Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Peridural anesthesia is believed to be a complicated kind of analgesia yielding grave complications (syncope, apnoe, collapse, persistant and pronounced hypotension, nematomyelia, paraplegia of the lower extremities, Brown--Seguard syndrome and many others). This king od anesthesia is permissible only in an anesthesiological or reanimatological department. The frequency of complications depends on a level of injecting the anesthetic, patient's status and age. The former is the greater the higher the level of the peridural space puncture. To combat against complications occurring while using this kind of analgesia everything necessary for reanimation provision (intubation of the trachea, closed and open heart massage, etc.) should be ready at hand.
 ...
PMID:[Complications of peridural anesthesia]. 122 52

The aim of this study was to evaluate factors relevant to morbidity and mortality in 54 patients undergoing oesophagectomy at Royal Newcastle Hospital between 1985 and March 1989. There was a high incidence of concurrent medical problems. Significant anaesthetic complications occurred in 6 patients. There were 16 serious general medical complications and 10 surgical complications. Respiratory complications included basal collapse (19), sputum retention (6), pulmonary oedema (2), pleural effusion/haemothorax (5), and severe aspiration syndrome (5). Seven patients required mechanical ventilation for more than 3 days. Two deaths occurred postoperatively. As a result of this audit, changes have occurred in patient selection, management of chylothorax, epidural analgesia and timing of tracheal extubation.
 ...
PMID:Peri-operative care for oesophagectomy patients. 187 43

The aim of this study was to assess the value of peridural thoracic analgesia (ATP) to prevent pain observed during pleural symphysis with tetracycline (STP) for pneumothorax (PNO). 12 patients (age 27 +/- 6 years) having a spontaneous PNO benefited from 13 SPT (1 gm, tetracycline diluted in 60 cc of normal saline) under cover of an APT (at the D5-D6 level) with Fentanyl (0.1 mg) and Bupivacaine 0.5% adrenalin (1 mg/kg). The protocol was used on three successive days. Repeated determinations of blood bupivacaine levels were performed in 9 patients on the first day. No patient had an intolerable pain which required injection of parenteral morphine and/or an interruption of the protocol. For two patients (one of them having a right symphysis and then a left symphysis one month later) the treatment sessions to achieve a symphysis were totally painless. 10 patients experienced moderate pain, mainly on the first day, which was relieved by reinjection of peridural bupivacaine (25 mg) (n = 9) or by the parenteral injection of non morphine analgesia (n = 1). No patient had a respiratory depression, collapse or bradycardia. The blood bupivacaine levels were always significantly less than the toxic levels (1.6 mg). The results observed suggest that APT, (Fentanyl and Bupivacaine) is an effective method, non toxic and well tolerated for the prevention of intolerable pain which is seen in SPT for PNO.
 ...
PMID:[Pleural symphysis with tetracyclines for pneumothorax. The value of thoracic peridural analgesia]. 203 49

A sixty-eight-year-old female developed severe hypotension immediately after the administration of epidural meperidine for post-thoracotomy pain. Two preceding injections of epidural opiates had been uneventful. The cardiovascular collapse was difficult to reverse and may have contributed to the patient's subsequent death. Cardiovascular complications have not been reported frequently as a possible side effect of epidural opiate analgesia.
 ...
PMID:Severe hypotension from epidural meperidine in a high-risk patient after thoracotomy. 275 44

Bupivacaine and chloroprocaine have proven to be valuable local anesthetics for a variety of surgical and obstetrical situations. Bupivacaine is particularly useful as a long acting agent which provides excellent sensory analgesia particularly during labor with minimal blockade of motor fibers. The 0.75% solution is useful for epidural surgical anesthesia since it does result in a decrease in onset time and a more marked motor blockade. In recent years, this agent has been reported to cause rapid cardiovascular collapse in some patients. Cardiotoxicity associated with bupivacaine is related not to the concentration employed but to the total dosage administered as a rapid intravenous injection. The careful administration of this agents to avoid an accidental intravenous injection should not preclude the use of 0.75% bupivacaine for epidural anesthesia in surgical patients. This concentration is not recommended in obstetrical cases. Chloroprocaine is valuable as a rapid onset, short duration local anesthetic with a low potential for systemic toxicity. The 3% solution is particularly useful for providing a rapid onset of action. In recent years, localized neural irritation has occurred in some patients in whom large amounts of this agent were administered epidurally or intrathecally. The local neural toxicity of chloroprocaine solutions is referably to the low pH and the inclusion of sodium bisulfite in these particular solutions. The toxicity of chloroprocaine solutions is related to total dosage rather than the concentration of solution employed. Careful administration of chloroprocaine epidurally in order to avoid accidental subarachnoid injection should preclude the possibility of local neural toxicity.
 ...
PMID:Is there a need for chloroprocaine 3% and bupivacaine 0.75%? 305 87

One hundred patients undergoing thoracotomy had their intercostal nerves blocked by cryoanalgesia before closure and the effect of this on their postoperative pain was evaluated. Of the 100 patients, 79 were free of pain, 12 had some discomfort, and nine reported severe pain necessitating narcotic analgesia (mean 1.5 injections per patient). Only five patients needed assisted removal of sputum, though eight showed retention of sputum or subsegmental collapse of lung radiographically. Overall, lack of pain and greater alertness much enhanced the value of physiotherapy, which resulted in a low incidence of complications and a smooth recovery. The technique of cryoanalgesia is simple, extremely effective, and apparently offers benefits not conferred by other methods of preventing pain after thoracotomy.
 ...
PMID:Cryoanalgesia for relief of pain after thoracotomy. 678 5

Two box jellyfish in particular cause problems in tropical Queensland waters. Chironex fleckeri inhabit calm waters close to the shore between November and May. The venom includes three major components: haemolytic dermatonecrotic and myocardial. The dermatonecrotic toxin causes a ladder pattern of whiplash lesions to the skin which ulcerate become necrotic and heal very slowly over months: Neuromuscular paralysis and cardiovascular collapse may be fatal within minutes of envenomation. Emergency treatment comprises inactivation of stinging capsules by vinegar removal of tentacles analgesia, cardiopulmonary resuscitation and the administration of the specific antivenom. Carukia barnesi ('Irukandji') are found in both coastal and open waters. A patch of erythema with papules at the sting site is characteristically followed 30 min later by the onset of a catecholamine mediated syndrome. Headache and severe abdominal and back pain are usual and may be followed by hypertension, tachyarrhythmias and cardiogenic shock.
 ...
PMID:Marine stingers in far north Queensland. 871 6

Two hundred one consecutive patients with cancer pain who received intrathecal pain treatment between 1985 and 1993 were included in this retrospective study undertaken to test the hypothesis that epidural metastasis is a common cause of "refractory" cancer pain and that its presence may affect the efficacy and the complication rates of intraspinal pain treatment. Fifty-seven (approximately 28%) patients were investigated by metrizamide myelography, computerized tomography (CT), magnetic resonance imaging (MRI), laminectomy, or neurohistopathology. Epidural metastases were found in 40 (70%) and spinal stenosis in 33 (approximately 58%); 7 patients with total and 26 with partial occlusion of the spinal canal. Presence of epidural metastasis affected catheter insertion complications, daily dosages, and complications of the intrathecal pain treatment only when it was associated with spinal canal stenosis (partial or total). During the period of the intrathecal treatment, the patients with confirmed epidural metastasis and total spinal canal stenosis needed significantly (P < 0.05) higher daily doses of opioid (means = 77 +/- 103 versus 22 +/- 29 mg) and intrathecal bupivacaine (means = 65 +/- 44 versus 33 +/- 20 mg) and had significantly (P < 0.05) higher rates (14% versus 0%) of radicular pain at injection and poor distribution of analgesia than those without epidural metastasis and spinal canal stenosis. In contrast, the rate of occurrence of post-dural puncture headache was significantly (P < 0.05) lower in patients with partial (4%) and total (14%) spinal stenosis than in those without (29%). Unexpected paraplegia occurred in four patients and was due to accidental injury during attempted dural puncture (N = 1) and collapse (due to cerebrospinal fluid leakage leading to "medullary coning" of an unknown epidural metastasis (N = 3).
 ...
PMID:Spinal epidural metastasis: implications for spinal analgesia to treat "refractory" cancer pain. 902 59

The presence of bone metastases predicts the presence of pain and is the most common cause of cancer-related pain. Although bone metastases do not involve vital organs, they may determine deleterious effects in patients with prolonged survival. Bone fractures, hypercalcaemia, neurologic deficits and reduced activity associated with bone metastases result in an overall compromise in the patient's quality of life. A metastasis is a consequence of a cascade of events including a progressive growth at the primary site, vascularization phase, invasion, detachment, embolization, survival in the circulation, arrest at the site of a metastasis, extravasion, evasion of host defense and progressive growth. Once cancer cells establish in the bone, the normal process of bone turnover is disturbed. The different mechanisms responsible for osteoclast activation correspond to typical radiologic features showing lytic, sclerotic or mixed metastases, according to the primary tumor. The release of chemical mediators, the increased pressure within the bone, microfractures, the stretching of periosteum, reactive muscle spasm, nerve root infiltration and compression of nerves by the collapse of vertebrae are the possible mechanisms of malignant bone pain. Pain is often disproportionate to the size or degree of bone involvement. A comprehensive assessment including a trusting relationship with the patient, taking a careful history of the pain complaint, the characteristics of the pain, the evaluation of the psychological status of the patient, neurological examination, the reviewing of diagnostic studies and laboratory findings, and individualization of the therapeutic approach, should precede any treatment. Radiotherapy is the cornerstone of the treatment. Low doses given in a single session are safe and effective, and reduce distress and inconvenience associated with repeated session. Radioisotopes are more imprecise in delivering specific doses of radiation, but have less toxicity and easy administration as well as effectiveness in subclinical sites of metastases, although storage, dispensing and administration should be under strict control. Chemotherapy and endocrine therapy are difficult to measure in terms of pain relief. Prophylactic fixation surgery can lead to improved survival and quality of life of patients with bone metastases. Surgical treatment should be undertaken when fracture occurs. Careful selection of patients for surgical spinal decompression is required. The potential benefits of surgical interventions have to be tempered with patient survival. The use of analgesics according to the WHO ladder is recommended. There is no clear evidence that non-steroidal anti-inflammatory drugs (NSAIDs) have a specific efficacy in malignant bone pain. The difficulty with incident pain is not a lack of response to systemic opioids, but rather that the doses required to control the incidental pain produce unacceptable side-effects at rest. Alternative measures are often required. The inhibition of bone resorption and hypercalcaemia can be reduced by the use of bisphosphonates. This class of drugs potentiate the effects of analgesics in improving metastatic bone pain. Invasive techniques are rarely indicated, but may provide analgesia in the treatment of pain resistant to the other modalities. Neural blockade should never be used as the sole modality for malignant bone pain, but should be considered as a helpful in specific pain situations. Careful appraisal and the application of a correct approach should enable the patient with bone metastases to obtain an acceptable pain relief despite the advanced nature of their malignant disease.
 ...
PMID:Malignant bone pain: pathophysiology and treatment. 906 7

The Thoracic Research Scholarship 1996 of the German Society for Thoracic and Cardiovascular Surgery enabled me to visit Barnes Hospital at the Washington University of St. Louis, USA, from May to July 1996. At that center Prof. J. D. Cooper has established lung-volume reduction surgery as a successful surgical treatment for patients with endstage pulmonary emphysema. The operation is performed using left-sided double-lumen intubation. After opening of the chest and pleura and starting single-lung ventilation the less diseased parts of the second lung collapse due to absorption atelectasis whereas the more diseased portion of the lung stays hyperinflated. Linear staplers buttressed with bovine pericardium are used to resect the diseased parts of the lungs. Approximately 20-30% of the total lung volume can be resected by this way on each side. After inspection of the lungs for air leaks and preparation of pleural tents the pleura is closed bilaterally. Postoperative analgesia is performed via epidural catheter and patients are extubated postoperatively as soon as possible, usually in the operating theatre. 150 bilateral lung-volume reduction procedures for patients with severe emphysema were performed between January 1993 and February 1996 in St. Louis. 6 months postoperatively the 1-second forced expiratory volume had increased by up to 51% and residual volume was reduced by 28%. 70% of patients who required continuous oxygen supply prior to the operation no longer required this measure: the PaO2 had increased by an average of 8 mmHg. These data demonstrate that bilateral lung-volume reduction surgery is a suitable treatment for patients with terminal pulmonary emphysema. Most important for the success of this procedure are clear selection and specific perioperative treatment of the patients.
 ...
PMID:German Thoracic Research Scholarship 1996: lung volume reduction for endstage pulmonary emphysema at the Washington University of St. Louis. 971 99


1 2 3 4 Next >>