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)

The authors report their results with 58 patients presenting with pelvic lithiasis who were treated by extracorporeal lithotrity with the Dornier HM3 system. They describe the appropriate procedure of analgesia and emphasize the difficulties to locate the pelvic calculi, which sometimes requires resorting to urography during the treatment. Out of the 58 cases, success was total in 55 (94.83%), after one session of lithotrity in 52 of them and after two sessions in 3. In 2 of the 3 cases of failure, the calculi were monohydrated calcium oxalate stones located very high in the ischiadic incisure. Five cases of presacral lithiasis were treated in the ventral position, successfully in 3 cases and without success in 2. Thus it appears that shock wave lithotrity with the Dornier HM3 system with radiological location is highly effective for the treatment of pelvic lithiasis.
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PMID:[Lithotripsy for pelvic lithiasis with the Dornier system with radiological location]. 194 Apr 26

The power and nociceptive intensity of shock waves generated by the Dornier HM3 extracorporeal shock wave lithotripter (ESWL) are voltage dependent and suited to algesimetry in a controllable voltage range of 8-30 kV. Fidelity of the HM3 as an algesimeter was tested by: (1) In vitro measurements of shock pressure at voltages between 14 and 30 kV were recorded by a force transducer at the point of clinical focus. (2) Unanaesthetized volunteer (n = 5) assessment and VAS pain scores of shocks in the range of 10-24 kV, yielding highly significant correlations between blinded randomized shock voltage (r = 0.88), and VAS scores (r = 0.84). (3) Voltage-tolerance curves generated from 33 ASA class 1 or 2 patients undergoing ESWL treatment under epidural analgesia with 0.125% bupivacaine, fortified with a bolus epidural dose of 100 micrograms fentanyl if pain arose during treatment. Voltage tolerance was increased by 50% after an epidural bolus of 100 micrograms fentanyl (P less than 0.001). The respiratory consequences of epidural fentanyl were assessed by changes of respiratory rate and rhythm recorded from capnographic tracings of expired carbon dioxide. This study indicates that the Dornier HM3 system provides a valuable opportunity to conduct precise, quantitative measurements of induced deep truncal pain, as well as the effectiveness and respiratory cost of analgesic interventions directly applicable to the safe management of acute pain.
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PMID:Critique of the Dornier HM3 lithotripter as a clinical algesimeter. 232 92

In a clinical study with a modified shock wave generator supplied by Dornier Medizintechnik for the Dornier Kidney Lithotripter HM3 the requirement of analgetics decreased significantly during Opioid-Analgesia. It could be shown that Extra-corporal Shock Wave Lithotripsy is possible without a central acting drug. Furthermore, a reduction of perioperative morbidity could be observed with the new generator.
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PMID:[Painless extra-corporal shock wave lithotripsy using the HM3 Dornier lithotripter]. 288 52

The first clinical application of extracorporeal SWL dates back to 1980. Since then the use of this method has spread widely and its indications have been extended progressively so that it way now be considered the treatment of choice in 80-90% of cases of ureterorenal lithiasis. Treatments without anesthesia or analgesics have been associated with an increase of retreatments from 5-14% (original HM3) to 45-60% (lithotripters not requiring anesthesia or analgesia). However, almost all lithotripter succeed in fragmenting stones sufficiently. The stone free rate varies with different lithotripters in the different series: 90-56% for stones of maximum diameter < 1 cm, 78-30% for stones of maximum diameter of 1-2 cm. and 52.5-10% for stones of maximum diameter of 2-3 cm. (the last figure was obtained with a piezoelectric lithotripter). Extracorporeal lithotripsy as monotherapy of staghorn stones has yelded a stone free rate varying between 31% and 55% with high percentages of residual fragments in about 50% of case of the various series. The stone free rate after treatment varies according to stone site: it is between 75% and 84% of caliceal stones for upper caliceal calculi and falls to under 60% for lower caliceal ones. The frequency of recurrences, that is, of new stones in patients stone free after SWL, is between 4% and 10% annually. Adding the percentage of true recurrences reported by the various authors at 19 to 42 months of follow-up (6.2-13.8%) to the fragment regrowth rate (17.2-22.3%) gives a total new stone rate of 23.4% and 36%. These figures are not greatly different from those reported in a population of untreated stone formers (10-15% per year). Extracorporeal lithotripsy seems thus not to influence lithiasis recurrence significantly.
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PMID:Extracorporeal shock wave lithotripsy. 893 18

We compared general anesthesia and intravenous sedation-analgesia for SWL on a Dornier HM3 lithotripter with respect to treatment and anesthesia time, X-ray exposure, shockwaves administered, and efficacy. The case records of 49 patients receiving general anesthesia and 118 patients who underwent intravenous sedation-analgesia were examined. Follow-up plain abdominal radiographs were evaluated for residual stones. Treatments accomplished under intravenous sedation-analgesia required less anesthesia time and less SWL time. The amount of fluoroscopy time was increased. The success rate in treating patients with these two types of anesthesia was not significantly different. Intravenous sedation-analgesia is safe and effective for shockwave lithotripsy in the HM3 lithotripter. This technique facilitates more rapid outpatient treatment and has excellent patient tolerance.
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PMID:Comparison of general anesthesia and intravenous sedation-analgesia for SWL. 897 79

After > 10,000 treatments-our HM3/4 and MPL 9000 have been replaced by the Siemens Lithostar multiline. As a ESWL center with ESWL as the primary treatment indication for all types of stones in kidney and ureter we report our initial experience with this new multifunctional lithotripter. The system consists of an electromagnetic shock-wave emitter (Focus 80 x 5 mm) and a digital fluoroscopy unit. Stone localization is achieved in a - 10 degrees and + 30 degrees position without movement of the patient. The treatment table itself allows most endourologic and percutaneous auxiliary procedures. Additionally, an intergrated inline ultrasound is available. From 10/94 to 08/95, 204 male and 96 female patients with a mean age of 50.7 (4-92) years underwent ESWL with the Lithostar multiline. The mean stone diameter was 10.3 (2-20) mm with 53% ureteral and 47% renal stones. 300 patients underwent 480 treatments (average shocks 3673, range 793-8000; mean energy level 5.5, range 1-9). Stone localization was achieved after 5 (1-39) min (mean fluoroscopy time 3.1 (0.5-16.2) min). In 92.7% no analgesic premedication was done, 56% of the patients needed no analgesics at all during ESWL. 44% received 8.1 (2-15) mg Piritramid intravenously. Epidural anesthesia was performed in only 2.3% for a second treatment. 95% of the patients had complete stone disintegration. In 68% disintegration was achieved in one session. ESWL was repeated for further disintegration in 18.5%, because of an unsuccessful treatment in 11.5% and because of technical interruption of the previous session in 2.5%. We saw subkapsular haematomas in 2%. Auxiliary procedures following ESWL were necessary in only 9.2% of the patients. In situ ESWL with the new Lithostar Multiline seems to be effective as the Domler HM3/4. Analgesia-free treatment was performed in more than 50% of the patients. Auxiliary procedures were less frequently necessary as compared to our previous experience with in situ ESWL.
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PMID:[Lithostar Multiline. A multi-function lithotripter for ESWL and endourology: initial clinical experiences]. 942 99