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

The use of a combination of medetomidine and ketamine as anaesthetic for dental surgery was investigated in 60 dogs. The nature of the interventions varied from inspection of the teeth with cleaning of the teeth or simple tooth extraction to extraction of one or more dental elements or endodontic treatment. The operations lasted between 20 and 70 minutes, with an average of 34 +/- 15 minutes. Medetomidine, 1000 m g/m2 body surface administered intramuscularly, was used as premedication. Anaesthesia was induced with intravenously administered ketamine at a dose of 2-3 mg/kg body weight. The effect of premedication was 'good' in 79.5% of patients, 'moderate' in 12%, and 'poor' in 8.5%. Seven patients were given additional 50% medetomidine, which caused the proportion of animals with 'good' premedication to increase to 91.5%. Twelve of the 60 patients showed convulsion-like symptoms of varying severity directly after the administration of ketamine. In 4 patients the tonic cramps were considered severe enough to warrant once-only administration of midazolam. The quality of anaesthesia in the maintenance phase was considered 'good' in 88% of the patients and 'moderate' in 12%. Recovery was 'good' in 74% of the patients, 'moderate' in 11%, and 'poor' in 15%. Heart rate after premedication with medetomidine was 53 +/- 3 beats per minute and increased to 86 +/- 4 beats per minute (P < 0.05) after administration of ketamine. It thereafter decreased, over a period of 20 minutes, to 60 +/- 3 beats per minute. The respiration rate was 15 +/- 1 per minute and remained unchanged throughout the operation. After completion of surgery, medetomidine was antagonized with atipamezole (2500 m g/m2) given intramuscularly. In 13% of the animals the recovery period was characterized by tremors and restlessness. It can be concluded that the combination medetomidine and ketamine provides adequate analgesia, hypnosis, and muscle relaxation for various dental surgical interventions to be performed.
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PMID:[Veterinary dentistry (13). The use of the combination medetomidine/ketamine in dogs for anesthesia in dental procedures: evaluation of its clinical application]. 928 Oct 85

The use of a combination of medetomidine and ketamine as anaesthetic for dental surgery was investigated in 60 dogs. The nature of the interventions varied from inspection of the teeth with cleaning of the teeth or simple tooth extraction to extraction of one or more dental elements or endodontic treatment. The operations lasted between 20 and 70 minutes, with an average of 34 +/- 15 minutes. Medetomidine, 1000 micrograms/m2 body surface administered intramuscularly, was used as premedication. Anaesthesia was induced with intravenously administered ketamine at a dose of 2-3 mg/kg body weight. The effect of premedication was 'good' in 79.5% of patients, 'moderate' in 12%, and 'poor' in 8.5%. Seven patients were given additional 50% medetomidine, which caused the proportion of animals with 'good' premedication to increase to 91.5%. Twelve of the 60 patients showed convulsion-like symptoms of varying severity directly after the administration of ketamine. In 4 patients the tonic cramps were considered severe enough to warrant once-only administration of midazolam. The quality of anaesthesia in the maintenance phase was considered 'good' in 88% of the patients and 'moderate' in 12%. Recovery was 'good' in 74% of the patients, 'moderate' in 11%, and 'poor' in 15%. Heart rate after premedication with medetomidine was 53 +/- 3 beats per minute and increased to 86 +/- 4 beats per minute (P < 0.05) after administration of ketamine. It thereafter decreased, over a period of 20 minutes, to 60 +/- 3 beats per minute. The respiration rate was 15 +/- 1 per minute and remained unchanged throughout the operation. After completion of surgery, medetomidine was antagonized with atipamezole (2500 micrograms/m2) given intramuscularly. In 13% of the animals the recovery period was characterized by tremors and restlessness. It can be concluded that the combination medetomidine and ketamine provides adequate analgesia, hypnosis, and muscle relaxation for various dental surgical interventions to be performed.
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PMID:[Veterinary dentistry (13). Evaluation of the use of medetomidine and ketamine to induce anaesthesia in dogs undergoing dental surgery]. 938 63

We have examined the use of presurgical morphine-midazolam combination in 80 children aged 2-10 y undergoing repair of hypospadias. They were allocated randomly, in a double-blind study, to receive one of four morphine-midazolam combination doses (n = 20 each); (group I: 75 microg/kg each) [corrected] (group II: 75 microg/kg [corrected] morphine, 50 microg/kg [corrected] midazolam); (group III: 50 microg/kg [corrected] morphine, 75 microg/kg [corrected] midazolam); (group IV: 50 microg/kg [corrected] each). Drugs were given after induction of anesthesia and before the start of surgery. Observational scoring system, using crying, movement, agitation, posture and localization of pain as scoring criteria, was used to assess the children during their stay in the recovery room together with their sedative and/or analgesic requirement. Pre-surgical morphine-midazolam administration produced stable hemodynamic variables with satisfactory postoperative analgesia suggesting 75 microg/kg [corrected] dose of both morphine and midazolam as upper permissible dose, and 50 microg/kg [corrected] each as lower effective dose.
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PMID:Morphine-midazolam combination doses for presurgical analgesia in children. 975 10

The aim of this clinical audit was to evaluate the home recovery and complications of 104 daycase anaesthetized children, as well as parent satisfaction. A questionnaire, explained at the time of preoperative visit, was given to parents at hospital discharge and returned by mail. Opioids were administered in 19% of the children whereas regional anaesthesia was performed in 28% of cases. In the recovery room, 8% of them suffered pain. At home, pain was the main problem (25%) and vomiting and agitation were found in 9% and 6% of the cases respectively. Parents reported anxiety in 45% of cases, and 14% called their general practitioner. Nevertheless, 94% were satisfied with the anaesthetic. A clinical audit is useful in detecting management deficiencies. Quality of home recovery may be improved by: wider use of perioperative analgesia, systematic prescription of take-home analgesia, designation of a hospital practitioner for advice, and closer collaboration with general practitioners.
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PMID:Paediatric day case anaesthesia: estimate of its quality at home. 983 13

Mechanical ventilation is a well-established strategy in intensive care medicine. ICU trauma patients require analgesia, and sedation mostly consists of benzodiazepines and opioids with increasing doses over time. The weaning period is complicated by the withdrawal syndrome, showing tachycardia, hypertonia, tachypnea and restlessness. Although treatment with clonidine can influence these symptoms, tachypnea still remains the main problem in weaning patients from mechanical ventilation. Adding sufentanil, an opioid with greater effects on analgesia than on respiratory depression compared with fentanyl, tachypnea can be reduced to normal frequency. In this way weaning management can be managed more easily for the benefit of both, the patient and physician. In comparison with a group of 50 patients treated with clonidine alone, 72 patients treated with clonidine/sufentanil showed a shorter period from the start of spontaneous ventilation until extubation (4.8 vs 7.6 days) and until discharge from the ICU (7.7 vs 12.4 days). The number of reintubations caused by respiratory exhaustion decreased from 16.0 to 2.8%.
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PMID:[In Process Citation] 1006 33

A prospective, double-blind, randomized, controlled study was undertaken to compare the perioperative analgesic and recovery characteristics of equipotent doses of tramadol, pethidine and nalbuphine (3.0 mg kg-1, 1.5 mg kg-1 and 0.3 mg kg-1 respectively) with placebo (saline 0.02 ml kg-1) given at induction of anaesthesia in 152 ASA 1 children and young adults undergoing tonsillo-adenoidectomy. Premedication (temazepam and diclofenac), induction and maintenance of anaesthesia (thiopentone, atracurium, nitrous oxide and isoflurane), with controlled ventilation, were standardized. Variables monitored were heart rate (HR) and systolic arterial pressure (SAP) during surgery, time to recovery of spontaneous respiration at the termination of anaesthesia and restlessness, time to awakening, sedation and emesis in the recovery unit. Increases in HR or SAP > 33% of baseline during surgery were treated with esmolol 2.0 mg kg-1 intravenously (i.v.) and restlessness during recovery was treated with the same opioid i.v. given with an aesthesia, or pethidine i.v. in the placebo group. With placebo, there was a high requirement for esmolol during surgery and for pethidine in the recovery ward. Tramadol did not reduce the rate of intra-operative treatment with esmolol, but reduced the tramadol requirement during recovery (P < 0.05). Pethidine and nalbuphine reduced the intra-operative esmolol requirement more significantly (P < 0.025 and P < 0.005 respectively) and the need for treatment during recovery with opioids (P < 0.005 each). The time to recovery of spontaneous respiration at the end of anaesthesia was only delayed by pethidine. Other recovery variables were similar, except that restlessness-pain scores were reduced by tramadol (P < 0.02), pethidine (P < 0.005) and nalbuphine (P < 0.005). These results suggest that pethidine 1.5 mg kg-1 and nalbuphine 0.3 mg kg-1 given with induction of anaesthesia provide better analgesia during and after tonsillo-adenoidectomy than does tramadol 3.0 mg kg-1. The delay to recovery of spontaneous respiration with pethidine suggests a greater safety profile of nalbuphine and tramadol.
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PMID:Analgesia for adenotonsillectomy in children and young adults: a comparison of tramadol, pethidine and nalbuphine. 1022 69

Fifty consecutive patients, studied prospectively, underwent an elective first metatarsophalangeal joint arthrodesis or proximal metatarsal osteotomy and modified McBride bunionectomy, with or without concomitant lesser toe procedures. A field block was administered only at and distal to the level of the tarsometatarsal joints using 30 cc equal parts 0.25% bupivacaine and 1% lidocaine without epinephrine. Before injection, the monitoring anesthesiologist gave the patient intravenous (IV) sedation, usually an amnestic agent. Narcotic analgesia was not given to any patient before or during surgery to evaluate the efficacy of the block. Detailed records were kept of all intraoperative medication and its dosage, including supplemental local anesthetic. Efficacy and outcome were measured via direct patient monitoring during surgery and by direct interview after surgery, first in the recovery area (visual pain analogue applied) and again at 24 to 48 hr after surgery (recollection of events, duration of block, use of narcotics after surgery, subjective patient satisfaction). Supplemental local anesthetic was required for 15 patients (primarily for those who underwent lesser toe procedures), IV narcotic was required for 3 patients, and conversion to general anesthesia was required for 4 patients for agitation, not pain. The average duration of the local block was 8 hr (range, 5-14 hr); none of the patients had recall of negative events, and overall patient satisfaction was 98%. Midfoot blocks are easy to administer and provide reliable anesthesia for reconstructive forefoot surgery. Monitored IV sedation enhances patient acceptance, facilitates block administration, and provides a valuable measure of patient safety and comfort.
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PMID:Midfoot field block anesthesia with monitored intravenous sedation in forefoot surgery. 1050 86

We report two cases of difficult delivery, one vaginal breech presentation and one vaginal twin delivery in agitated parturients who were not given epidura analgesia. Maternal agitation was caused by pain and led to the risk of difficult fetal extraction. Epidural analgesia is not useful during the second stage of labor because of delayed onset of action of the administered drugs. Spinal injection of 10 microg of sufentanil was followed by rapid analgesia, maternal sedation and atraumatic deliveries. The usefulness of this technique is discussed for analgesia during the second stage of labor when epidural analgesia has not been performed.
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PMID:[Opioid spinal anesthesia at the end of labor for potentially difficult deliveries]. 1079 Jun 34

The postoperative pain treatment is one of important factors of a successful outcome after kidney transplantation. Improperly controlled pain leads to agitation, tachycardia, hypertension and increases risk of respiratory complications. Many studies have demonstrated good analgetic effect of morphine delivered by the method of patient controlled analgesia (PCA). Because the intensity of postoperative pain in end-stage kidney insufficiency patients can be modified by the type of received anaesthesia, it was decided to analyze the influence of standardized general anaesthesia on postoperative morphine consumption. 140 (ASA III) patients scheduled for kidney transplantation were included. Patients were divided into four groups; group K (control)--anaesthetised with fentanyl and N2O, group 1--fentanyl, N2O plus halothane, group 2--fentanyl, N2O plus propofol, group 3--fentanyl, N2O plus isoflurane. After operation and initial loading dose, PCA infusion of morphine was started. Bolus doses were set to 30 ug/kg, and lockout interval 10 min. Our results suggest that observed greater morphine consumption after GA with the use of propofol is connected with better psychomotor functions. In that group patients were better oriented and more efficiently controlled the PCA pump and pain.
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PMID:The influence of the type of anaesthesia on postoperative pain after kidney transplantation. 1085 Jun 7

The role of analgesia and sedation in intensive care units (ICU) is ancillary to other intensive care strategies, nevertheless they permit that every other diagnostic and therapeutic procedure is safely performed by keeping the patient pain-free, anxiety-free and cooperative. Commonly used opioids in ICU include morphine, fentanyl, sufentanil and remifentanil. The choice among opioid drugs relies on their pharmacokinetics and their pharmacodynamic effects. Cardiovascular stability observed with fentanyl and sufentanil indicates their use in hemodynamically compromised patients. Short-acting remifentanil offers several advantages in patients requiring prolonged infusions. The organ-independent metabolism of this newer molecule may be valuable in patients with multiple organ failure. The main indications for opioid analgesia and sedation in ICU include: 1) Anxiety, pain and agitation: in turn, they can increase cardiac workload, myocardial oxygen consumption and rate of dysarrhythmias; 2) immediate postoperative period after major surgery; 3) short-term invasive procedures. Potential advantages offered by opioids in the ICU setting also include: a) Cardiac protection: in animal models, it has been observed that delta-opiate receptor stimulation confers a preconditioning-like protective effects against myocardial ischemia; b) Neuroprotection: recent studies suggest that mu- and kappa-opiate receptors are involved in ischemic preconditioning against seizures in the brain. During opioid therapy in the ICU, drug tolerance and withdrawal symptoms should be anticipated and the dose adjusted accordingly.
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PMID:Rational use of opioids. 1137 35


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