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)

Some reference opioids containing the Dmt-Tic pharmacophore, especially the delta agonists H-Dmt-Tic-Gly-NH-Ph (1) and H-Dmt-Tic-NH-(S)CH(CH2-COOH)-Bid (4) (UFP-512) were evaluated for the influence of the substitution of Gly with aspartic acid, its chirality, and the importance of the -NH-Ph and N(1)H-Bid hydrogens in the inductions of delta agonism. The results provide the following conclusions: (i) Asp increases delta selectivity by lowering the mu affinity; (ii) -NH-Ph and N(1)H-Bid nitrogens methylation transforms the delta agonists into delta antagonists; (iii) the substitution of Gly with L-Asp/D-Asp in the delta agonist H-Dmt-Tic-Gly-NH-Ph gave delta antagonists; the same substitution in the delta agonist H-Dmt-Tic-NH-CH2-Bid yielded more selective agonists, H-Dmt-Tic-NH-(S)CH(CH2-COOH)-Bid and H-Dmt-Tic-NH-(R)CH(CH2-COOH)-Bid; (iv) L-Asp seems important only in functional bioactivity, not in receptor affinity; (v) H-Dmt-Tic-NH-(S)CH(CH2-COOH)-Bid(N(1)-Me) (10) evidenced analgesia similar to 4, which was reversed by naltrindole only in the tail flick. 4 and 10 had opposite behaviours in mice; 4 caused agitation, 10 gave sedation and convulsions.
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PMID:Further studies on lead compounds containing the opioid pharmacophore Dmt-Tic. 1868 Feb 74

A 31-year-old woman suffering from bronchiolitis obliterans received bilateral living-donor lung transplantation to treat end-stage respiratory failure. After 5 days' mechanical ventilation, the patient was successfully extubated. During mechanical ventilation, the patient was sedated with a continuous intravenous infusion of propofol and dexmedetomidine (DEX). To assuage postoperative pain, morphine was infused, first intravenously, then epidurally. The administration of DEX was continued after extubation to prevent agitation. After the administration of epidural morphine was discontinued on day 10 in the intensive care unit (ICU), the patient complained of pain in the oral cavity. Greater pain was reported after the discontinuation of DEX, and symptoms of tachycardia and dyspnea appeared. A dermatologist diagnosed the oral symptoms as herpetic stomatitis, and a course of treatment with aciclovir was begun. A continuous infusion of DEX was again started on the same day, and was continued until ICU day 13. During the administration of DEX, the oral cavity pain was bearable. The patient was successfully discharged from the ICU on ICU day 13. We conclude that DEX could be used to provide analgesia for herpetic stomatitis after living-donor lung transplantation, at a dosage that achieves appropriate sedation.
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PMID:Analgesic effect of dexmedetomidine in a patient with herpetic stomatitis after living-donor lung transplantation. 1868 39

Fentanyl is frequently used for analgesia during emergency procedures. We present the cases of 2 patients who developed agitation and delirium after intravenous fentanyl administration. These patients were chronically taking selective serotonin reuptake inhibitors (SSRIs). Both developed neuromuscular examinations consistent with serotonin syndrome, a diagnosis that must be established on the basis of clinical criteria. Although they required aggressive supportive care, including mechanical ventilation, both patients made a full recovery. Use of fentanyl for procedural sedation may precipitate serotonin syndrome in patients taking SSRIs or other serotonergic drugs.
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PMID:Serotonin syndrome precipitated by fentanyl during procedural sedation. 1875 61

Administering sedative and analgesic medications is a cornerstone of optimizing patient comfort and minimizing distress, yet may lead to unintended consequences including delayed recovery from critical illness and slower liberation from mechanical ventilation. The use of structured approaches to sedation management, including guidelines, protocols, and algorithms can promote evidence-based care, reduce variation in clinical practice, and systematically reduce the likelihood of excessive and/or prolonged sedation. Patient-focused sedation algorithms are multidisciplinary, including physician, nurse, and pharmacist development and implementation. Key components of sedation algorithms include identification of goals and specific targets, use of valid and reliable tools to assess analgesia, agitation, and sedation, and incorporation of logical medication selection. Sedation protocols generally focus on a) algorithms that incorporate treating sedation and analgesia based upon escalation, de-escalation, or changing medications according to specific targets, or b) daily interruption of sedative and opioid analgesic infusions. Many published sedation protocols have been tested in controlled clinical trials, often demonstrating benefit such as shorter duration of mechanical ventilation, reduced ICU length of stay, and/or superior sedation management compared to usual care. Implementation of sedation algorithms in ICUs is a challenging process for which sufficient resources must be allocated.
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PMID:Protocolized and target-based sedation and analgesia in the ICU. 2207 13

A descriptive survey-based study was undertaken to test the validity and reliability of three scales that are used to assess sedation during opioid administration for pain management: the Inova Health System Sedation Scale (ISS), the Richmond Agitation and Sedation Scale (RASS), and the Pasero Opioid-Induced Sedation Scale (POSS). The study was conducted in a large (830 beds) suburban level I trauma hospital with a random convenience sample of 96 medical-surgical nurses. The study reports: measures of reliability and validity of each scale and significant findings related to correct nursing score and selected actions; nurses' ratings of each scale in terms of combined ease of use; information provided by the scale to inform clinical decisions; and nursing confidence measures. Both the RASS and the POSS demonstrated adequate measures of reliability and validity for measurement of sedation during opioid administration for pain management. However, the POSS scored higher in combined measures of ease of use, nursing confidence, and usefulness of information provided to make clinical decisions. The POSS also yielded the highest percentage agreement with the correct score and correct nursing actions chosen by the nurse among the three scales tested. Study results have clinical significance for accuracy of clinical assessments and subsequent actions on behalf of patients experiencing advancing sedation during opioid analgesia. The POSS can be recommended as a superior sedation scale for the measurement of sedation during opioid administration for pain management.
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PMID:Comparison of selected sedation scales for reporting opioid-induced sedation assessment. 1970 53

Although intracranial hypertension may arise from diverse pathology, several basic principles remain paramount to understanding its dynamics; however, the management of elevated intracranial pressure (ICP) may be very complex. Initial management of common ICP exacerbants is important, such as addressing venous outflow obstruction with upright midline head positioning and treating agitation and pain with sedation and analgesia. Surgical decompression of mass effect may rapidly improve ICP elevation, but the impact on outcome is unclear. Considerable effort has been put forth to understand the roles of multimodal intensive care monitoring, osmolar therapy, cerebral metabolic suppression, and temperature augmentation in the advanced management of elevated ICP. Establishing a protocol-driven approach to the management of ICP enables the rapid bedside assessment of multiple physiologic variables to implement appropriate treatments, which limit the risk of developing secondary brain injury.
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PMID:Management of intracranial pressure. 1981 35

Pain assessment in patients who are unable to verbally communicate with medical staff is a challenging problem in patient critical care. The fundamental limitations in sedation and pain assessment in the intensive care unit (ICU) stem from subjective assessment criteria, rather than quantifiable, measurable data for ICU sedation and analgesia. This often results in poor quality and inconsistent treatment of patient agitation and pain from nurse to nurse. Recent advancements in pattern recognition techniques using a relevance vector machine algorithm can assist medical staff in assessing sedation and pain by constantly monitoring the patient and providing the clinician with quantifiable data for ICU sedation. In this paper, we show that the pain intensity assessment given by a computer classifier has a strong correlation with the pain intensity assessed by expert and non-expert human examiners.
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PMID:Agitation and pain assessment using digital imaging. 1996 39

An air-enflurane mixture was used for inhalation analgesia in conscious patients undergoing painful procedures such as burns dressings. A preliminary study indicated that enflurane possessed definite analgesic properties, but that the concentration of the air-enflurane mixture was critical if restlessness was to be avoided and cooperation retained. Further studies established that 1% enflurane in air provided good analgesia in the absence of anaesthesia. The analgesic effects were similar to those produced by 0.35% methoxyflurane in air, but were produced in a much shorter time (about 3 minutes compared with 9 to 10 minutes). Preoperative starvation was unnecessary and nausea and vomiting were absent. Details are given of the use of enflurane analgesia in 32 conscious burned patients who underwent 101 burns dressing procedures.
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PMID:Enflurane analgesia. 2089 49

Agitation during the emergence from general anesthesia is a great post-operative problem that often injures the patients themselves and requires the medical staff to restrain and calm the patients. The predisposing factors for emergence agitation include anesthesia, operation, and patient. Sevoflurane anesthesia results in higher incidence of emergence agitation than halothane, because of the rapid emergence, and its effects on central nervous system inducing convulsion and post-operative behavioral changes. The otorhinolaryngologic and ophthalmologic surgeries, post-operative pain, young age, pre-operative anxiety, no past surgical history, and adjustment disorder of patients are risk factors for emergence agitation. The change from sevoflurane to propofol during anesthesia maintenance is a contributing factor to reduce incidence of emergence agitation. The medications including opioids, midazolam, alpha-2 agonists, ketamine, non-steroidal anti-inflammatory drugs, nitrous oxide, and propofol, and aggressive nerve block such as caudal epidural block for post-operative sedation and analgesia are effective to avoid incidence of emergence agitation. The calm emergence following general anesthesia would decrease the self-injuring behavior, and enhance the parent and caregiver satisfaction in general anesthesia and surgery.
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PMID:[Predisposing factors and prevention of emergence agitation]. 2152 May 89

More than 200 studies and reports have been published regarding the use of dexmedetomidine in infants and children. We reviewed the English literature to summarize the current state of knowledge of this drug in children for the practicing anesthesiologist. Dexmedetomidine is an effective sedative for infants and children that only minimally depresses the respiratory system while maintaining a patent airway. However, dexmedetomidine does depress the cardiovascular system. Specifically, bradycardia, hypotension, and hypertension occur to varying degrees depending on the age of the child. Hypertension is more prevalent when larger doses of dexmedetomidine are given to infants. Consistent with its 2-hour elimination half-life, recovery after dexmedetomidine may be protracted in comparison with other sedatives. Dexmedetomidine provides and augments analgesia and diminishes shivering as well as agitation postoperatively. The safety record of dexmedetomidine suggests that it can be used effectively and safely in children, with appropriate monitoring and interventions to manage cardiovascular sequelae.
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PMID:Review article: Dexmedetomidine in children: current knowledge and future applications. 2182 7


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