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

Being advanced in years is not in itself a high risk in anaesthesia; however, altered pharmacokinetics and pharmacodynamics, mental dysfunction and the administration of anaesthetics complicate the postoperative period. In order to examine the problem of sedation in elderly patients, we studied the effects and side effects of continuous peridural anaesthesia for abdominal surgery. METHODS. On the day before surgery we inserted a peridural catheter (Perifix 400, Braun, Melsungen, FRG) between T-12 and L-4 in 52 patients in a sitting position (mean age 69.3 +/- 10.9 years) using the loss-of-resistance technique. If no signs of spinal anaesthesia became apparent, the exact position of the catheter was determined using 9 or 10 ml bupivacaine 0.5%. Next day, after premedication with atropine, pethidine or midazolam, 20-25 ml bupivacaine 0.5% was instilled through the peridural catheter. During surgery patients were sedated using a small dose of propofol. We also insufflated oxygen (2 l/min). Blood pressure, heart rate, and blood gases were monitored and electrocardiography and pulse oximetry performed. As postoperative pain therapy, we administered morphine through the peridural catheter at intervals of 8 h. For statistical evaluation we used Wilcoxon's test. RESULTS. An adequate degree of analgesia was found between T-4 and T-7 and abdominal muscle relaxation was satisfactory. Heart rate decreased by 10.3% after the administration of local anaesthetics. After surgery had begun, blood pressure decreased over a period of 30 min (systolic by 20.5% and diastolic by 14.2%) but it remained constant at this level during the rest of the operation (see Fig. 1). Neither of these side effects was significant. Oxygen saturation and blood gases were normal. During the operation, a mean dose of 325 mg propofol/h was necessary to maintain sedation. After surgery all patients were awake, suffered no pain and had complete amnesia with regard to the operation. The postoperative peridural dosage of 5 mg morphine (three times in 24 h) was very effective. Because some patients vomited we used between 50 and 100 mg tramadol (four times in 24 h) instead of morphine. Early mobilization of patients was possible and there were no pulmonary complications such as pneumonia. CONCLUSIONS. If carried out by an experienced physician, continuous peridural anaesthesia can be an alternative method in abdominal surgery for elderly patients. We see advantages in the minimal disturbance of pulmonary and mental function, in the minimal amount of sedation required and in the successful postoperative pain therapy.
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PMID:[Continuous peridural anesthesia in abdominal surgery. An alternative for elderly patients]. 144 12

More than 20 second-generation lithotriptors have been introduced for extracorporeal shock-wave lithotripsy. Despite great technical progress, each machine still has its specific short-comings. In cooperation, Storz Medical (Kreuzlingen, Switzerland) and the Department of Urology (Klinikum Mannheim, FRG), have developed a new lithotriptor designed to overcome these drawbacks. Energy source: Electromagnetic cylinder with paraboloid reflector (40 cm) for focusing, providing a wide range of pressure (190-1,000 bar) and a focal zone of 28 x 6 mm. The focal depth is maximally 15 cm. Coupling and positioning: Water cushion with patient lying on a specially designed 'acoustic cradle' consisting of an impedance-adapted foil. This is integrated in either a manually or automatically operated table. Localization: Coaxial ultrasound probe for real-time scanning and integrated C arm with pulsed fluoroscopy using a virtual focus (moved along x-axis) for stone localization. In 1989, we commenced with the first treatment based on our own in vitro and in vivo studies to determine the range of energy required for safe application. We treated 137 stones (100 caliceal, 19 pelvic and 18 ureteral) in 88 patients. The mean generator voltage was 16 kV (10-18 kV). Successful disintegration was achieved in 83 patients (95%) employing an average of 2,359 impulses (940-3,500). Thirteen percent of the treatments were performed without any anesthesia on lower generator voltage (10-15 kV), whereas the majority of calculi were treated under intravenous analgesia. The 5 failure cases included 2 stones in a caliceal diverticulum. Moreover, 12 patients with biliary calculi (11 gallstones and 1 bile duct stone) were successfully treated; 1 of these cases required a second treatment session.
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PMID:Modulith SL 10/20--experimental introduction and first clinical experience with a new interdisciplinary lithotriptor. 228 15

Analgesia and anesthesia during labor were surveyed by the use of a questionnaire sent to university hospitals in USA, UK, France, FRG, GDR, Japan, and also other types of institutions in Japan. A rather negative attitude toward analgesia and anesthesia during labor was encountered less often in Japan than in USA, UK, and FRG, but the actual frequency of use was much less in Japan. Narcotics and/or tranquilizers were most frequently used in the first stage of labor. The only exception was France where lumbar epidural anesthesia was actually used as a method of choice at 70% of the institutions. Lumbar epidural anesthesia or some other regional block was the method of choice in the second stage except in UK where inhalation of nitrous oxide was the method of choice at 48% of the institutions. Augmentation of labor was much more frequent and the number of annual deliveries were much less in Japan. Higher C-section rate was seen in USA.
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PMID:Analgesia and anesthesia during labor in Japan and developed countries. 259 85

To determine how pain is assessed and managed in the early postoperative period, what the prescribing habits and general opinions on postoperative pain are, and what suggestions for future improvement could be made, questionnaires were sent to 430 anesthesia departments in the FRG. Of these, 188 were returned (38% response). Systemic treatment (opiates, major and minor tranquilizers, peripherally acting analgesics and spasmolytics) was preferred in most cases, although regional anesthesia/analgesia seems to be rather popular. Data are given not only for analgesic techniques, but also for the most frequently used drugs. The study highlighted deficiencies in communication between the anesthetic staff and the patients that resulted in poor assessment of acute pain problems. The findings indicate a need to document pain and pain relief more often and more precisely in order to improve postoperative pain control.
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PMID:[Status of postoperative pain therapy in West Germany. Results of a representative survey]. 288 94

Since the initiation of the clinical trial utilizing a second-generation lithotripor (Lithostar, Siemens, Erlangen, FRG), 96 patients with distal ureteral calculi (i.e. calculi below the pelvic brim) underwent local shock-wave lithotripsy. Routine treatment was conducted under intravenous sedation and light analgesia only. Complete stone disintegration was achieved in 84 patients (87.5%), 11 requiring two sessions and 1 patient, three. In 7 patients ureteroscopy became necessary after unsuccessful local shock-wave treatment. In 2 of these patients a 9-french flexible ureteroscope and the Storz Q-switched neodymium-YAG laser was used for stone disintegration. In 3 cases loop extraction and in 2 cases open surgery had to be performed for definitive stone removal. All pre- and postoperative manipulations (except open surgery) were done on the Lithostar. Local shock-wave lithotripsy is a highly successful, noninvasive, time-saving and easily applicable technique. It has become our primary approach in the treatment of distal ureteral calculi.
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PMID:Local shock-wave lithotripsy of distal ureteral calculi. 304 4