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

There is a need for a simple clinical measurement that will indicate the extent of myocardial salvage after successful thrombolysis. This study examined whether coronary artery reperfusion reduced the infarct size as assessed electrocardiographically after thrombolytic treatment. The sum of the (sigma) ST segment area in leads showing ST segment elevation in the 12 lead electrocardiogram at presentation was used as an index of potential myocardial injury (initial ischaemic index). The evolved infarct size at 48 h was assessed by a QRS scoring system. Two groups of patients, both admitted with anterior myocardial infarction within 6 h of onset, were studied. Group 1 (n = 35) received analgesia only and group 2 (n = 33) received thrombolytic treatment either by the intracoronary (streptokinase, n = 13) or intravenous route (anistreplase, n = 20). Reperfusion was assessed angiographically. The mean (SD) potential infarct size assessed by the initial ischaemic index was similar in both groups (group 1, sigma ST area = 115 (60) mm2 and group 2 = 126 (77 mm2). The QRS score representing evolved infarct size was significantly lower in the treated group (4.1 (2.5] than in group 1 (7.8 (2.6]. The 95% confidence intervals for QRS scores based on the admission sigma ST area from patients with successful reperfusion were applied to a third set of patients (n = 22) to test the ability of the admission ST area (myocardial injury) to predict the QRS score accurately. While patients with successful reperfusion had significantly lower QRS scores than those who did not (4.5 (3.1) versus 9.3 (3.4)), the wide confidence intervals caused by inter-individual variability precluded an accurate prediction of the QRS score in an individual from the sigma ST area at time of presentation. There was no difference in infarct size in patients treated early (</= 3 h) (QRS score 4.2(2.8)) or later (3-6 h) (4.1(2.1)). This study provides evidence that sequential electrocardiographic changes are reduced in patients with anterior infarction who achieve reperfusion after thrombolytic treatment and that this benefit is shown with treatment given up to six hours after infarct onset. None the less, the relation between the initial ischaemic index and the evolved QRS score has wide confidence intervals, reflecting inter-individual variability, and does not allow the prediction of a QRS score in an individual patient.
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PMID:Electrocardiographic evidence of myocardial salvage after thrombolysis in acute myocardial infarction. 266 93

Atrial pacing was used for preoperative evaluation of six patients with recent anterior myocardial infarction (MI) (e.g. within 6 weeks) scheduled for abdominal emergency surgery. Central and coronary haemodynamics were used to compare changes in myocardial work and oxygenation with alternations of the non-invasive variables rate pressure product (RPP) (systolic blood pressure X heart rate), triple product (TP) (systolic blood pressure X heart rate X mean pulmonary arteriolar occlusion pressure) and ST-T segments (lead V5). There was good correlation between myocardial oxygen consumption and rate pressure product and triple product during pacing to stable angina pectoris. ST-T-segment depressions were recorded already at moderate chest discomfort and correlated well with a decrease in coronary vascular resistance. Changes in myocardial oxygen consumption induced by combined thoracic epidural analgesia (T3-4 to L1-2) and light general anaesthesia with nitrous oxide and fentanyl were poorly correlated with changes in rate pressure product or triple product. ST-T-segment depressions were recorded on five occasions in four of the patients, all in association with intubation and/or extubation. Only on one of these occasions could RPP or TP have indicated that myocardial oxygen demand exceeded supply. On the other four occasions, it was probable that myocardial ischaemia was induced by transient arterial hypoxaemia. The V5 ST-T-segment was the most sensitive non-invasive variable to monitor. The anaesthetic method was safe in all patients, as judged by good intraoperative cardiovascular stability, low morbidity and absence of intra- or postoperative reinfarction.
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PMID:Invasive analysis of non-invasive indicators of myocardial work and ischaemia during anaesthesia soon after myocardial infarction. 731 77

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