Each of these groups of medications has their particular benefits: benzodiazepines provide the greatest amnesia, opiates are the only agents to provide analgesia, and propofol is the most easily titratable and the least likely to excessively accrue. The literature seems to favor propofol over the benzodiazepines as the most cost-effective solution to sustained sedation. A newly approved agent, dexmedetomidine, holds promise as a continuous infusion that can provide both anxiolysis and analgesia, but without the ventilatory depression seen in the other classes of sedatives. Further research is needed to determine the role of dexmedetomidine in the ICU. The emerging standard of care for sustained sedation is the use of standardized protocols, formulated with the help of clinical practice guidelines, and titrated with the guidance of sedation monitoring.
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PMID:Use of sedative medications in the intensive care unit. 1608 71

General anesthesia is defined as complete anesthesia affecting the entire body with loss of consciousness, analgesia, amnesia, and muscle relaxation. There is a wide spectrum of agents able to partially or completely induce general anesthesia. Presently, there is not a single universally accepted technique for anesthetic management during cardiac surgery. Instead, the drugs and combinations of drugs used are derived from the pathophysiologic state of the patient and individual preference and experience of the anesthesiologist. According to the definition of general anesthesia, current practices consist of four main components: hypnosis, analgesia, amnesia, and muscle relaxation. Although many of the agents highlighted in this review are capable of producing more than one of these effects, it is logical that drugs producing these effects are given in combination to achieve the most beneficial effect. This review features a discussion of currently used anesthetic drugs and clinical practices of general anesthesia during cardiac surgery. The information in this particular review is derived from textbooks, current literature, and personal experience, and is designed as a general overview of anesthesia during cardiac surgery.
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PMID:General anesthesia in cardiac surgery: a review of drugs and practices. 1611 65

Our charge was to define anaesthesia as produced by inhaled anaesthetics. A definition may be useful to an understanding of the anaesthetic state, and it may guide studies of the mechanisms by which anaesthesia is produced. All inhaled anaesthetics act on the central nervous system to produce two reversible conditions, immobility and amnesia, that define the anaesthetic state. No other reversible, clinically useful, conditions are essential to the definition. Some conditions are unmeasurable (unconsciousness), not present for all inhaled anaesthetics (relaxation), or are not present at anaesthetizing concentrations (suppression of autonomic reflexes.) One (analgesia) is unmeasurable (the anaesthetized patient cannot tell an investigator that he/she hurts or does not hurt), and surrogate measures (increases in breathing, blood pressure, and heart rate with surgery) suggest that some pain is perceived. These and myriad other changes produced by inhaled anaesthetics are side effects; they do not define anaesthesia; only immobility and amnesia supply such a definition.
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PMID:Anaesthesia defined (gentlemen, this is no humbug). 1663 11


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