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

Pethidine is commonly used in single doses as a preoperative medication or in multiple doses as an analgesic. The clinical consequences of altered disposition are more likely to result from its analgesic use. Correlations between plasma pethidine concentration, analgesia and side effects such as respiratory depression, have been established, but considerable overlap exists between concentrations producing therapeutic and non-therapeutic effects. The current practice of intermittent pethidine administration (intravenous, intramuscular and oral) for analgesia results in fluctuations in pethidine plasma concentrations which are associated with incomplete pain relief and side effects. Continuous intravenous infusion of pethidine may avoid these difficulties. Changes in pethidine disposition have been observed in patients with liver disease and in the elderly. Measurement of plasma pethidine concentrations may be helpful as an aid to the management of such patients. In renal disease, metabolites may accumulate and cause side effects.
 ...
PMID:Clinical pharmacokinetics of pethidine. 35 12

Sixty eight anesthesia procedures during abdominal delivery in patients with late toxemia of pregnancy have been analysed. In 32 cases the diagnosis was preeclampsia, in 8 cases--eclampsia, in 28 cases III degree nephropathy. Depending on the variant and method of anesthesia the subjects were divided into 3 clinical groups. Group I comprised 31 women to whom cesarean section was performed under general endotracheal anesthesia. In group II (24 pregnant women) analgesia was achieved by prolonged epidural anesthesia (PEA). In group III (13 patients) a combination of PEA and superficial endotracheal anesthesia was used. Analysis of the anesthesia techniques in patients with severe late toxemia of pregnancy has established that in endotracheal anesthesia it is sometimes impossible to block completely pathological and operation-induced nociceptive pulsation. PEA has a good analgetic effect but ensures no neuroautonomous protection, and upon discontinuation of action of the local anesthetic there is a danger of the onset of the convulsion syndrome and signs of preeclampsia or eclampsia. Taking into account the advantages and disadvantages of endotracheal anesthesia and PEA, a technique based on the combination of both variants has been selected, which ensures optimal anesthesiological protection in abdominal delivery.
 ...
PMID:[The choice of anesthesia during abdominal delivery in patients with severe forms of late pregnancy toxemias]. 149 74

The pharmacology, pharmacokinetics, clinical efficacy, adverse effects, and dosage of oxaprozin are reviewed. Oxaprozin, a nonsteroidal anti-inflammatory drug (NSAID) under consideration for approval by the Food and Drug Administration, is characterized as a propionic acid. By inhibiting cyclo-oxygenase, oxaprozin decreases the formation of prostaglandin (PG) precursors from arachidonic acid, resulting in decreased PG biosynthesis and reduced pain and inflammatory responses. Oxaprozin is well absorbed after oral administration, and peak plasma concentration is reached in three to six hours. Oxaprozin is primarily eliminated by urinary excretion of the unchanged drug. It has a long elimination half-life and persists in synovial fluid. In clinical studies, oxaprozin was equally or more effective than aspirin and as effective as naproxen in the treatment of rheumatoid arthritis. For treatment of osteoarthritis, oxaprozin was as effective as naproxen and more effective than aspirin or piroxicam. Studies have also shown oxaprozin to be effective therapy for juvenile rheumatoid arthritis and ankylosing spondylitis. Oxaprozin, like other NSAIDs, can cause gastrointestinal adverse effects. Other possible adverse effects include allergic reactions, analgesic nephropathy, hepatotoxicity, and increased bleeding times. For adults, the anticipated daily dosage is 600-1200 mg given as a single dose for rheumatoid arthritis, osteoarthritis, and analgesia. In children, oxaprozin 10-20 mg/kg/day has been used to treat juvenile rheumatoid arthritis. Oxaprozin is as effective as other NSAIDs and offers once-daily dosing; however, it does not offer any therapeutic advantage over other currently available NSAIDs.
 ...
PMID:Oxaprozin: a once-daily nonsteroidal anti-inflammatory drug. 845 76

Patients with renal disease are at risk of further deterioration of renal function and acute tubular necrosis when subjected to anaesthesia and surgery. Optimal fluid loading and careful selection of anaesthetic techniques and agents, appropriate monitoring and the use of mannitol and dopamine assist in the maintenance of renal blood flow and help preserve renal function in these patients. In association with renal failure, physiological changes in other systems result in reduced oxygen supply to the tissues, metabolic disturbances, impairment of the coagulation and immune defence mechanisms and an increased risk of cardiac and cerebrovascular catastrophe. Although many anaesthetic techniques including regional analgesia may be used successfully in these patients caution with most drugs, especially pethidine, phenoperidine, suxamethonium and all non-depolarising neuromuscular relaxants is recommended. Of the volatile anaesthetics currently available, halothane is the agent of choice. Oxygen therapy and close monitoring of cardiorespiratory function are necessary postoperatively.
 ...
PMID:Anaesthesia for the patient with impaired renal function. 635 49

We report our experience with the transperitoneal (TP) and retroperitoneal (RP) approaches for performing laparoscopic nephrectomy for benign disease. Thirty-three patients with benign renal disease underwent laparoscopic nephrectomy, 23 by the TP and 10 by the RP approach. The average age of the patient, ASA score, and specimen weight were similar for the two groups. The average operating time for the TP approach was 5.6 hours v 5 hours for the RP approach. The average hospital stay was 2.8 and 3 days for TP and RP groups, respectively. The use of postoperative analgesics was similar in the two groups (37 mg of morphine sulfate equivalent v 39 mg of morphine sulfate equivalent for the TP and RP groups, respectively). However, the RP group required less time to resume normal oral intake than the TP group (0.3 v 0.6 days). When assessed according to specimen weight of 100 or less, there was a significant reduction in the postoperative analgesia requirements for the RP group of patients (11 mg of morphine sulfate equivalent v 28 mg of morphine sulfate equivalent for the TP group). In this subgroup of patients, the resumption of oral intake also occurred more quickly in the RP than the TP group (0.4 v 0.5 days). The hospital stay and total convalescence time were similar for the two groups. Four complications occurred in the 33 patients: 2 patients (1 TP and 1 RP), required conversion to open surgery, 1 asthenic patient developed a vastus lateralis bruise undergoing a TP approach, and a brachial nerve palsy occurred in a morbidly obese patient who failed a TP approach. The RP approach to laparoscopic nephrectomy reduces the time to resuming normal oral intake for patients postoperatively and, in those patients with a small specimen, may significantly reduce their postoperative analgesia requirements. However, the RP approach for laparoscopic nephrectomy for benign disease does not significantly improve the length of hospital stay or the patient's ultimate postoperative return to normal activity in comparison to the TP approach. There does appear to be a trend toward a shorter operative time for the RP approach. The RP laparoscopic approach is our method of choice for patients with benign renal disease.
 ...
PMID:Laparoscopic nephrectomy for benign disease: comparison of the transperitoneal and retroperitoneal approaches. 883 28

Anesthesia in the white rhinoceros (Ceratotherium simum) has routinely involved potent narcotic anesthetic agents such as etorphine or carfentanil with their associated adverse side effects. In captive rhinoceroses conditioned to routine handling, a combination of butorphanol and azaperone at mean (+/- SD) doses of 69.3 +/- 18.0 mg and 103.1 +/- 20.9 mg, respectively, was used to produce levels of neuroleptanalgesia ranging from light "standing" sedation to deeper planes of anesthesia producing sternal and lateral recumbency. This combination was used for repeated (minimum repeat frequency of 3 days between events) anesthetic episodes (n = 26) in two animals, with the remaining episode performed in a white rhinoceros with chronic renal disease. The action of butorphanol was satisfactorily reversed with naltrexone (125 mg i.v. and 125 mg i.m.). Results (mean +/- SD) include sternal recumbency achieved in 14.1 +/- 8.1 min after i.m. dosing, standing and ambulation occurred in 1.7 +/- 0.6 min after reversal, heart rate was 62.0 +/- 10.1 beats/min, respiratory rate was 14.7 +/- 5.6 breaths/min, and percentage of oxygen saturation of hemoglobin (Spo2) was 89.2 +/- 3.0%. Without supplementation, the total elapsed time ranged from 44.9 min to 103.0 min, whereas elapsed times up to 214.3 min were achieved with supplementation (mean time to supplementation was 28.0 +/- 13.9 min after initial dosing). Butorphanol and azaperone produced adequate muscle relaxation and apparently adequate analgesia for minor surgical interferences, including abdominal laparoscopy. Respiratory rates and Spo2 measurements were improved compared with reports of using more potent opioids in this species.
 ...
PMID:Butorphanol and azaperone as a safe alternative for repeated chemical restraint in captive white rhinoceros (Ceratotherium simum). 1098 32

Caffeine has been an additive in analgesics for many years. However, the analgesic adjuvant effects of caffeine have not been seriously investigated since a pooled analysis conducted in 1984 showed that caffeine reduces the amount of paracetamol (acetaminophen) necessary for the same effect by approximately 40%. In vitro and in vivo pharmacological research has provided some evidence that caffeine can have anti-nociceptive actions through blockade of adenosine receptors, inhibition of cyclo-oxygenase-2 enzyme synthesis, or by changes in emotion state. Nevertheless, these actions are only considered in some cases. It is suggested that the actual doses of analgesics and caffeine used can influence the analgesic adjuvant effects of caffeine, and doses that are either too low or too high lead to no analgesic enhancement. Clinical trials suggest that caffeine in doses of more than 65 mg may be useful for enhancement of analgesia. However, except for in headache pain, the benefits are equivocal. While adding caffeine to analgesics increases the number of patients who become free from headache [rate ratio = 1.36, 95% confidence interval (CI) 1.17 to 1.58], it also leads to more patients with nervousness and dizziness (relative risk = 1.60, 95% CI 1.26 to 2.03). It is suggested that long-term use or overuse of analgesic medications is associated with rebound headache. However, there is no robust evidence that headache after use or withdrawal of caffeine-containing analgesics is more frequent than after other analgesics. Case-control studies have shown that caffeine-containing analgesics are associated with analgesic nephropathy (odds ratio = 4.9, 95% CI 2.3 to 10.3). However, no specific contribution of caffeine to analgesic nephropathy can be identified from these studies. Whether caffeine produces nephrotoxicity on its own, or increases nephrotoxicity due to analgesics, is yet to be established.
 ...
PMID:A benefit-risk assessment of caffeine as an analgesic adjuvant. 1177 46

Non-pharmacological interventions are the first-line therapy for osteoarthritis. If non-pharmacological therapy fails, paracetamol (up to 4 g daily) should be added. If paracetamol fails, the patient's risk factors for gastrointestinal and renal disease should be assessed. In patients with gastrointestinal risk factors, a COX-2-specific inhibitor (CSI) would be used in preference to a conventional non-steroidal anti-inflammatory drug (NSAID). In patients with renal risk factors, NSAIDs and CSIs should be used with care. In patients who continue to have problems, other treatments should be considered; these might include intra-articular hyaluronan or depot corticosteroid, analgesia or glucosamine.
 ...
PMID:Pharmacological therapies for the treatment of osteoarthritis. 1179 56

All fluid intake and urine output were monitored and measured in 103 consecutive women with normal blood pressure and without a history of pre-existing renal disease during induced labour for various indications. Epidural analgesia was administered in all these women and labour was augmented with oxytocin infusion. All urine specimens passed were tested for specific gravity. The temperature of the labour rooms was between 25 and 27 degrees C. Analysed results (from 50 women) shows that at a mean fluid intake of 75 ml/hour (standard deviation (SD) 21.84), oliguria (urine output <30 ml/hour) occurred in 42 (84%) of the women. There was a positive correlation between fluid intake and urinary output (r(2)=0.8515, P<0.0001). Urinary specific gravity was high (>1010) in all the specimens throughout the study. This study suggests that oliguria may be a common component of labour managed in this manner and its interpretation in pre-eclamptics in labour may be viewed in this context. Oliguria may therefore be a poor indicator of renal function or worsening pre-eclampsia during labour and its management needs to be limited to the severe and persistent variety to avoid renal complications. We believe from this study that relevant urine and blood biochemistry are better correlates of renal function in labour.
 ...
PMID:Urinary output during induced labour in normotensive women: a prospective pilot study. 1551 72

In this report, 16 patients with end-stage renal disease undergoing forearm arteriovenous shunt surgery were subjected to an ultrasound-guided axillary approach for brachial plexus nerve block. Two doses of 15 ml lidocaine 1.5% were injected using a double-shot technique The spread of the solution within the plexus sheath could be visualized using a high-resolution 12-MHz imaging probe. Most patients (94%) experienced an excellent analgesia in the regions innervated by median, ulnar and radial nerves with a lower percentage of complete analgesia (63%) in the areas innervated by musculocutaneous nerve. Three patients, who complained of pain during the surgery required further supplements of narcotics. There were no complications such as, nerve injury, puncture of the axillary vessels or other systemic reactions. This technique provides adequate analgesia - without complications and without difficulty - for extremity surgery in patients with end-stage renal diseases.
 ...
PMID:Ultrasound-guided axillary brachial plexus block in patients with chronic renal failure: report of sixteen cases. 1594 25


1 2 3 Next >>