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)

Acute myocardial infarction is potentially a highly treatable disease. Immediate interventions are directed to decreasing tissue hypoxia with oxygen and improving bloodflow to ischemic myocardium using nitrates and thrombolytic agents. Cardiac workload should be reduced by eliminating endogenous catecholamine release with analgesia and sedation, and beta blockade in patients without CHF to decrease heart rate and myocardial oxygen demand. Treatment of the complications of AMI include dysrhythmia prophylaxis, monitoring and specific therapy. Treatment of pump failure includes using vasodilators, vasopressors and positive inotropic agents. Early recognition and timely initiation of appropriate therapy should be every physician's goal.
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PMID:Update: drug therapy for acute myocardial infarction. 187 27

To examine the interaction of epidural anesthesia, coagulation status, and outcome after lower extremity revascularization, 80 patients with atherosclerotic vascular disease were prospectively randomized to receive general anesthesia combined with postoperative epidural analgesia (GEN-EPI) or general anesthesia with on-demand narcotic analgesia (GEN). Demographics did not differ between groups except that the GEN-EPI group had a higher incidence of diabetes mellitus and of previous myocardial infarction. Coagulation status was monitored using thromboelastography. An additional 40 randomly selected patients without atherosclerotic vascular disease undergoing noncardiovascular procedures served as controls for coagulation status. Vascular surgical patients were hypercoagulable compared with control patients before operation and on the first postoperative day. Postoperatively, this hypercoagulability was attenuated in the GEN-EPI group and was associated with a lower incidence of thrombotic events (peripheral arterial graft coronary artery or deep vein thromboses). The rates of cardiovascular, infectious, and overall postoperative complications, as well as duration of intensive care unit stay, were significantly reduced in the GEN-EPI group. Stepwise logistic regression demonstrated that the only significant predictors of postoperative cardiovascular complications were preoperative congestive heart failure and general anesthesia without epidural analgesia. We conclude that in patients with atherosclerotic vascular disease undergoing arterial reconstructive surgery (a) thromboelastographic evidence of increased platelet-fibrinogen interaction is associated with early postoperative thrombotic events, and (b) epidural anesthesia and analgesia is associated with beneficial effects on coagulation status and postoperative outcome compared with intermittent on-demand opioid analgesia.
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PMID:Effects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery. 195 66

Choice of anaesthesia between drug and acupuncture for dental surgeries has been a historical issue. Using the tool of decision analysis and clinical data from the medical literature, we developed an adequate mechanism for decision-making in the choice of dental anaesthesia. Our original approach toward the solution of this issue was two-dimensional decision analysis. In general our analytical results revealed that drugs are the preferred selection of anaesthesia for dental surgery. However, this conclusion is subject to the influence of a patient's physical and/or mental state. A typical decision analysis indicated that acupuncture analgesia is the preferred selection for dental patients with myocardial infarction.
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PMID:Choice of anaesthesia in dental operations. 207 2

We have recently shown the serotonin 5-HT1A receptor agonist buspirone to produce analgesia in several pain tests in rats. As a 5-HT1A agonist, buspirone may change serotonergic (5-HT) tone to alter the balance of central monoaminergic (MA) systems that function in analgesia. MA-reuptake blocking drugs have been shown to produce analgesia, both when given alone and in combination with a variety of other agents, presumably via their action upon MA neurochemistry. The present study was undertaken to examine the effect of systemic administration of the 5-HT-reuptake blocker amitriptyline (AMI: 10 mg/kg), NE-reuptake blocker desipramine (DMI: 10 mg/kg) or DA-reuptake blocker GBR-12909 (7.5 mg/kg) on patterns of analgesia produced by buspirone (1-5 mg/kg) in thermal and mechanical pain tests in rats. Neither reuptake blocking agents or buspirone, when administered alone or in combination, produced overt changes in motor activity at the doses tested. AMI alone was not analgesic in either thermal or mechanical pain tests. In both assays, AMI reduced the analgesic action of buspirone, with greater effects seen in the thermal test. When administered alone, DMI produced significant analgesia against thermal and mechanical pain. DMI significantly attenuated the analgesic action of all doses of buspirone in both pain tests. Alone, GBR-12909 did not affect nociception in thermal or mechanical tests. GBR-12909 decreased buspirone-induced analgesia at all doses in the thermal test, while having no effect on buspirone-induced analgesia against mechanical pain. These results demonstrate that facilitation of 5-HT, NE and DA function with reuptake blocking drugs did not enhance the analgesic action of buspirone. These data indicate against the adjuvant use of reuptake blocking compounds and buspirone as analgesics. Furthermore, such findings may suggest other possible non-MA substrates of buspirone-induced analgesia.
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PMID:Effects of systemically administered monoamine reuptake blocking agents on patterns of buspirone-induced analgesia in rats. 214 89

The authors described the pregnancy and delivery of a woman with unstable angina pectoris (ECG data for ischemic disease of the heart). Delivery occurred through the vagina without complications for the mother and fetus. The literary references treat the question about course of pregnancy, way of delivery and analgesia in women with myocardial infarction during pregnancy.
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PMID:[Pregnancy and myocardial infarct]. 225 41

The study of clinical manifestations and cardiodynamics in macrofocal myocardial infarction was conducted a few hours or days since the disease onset. Altogether 36 patients were examined. Obsidan administration was employed in 24 patients, basic indication to its use being clinico-hemodynamic++ signs of sympathetic hyperactivity. Clinical response to the drug was correlated with reactions of neurohumoral adaptation of the acute phase: levels of cyclic AMP, GMP and serotonin. Potentiating effect on obsidan analgesia, resolution of clinical symptoms of sympathetic hypertonus efficient energetic regime of the heart are mediated by activation of stress-limiting systems, i.e. links of cGMP and serotonin mechanisms.
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PMID:[Mechanisms of the effect of obsidan on the clinical picture of myocardial infarction at the early stage of the disease]. 261 6

Twenty patients with moderate or severe pain of suspected myocardial infarction received nalbuphine 50 mg intravenously as analgesia in 2 divided doses of 30 mg and 20 mg with 10 mg metoclopramide and were observed for 2 hours. Eighteen patients received nalbuphine outside hospital. The median time from onset of pain to treatment was 73 minutes. Within 30 minutes of the drug's administration 90% of all patients reported satisfactory pain relief (grade 0 or 1). For those with definite myocardial infarction 83% reported satisfactory pain relief at 30 minutes. There were no significant adverse cardiorespiratory effects observed or serious side-effects reported. Nalbuphine is effective and safe when used in this higher dose, although no additional analgesic effect was demonstrated when compared with lower established doses used early in acute myocardial infarction.
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PMID:High dose nalbuphine in early acute myocardial infarction. 271 14

Recently, more attention has been focused on the detection and treatment of silent myocardial ischaemia. Electrocardiographic signs of exercise-induced asymptomatic myocardial ischaemia are very common findings among survivors of acute myocardial infarction. From data of our population we found that silent exercise-induced ischaemia is present in 15-20% of all patients, and that about half of the patients with exercise-induced ST-segment depression were free of symptoms. Ergometric data at the ischaemic threshold are similar between asymptomatic and symptomatic patients while the presence of symptoms is more frequent in patients who were also symptomatic before the myocardial infarction. During the training period, the majority of the 'silent' patients remained asymptomatic, 23% developed effort angina, and 9% developed angina at rest. Training monitoring may be helpful in identifying the variability of symptoms. Physical training, in particular an intermittent programme, increased the work-load at which the ECG ischaemic signs appeared. Among the possible mechanisms responsible for exercise-induced silent ischaemia, a different pain tolerance and control of analgesia may be ascribed to explain the absence of pain, perhaps also determined by different endogenous beta-endorphin levels.
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PMID:Silent ischaemia in post-myocardial infarction patients submitted to physical training. 324 37

A total of 141 patients admitted to hospital with a diagnosis of suspected myocardial infarction were randomized to treatment with intravenous diamorphine (71) or nalbuphine (70). Myocardial infarction was subsequently confirmed in 109 patients. Both drugs provided good analgesia. Heart rate, blood pressure, respiratory rate, peak flow and minute volume were measured over a three-hour study period. Except for a slight fall in systolic blood pressure in the nalbuphine-treated group, there were no statistically significant differences between the groups. The nalbuphine-treated group had higher levels of aspartate aminotransferase and hydroxybutyric acid dehydrogenase but not creatine phosphokinase. The haemodynamic outcome and mortality at three months of the two groups were similar. It is concluded that nalbuphine provides effective analgesia coupled with few adverse circulatory or respiratory effects.
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PMID:Experience with nalbuphine, a new opioid analgesic, in acute myocardial infarction. 330 98

Aneurysm of the descending thoracic or thoracoabdominal aorta was repaired in 12 cases during simple aortic cross-clamping. The regimen for anaesthesia and general monitoring is presented. It includes thoracic epidural analgesia with intravenous general anaesthesia, use of a double-lumen endotracheal tube, continuous registration of ECG, body temperature, urinary output, systemic and pulmonary arterial pressures and central venous pressure, and intermittent measurement of pulmonary capillary wedge pressure (PCWP), cardiac output, blood gases and haemoglobin. Mannitol (25-40 g) is infused prior to aortic cross-clamping, and infusion of sodium nitroprusside and possibly nitroglycerin is begun just before clamping to control left ventricular afterload and preload. Sodium bicarbonate is given to maintain positive base excess. Before declamping, ventilation is increased by 50% and rapid infusion of blood, plasma and crystalloids is begun in order to raise PCWP by 3-5 mmHg. The clamp is gradually released, and small doses of vasopressor may be required to stabilize the circulation. The operation was uncomplicated in 11 cases, but a patient with ruptured aneurysm died of myocardial infarction.
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PMID:Anaesthesia in surgery for aneurysm of the descending thoracic or thoracoabdominal aorta. 335 96


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