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)

An 80-year-old male with severe bullous emphysema underwent bilateral volume reduction surgery. He had suffered from dyspnea and was classified into Hugh-Jones III. In spirogram, forced vital capacity in 1 second was markedly low (0.38 l, corresponding to 19.4 % in % FEV1.0). Anesthesia was maintained by isoflurane combined with thoracic-epidural anesthesia to make extubation possible at the end of surgery. We used a critical care type ventilator (Servo 900C, Simens) for pressure controlled ventilation for fear that positive pressuse ventilation creates or aggravates airleaks. Surgery and anesthesia were performed uneventfully. We recommend lower concentration of a volatile agent combine with thoracic epidural analgesia and pressure controlled ventilation for the volume reduction surgery.
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PMID:[Anesthesia for bilateral volume reduction surgery in a patient with severe bullous emphysema]. 895 79

A retrospective review of the Greenville Memorial Hospital trauma registry revealed 70 patients admitted with sternal fractures over a 38-month period. Localized sternal tenderness was present in 68 (97.1%), external signs of contusion/ecchymosis in 33 (47.1%), and dyspnea in 10 (14.3%) patients. The mechanism of injury was motor vehicle crash in 64 (91.4%) patients, with 46 of these restrained. Isolated sternal fractures were present in 34 (48.6%) patients. Only one death occurred. All sternal fractures were managed with analgesia and rest; surgery was required only when indicated for associated injuries. No patient was found to have an aortic injury or clinically significant cardiac dysrhythmia. Conclusions in this study that differ from those in previous studies can possibly be attributed to an evolving mechanism of sternal injury. This retrospective review shows no association between sternal fracture and clinically significant cardiac injury or injury to the thoracic aorta.
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PMID:Sternal fracture: a benign entity? 898 65

Asthma and heavy smoking are the risk factors for postoperative respiratory distress, especially after general anesthesia. We experienced a case of sigmoidectomy in a geriatric patient with severe obstructive lung disease accompanied by asthma and a long history of smoking. The patient was a 70 year old man with 1 second volume of less than 0.6 l, because of asthma and long smoking history of 40 pieces of cigarettes a day for 50 years. We considered that general anesthesia with tracheal intubation might worsen the respiratory state after surgery and chose combined spinal and epidural anesthesia. He received sigmoidectomy under spinal anesthesia with 0.3% dibucaine 2.4 ml combined with epidural anesthesia. As the level of analgesia went up to Th4, the patient complained of dyspnea and he discharged a plenty of sputum. Without any special treatment his dyspnea disappeared spontaneously. During and after the surgery, no exacerbation occurred in his respiratory state. It is suggested that spinal anesthesia combined with epidural anesthesia is useful for a patient with severe obstructive lung disease.
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PMID:[Combined spinal and epidural anesthesia for laparotomy in a geriatric patient with severe obstructive lung disease]. 909 19

The principal aim of palliative care is to bring symptomatic relief to patients with progressive disease. Residents graduating from a university general surgery training program should be competent to manage common symptoms associated with advanced cancer. This study used performance-based testing to evaluate the skills of resident physicians in managing common symptoms of a patient with advanced cancer. Thirty-three resident physicians (PGY 1 to 6) were presented with four clinical symptoms of a patient with advanced cancer: (1) nausea and vomiting associated with regular morphine use; (2) lack of appetite in the last weeks of life of a terminally ill patient; (3) constipation associated with codeine analgesia; and (4) dyspnea associated with diffuse lung metastases. The management plan for the symptom problems was evaluated by using a predefined checklist. A significant number of residents showed deficits in the management of common symptoms of advanced cancer. Scheduled dosing of antiemetics was infrequently prescribed for opioid-related nausea and vomiting. Most physicians inappropriately managed lack of appetite by using forced feeding. Opioids were infrequently used in the management of terminal dyspnea. The absence of difference in scores between junior and senior residents suggests that adequate management of the symptoms of terminal cancer is not being effectively taught in postgraduate training programs.
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PMID:Residents' management of the symptoms associated with terminal cancer. 925 84

In patients scheduled for cesarean section (c-section) using combined spinal epidural anesthesia (CSEA), we compared the cephalad spreading speed during double-segment technique (DST) with that of single-space technique (SST) of CSEA. In the patients of SST group (n = 169), a 17-G Tuohy needle was introduced at the L 3-4, and then a long spinal needle was inserted through the Tuohy needle. In the patients of DST group (n = 16), a Tuohy needle was introduced at the T 11-12, and a spinal needle was inserted at the L 3-4. After 0.3% hyperbaric dibucaine 1.0 ml was injected through the spinal needle, 1.5% mepivacaine 10 ml was injected through the epidural catheter in both the groups. The analgesic level was measured at 5-min intervals, and blood pressure and complaints of patients were also recorded. The cephalad spread of analgesia was significantly higher in DST group than in SST group at 5 and 10 min after the administration of local anesthetics. Two patients in SST group, epidural catheterization was not possible. There were no difference in the incidences of hypotension, nausea and dyspnea between the groups. We conclude from these results that DST for CSEA is preferable to SST for c-section.
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PMID:[Comparison of double-segment technique with single-space technique for cesarean section using combined spinal epidural anesthesia]. 1003 91

A 30-year-old female was scheduled for an expander insertion of the breast under local anesthesia. Thirty minutes after infiltration anesthesia with lidocaine and bupivacaine mixture, she suffered from dyspnea. She was intubated and transferred to our hospital. As her vital signs were stable and consciousness was clear, she was extubated in the emergency room. However, she was reintubated at night and ventilated mechanically for two days. Three months later, breast expander insertion was performed under general anesthesia. After extubation, dyspnea attack occurred and midazolam was injected. Seven months later, the reconstruction of TRAM flap was performed under general anesthesia and continuous subcutaneous injection of morphine was used for the postoperative analgesia. After extubation, she was sedated deeply and dyspnea attack did not occur. A month later, she was scheduled for the debridment and the resuture. Then, dyspnea attack occurred in the ward at night. The apnea monitor was attached to her in recovery room after extubation following the operation of debridment and resuture. Dyspnea attack appeared and was diminished with midazolam injection. We diagnosed her as hysteria with CMI and MMPI psychologic tests.
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PMID:[Dyspnea attack due to hysteria after general anesthesia]. 1084 92

A case is presented of a neonate with Hirschsprung's disease, associated with congenital central hypoventilation syndrome. After an ileostomy (at 2 days) and a stoma revision (at 10 days), postoperative pain management was established by continuous intravenous infusion of morphine, which caused severe postoperative respiratory depression. At 6 weeks a re-exploration and stoma revision was performed using postoperative epidural analgesia with bupivacaine. This caused no respiratory depression. A colectomy under epidural analgesia at 8 months was also uneventful. Respiratory difficulties in children with congenital central hypoventilation syndrome associated with Hirschsprung's disease are discussed in relation to the technique of choice for postoperative pain management.
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PMID:Clinical letter: epidural analgesia in a newborn with Hirschsprung's disease, associated with congenital central hypoventilation syndrome. 1112 13

Gynaecological malignancies affect the respiratory system both directly and indirectly. Malignant pleural effusion is a poor prognostic factor: management options include repeated thoracentesis, chemical pleurodesis, symptomatic relief of dyspnoea with oxygen and morphine, and external drainage. Parenchymal metastases are typically multifocal and respond to chemotherapy, with a limited role for pulmonary metastatectomy. Pulmonary tumour embolism is frequently associated with lymphangitic carcinomatosis, and is most common in choriocarcinoma. Thromboembolic disease, associated with the hypercoagulable state of cancer, is treated with anticoagulation. Inferior vena cava filter placement is indicated when anticoagulation cannot be given, or when emboli recur despite adequate anticoagulation. Palliative care has a major role for respiratory symptoms of gynaecological malignancies. Treatable causes of dyspnoea include bronchospasm, fluid overload and retained secretions. Opiates are effective at relieving dyspnoea associated with effusions, metatases, and lymphangitic tumour spread. Non-pharmacological therapies include energy conservation, home redesign, and dyspnoea relief strategies, including pursed lip breathing, relaxation, oxygen, circulation of air with a fan, and attention to spiritual suffering. Identification and treatment of gastroesophageal reflux, sinusitis, and asthma can improve many patients' coughs. Chest wall pain responds to local radiotherapy, nerve blocks or systemic analgesia. Case examples illustrate ways to address quality of life issues.
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PMID:Pulmonary medicine and palliative care. 1135 3

As we die, our respiratory pattern is altered and we seem to gasp and struggle for each breath. Such gasping is commonly seen as a clear sign of dyspnoea and suffering by families and loved ones, however, it is unclear whether it is perceived at all by the dying person. Narcotics and sedatives do not seem to affect these gasping respirations. In this issue of the Journal of Medical Ethics, we are asked to consider whether the last gasp of a dying patient could be or, perhaps, even should be avoided by administering neuromuscular blockers to palliate dying patients. For many reasons, such as our current failure to alleviate pain and distress, stories of inadequate analgesia and sedation in critically ill paralysed patients and the inability to know the intent-whether to palliate or to euthanise-it would seem that administering neuromuscular blockers should not be ethically permissible.
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PMID:Neuromuscular blockers--a means of palliation? 1204 1

An 18-year-old woman pregnant at 37 weeks gestation and with a history of recurrent urinary tract infection was admitted with a clinical picture of pyelonephritis that responded favorably to antibiotic treatment. After 2 days, cervical ripening was induced with prostaglandin E2 gel and labor was induced with oxytocin. The patient requested epidural analgesia. Six hours after induction, cesarean delivery was indicated owing to risk of fetal distress. The operation was carried out under epidural anesthesia with 10 mL of 0.5% bupivacaine without a vasoconstrictor. After delivery, uterine atony was treated unsuccessfully with oxytocin and methylergometrine maleate; the obstetrician then gave an intramyometrial injection of 0.25 mg of 15-methyl-prostaglandin F2alpha (PGF2alpha). After 5 minutes, SpO2 fell to 89%, accompanied by dyspnea and sinus tachycardia of 130-140 beats/min, with normal cardiorespiratory sounds. The patient was transferred to the postoperative recovery unit, where a chest radiograph led to a diagnosis of acute pulmonary edema. Treatment to reduce edema was successful. PGF2alpha and its analogs are useful for treating uterine atony that does not respond to other drugs, but side effects are not unknown. Caution in prescribing PGF2alpha and care in monitoring the patient's reaction are therefore recommended during and after anesthesia. Unnecessary overhydration should be avoided.
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PMID:[Pulmonary edema related to administration of 15-methyl-prostaglandin F2alpha during a cesarean section]. 1507 4


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