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

With improving standards of antenatal care, severe pre-eclampsia dn eclampsia are becoming less common and experience in the management of these conditions is lessening. Co-ordinated plans for the care of patients should be established by obstetricians and anaesthetists working as a team. A suitable regime for drug therapy in severe pre-eclampsia or eclampsia is the following: Initial management Diazepam 10 mg slowly i.v. Pethidine 100-150 mg i.m. or i.v. in incremental dosage, or extradural blocks, if analgesia is also required. Hydrallazine 20 mg i.v. initially, followed by 5 mg at intervals of 20 min until the diastolic pressure is less than 110 mm Hg. Then, preferably by syringe pump in a concentration of 2 mg/ml, at a rate of 2-20 mg/h. If vomiting occurs this can be controlled by administration of atropine. Subsequent management Sedation and anticonvulsant therapy. Continue diazepam and, in severe cases, institute chlormethiazole infusion. Continue analgesia with pethidine or extradural block. Control of hypertension by adjusting the dose of hydrallazine. If tachycardia exceeds 120 beat/min give propanolol 2-4 mg i.v. Plasma protein depletion with groww oedema is treated by administration of salt-free albumin or plasma protein fraction. Diuretic therapy is indicated if there is gross oedema or signs suggestive of acute renal failure. Oliguria associated with increased blood urea may be a result of renal failure or dehydration. The latter should be evident from the patient's condition and central venous pressure, but i.v. fluids and frusemide 20-40 mg can be used as a therapeutic test. Mannitol reduces cerebral oedema and may be given if diuresis has been first produced with frusemide. Potassium chloride is given if the plasma potassium decreases to less than 3 mmol/litre. Heparin therapy is considered if there is clinical evidence of disseminated intravascular coagulation.
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PMID:The management of severe pre-eclampsia and eclampsia. 83 44

A 31-yr-old parturient with myotonic dystrophy and asthma presented for elective Caesarean section. The patient was receiving warfarin having had two previous episodes of thromboembolism. Anticoagulation was subsequently provided by heparin in the weeks prior to delivery. The combination of the patient's medical conditions and the continuing need for anticoagulation presented a considerable anaesthetic problem in planning anaesthesia and analgesia for both elective and emergency delivery. Heparin was discontinued on the day prior to surgery and restarted immediately after surgery. During surgery flowtron anti-embolitic boots were used. Warfarin therapy was recommenced on the seventh postoperative day. Anaesthesia for Caesarean section was provided using a combined spinal epidural technique using a separate needle, separate interspace method. Postoperative pain was relieved by using a continuous epidural infusion, transcutaneous nerve stimulation and diclofenac. No new neurological problems arose despite the use of epidural analgesia in the presence of heparin anticoagulation. This method of providing anaesthesia and postoperative analgesia without the use of opioids in an anticoagulated, asthmatic, myotonic parturient has not been described elsewhere.
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PMID:Anaesthesia for caesarean section in a patient with myotonic dystrophy receiving warfarin therapy. 761 49

Patients who undergo percutaneous transluminal coronary angioplasty (PTCA) by the femoral approach are usually required to lie flat in bed for 6 to 24 hours, which may result in significant discomfort. This study was performed to evaluate the safety and benefit of a flexible sheath that enables patients to sit at a 60-degree angle while the sheath is in place in the femoral artery. Sixty patients were randomly assigned to receive either flexible or nonflexible sheaths before PTCA. Patients with flexible sheaths were allowed to sit at an angle of 60 degrees after the procedure. Heparin management was the same in both groups. Frequency of calls to nurses for back pain was recorded for both groups. For analgesia, nalbuphine was administered in 2-mg increments. All sheaths were removed the day after the procedure. Femoral ultrasound was used to detect groin complications (hematoma, pseudoaneurysm, or arteriovenous fistula) and was performed in all patients. Baseline characteristics were similar in both groups. There were no differences in ease of sheath insertion or guide catheter movement through the sheaths. The arterial pressure waveform was not dampened in any of the flexible sheath patients while in the sitting position. Patients with flexible sheaths had fewer calls for back pain and required less nalbuphine than patients with nonflexible sheaths. Groin complications were similar in both groups. In conclusion, by allowing patients to sit up to an angle of 60 degrees, flexible sheaths have a beneficial effect in reducing back pain and the need for analgesics after PTCA.
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PMID:Randomized comparison of flexible versus nonflexible femoral sheaths on patient comfort after angioplasty. 864 84

A successful heterotopic cardiac transplantation was performed between sibling female Yorkshire Juvenile swine. Adequate pre-medication with azaperone and a smooth induction were ensured for both pigs, which were anaesthetized simultaneously with sodium thiopentone followed by endotracheal intubation and intermittent positive pressure ventilation. Inhalation anaesthetic agents were used for maintenance, neuromuscular blockade was achieved with cisatracurium and both fentanyl and tramadol were used to provide analgesia. Invasive monitoring was used in both the donor and recipient. Central venous pressure (CVP) was maintained at > 10 cm H2O and mean arterial pressure (MAP) > 60 mmHg. Heparin was injected during the surgical dissection of the heart in the donor to prevent coronary thrombosis and prior to aortic side clamping for end-to-side anastomosis of the donor heart in the recipient abdomen. After transplantation, the cardiovascular parameters of the recipient showed a MAP of 85-105 mmHg and a CVP of 8-10 cm H2O while echocardiography of the transplanted heart confirmed an ejection fraction (EF) of 80%. A functional anaesthetic team was assembled and trained to provide anaesthesia for porcine cardiac transplantation. The transplanted heart suffered pump failure after 69 days and was excised for performance of tissue analysis.
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PMID:Provision of anaesthesia for porcine cardiac transplantation at the veterinary school in Trinidad and Tobago. 1297 58

A 65-year-old man underwent transversal colectomy for colon cancer under combined epidural and general anesthesia. On the 1st postoperative day, he developed consciousness loss and low SpO2 (< 90%) after walking, and pulmonary embolism was diagnosed by CT-scan and pulmonary scintigraphy. His consciousness and hemodynamic state recovered, and anticoagulation therapy was started after extraction of the epidural catheter. Heparin 5000 units was injected and continuous injection was started. Five hours after the extraction of the catheter, he developed paraplegia and analgesia below L1, and epidural hematoma was found with magnetic resonance imaging (MRI). Emergent laminectomy was performed and the hematoma was removed. The day after laminectomy, injection of heparin was started and 1 g x day(-1) of methylpredonisolone administered for 3 days. His paraplegia did not improve after the laminectomy. We discussed about pulmonary embolism and epidural hematoma.
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PMID:[Case of epidural hematoma developed after extraction of the epidural catheter and heparin injection in a patient with pulmonary embolism after colectomy]. 1841 95