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)

Carcinoid syndrome creates many challenges during anaesthesia, including hypertension, hypotension and bronchospasm. These challenges are less common and less severe after the routine use of octreotide. We describe the use of remifentanil as part of the anaesthetic management of a 67-yr-old man undergoing resection of a carcinoid tumour of the terminal ileum. The combination of perioperative octreotide administration, intraoperative remifentanil infusion and sevoflurane anaesthesia, with postoperative epidural analgesia proved satisfactory. We review the recent literature and suggest that remifentanil is a useful addition to the armamentarium of the anaesthetist in the management of a patient with carcinoid syndrome.
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PMID:Remifentanil and anaesthesia for carcinoid syndrome. 1503 95

Tramadol hydrochloride is a widely prescribed, centrally acting analgesic marketed in over 90 countries. Before being released in the U.S. in 1995, the drug had been available in Europe for almost two decades. Thus, the pharmacokinetic and pharmacodynamic properties of tramadol have been extensively investigated. However, additional information about the drug continues to be discovered. Tramadol exists as a racemic mixture with the (+)-enantiomer and the (-)-enantiomer, and at least some of their metabolites, having different effects. Tramadol has dual mechanisms of action by which analgesia may be achieved: micro-opioid receptor activation and enhancement of serotonin and norepinephrine transmission. Serotonin syndrome may occur in patients taking combinations of tramadol and other agents that increase serotonin activity. The relative degree of contribution of each mechanism toward pain control is not fully understood. By increasing serotonin and norepinephrine neurotransmission, tramadol may conceivably also exert a degree of antidepressant effect. Therefore, tramadol may be of particular value in patients with chronic pain who also suffer from depression. This drug has been shown to be beneficial in the treatment of a wide range of acute and chronic pain syndromes, including neuropathic pain. While abuse of tramadol may occur, several large studies have demonstrated that the incidence of abuse is rather low, about one case per 100,000 patients.
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PMID:Tramadol: basic pharmacology and emerging concepts. 1918 Feb 60

There are limited numbers of reports concerning the management of pregnancy complicated by carcinoid tumors. Octreotide, the synthetic analogue of somatostatin, has been found to be beneficial in preventing the perioperative exacerbation of carcinoid syndrome. We present a case of the successful use of neuraxial analgesia/anesthesia for labor and vaginal delivery in a symptomatic parturient afflicted with carcinoid syndrome, who received an intravenous infusion of octreotide throughout labor and vaginal delivery.
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PMID:Carcinoid tumor and intravenous octreotide infusion during labor and delivery. 1920 Jul 14

Carcinoid tumours are neuroendocrine in origin and release vasoactive substances. Carcinoid tumours may be associated with carcinoid syndrome in 2-5% of patients and result in haemodynamic instability, bronchospasm, volume and electrolyte imbalance, and hyperglycaemia. We present the anaesthetic management of a 29-year-old parturient with metastatic carcinoid tumour. Although our patient did not ultimately develop carcinoid syndrome during the peripartum period, it was important that we used a multidisciplinary team approach, with close monitoring of her antenatal progress, and planned epidural analgesia for labour and delivery.
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PMID:Anaesthetic management of a pregnant woman with carcinoid disease. 1944 2

Serotonin syndrome is a rare but potentially life-threatening adverse drug reaction resulting from the use or overuse of serotonergic medications alone or in combination. Mild symptoms, overlapping features with similar conditions and clinician lack of awareness are the major reasons for an often missed diagnosis. Not surprisingly, this condition is significantly underreported as a potential complication of endoscopy if serotonergic medications are used periprocedurally for sedation and analgesia. Here we report the case of a patient with relapsed chronic hepatitis C on antidepressant medications who developed signs and symptoms of serotonin syndrome after a percutaneous liver biopsy. Review of the patient's medication list suggested a possible interaction between her home antidepressants and the post-procedure use of fentanyl for abdominal pain. The patient required monitoring in the medical intensive care unit and stabilized after the administration of benzodiazepines and temporary discontinuation of her home medications. We propose that clinicians need to be aware of the increased risk of serotonin syndrome in the outpatient endoscopy setting, particularly with the wider use of serotonergic antidepressants now available and the repeated number of liver biopsies being performed for management of patients with chronic liver disease.
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PMID:Serotonin Syndrome in a Patient on Trazodone and Duloxetine Who Received Fentanyl following a Percutaneous Liver Biopsy. 2607 31