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)

Takayasu's disease is a rare form of nonspecific obliterative panarteritis of unknown origin, mainly located at supraaortic, renal, and pulmonary arteries and resulting in multiple stenoses and occlusion of major arteries. Predominantly young women in the first three decades of life are affected. Absence of arm pulses, vascular bruits, and retinopathy are classic symptoms. Another symptom is hypertension of the lower extremities and hypotension of the upper extremities, thus potentially impairing cerebral perfusion. A 25-year-old female patient with a 2-year history of Takayasu's disease presented for therapeutic abortion on the grounds of her medical condition. There were significant stenoses of the left common carotid artery and the internal carotid artery. The left subclavian artery was totally obliterated. The arterial blood supply to the left arm was accomplished by the left vertebral artery via a subclavian steal syndrome. Brachial and radial pulses were absent in both arms. General, spinal or epidural anesthesia can produce arterial hypotension. Blood pressure assessment at the lower extremities does not allow conclusions about perfusion of supraaortic arteries and cerebral perfusion pressure. Thus, a paracervical block was performed; sedation and analgesia were achieved with small doses of midazolam and alfentanil. We planned that if general anesthesia became necessary we would induce anesthesia with etomidate and alfentanil and maintain anesthesia by mask ventilation with nitrous oxide in oxygen and supplementary doses of alfentanil. Invasive monitoring such as arterial or Swan Ganz catheterization, was contraindicated because of the possibility that inflamed vessels would become irritated. Therefore, we only monitored ECG, blood pressure at the leg, ventilation parameters, and oxygen saturation at the ear lobe by pulse oximetry.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Anesthesiology problems in Takayasu's syndrome]. 167 86

Takayasu aortoarteritis in a pregnant patient is often associated with severe life-threatening complications. The coexistence of associated dilated cardiomyopathy can further complicate the pregnancy, particularly during parturition and at the time of delivery. We describe the management of labor analgesia in a symptomatic parturient suffering from advanced Takayasu aortoarteritis with dilated cardiomyopathy and a recent episode of congestive cardiac failure. The patient was man-aged with graded epidural analgesia instituted early in labor. Intermittent boluses of 0.0625% bupivacaine with 2 microg/mL fentanyl were administered epidurally, which provided adequate analgesia without impaired hemodynamic status.
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PMID:Takayasu aortoarteritis with dilated cardiomyopathy: anesthetic management of labor analgesia. 2064 70

Takayasu's arteritis is a rare, progressive panendarteritis involving all layers of the arterial wall. This disease includes variable involvement of the aorta and its major branches. The most common complication with this condition is severe, uncontrolled hypertension, often leading to end organ dysfunction. We describe the management of a 27-year-old woman diagnosed with Takayasu's arteritis that presented in labor with intense pain and underwent a combined spinal-epidural for anesthetic management. Per literature review, a combined spinal-epidural technique for planned vaginal delivery has not been described for a laboring Takayasu patient. Our technique, utilizing intrathecal opioids and a low-dose local anesthetic-opioid epidural infusion, provided adequate analgesia while maintaining hemodynamic stability throughout labor augmentation and successful vaginal delivery.
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PMID:Combined Spinal-Epidural for Vaginal Delivery in a Parturient With Takayasu's Arteritis. 2821 Jun 35