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

The choice of appropriate anaesthesia in a more or less seriously ill patient requires detailed information on the risk and tolerance of each specific anaesthetic regimen. The objective of this prospective, randomised clinical trial was to test the hypothesis that three regimens of general anaesthesia--neurolept-(NLA), balanced (BAL), and intravenous propofol anaesthesia (IVA)--differ with regard to safety and comfort. The criteria for the intraoperative safety and postoperative comfort of the patients were the incidents, events and complications (IEC) that required medical treatment as well as the evaluation of postoperative complaints by the patients according to the IEC list and patient questionnaires of the German Society of Anaesthesia and Critical Care Medicine (DGAI). METHODS. The study duration was about 4 months, from January to April 1992. During this period the patients of all nine operative departments of the hospital received strictly randomised NLA, BAL, or IVA. Patients who had regional anaesthesia or were not capable of understanding the German language, were nonco-operative, or were seriously ill (ASA class IV to V) as well as children under 18 years of age did not participate in the study. All eligible patients provided their informed consent. ANAESTHESIA. For premedication 10 mg chlorazepate was administered the night before and on the day of surgery. Anaesthesia was conducted under normoventilation using a mixture of 70% nitrous oxide and 30% oxygen. NLA patients were induced intravenously with 0.2 mg/kg body weight etomidate and received 0.005 mg/kg fentanyl and 0.07 mg/kg droperidol before the start of surgery. The repetition dose was 0.2 mg fentanyl and 2.5 mg droperidol. In the BAL patients the dose of fentanyl and droperidol was reduced to 50% due to the addition of isoflurane up to 1 vol. %. IVA patients received 2 mg/kg propofol over 3 min followed by an infusion of 3-5 mg/kg per hour together with 0.2 mg fentanyl/h. Neuromuscular blockade was accomplished with vecuronium 0.1 mg/kg. If the blood pressure and heart rate increased by more than 20% of preoperative values, analgesia was reinforced by an additional fentanyl dose. Anaesthesia was subsequently enhanced by increasing the neurolept/propofol/isoflurane dose by up to 50%. DATA COLLECTION. The following parameters were registered: patients' personal data and physical condition according to ASA classification; the grade of risk according to the Munich risk checklist; the frequency of IEC during surgery; the patients' permanent medications; postanaesthetic vigilance and recovery; the acceptance of the assigned anaesthetic by the physician; the cost of the anaesthetic used; and pre- and post-operative complaints as well as the assessment of anaesthesia by the patient. The statistical evaluation was performed using the chi-square test. RESULTS. A total of 1,346 patients were enrolled in the study; 28 (2%) were excluded because the treatment protocol was changed by the anaesthesiologist. Seventy per cent were recruited from general, gynaecologic, or otorhinolaryngologic surgery. The three anaesthetic regimens (NLA, BAL, and IVA) were used in other departments with the same frequency with the exception of ophthalmology and urology (P > 0.1) (Fig. 1). Of the 1,318 eligible patients, 443 received NLA, 443 BAL, and 432 IVA (P = 0.8). The distribution of the various parameters was surprisingly similar among the three groups: the average age was 50 years (P = 0.91), body weight 71 kg (P = 0.33), reference or initial blood pressure 130/80 mm Hg (P = 0.36), average time of anaesthesia 103 min (P = 0.82), and all had the same risk score (P = 0.42). Sixty per cent were female. An average of 85% of the 18- to 89-year-old patients were considered to be healthy according to the ASA risk classification (P = 0.42). However, on applying the Munich risk checklist the average number of healthy individuals was 5% to 10% lower than that of the ASA risk classification.
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PMID:[Quality comparison of modified neurolept-, balanced and intravenous anesthesia. 1. Study design and patient analysis of the Krefelder study 1992]. 870 57

We have compared the dose requirements and recovery characteristics of a continuous mivacurium infusion given by the anaesthetist to maintain 95-100% block at the hand muscles with that of a surgeon-controlled, on-demand dosing technique based on the direct assessment of abdominal muscle tone during elective Caesarean section. Twenty-four full term pregnant patients were included. A rapid-sequence induction using thiopentone 3-5 mg.kg-1 and succinylcholine 1 mg.kg-1 was used. Anaesthesia was maintained with fentanyl, N2O and isoflurane 0.5%. The mechanomyographic response of the adductor pollicis muscle to supramaximal train-of-four (TOF) ulnar nerve stimulation was recorded. Muscle relaxation was achieved initially with mivacurium 0.1 mg.kg-1 followed either by a continuous infusion of mivacurium to maintain 95-100% block at the adductor pollicis muscle (n = 12) or by surgeon-controlled relaxation (SCR) technique using a syringe pump for patient-controlled analgesia to administer on-demand doses of mivacurium 0.05 mg.kg-1 (n = 12). The lockout interval was three minutes and the maximum hourly dose of mivacurium allowed was 0.6 mg.kg-1. The total doses of mivacurium (mean +/- SD) were 23.2 +/- 10.4 and 12.4 +/- 3.5 mg in the infusion and SCR groups, P < 0.01. On-demand, surgeon-controlled doses of mivacurium were injected at a mean of T1 42.3 +/- 36%. At the end of surgery, T1 and TOF ratio were respectively 16.7 +/- 13%, 5 +/- 10% and 48 +/- 37%, 30 +/- 24% in the infusion and SCR groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Surgeon-controlled mivacurium administration during elective caesarean section. 772 Jan 67

Anaesthesia is induced, as usual, after inhalation of oxygen at 100 vol p. 100, with propofol 2-2.5 mg.kg-1 associated with a muscle relaxant for tracheal intubation. The inhalation of oxygen is maintained as long as the spontaneous ventilation is persisting. The trachea is intubated following the occurrence of apnoea. Anaesthesia is maintained with a continuous infusion of propofol at a low rate of about 4-8 mg.kg-1.h-1. At this rate the arterial pressure remains very stable during the whole course of the procedure. The infusion rate depends also on the dose and the type of the associated analgesic agent. Analgesia can be obtained either with alfentanil 30 micrograms.kg-1.h-1 or with fentanyl 1.5 micrograms.kg-1, administered about every 30 min. Muscle relaxation should remain stable until the end of the main surgical period. Nitrous oxide does not seem to interfere with surgery. Its involvement in the occurrence of postoperative nausea and vomiting has not been proven. Atropine (0.02 mg.kg-1, possibly repeated) should be administered as soon as the heart rate decreases below 50 b.min-1. When a gradual postanaesthetic recovery is desirable, the infusion rate of propofol is progressively decreased (decrease of about 2 mg.kg-1.h-1 every 20-30 min, according to the FETCO2 and the temperature).
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PMID:[Use of Diprivan in laparoscopic surgery]. 787 42

Paralysis via neuromuscular blockade in ICU patients requires mechanical ventilation. This review historically addresses the technological advances and scientific information upon which ventilatory management concepts are based, with special emphasis on the influence such concepts have had on the use of neuromuscular blocking agents. Specific reference is made to the scientific information and technological advances leading to the newer concepts of ventilatory management. Information from > 100 major studies in the peer-reviewed medical literature, along with the author's 25 yrs of clinical experience and academic involvement in acute respiratory care is presented. Nomenclature related to ventilatory management is specifically defined and consistently utilized to present and interpret the data. Pre-1970 ventilatory management is traced from the clinically unacceptable pressure-limited devices to the reliable performance of volume-limited ventilators. The scientific data and rationale that led to the concept of relatively large tidal volume delivery are reviewed in the light of today's concerns regarding alveolar overdistention, control-mode dyssynchrony, and auto-positive end-expiratory pressure. Also presented are the post-1970 scientific rationales for continuous positive airway pressure/positive end-expiratory pressure therapy, avoidance of alveolar hyperxia, and partial ventilatory support techniques (intermittent mandatory ventilation/synchronized intermittent mandatory ventilation). The development of pressure-support devices is discussed and the capability of pressure-control techniques is presented. The rationale for more recent concepts of total ventilatory support to avoid ventilator-induced lung injury is presented. The traditional techniques utilizing volume-preset ventilators with relatively large tidal volumes remain valid and desirable for the vast majority of patients requiring mechanical ventilation. Neuromuscular blockade is best avoided in these patients. However, adequate analgesia, amnesia, and sedation are required. For patients with severe lung disease, alveolar overdistention and hyperoxia should be avoided and may be best accomplished by total ventilatory support techniques, such as pressure control. Total ventilatory support requires neuromuscular blockade and may not provide eucapnic ventilation.
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PMID:A historical perspective on ventilator management. 792 33

Although minimally invasive, urological laparoscopic surgery is still a major surgery and has special characteristics which should not be ignored. Our protocol includes: premedication with diazepam and atropine, preinduction with fentanyl, induction with propofol, followed by atracurium or succinylcholine for tracheal intubation. Anesthesia is sustained with continuous pump infusion of propofol at gradually lower doses and is discontinued on removing the abdominal trocars. Muscle relaxation throughout the operation is maintained with atracurium in continuous infusion and is discontinued at the same time as propofol. Intraoperative analgesia is achieved with bolus administration of fentanyl. We routinely use vesical and nasogastric catheters; the latter is removed at the end of the operation. Similarly, compressive bandaging is done for the lower limbs in all patients. Intraoperative monitoring includes ECG, heart rate, arterial blood pressure (noninvasive method), end expiratory CO2, O2 saturation, minute/volume, tidal volume and respiratory rate, airway pressures, temperature and diuresis. Pulmonary ventilation is by IPPV with a mixture of oxygen and air, maintaining FiO2 at 0.4. Nitrous oxide is not utilized, therefore the airways were only used for lung ventilation and not for the administration of inhalatory anesthetic agents. The higher increments of end expiratory CO2 of up to 48 mm Hg were observed at the end of the procedure following peritoneal desufflation. In summary, the technique of choice is total i.v. anesthesia with propofol and monitoring as complete as possible (noninvasive). Furthermore, capnographic and capnometric control of end expiratory CO2 is warranted.
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PMID:[Anesthesia in urologic laparoscopic surgery]. 823 32

There is little clinical data in the literature on the anaesthetic management of paediatric patients with Eisenmenger's syndrome undergoing non-cardiac surgery. This paper reviews our experiences with either such patients who underwent a total of 11 surgical procedures. Of the eight children, six had Down's syndrome and an atrio-ventricular septal defect, one had a ventricular septal defect and one an atrial septal defect. Nine of the eleven operations consisted of minor dental, plastic or ENT procedures, while one patient underwent two laparotomies. Premedication (trimeprazine/ meperidine combination or midazolam) was administered on three occasions. Induction of anaesthesia was achieved by either inhalation of halothane (2), or intravenously with thiopentone (6), ketamine (2) or propofol (1). Muscle relaxation and mechanical ventilation were employed only for both intra-abdominal procedures, otherwise patients were allowed to breathe spontaneously with, or without, manual assistance. Halothane (8), isoflurane (2) and enflurane (1) were all used for maintenance of anaesthesia. Non-invasive monitoring was applied intraoperatively for minor procedures, and arterial and central venous catheters inserted for the laparotomies. Postoperative analgesia for both these cases was provided by an epidural infusion of bupivacaine 0.125% and fentanyl 5 micrograms x ml(-1). A single im bolus of morphine was required following a dental clearance, otherwise pain relief for the rest of the cases was achieved by local anaesthetic infiltration and NSAIDS. With the exception of a single episode of bradycardia, induction, maintenance and recovery from anaesthesia were well tolerated in all cases. In conclusion, our experience suggests that despite theoretical risks, children with Eisenmenger's syndrome appear to tolerate a variety of anaesthetic techniques.
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PMID:The anaesthetic management of the child with Eisenmenger's syndrome. 870

The paca (Agouti pace) is a neotropical rodent that requires chemical restraint for handling due to its aggressive nature and susceptibility to stress. Eighteen adult pacas (seven males and 11 females) weighing 6.25+/-2.22 (mean +/- SD) kg were given ketamine hydrochloride (25.0 mg/kg), acetylpromazine maleate (0.125 mg/kg), and atropine sulfate (0.05 mg/kg) combined by i.m. injection during field procedures that included sexing, marking, translocations, physical examinations, and minor surgeries. In all individuals, the induction of anesthesia was rapid and uneventful. Righting reflexes were abolished after 5.95+/-3.56 min, and all animals ceased to react to manipulation after 9.55+/-3.48 min. Response to interdigital and pinnal painful stimuli disappeared after 10.67+/-3.46 min and 11.11+/-3.83 min. respectively. Analgesia and depth of anesthesia were excellent in 61.0% of the animals and good in 39.0%. Muscle relaxation was excellent in 77.8% and good in 22.2%. Duration of anesthesia was 57.33+/-31.10 min. Recovery occurred without psychomotor disturbances, and every animal remained calm until normal ambulation resumed 115.00+/-37.00 min postinjection. The anesthetic protocol was safe for both the animal and the human personnel and is recommended for routine management and medical procedures, including minor surgeries, in A. paca.
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PMID:Restraint of the paca (Agouti paca) with ketamine hydrochloride, acetylpromazine maleate, and atropine sulfate. 980 3

Dimenhydrinate is an inexpensive antihistaminic drug, that is frequently used as an anti-emetic during anaesthesia. The popularity of the drug is contrasted by the lack of modern studies concerning its efficacy in reducing the incidence of post-operative nausea and vomiting. Thus, dimenhydrinate was compared with placebo in this prospective, randomized, double-blind study. One hundred and thirty-three female in-patients were studied. They were stratified according to the type of surgery (laparoscopic cholecystectomy, thyroid resection or knee arthroscopy) to ensure an homogeneous distribution in both groups. General anaesthesia was induced with etomidate, fentanyl, vecuronium and maintained with enflurane in N2O/O2. Neuromuscular block was reversed with pyridostigmine/atropine. Patients in the dimenhydrinate group (n = 67) received 62 mg dimenhydrinate intravenously after induction of anaesthesia. Placebo patients (n = 66) received saline. Administration of dimenhydrinate (and placebo) was repeated three times during the 48-h study to mitigate the short half-life of the drug. Post-operative analgesia and anti-emetic rescue medication was standardized. Episodes of vomiting, retching and the need for additional anti-emetics were recorded. Nausea was assessed using a 10-cm visual analogue scale. Post-operative nausea and vomiting was rated as 'none', 'mild', 'moderate' and 'severe' using a fixed scoring algorithm. There were no differences between the two groups with regard to biometric data, type of surgery and distribution of risk factors for developing post-operative nausea and vomiting. In the dimenhydrinate group, more patients remained completely free from post-operative nausea and vomiting compared with placebo (dimenhydrinate: 38.8%; placebo: 15.1%; P = 0.004). The incidence of severe post-operative nausea and vomiting was also reduced from 39.4% to 14.9%. No relevant side effects were observed. Intra-operative dimenhydrinate, followed by three further administrations after surgery, reduces the incidence and the severity of post-operative nausea and vomiting without side effects. However, there still remained an unacceptable high number of patients who were not prevented completely from experiencing post-operative nausea and vomiting.
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PMID:Dimenhydrinate for prevention of post-operative nausea and vomiting in female in-patients. 1039 Jun 62

Eight buffalo calves (8-12 months, 70-100 kg) were randomly assigned to two groups of four animals each. Animals of group I were given detomidine (100 micrograms/kg), whereas animals of group II received a mixture of detomidine (100 micrograms/kg), diazepam (100 micrograms/kg) and ketamine (3 mg/kg) (DDK) intravenously. Various clinical parameters, such as weak time, down time, pedal and pinprick reflexes, muscle relaxation and extent of sedation, as well as heart and respiratory rates and electrocardiograms were measured before (time 0) and 15, 30, 45, 60, 75 and 90 min after treatment. In all the animals of group II (DDK), the pedal reflex was completely abolished (score: 3.00 +/- 0.00) within 5 min, the pinprick response was either very weak or it was completely abolished at this interval. Muscle relaxation and sedation were excellent within 5 min of DDK administration. The depth of sedation and analgesia was maximum from 5 to 15 min postinjection. Detomidine alone, however, failed to produce appropriate depression of the pedal and pinprick reflexes, sedation was mild and muscle relaxation was inadequate. Heart rate showed a significant (P < 0.05) decrease in group I, but the decrease was non-significant in group II. A more pronounced increase in respiratory rate was observed in group I as compared to group II. Animals of both groups recovered within 90 min without any complication. Minimal changes in the cardiovascular system in the group given the DDK combination were an advantage over the group given detomidine. The results indicated that DDK combination is safe and suitable for 15 min of anaesthesia with excellent muscle relaxation and has only limited cardiorespiratory effects in buffaloes.
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PMID:Detomidine-diazepam-ketamine anaesthesia in buffalo (Bubalus bubalis) calves. 1084 67

Sedation and analgesia will be required in the mechanically ventilated pediatric trauma patient. Adequate provision of both has a number of beneficial physiologic and psychologic effects. There are a number of categories of sedatives available for use. To provide optimal management and avoid adverse sequellae, an understanding of the pharmacology of these agents should guide their use in this group of patients, who are likely to have variable pharmacokinetic responses and therapeutic goals. Neuromuscular blockade is warranted in only a select population of mechanically ventilated ICU patients. Given newer ventilator technology and modes, it is certainly possible to achieve patient-ventilator synchrony with the use of sedation alone. Neuromuscular blockade is associated with a number of possible adverse effects, including prolonged weakness or paresis, and prohibits ongoing clinical assessment. When the use of this therapy is deemed necessary, it is again essential to understand the pharmacodynamics and pharmacokinetics of the available agents to avoid potential complications.
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PMID:Paralyzation and sedation of the ventilated trauma patient. 1158 7


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