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)

Benzodiazepines are widely used as neuroleptics in anaesthesia, but they give rise to drowsiness at the end of surgery. Anexate is an imidazobenzodiazepine with specific antagonistic activity for benzodiazepines. We have administered 0.2 mg i.v. of the drug to 20 adult patients after anaesthesia with tiopentale (250 mg), pancuronium bromide (0.07 mg.kg-1), flunitrazepam (2 mg) and fentanyl (0.10 mg); after the first dose fentanyl was administered (0.10 mg) about every 30 minute. Analgesia was supplemented with nitrous oxide 66%. Blood pressure and heart rate did not changes significantly after Anexate; respiratory volume increased significantly in all cases (ANOVA P less than 0.001). Consciousness was rapidly resumed in all cases and patients demonstrated to be oriented in time and space soon after Anexate. In 14 out of 20 patients drowsiness reappeared after about 30 minute and further doses of 0.1 mg of the drug (to a maximum of 0.4 mg in some cases) were necessary. Side effects were rare and slight, their occurrence depending on the speed of administration. In our opinion a total dose of 0.3 to 0.4 mg Anexate is need to fully antagonize the sedative effect of 2 mg flunitrazepam.
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PMID:[Clinical evaluation of the efficacy of Ro 15-1788, Anexate after balanced intravenous anesthesia with flunitrazepam and fentanyl]. 251 85

In order to antagonize immediate postoperative somnolence, 24 surgical patients were given a two-rate infusion of physostigmine, aiming at a constant plasma concentration in the range of 1 to 10 ng/ml. Plasma concentrations of physostigmine were determined during infusion and after infusion and the effects of physostigmine on analgesia and postoperative sedation, and its side effects were monitored throughout. On the 1st postoperative day some of the patients (n = 8) were given 5 mg physostigmine orally, after which plasma concentrations as well as effects were measured. Steady-state concentrations were generally lower than predicted. Clearance varied between 10 and 85 ml/min x kg with a mean of 40.8 +/- 21.0 ml/min x kg. Oral bioavailability was 25.3 +/- 11.1%. Physostigmine administered as an intravenous infusion antagonized immediate postoperative somnolence in 21 out of 24 patients. Effects were poorly correlated with the established steady-state concentration of physostigmine. The patients' experience of postoperative pain relief was mostly satisfactory and the side effects of physostigmine infusion were generally limited. The effects of physostigmine in the immediate postoperative period seemed dependent on the dose as well as on the time which had elapsed since administration of anticholinergic drugs. After oral physostigmine administration the following morning, the majority of patients experienced side effects such as nausea and abdominal pain. In conclusion, physostigmine given as infusion antagonizes postoperative somnolence. However, the arousal effect was considered not better than that resulting from a bolus dose of the drug, although the infusion regimen allowed a prolonged clinical effect duration.
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PMID:Reversal of postoperative somnolence using a two-rate infusion of physostigmine. 258

The analgesic efficacy of a single 100-mg suppository of diclofenac sodium given after elective cholecystectomy was studied in 30 healthy patients in a double-blind randomised controlled manner. The mean 24-hour postoperative morphine consumption of the placebo group and the diclofenac group was similar (45 mg). Analysis of the cumulative hourly morphine consumption from the patient-controlled analgesia system failed to show any statistically significant differences between the groups. Peak expiratory flow rate, forced expiratory volume at 1 second and forced vital capacity decreased 24 hours after operation to less than 50% of pre-operative values in both groups. Subjective experiences of pain, nausea and drowsiness assessed by linear analogue scoring were similar in both groups.
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PMID:Failure of rectal diclofenac to augment opioid analgesia after cholecystectomy. 264 90

The side-effects of two opioid agonist-antagonists, nalbuphine and pentazocine, were assessed when used for patient-controlled postoperative analgesia. Forty ASA I or II patients scheduled for upper abdominal surgery were randomly allocated to two equal groups. The anaesthetic technique was the same for all the patients: premedication with atropine and diazepam, induction with thiopentone and suxamethonium and maintenance with fentanyl, pancuronium, nitrous oxide and halothane. Patient-controlled computer assisted analgesia (On-Demand Analgesia Computer) was started in the recovery room at least 2 h after the last administration of fentanyl. The parameters used were: a routine hourly dose (the half of that received during the previous hour), with on demand delivery of nalbuphine (15 micrograms.kg-1) or pentazocine (45 micrograms.kg-1) aliquots respectively, with a refractory period between two demands of 4 min and a total hourly maximum dose of 16 mg and 48 mg respectively. The following parameters were measured before the start of self-administration, and every hour afterwards for 24 h: systolic (Pasys) and diastolic blood pressures, heart rate, pressure-rate product (PRP), respiratory rate, end-tidal CO2 and pain (by way of a three point scale). Analgesia was assessed on a four-point scale every 6 h. The total doses of nalbuphine and pentazocine administered were 94 +/- 43 mg and 251 +/- 150 mg respectively. The only parameters significantly different between the two groups were Pasys and PRP, being higher in the pentazocine group. There were no significant differences in the side-effects (drowsiness, nausea, vomiting, headache, amnesia, logorrhoea and urine retention). All patients in both groups were satisfied with this technique.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Comparison of nalbuphine and pentazocine in the treatment of postoperative pain by self-administration]. 266 Jun 40

The analgesic effect of extradural clonidine was evaluated in a double-blind study. In the recovery room, following orthopaedic or perineal surgery 20 ASA I and II patients were allocated randomly to two groups. The extradural clonidine (EC) group received clonidine 2 micrograms kg-1 in isotonic saline solution 15 micrograms ml-1. The extradural saline (ES) group received the equivalent volume of plain isotonic saline solution. Pain was evaluated by a visual analogue scale (VAS) at 15-min intervals for the first 2 h and subsequently at 30-min intervals for the following 4 h. Morphine 5 mg was given s.c. when patients complained of pain after extradural saline or clonidine. In the EC group, the mean (SD) maximum pain relief was 68.2 (24.1)% of the initial VAS score, but it was only 14.7 (25.2)% in the ES group. The mean duration of analgesia, before injection of morphine, was significantly longer in the EC group (210 (87) min) compared with the ES group (45 (27) min) (P less than 0.001). Drowsiness and moderate hypotension were observed in the EC group.
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PMID:Postoperative analgesia with extradural clonidine. 268 51

Perineal pain during the course of routine epidural analgesia with bupivacaine was treated with a 10-ml top-up of either bupivacaine 25 mg, fentanyl 100 micrograms or fentanyl 100 micrograms plus bupivacaine 10 mg, in 46 women in the first stage of labour. Only fentanyl plus bupivacaine produced consistently reliable analgesia which was quicker in onset and longer in duration (140, SD 26 minutes) than either fentanyl (114, SD 26 minutes) or bupivacaine (99, SD 44 minutes) alone. Side effects, itching and drowsiness, which were not troublesome, were more frequent in the groups given fentanyl.
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PMID:Epidural fentanyl and perineal pain in labour. 259 69

Twenty patients were studied in the early post-operative period after cardiac surgery with sternotomy. Buprenorphine was prescribed: 0.3 mg intra-muscularly after total recovery from anaesthesia (8th hour) then every 8 hours if requested during 72 hours. The patients auto-estimated their level of analgesia, the clinical effects were measured with regard to heart rate, systolic and diastolic arterial pressure, and respiratory rate, before, 2 and 4 hours after each injection. Buprenorphine administration produces an effective, long lasting (8 to 12 hours) analgesia. No significant changes in haemodynamic or respiratory parameters were noticed. Side effects occurred rarely: 5 cases of drowsiness, reversible by verbal stimulation, 2 of nausea and sweats, 2 retentions of urine (after vesical catheter withdrawal). Parenteral buprenorphine is satisfactory for treatment of severe thoracic pain due to sternotomy, although the oral route would be safer during effective anticoagulant treatment.
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PMID:[The use of buprenorphine in the postoperative period in heart surgery. Evaluation of its efficacy and tolerance]. 273 Oct 59

A transdermal formulation of fentanyl (TTS-fentanyl, Alza Corp., Palo Alto, CA) was evaluated in 13 surgical patients after an abdominal operation. An intraoperative dose of fentanyl (100-200 micrograms i.v.) was administered at the same time as the TTS-fentanyl systems (50-125 micrograms/h) were applied to the antero-lateral chest wall. The TTS-fentanyl systems remained in situ for 24 h and were then removed and a second lot of systems were applied to the contra-lateral chest wall. There was a mean (S.D.) delay time of 12.7 (9.6) h before minimum effective blood fentanyl concentrations (MEC) were obtained from the systems and pseudo-steady state was reached between 36 and 48 h. There was a decay time of 16.1 (7.1) h after the systems were removed for the blood fentanyl concentration to decrease to less than the mean MEC for the control of postoperative pain. There was marked variability between patients in the actual hourly fentanyl dose rate determined from the residual amount of fentanyl remaining in the system and the duration of application. Significantly more supplementary pethidine was administered for inadequate postoperative analgesia between 0 and 12 h compared to the 12-24, 24-36 and 36-48 h periods; this was consistent with the observed delay time. Three patients required a reduction in the hourly fentanyl dose rate because of bradypnoea while 1 patient required an increase in dose because of inadequate pain relief. Nausea was the most frequently reported side effect (85% of patients) while bradypnoea, drowsiness, unpleasant dreams and headache were also reported. These effects were due to the combined effects of a sustained blood fentanyl concentration and the intermittent supplementary pethidine doses. Side effects due to the topical formulation were transient and included erythema (8 patients) and a minor rash (2 patients) in the area occluded by the systems. The TTS-fentanyl systems provided a significant contribution to postoperative pain control but, at the TTS dose rates used, supplementary doses of pethidine were required by all patients probably to control 'incident' pain.
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PMID:The transdermal administration of fentanyl in the treatment of postoperative pain: pharmacokinetics and pharmacodynamic effects. 274 92

We studied 20 otherwise healthy women undergoing lower abdominal surgery. Immediately after wound closure, while still anaesthetized, they received either electroacupuncture (EA) or no further treatment. They were allowed pethidine for postoperative analgesia by patient-controlled infusion pump. Signs of postoperative distress (pain, nausea, drowsiness) were evaluated after 2 and 6 h by visual analogue scale scores. The group receiving EA consumed half the quantity of pethidine as that used used by the no treatment group. Two patients in the EA group had no postoperative analgesia in the first 2 h. There was no difference in the assessments of postoperative distress between groups. No patient was aware of having received EA or not.
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PMID:Electroacupuncture and postoperative pain. 278 84

Three important anaesthesiological methods are considered to be appropriate in anaesthetizing patients undergoing extracorporal shock wave lithotripsy: general anaesthesia, epidural anaesthesia and recently opioid analgesia. In 161 patients who underwent ESWL in epidural anaesthesia, the dosage of the local anaesthetic (bupivacaine 0.5% without adrenaline) was dependent on the level of insertion of the Tuohy-needle and on the age of the patients. Under a sufficient therapy with crystalloids and colloids, cardiovascular parameters such as blood pressure and heart rate remained remarkably stable. In 10 patients the influence of epidural anaesthesia during ESWL on the glomerular filtration rate (GFR) was investigated. After the injection of radio-labelled 51-Cr-EDTA the GFR was significantly reduced by the epidural block. Under the influence of extracorporal shock waves the GFR increased significantly and in some cases exceeded the original value. Opioid analgesia with alfentanil in awake, spontaneously breathing patients is well accepted by patients with kidney stone disease who have to undergo ESWL. The analgesia is achieved by administering an initial bolus injection (30 micrograms/kg) of alfentanil and applying additional injections--each 15 micrograms/kg--on demand. A study with 360 patients was performed in order to investigate the suitability of opioid analgesia during ESWL with special regard to cardiovascular and respiratory depression and other side-effects. Mean systolic and diastolic blood pressure and heart rate were almost not affected. Under insufflation of oxygen by a nasal tube, the mean PaCO2 always showed normal values. Mean PaCO2 increased to 50 mm Hg. A mild drowsiness could be observed in all patients. Two of them developed a complete respiratory arrest accompanied by a muscular rigidity of the chest wall so that respiratory support by mask ventilation became necessary. The "extracorporal piezoelectric lithotripsy" (EPL) is a new method of non-invasive disintegration of kidney stones and can be performed in the non-anaesthetized patient. The efficacy of this much more profitable procedure is equivalent to the ESWL, so that the EPL seems to have a great future.
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PMID:[Anesthesia during extracorporeal shock wave lithotripsy]. 281 88


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