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

Patients with primary pulmonary hypertension occasionally present for surgery. Anaesthesia requires continuous cardiovascular monitoring and maintenance of stable pulmonary and systemic haemodynamics. The management of a patient with severe pulmonary hypertension, undergoing open lung biopsy under a combination of general anaesthesia and thoracic epidural analgesia is reported and the problems of primary pulmonary hypertension are discussed.
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PMID:Thoracic epidural anaesthesia and primary pulmonary hypertension. 161 87

In this clinical study, 20 high risk infants and neonates were monitored to identify and characterize pulmonary hypertensive crises following surgery for congenital cardiac defects. Monitoring included right ventricular or pulmonary artery pressure catheters and transcutaneous oximetry. Eleven patients also had continuous analog recording of hemodynamic data so that antecedents of crises and the sequence of events following treatment could be reconstructed. Eleven of the 20 patients had one or more crises. Six of these ultimately died whereas 5 patients survived with aggressive vasodilator therapy. Four patients without crises but with episodic pulmonary hypertension benefitted from pulmonary vasodilator therapy to ease weaning from ventilatory support. Typically, each crisis was associated with a stress event. Crises were difficult to ablate if not rapidly treated and multiple crises would often cluster following an initial event. High dose narcotic (fentanyl) analgesia was found to be important in the postoperative management. Tolazoline and oxygen were the most consistently useful vasodilators, but isoproterenol and nitrates also played a role. Five of the children who died were examined post mortem: histologically, there was increased pulmonary arterial muscularization in 2, in none were there changes of fixed pulmonary vascular disease. The postoperative management must be individualized on the basis of monitored responses of pulmonary circulation.
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PMID:Pulmonary hypertensive crises following surgery for congenital heart defects in young children. 177 78

We present the case of a parturient with severe mitral stenosis and pulmonary hypertension who received general anaesthesia using alfentanil for urgent Caesarean section. Alfentanil promoted haemodynamic stability and allowed immediate postoperative extubation. Epidural morphine provided postoperative analgesia. This combination permitted early ambulation and prevention of thromboembolism. A disadvantage of this technique, neonatal respiratory depression, was promptly reversed with a single dose of naloxone. The anaesthetic management of mitral stenosis in pregnancy is discussed and the neonatal pharmacokinetics of maternally administered alfentanil are presented.
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PMID:Alfentanil for urgent caesarean section in a patient with severe mitral stenosis and pulmonary hypertension. 211 2

Maternal pulmonary hypertension can be life threatening, and many problems and complications can occur during labor and delivery as well as postpartum. A case of severe maternal pulmonary hypertension was monitored with a pulmonary artery catheter. Intrathecal morphine was administered for labor analgesia, and low-dose dopamine was utilized for maternal oliguria. Neither the morphine nor the dopamine resulted in adverse maternal hemodynamic effects. Both analgesia and resolution of the oliguria were accomplished.
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PMID:Intrathecal morphine analgesia and low-dose dopamine for oliguria in severe maternal pulmonary hypertension. A case report. 237 60

We describe the intrapartum management of a patient with severe pulmonary hypertension using extradural analgesia with a low dose of 0.125% bupivacaine and fentanyl 20 micrograms ml-1 by continuous infusion at a rate of 2.5 ml h-1. This provided effective analgesia and haemodynamic stability. The importance of continuous direct measurement of pulmonary artery pressure is emphasized.
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PMID:Extradural analgesia in the intrapartum management of a patient with pulmonary hypertension. 276 36

A 69-year-old patient with severe impairment of left ventricular function secondary to dilated cardiomyopathy underwent a successful total hip replacement under epidural analgesia. Perioperative heart rate and mean arterial pressure were stable at an analgesic level up to the seventh thoracic dermatome, achieved with mepivacaine two per cent with epinephrine. Asymptomatic pulmonary hypertension, occurring during the insertion of the femoral prosthesis, subsided spontaneously over the next twelve hours. The circulatory effects of epidural analgesia and their significance in a patient with dilated cardiomyopathy are discussed.
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PMID:Epidural analgesia for total hip replacement in a patient with dilated cardiomyopathy. 394 54

In a patients with severe pulmonary hypertension, haemodynamic observations, including cardiac output and pressure measurement in the systemic and the pulmonary circulation, were performed during vaginal delivery under selective segmental epidural block from T9 to L1 combined with bilateral pudendal blocks. No hypotensive episodes were observed in connection with the epidural block, but a gradual increase in the pulmonary pressures was observed during the stages of delivery. After perineal analgesia was achieved with bilateral pudendal blocks, a 2100 g girl with an Apgar score of 9 at 1 min was delivered by vacuum extraction. The patient died 9 days after the delivery because of intractable cardiac failure.
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PMID:The use of epidural analgesia for delivery in a patient with pulmonary hypertension. 711 25

We have studied the analgesic efficacy of a single i.v. dose of tenoxicam 20 mg, given 10 min before induction of anaesthesia in 25 patients undergoing elective Caesarean section. Another group of 25 similar patients served as controls. Nalbuphine consumption in the first 24 h after operation was reduced by 50% when tenoxicam was given. The median time to first request for analgesia was increased from 25 to 110 min in the tenoxicam group. Subjective experiences of pain and sedation were significantly greater in the control group up to 24 h after operation. The haemodynamic variability after intubation was of shorter duration in the tenoxicam group. There was no significant difference in incidence and severity of postoperative nausea and vomiting between the two groups. The surgeon's assessment of uterine relaxation and bleeding, using a visual analogue score, and infant well-being, as judged by Apgar score and cord blood-gas analysis, showed no significant difference between the two groups. There was no evidence of premature closure of the ductus arteriosus or pulmonary hypertension. We conclude that a single i.v. dose of tenoxicam is a useful pretreatment to minimize the haemodynamic variability of light general anaesthesia at induction-delivery and in reducing 24 h postoperative opioid consumption.
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PMID:I.v. tenoxicam for analgesia during caesarean section. 757 99

This is the report of a series of eight patients with pulmonary hypertension (primary and secondary) who delivered at the McMaster University Medical Centre between 1978 and 1987. Seven of the eight patients delivered vaginally and had a successful outcome. The eighth patient was admitted as an emergency and died shortly after Caesarean section under general anaesthesia, performed to save the infant. The other seven patients were all managed by a team, including anaesthetists, cardiologists and obstetricians, from about 25 wk. The patients were hospitalized pre-partum and received oxygen therapy and anticoagulation with heparin. Analgesia in labour was managed, once anticoagulation was reversed, by low concentrations of epidural bupivacaine (0.125%-0.375%) and fentanyl. The patients were monitored during labour and delivery with oximetry and arterial and central venous pressure lines. Pulmonary arterial lines were not used because of increased risk and questionable usefulness. Vaginal delivery was managed with vacuum extraction or forceps lift-out to minimize the stress of pushing. After delivery, all patients were monitored in an intensive care unit for several days, anticoagulation was restarted, and all patients were discharged home taking oral anticoagulant therapy. The successful management of pulmonary hypertension in pregnancy should include team management started early in pregnancy and controlled vaginal delivery utilizing epidural analgesia.
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PMID:Pulmonary hypertension and pregnancy: a series of eight cases. 806 91

A Caesarean section was performed in a 34-year-old patient experiencing a major left heart failure secondary to an anterior myocardial infarction which occurred four years before. At the end of pregnancy, she developed a mild pulmonary hypertension. Caesarean section was decided to maintain a stable haemodynamic status. For the same reason, general anaesthesia with etomidate was preferred rather than epidural analgesia. Haemodynamic monitoring allowed the adequate management of blood pressure, heart rate, pulmonary blood pressure and arterial oxygen saturation. Postoperative analgesia was obtained with opioids administered epidurally.
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PMID:[Cesarean section and left ventricular failure caused by coronary artery disease: anesthetic management]. 857 9


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