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)

One hundred fifty-three lung lavage procedures were performed on 81 cystic fibrosis patients during the years 1963 to 1976. Local analgesia was used in 24 lavages done via a rigid bronchoscope and in a group of 73 lavages directed by a fiberoptic bronchoscope. No abnormalities in cardiac rate or rhythm were observed with the lavages directed by fiberoptic bronchoscope. Fifty-six lavages were performed under general anesthesia with 20 cardiac abnormalities being noted among this group. Subjective improvement was noted in 96% of the 56 patients who had lavage under general anesthesia. Objective improvement was apparent in 45% of the 24 patients who had lavage with the rigid bronchoscope and 64% of the 36 patients who had lavage by fiberoptic bronchoscopy. It is concluded that patients with cystic fibrosis of varying stages of disability can more safety (and with good improvement) have bronchial washouts with the fiber-optic bronchoscope than with either of the other two techniques.
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PMID:Comparison of three techniques of lung lavage in patients with cystic fibrosis. 91 36

Hemoptyses are common in cystic fibrosis (CF) patients. They range from massive life-threatening (> 240 mL/24 hours) to recurrent minor streaking. Limited pulmonary reserve, potential concurrent chest infection, and the progressive nature of CF pose a high risk to this subgroup. Conservative management and selective bronchial artery embolization (BAE) control most acute episodes, but the recurrence rate is high. The possible need for lung transplantation in future makes an extrapleural approach for bronchial artery ligation desirable. The aim of this study was to assess the role of extrapleural bronchial artery ligation in the treatment of recurrent hemoptysis in CF patients. This is a retrospective analysis of four patients between 1986 and 1999 treated by extrapleural thoracotomy and ligation of bronchial arteries. Indications, surgical experience, and outcome are presented. Three patients underwent unilateral, and one patient bilateral extrapleural thoracotomy (in two separate sessions) for bronchial artery ligation. There were three men and one woman, with a mean age of 26.6 years (range 19-32 years). Indications were failure to stabilize the bronchial arterial catheter for BAE (three cases), recurrence after BAE previously controlled bleeding (one case), and communication with the right costocervical trunk signifying risk to the spinal circulation (one case). The mean follow-up was 68 months (range 3-144 months). There was one death in this series, a patient who was asphyxiated with hemoptysis, requiring ventilation preoperatively. He underwent successful extrapleural thoracotomy for bronchial artery ligation, with no further bleeding but succumbed to severe chest infection and multiorgan failure a few days later. Two patients had recurrent bleeding 12 and 36 months after surgery. Selective bronchial angiography proved the contralateral bronchial arteries to be the culprit. Extrapleural bronchial artery ligation is an effective method of controlling hemoptysis in CF, when BAE has failed. This approach minimizes pleural adhesions and is, therefore, desirable in the future consideration for lung transplantation. In this experience, muscle-sparing thoracotomy and postoperative epidural analgesia significantly improved the postoperative recovery.
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PMID:Extrapleural bronchial artery ligation for life-threatening hemoptysis in cystic fibrosis--a case report. 1099 21

Nonsteroidal anti-inflammatory drugs (NSAIDs) possess antipyretic, analgesic and anti-inflammatory effects. They are frequently used in children and have numerous therapeutic indications, the most common ones being fever, postoperative pain and inflammatory disorders, such as juvenile idiopathic arthritis (JIA) and Kawasaki disease. Their major mechanism of action is through inhibition of prostaglandin biosynthesis by blockade of cyclo-oxygenase (COX). The disposition of most NSAIDs has been mainly studied in infants > or = 2 years of age. Compared with adults, the volume of distribution and clearance of NSAIDs such as diclofenac, ibuprofen (infants aged between 3 months and 2.5 years), ketorolac and nimesulide were increased in children. The elimination half-life was similar in children to that in adults. These pharmacokinetic differences might be clinically significant with the need for higher loading and/or maintenance doses in children. Ibuprofen, acetylsalicylic acid (ASA) and acetaminophen are the most frequently used agents for fever reduction in children. Over the past 20 years, because of the association between ASA use and Reye's syndrome, most of the interest has been directed toward ibuprofen and acetaminophen. In view of its comparable antipyretic efficacy, but superior tolerability profile, acetaminophen, when used appropriately with age-adapted formulations, should remain the first-line therapy in the treatment of childhood fever. At the moment, there is no scientific evidence to recommend simultaneous use of these two antipyretic drugs. Most NSAIDs provide mild to moderate analgesia, with the exception of ketorolac which has a strong analgesic activity. The analgesic efficacy of ketorolac, ketoprofen, diclofenac and ibuprofen in the treatment of postoperative pain has been mainly studied following a single dose, in children of > or = 1 year of age undergoing minor surgeries. In this setting, when used either alone or in adjunct to caudal or epidural anaesthesia, they were associated with an opioid-sparing effect and were well tolerated. With the exception of ketorolac use in children undergoing tonsillectomy, where controversy exists regarding the risk of postoperative haemorrhage, NSAIDs have not been associated with an increased risk of perioperative bleeding. NSAIDs are the first-line therapy in JIA. They appear to be equally effective and tolerated, with the exception of ASA which is associated with more adverse effects. ASA has been used for many years in the treatment of Kawasaki disease and is part of the standard modality of treatment in combination with intravenous gammaglobulins. More recently, lung inflammation associated with cystic fibrosis (CF) has become a new target for NSAIDs. Despite promising preliminary results with ibuprofen, numerous questions need to be answered before this new strategy becomes part of the conventional treatment of patients with CF. In summary, NSAIDs are effective in reducing fever, alleviating pain and reducing inflammation in children, with a good tolerance profile. Pharmacokinetic studies are needed to characterise the disposition of NSAIDs in very young infants in order to use them rationally. To date, no studies have been published on the disposition, tolerability and efficacy of specific COX-2 inhibitors in children. Further clinical experience with these agents in adults is warranted before undergoing trials with specific COX-2 inhibitors in children.
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PMID:Risks and benefits of nonsteroidal anti-inflammatory drugs in children: a comparison with paracetamol. 1173 67

The anaesthetic management is described of a patient with cystic fibrosis who had had a double lung transplantation for intractable respiratory failure. An epidural block provided analgesia/anaesthesia for vaginal birth and bilateral tubal ligation.
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PMID:Epidural analgesia for vaginal delivery in a patient with cystic fibrosis following double lung transplantation. 1532 Dec 46

Severely impaired pulmonary function due to cystic fibrosis is associated with a poor pregnancy outcome. A 19-year-old primigravida with cystic fibrosis had a forced expiratory volume in one second 34% of predicted and a low body mass index of 17.1 kg/m(2) before pregnancy. During pregnancy she required several admissions to hospital for deteriorating pulmonary function due to infection. She also developed gestational diabetes and required overnight feeding via a gastrostomy tube throughout pregnancy to improve her nutritional status. With close medical attention, pulmonary function tests remained stable. A joint decision was made to deliver the baby by caesarean section at 33 weeks' gestation as this was considered optimal time for mother and baby and to avoid potential catastrophic pulmonary deterioration later in pregnancy. A combined spinal-epidural technique provided adequate anaesthesia. Pulmonary function tests were performed in theatre before and after the spinal injection, as well as two and five hours postoperatively. Despite a spinal anaesthetic block to T5 bilaterally, lung function tests remained stable. An epidural infusion provided good postoperative analgesia. The outcome was successful for mother and fetus.
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PMID:Caesarean section in a patient with cystic fibrosis. 1562 46

Numerous case reports, uncontrolled studies, and small randomized placebo-controlled trials have investigated the role of aerosolized opioids in the treatment of both dyspnea and pain. Recently, aerosolized furosemide was studied for the treatment of dyspnea. A direct effect on either pulmonary stretch receptors or irritant receptors has been proposed to explain the apparent effectiveness of these drugs. A review of the literature found 37 studies and reports: 23 on aerosolized opioids to treat dyspnea, 7 for analgesia, and 7 on aerosolized furosemide. In general, prospective double-blind randomized placebo-controlled trials have investigated the effects of aerosolized opioids on dyspnea and exercise tolerance in patients with stable chronic cardiopulmonary disease, and found no effect. In contrast, the vast majority of studies found that aerosolized opioids relieved dyspnea better than parenteral opioids and with less systemic adverse effects in patients with terminal lung cancer and cystic fibrosis. However, most of these findings come from uncontrolled studies and case reports. Aerosolized opioids also have been found to provide effective analgesia, again with less systemic adverse effect. Small, generally uncontrolled, studies suggest that aerosolized furosemide may relieve dyspnea both in patients with terminal cancer and those with chronic obstructive pulmonary disease. Routine clinical use of aerosolized opioids to treat dyspnea in terminal illness will require large randomized placebo-controlled trials. However, until these studies are done, the risk/benefit ratio favors use of aerosolized opioids and furosemide in selected patients, based on the principle of compassionate care.
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PMID:The role of inhaled opioids and furosemide for the treatment of dyspnea. 1759 33

Cystic fibrosis affects 1 in 1600-2500 live births and is inherited in an autosomal recessive manner. It primarily involves the respiratory, gastrointestinal and reproductive tracts, with impaired clearance of, and obstruction by, increasingly viscous secretions. Severe respiratory disease, diabetes and gastro-oesophageal reflux may result. Improvements in medical management and survival of cystic fibrosis patients means more are committing to pregnancies. Although guidance for anaesthesia in this patient group is available, management and outcome data associated with more severe cases are sparse. Patients with severe cystic fibrosis require multidisciplinary input and should be managed in a tertiary referral centre. Close monitoring of respiratory function and preoperative optimisation during pregnancy are mandatory. The risk of preterm labour and delivery is increased. Pregnancy and delivery can be managed successfully, even in patients with FEV1 <40% predicted. Neuraxial anaesthesia and analgesia should be the technique of choice for delivery. Postoperative care should be carried out in a critical care setting with the provision of postoperative ventilation if necessary.
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PMID:Anaesthesia for parturients with severe cystic fibrosis: a case series. 2436 Nov 90

Cystic fibrosis (CF) is a severe disease that is transmitted with an autosomal recessive inheritance pattern, and is the commonest disease among Caucasian populations (1/2,500). There are many clinical manifestations that derive from its multiorgan dysfunctions, mainly in the respiratory and digestive tract. In addition, lung disease injury is principally responsible for morbidity and mortality in CF patients. Blocking the rectus sheath, first described by Schleich in 1899, is a loco-regional technique that provides adequate analgesia in those surgical procedures with midline or umbilical incisions.
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PMID:Blocking the rectus sheath guided by ultrasound in an 8-year-old patient with cystic fibrosis: reporting a case. 2673 16

Cystic fibrosis (CF) is the most common life-limiting genetic disease in Caucasians. Declining lung function is the principal cause of death, but liver involvement can lead to the need for liver transplantation. General anesthesia has detrimental effects on pulmonary function, increasing perioperative morbidity and mortality in CF patients. Regional anesthetic techniques improve outcomes by reducing anesthetic drugs and administration of opioids, and hastening extubation, awakening, and restarting respiratory of physiotherapy. There is a growing evidence that thoracic epidural anesthesia is feasible in pediatric patients. Concerns about coagulopathy and immunosuppression have limited its use in liver transplantation. Ultrasonography is becoming an adjunct tool in neuraxial blocks, allowing faster and easier recognition of the epidural space, and reducing vertebral touch and number of attempts. In pediatric patients, it is still debated whether anesthesia has detrimental effects on cognitive development. Efforts to make regional techniques easier and safer by ultrasonography are ongoing. We report the first case of continuous thoracic epidural analgesia after pediatric liver transplantation in a 10-year-old boy affected with CF with macronodular cirrhosis. Despite a challenging coagulation profile, the echo-assisted procedure was safely performed and allowed extubation in the odds ratio, postoperative awakening and comfort, and quick resumption of respiratory physiotherapy.
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PMID:Postoperative pain management of liver transplantation in cystic fibrosis: Is it time to start US-guided neuraxial blocks? 2783 95

This review focuses on nasal and pulmonary delivery of NSAIDs (non-steroidal anti-inflammatory drugs) for fast-onset analgesia, for the potential prevention of Alzheimer's disease (AD), as well as for an add-on treatment in cystic fibrosis (CF) and non-small cell lung cancer (NSCLC). I discuss how the physicochemical properties of NSAIDs can be modified with respect to the biological characteristics of the target site. Innovative technology and/or dosage forms can promote an effective therapy.
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PMID:Modifying the physicochemical properties of NSAIDs for nasal and pulmonary administration. 3010 68


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