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

In 70 patients (maxillo-facial-, neurosurgical-, abdominal- and gynaecological operations) the technique of "analgetic anaesthesia" using high doses of fentanyl (0.025 mg/kg body weight) and naloxone as its antagonist (0.02 mg/kg body weight) has been employed. All patients were artificially ventilated with N2O/O2 in a 3:1 ratio. Muscle relaxation was achieved with pancuronium-bromide (0.08 mg/kg). The patients had no apparent heart or lung disease. The youngest patient was 4 years of age, the oldest 82 years of age (average age 48.9). The necessity for a reinjection of fentanyl (half the initial dose) was determined by continously monitoring heart rate. This variable appeared to be the most subtle index indicating a reduction in analgesia. Sufficient analgesia was maintained once the heart rate stayed 20% below preanaesthetic levels. At the end of the operation naloxone reversed the respiratory depression. There was no evidence indicating postoperative pain, which may have required administration of additional analgesics. If deep analgesia was maintained up to the last surgical procedures no emesis appeared in the post operative period. The incidence of emesis was higher 10% compared to the classical neuroleptanalgesia with droperidol this was often noted in cases where blood accumulated in the stomach (maxillo-facial operations) (70%). In 3% of all cases psychomotor agitation with delirium appeared right after the injection of naloxone. This lasted for about 15 minutes. We suspect that due to the sudden and powerful effect of naxolone, in replacing fentanyl from its receptor site, acute withdrawal symptoms may be precipitated.
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PMID:[High doses of fentanyl as the sole anaesthetic agent and naloxone as its antagonist (author's transl)]. 113 60

The realization that many intensive care patients develop psychoreactive problems ranging from confusion to depression to frank mutism led us to include Dehydrobenzperidol (DHB) in our analgesia and sedation scheme. The early prophylactic administration of this drug was found to be particularly effective in the prevention of delirium following an alcohol and/or drug overdose.
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PMID:[Psychopharmacologic aspects in intensive care medicine]. 181 35

20 women undergoing voluntary induced abortion for the first time who were 25-35 years old and weighed 55-65 kg. received .2 mg/kg diazepam iv and 2 mg/kg ketamine iv. 5 and 10 minutes after starting of anesthesia, 10 patients received 4 mcg/kg naloxone iv for a total dose of 8 mcg/kg. The remaining 10 patients received 2 ml of physiological solution iv twice. The interval between the administration and onset of anesthesia was 78 + or - 10.3 seconds in the control group and 79.1 + or - 12.9 seconds in the treatment group. The duration of anesthesia was 7.5 + or - .8 minutes in controls and 7.4 + or - 1 minute in the naloxone-treated group. The recuperation as measured by answering simple commands was 23.8 = or - 3 minutes in controls and 24 + or - 4.2 minutes in the naloxone group. Recognition of persons was 36.5 + or - 5.3 minutes and 36 + or - 5.2 minutes, respectively; and the regaining of spacial- temporal orientation took 75 + or - 9.8 minutes and 73.8 + or - 12.2 minutes, respectively. These figures were without statistical significance. There were 13 and 14 instances of side effects in controls and the naloxone treatment group, respectively. 1 case of delirium occurred in both groups; 3 cases of diplopia in both groups; 6 and 5 instances of floating, respectively; 3 and 4 instances of vertigo, respectively; and 1 case of vomiting in the naloxone group. 1 patient in each group considered the experience unpleasant, 4 patients each were unaffected, and 1 each judged it pleasant. The score on the scale of analgesia was 2.4 + or - 1.2 in the control group and 2.3 + or - .9 in the naloxone-treated group. In conclusion, clinical doses of naloxone did not appreciably modify the action of ketamine, and clinical doses of ketamine do not interfere the opiate receptors.
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PMID:[In clinical use conditions naloxone does not antagonize the effects of ketamine]. 345 87

Despite the widespread use of meperidine as an analgesic, its potential for producing delirium has been overlooked. Six cases demonstrating meperidine-induced behavioral toxicity are reported. Toxicity was more likely when meperidine was combined with cimetidine or drugs having anticholinergic activity. Discontinuation of meperidine and substitution of morphine for analgesia were usually successful in treating the delirium. Physostigmine reversed the delirium in one patient. The authors suggest that the delirium results from the excessive anticholinergic activity of meperidine or its only active metabolite, normeperidine.
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PMID:Meperidine-induced delirium. 360 28

Cowden syndrome is a rare syndrome of chromosome abnormalities presenting with polyposis of digestive tracts, characteristic skin eruption and neuromuscular disorders. A 56-year-old male patient with Cowden syndrome underwent upper abdominal surgery under general anesthesia followed by post-operative epidural analgesia with buprenorphine. Proposed total gastrectomy was not performed because of massive invasion of carcinoma in the abdominal cavity and gastrojejunostomy was done instead. The anesthesia was satisfactory with inhalation of nitrous oxide and enflurane with intravenous vecuronium. Neuromuscular monitoring with electric twitch-responses of the hand showed normal patterns throughout the anesthesia. The recovery from anesthesia and neuromuscular blockade was prompt. Intermittent epidural buprenorphine, twice a day (0.2 mg of buprenorphine in 9 ml of normal saline for one time) was started just after the recovery of anesthesia and continued for four days. Delirium occurred two days after beginning epidural buprenorphine and disappeared three days after its discontinuation. The patient died 52 days after the operation from obstructive jaundice and sepsis. The delirium, therefore, seems to have been caused by buprenorphine possibly due to its impaired metabolism by the liver. Although we did not experience any abnormal neuromuscular reactions to vecuronium or anesthetic agents, it is important to perform preoperative neuromuscular examinations and peri-operative monitoring in the anesthetic management of a patient with this syndrome.
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PMID:[Anesthetic management of a patient with Cowden syndrome]. 773 7

Patients admitted to the intensive care unit often experience some degree of pain and frequently are anxious, confused or delirious. Relief of pain, anxiety and agitation is important for effective patient care. Initial attention should be directed toward eliminating organic causes of delirium. Opioids are the cornerstone of analgesia, while benzodiazepines and haloperidol are commonly used for sedation and relief of agitation. When sedative agents fail to control agitation and effective ventilation of the patient is compromised, it may be appropriate to pharmacologically paralyze the patient.
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PMID:Analgesia, sedation and paralysis in the intensive care unit. 781 Apr 69

The role of neuroleptic drugs as adjuvant analgesics has been a subject of longstanding controversy. Despite frequent claims of efficacy, evidence from controlled trials supports neither claims of intrinsic analgesic properties nor the routine use of the neuroleptics as a means to reliably induce clinically useful analgesia. Methotrimeprazine is unique in that there is evidence for reliable dose-related analgesia that is comparable to opioid-mediated analgesia, although routine use is not recommended. Despite probable interaction with opioid receptors, there is insufficient evidence to support a role for the butyrophenone category of neuroleptics as adjuvant analgesics. Limited trials of the neuroleptics may be considered for pain that has been unresponsive to more conventional pharmacologic approaches, especially when associated with headache, nerve injury, or psychological distress. The neuroleptics have an important role in the symptomatic management of agitation, delirium, and nausea, particularly in patients with cancer.
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PMID:The neuroleptics as adjuvant analgesics. 782 84

This article discusses the use of an algorithm developed by nurses at the University of Minnesota Hospital and Clinic in Minneapolis, that can be used to distinguish the need for sedative, anxiolytic, and analgesic agents for patients in the medical intensive care unit (MICU). Many problems associated with patient sedation and analgesia exist within the critical care environment. These problems include undersedating patients with neuromuscular blockade; rapidly tapering or abruptly discontinuing high-dosage sedation, which often results in withdrawal symptoms; over-use of high-dosage continuous intravenous infusions of short-acting benzodiazepines and analgesics; failure to recognize delirium; and resistance to modifying drug regimens when patient outcomes are not satisfactory.
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PMID:An algorithm to distinguish the need for sedative, anxiolytic, and analgesic agents. 788 99

We have observed among patients of the Southern Community Hospice Programme that up to 25% experience acute delirium when treated with morphine and improve when the opioid is changed to oxycodone or fentanyl. This study aimed to confirm by a prospective trial that oxycodone produces less delirium than morphine in such patients. Oxycodone was administered by a continuous subcutaneous infusion, as this allowed more flexible and reliable dosing, and patients were monitored for any adverse reactions to the drug. Thirteen patients completed the study. Statistically significant improvements in mental state and nausea and vomiting occurred following a change from morphine to oxycodone. Pain scores improved but did not reach a level of statistical significance. The phenotype status of the patients was tested to establish their capacity to metabolize oxycodone. One patient who did not achieve adequate pain control proved to be a poor metabolizer. These results show that oxycodone administered by the subcutaneous route can provide effective analgesia without significant side effects in patients with morphine-induced delirium. This treatment allows patients to remain more comfortable and lucid in their final days. A small proportion of patients who do not metabolize oxycodone effectively may not receive this benefit.
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PMID:Attenuation of morphine-induced delirium in palliative care by substitution with infusion of oxycodone. 880 81

Oxycodone is a strong opioid that has been available for at least 70 years. At present, commercially prepared parenteral oxycodone is only available in Finland. We report in this paper our experience of administering oxycodone s.c. From 21 October 1996 to 31 July 1998, 63 advanced cancer patients received intermittent s.c. injections of oxycodone via the Edmonton Injector, a simple, low-cost mechanical device. Local tolerance and systemic toxicity were followed prospectively. Only 2 patients developed s.c. injection site intolerance, and in both cases doses of 50 mg/ml or more were being administered. Most of the patients in this study were rotated to oxycodone because of opioid toxicity, and in 34% of those patients their delirium subsided. A subgroup of 19 patients who underwent rotation to oxycodone SC from morphine and hydromorphone were studied for equivalent analgesia with oxycodone. We found a ratio (mean +/- SD) of 1.2+/-0.4 for morphine s.c. to oxycodone s.c. and a mean ratio of 0.5+/-0.4 for hydromorphone s.c. to oxycodone s.c. When hydromorphone s.c. was converted to a morphine s.c. equivalent dose and the results for these patients were added to those for the morphine s.c. group, the mean and median overall ratios of morphine s.c. equivalent dose to oxycodone were 1.9+/-1.5 and 1.4, respectively. The cost of the oxycodone s.c. was also evaluated and was found to be comparable to that of morphine s.c. and lower than that of hydromorphone s.c. We conclude that s.c. oxycodone can be an effective, safe and inexpensive alternative opioid agonist.
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PMID:The use of intermittent subcutaneous injections of oxycodone for opioid rotation in patients with cancer pain. 1042 53


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