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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Prolonged epidural anesthesia has been analysed in 288 patients operated on for atherosclerosis and vascular stenosis. To prolong anesthesia the authors have for the first time administered morphilong into the epidural space. The efficacy of anesthesia was assessed by Nanovoltaampere meter P-341 used for the measurement of skin potential, which in the course of anesthesia decreased by 40-50%. The quality of anesthesia was assessed by microcirculation state. It is recommended during surgery on major vessels to extend the area of epidural anesthesia towards the lower extremities. Analgesia with morphilong was effective for 22.3 +/- 4 h. Complications during anesthesia were observed in 31.2% of patients, in 6.2% of cases they required drug therapy. The incidence of postoperative pneumonias after epidural anesthesia reduced from 8 to 1.6% as compared to conventional anesthesia techniques.
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PMID:[Characteristics of prolonged epidural anesthesia in surgery of the magistral vessels]. 178 87

The permeability of spinal dura mater (SDM) was examined for morphine and tetracaine hydrochloride in 7 suddenly died patients with profound morphological manifestations. Atherosclerosis was found to show an average 37% increase in SDM permeability. With this, the efficiency of postoperative epidural analgesia (EA) with morphine was studied in 32 surgical patients with concurrent atherosclerosis. EA was demonstrated to be not only beneficial for this category of patients, unlike control patients, but followed by a significant decrease in respiratory center sensitivity to CO2. It was concluded that the regularities found should be taken into account during EA with narcotic analgesics in patients with concurrent atherosclerosis.
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PMID:[The effect of concurrent atherosclerosis on the permeability of the dura mater and the efficacy of epidural analgesia with morphine and dicain]. 259 24

The influence of age, concomitant atherosclerosis and pregnancy on the efficiency of postoperative peridural analgesia with morphine was studied in 2000 patients. It was found that the incidence of adequate analgesia was linearly increased with the age of the patients and the morphine dose. The influence of atherosclerosis and pregnancy manifested itself in the improvement of the analgetic and sedative effect of morphine. The data obtained are thought to be associated with changed permeability of diffuse barriers for the analgetics.
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PMID:[Results of peridural morphine analgesia in the early postoperative period]. 370 31

Coronary artery disease (CAD), arterial hypertension, chronic bronchitis and diabetes mellitus are the most frequently encountered diseases complicating the clinical course of the vascular patient. Clinical signs of cardiac or pulmonary disease are often absent in patients with decreased functional capacity due to claudication. For instance, clinical evidence of coronary artery disease was found in 36% of patients scheduled for different vascular surgical procedures, whereas coronary angiography revealed significant stenoses in as many as 53-68%. Patients with chronic hypertensive disease, coronary artery disease and increased impedance to left ventricular ejection due to atherosclerosis frequently develop impairment of left ventricular (LV) function. Even without clinical or radiological evidence, approximately 20-35% of vascular patients have a LV ejection fraction below 50% indicating impaired systolic LV function. The incidence of diabetes mellitus in vascular surgical patients is around 18%. When requiring insulin treatment, diabetes is an independent risk factor for postoperative ischemic events and congestive heart failure. Those with autonomic neuropathy are often asymptomatic as regards coronary artery disease. Coronary artery disease is responsible for over 50% of the immediate, medium- and long-term mortality and morbidity. Unstable myocardial ischemia, acute myocardial infarction which is detected by troponin I and ischemic pulmonary edema are the most common immediate postoperative cardiac complications. A large number of recent studies, using long-term ECG recording techniques, have allowed more accurate estimation of the incidence and time course of perioperative myocardial ischemia in vascular surgical patients. The highest incidence of ischemia when compared to daily life activities has been noted during the first two days after surgery but has been reported to remain elevated even 3-5 days after surgery. Interestingly, the incidence of intraoperative ischemia is lower than that observed during daily life. Knowledge of the etiology of perioperative myocardial infarction is essential if one is to improve cardiac outcome after vascular surgery. Many studies have addressed this important field in patients undergoing vascular surgery. They have documented a relationship between perioperative myocardial ischemia and postoperative myocardial infarction. Although postoperative myocardial infarctions are in most cases limited to endocardium (non Q wave infarction) they significantly reduce life expectancy of the vascular surgical patients. The reduction of cardiac risk following general surgery should focus on methods by which the incidence of myocardial ischemia, particularly during the postoperative period, could be reduced. These methods include intensive intraoperative analgesia or preventive administration of cardiovascular treatment which limit postoperative stress: alpha-2 agonists or betablocking agents. There are, at present, no studies which convincingly confirm an overall decreased mortality if coronary bypass surgery is performed prior to peripheral vascular surgery. Although it has been demonstrated that the mortality of the peripheral procedure is reduced to approximately one half, the mortality of a coronary bypass procedure in vascular surgical patients is five to eight times that recorded in a coronary artery bypass population without peripheral vascular disease. It remains to be shown if the use of coronary angioplasty prior to peripheral vascular surgery can provide a more satisfactory overall outcome. Several non-invasive techniques have been suggested to improve the identification of high-risk patients undergoing vascular surgery. These tests include exercise ECG, ambulatory ECG, dipyridamolethallium scintigraphy and determination of left ventricular ejection fraction by gated radionuclide imaging. (ABSTRACT TRUNCATED)
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PMID:[Physiopathologic introduction to anesthesia and resuscitation of the vascular patient]. 955 51

Paracetamol (acetaminophen) is well established as a leading non-prescription antipyretic analgesic drug. Future developments are likely to include new formulations to achieve rapid absorption for a fast onset of action, and prolonged absorption to extend the duration of action for regular long-term administration. Better dosage forms are also required for rectal administration. The availability of intravenous paracetamol has greatly extended the use of this drug as an adjunct to postoperative analgesia and for control of fever in the intensive care setting. Intravenous paracetamol is available in only a few countries at present, but it seems inevitable that it will be marketed much more widely in the future. The misuse of paracetamol as a fashionable agent for self-poisoning seems likely to continue, and liver failure may still occur in the small proportion of overdose patients who present too late for effective antidotal treatment with N-acetylcysteine. Much effort is being devoted to the study of the molecular mechanisms of paracetamol hepatotoxicity, and it is hoped that further advances may make it possible to prevent liver failure in all patients, irrespective of delays in presentation. At the same time, there is great interest in the mechanisms of the therapeutic actions of paracetamol and its effects on the different isoforms of cyclo-oxygenase. There will probably be important new findings in this area and these may lead to wider clinical use. Meantime, possible novel therapeutic applications for paracetamol include its use as an antioxidant to prevent atherosclerosis and cardiovascular disease by inhibiting the oxidation of low-density lipoproteins, and to prevent the formation of cataracts.
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PMID:[New perspectives on paracetamol]. 1475 91

Acute coronary syndromes encompass a heterogenous group of patients with different clinical presentations, who have differences in both the extent and severity of underlying coronary atherosclerosis and who have different degrees of risk of progression to myocardial infarction. For each patient, the pre-hospital practitioner should make individual treatment decisions based on the history and examination, the ECG findings, the facilities and diagnostic equipment available and the transfer time to the nearest appropriate hospital. Patients with acute ischaemic chest pain should have oxygen, aspirin, nitrates and opioid analgesia. A 12 lead ECG should be performed within 5 minutes of initial assessment. If the ECG reveals ST-segment elevation or presumed new LBBB, this signifies acute myocardial infarction and in most cases immediate reperfusion therapy should be considered. The evidence of benefit in terms of mortality and morbidity following prompt anti-platelet and fibrinolytic therapy in such cases is unequivable. Pre-hospital fibrinolysis is now well established and should be undertaken in patients with acute infarction on clinical and ECG grounds if the transfer to hospital is likely to exceed 30 minutes and it is less than 12 hours since the onset of pain. Patients with no ECG evidence of infarction may still be at considerable risk and should still be conveyed to the nearest appropriate medical facility. Whilst en-route, they should receive aspirin, nitrates, low molecular weight heparin (LMWH) and beta blockers provided there are no contra-indications.
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PMID:Acute coronary syndrome. 1501 5

In addition to their classical known effects, such as analgesia, impairment of cognition and learning and appetite enhancement, cannabinoids have also been related to the regulation of cardiovascular responses and implicated in cardiovascular pathology. Elevated levels of endocannabinoids have been related to the extreme hypotension associated with various forms of shock as well as to the cardiovascular abnormalities that accompany cirrhosis. In contrast, cannabinoids have also been associated with beneficial effects on the cardiovascular system, such as a protective role in atherosclerosis progression and in cerebral and myocardial ischaemia. In addition, it has also been suggested that the pharmacological manipulation of the endocannabinoid system may offer a novel approach to antihypertensive therapy. During the last decades, the tremendous increase in the understanding of the molecular basis of cannabinoid activity has encouraged many pharmaceutical companies to develop more potent synthetic cannabinoid analogues and antagonists, leading to an explosion of basic research and clinical trials. Consequently. not only the synthetic THC dronabinol (Marinol) and the synthetic THC analogue nabilone (Cesamet) have been approved in the United States, but also the standardized cannabis extract (Sativex) in Canada. At least three strategies can be foreseen in the future clinical use of cannabinoid-based drugs: (a) the use of CB(1) receptor antagonists, such as the recently approved rimonabant (b) the use of CB(2)-selective agonists, and (c) the use of inhibitors of endocannabinoid degradation. In this context, the present review examines the effects of cannabinoids and of the pharmacological manipulation of the endocannabinoid system, in cardiovascular pathophysiology.
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PMID:Cannabinoids as therapeutic agents in cardiovascular disease: a tale of passions and illusions. 1745 Jan 70

Chronic refractory angina pectoris is a clinical entity characterized by a persistent thoracic pain, despite pharmacological therapy (Canadian Cardiovascular Society functional class 3-4); the patients show a severe, diffuse coronary atherosclerosis not amenable to myocardial revascularization at coronary angioplasty or bypass grafting. This clinical entity which is becoming ever more frequent is a cause of a poor quality of life necessitating repeated hospitalization. Many therapeutic alternatives have been proposed for the treatment of these patients, but results were inconclusive. In this review their pathophysiological background, clinical efficacy, safety and complications are analyzed. Data concerning spinal cord stimulation, upper thoracic sympathectomy, high thoracic epidural analgesia, chronic-intermittent urokinase administration, enhanced external counterpulsation and transmyocardial laser revascularization are presented. Finally, the main research directions in this particular field are reported.
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PMID:[Non-pharmacological, non-conventional therapy of chronic refractory angina pectoris]. 1939 5

Serine proteases such as thrombin, trypsin and mast cell tryptase can act on different cell types through protease-activated receptors (PARs). These receptors have been shown to be implicated in several phenomena such as inflammation, platelet activation, immune response and atherosclerosis. Several studies recently reported PARs expression on neurons and some of them demonstrated that these receptors could interfere with nociception. The contribution of PAR(1) to inflammatory pain and the mechanism involved in this phenomenon were investigated. Intraplantar injection of PAR(1) agonist increased withdrawal latency and reduced response frequency to von Frey filaments, thus inhibiting nociceptive response to both mechanical and thermal stimuli in mice. PAR(1) agonist also reduced carrageenan-induced inflammatory hyperalgesia. The anti-nociceptive effects of PAR(1) agonist were mediated by endogenous opioids, as this effect was inhibited by local injection of naloxone methiodide, and because intraplantar injection of PAR(1) agonist increased mRNA expression of the endogenous opioid precursor proenkephalin. However, PAR(1) agonist was not able to inhibit calcium signals in isolated sensory neurons exposed to pro-nociceptive agents. Finally, despite similar inflammatory parameters, PAR(1)-deficient mice showed a strong potentiation of inflammatory hyperalgesia induced by the intraplantar injection of either formalin or carrageenan, or in the chronic model of collagen-induced arthritis, compared to wild-type mice. This study highlights a previously unknown endogenous mechanism of analgesia, showing a central role for the thrombin receptor PAR(1) in the regulation of inflammatory pain and as an activator of opioid pathways.
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PMID:Thrombin receptor: An endogenous inhibitor of inflammatory pain, activating opioid pathways. 1967 41

Based on Capillary Gate Theory and Tissue Repair Theory, this paper describes the "Stress Repair Mechanism" (SRM) that maintains and repairs vertebrate tissues. It accounts for most of the mysterious manifestations of allostasis that remain unexplained by Hypothalamic-Pituitary-Axis (HPA) hormones and thereby enables the Universal Theory of Medicine predicted by Hans Selye. SRM activity explains hemodynamic physiology, capillary hemostasis, infarction, Korotkoff sounds, blood pressure, hypertension, diabetes, allostasis, allostatic load, anesthesia, analgesia, atherosclerosis, apoptosis, malignancy, eclampsia, sepsis, Multi-System Organ Failure (MSOF), the surgical stress syndrome, the fight or flight response, and numerous other manifestations of physiology and pathology. SRM function comprises the autonomic nervous system, the vascular endothelium, and the dynamic enzymatic interaction of blood-borne hepatic Factors VII, VIIIC, IX and X that produces thrombin, soluble fibrin and insoluble fibrin, whose combined effects account for all SRM manifestations. The vascular endothelium is a diaphanous neuroendocrine organ that lines all blood vessels and is the sole constituent of capillary walls. It secretes tissue factor into extravascular tissues, and insulates those tissues from the hepatic enzymes, so that tissue disruption exposes tissue factor to the enzymatic interaction and activates tissue repair. The vascular endothelium also releases nitric oxide and von Willebrand Factor into blood in accord with autonomic balance to regulate the enzymatic interaction to govern tissue perfusion and organ function. Therefore, continuously fluctuating combinations of nervous stimuli that affect autonomic balance and forces that disrupt tissues determine SRM activity.
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PMID:A stress repair mechanism that maintains vertebrate structure during stress. 2044 76


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