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)

The synthetic opioid tramadol was given to 40 patients during surgery according to a fixed, calculated infusion scheme. Anesthesia was started with thiopental and the patients were given different nitrous oxide concentrations via a semi-open system (group 1: 60%, group 2: 75%). The aim of this study was to clarify whether this anaesthetic procedure is practicable or whether it has grave disadvantages in comparison with the anesthesia models used so far. Furthermore we wanted to clarify whether under this infusion scheme the proportion of N2O in the inspiratory mixture is sufficient or whether higher concentrations are required. In 24 of 40 patients analgesia or the depth of anaesthesia was insufficient so that additional enflurane application was necessary. Postoperative respiratory depression in three patients had to be treated with naloxone. The advantages of this procedure are the safe and easy practicability, absence of significant changes in the haemodynamic parameters, good postoperative response of the patients and postoperative pain relief as well as the low incidence of postoperative side effects such as nausea, vomiting and CO2-retention.
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PMID:[Tramadol infusion anesthesia with the substitution of enflurane and various nitrous oxide concentrations]. 391 7

Several modifications of the Bain system for nitrous oxide analgesia or general anesthesia were tested for rebreathing and retention of CO2. The classic Bain circuit causes the most rebreathing as measured by the fractional concentration of CO2 in a sample of inspired gas (FICO2), but stimulation of the respiratory system seems to allow near normal end tidal CO2 and arterial CO2 tensions. The most predictable systems that have the least amount of rebreathing are those that have the least dead space.
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PMID:Evaluation of rebreathing in various modifications of the Mapleson-D system. 392 98

To identify the opioid antagonist activity of nalmefene and to determine its duration in man, six healthy male subjects were pretreated on separate days with a saline placebo, 0.5 mg, 1 mg, or 2 mg nalmefene intravenously in a randomized double-blind fashion. Opioid challenges with fentanyl, 2 micrograms/kg, then were administered 1, 2, 4, 6, and 8 h afterward. Respiratory depression was monitored by ventilatory and occlusion pressure responses during CO2 rebreathing, while analgesia to experimental pain was identified with the submaximal effort tourniquet ischemia test. One hour following placebo pretreatment, the initial fentanyl dose produced marked respiratory depression. Minute ventilation and occlusion pressure at a PCO2 60 mmHg during rebreathing (VE60 and P(0.1)60) were reduced to 29 and 41% of control, respectively. The slopes of the ventilatory and occlusion pressure responses also decreased significantly to 51 and 55% of control. Respiratory effects were similar with all subsequent fentanyl doses. Pretreatment with 2 mg nalmefene completely prevented the subjective and respiratory effects of fentanyl for the entire 8 h of the experiment. Nalmefene, 1 mg, significantly blunted the fentanyl effects for the same period, but VE60 values at 6 and 8 h were depressed significantly (P less than 0.05) to 66 and 61% of control. The antagonist effects of the lowest nalmefene dose, 0.5 mg, persisted for about 4 h, at which time VE60 was 64% of control. Fentanyl administration produced consistent increases in pain tolerance (44-55% above control) throughout the experiment. Nalmefene pretreatment abolished this analgesic response in a dose-related time course that mirrored the respiratory effects almost exactly.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prolonged antagonism of opioid action with intravenous nalmefene in man. 394 4

Spinal anaesthesia with bupivacaine (22.5 mg) or with a glucose-containing solution of bupivacaine (20 mg) or tetracaine (15 mg) was given to 21 patients allocated randomly to these three groups. A urodynamic study was performed by CO2 cystometry. It consisted of recording of first sensation of bladder filling, sensation of full bladder, strength of maximal detrusor contraction, bladder capacity and urethral pressure. At the same time, using a quantitative method for measuring muscle strength, the motor block was evaluated for three separate movements--hip flexion, knee extension and plantar flexion of the big toe. After the spinal injection, the micturition reflex was rapidly blocked. One minute after the injection, eight patients experienced no strong desire to void when the bladder was overfilled, and 5 min after the injection bladder paralysis was present in most patients. The length of time from spinal injection to complete recovery of detrusor strength was 7-8 h and did not differ significantly between the three groups. The level of analgesia lay at or caudal to L5 when the detrusor strength returned. On the average, sensibility (pin-prick) in the sacral segments returned simultaneously with or somewhat earlier than complete recovery of detrusor strength. The muscle strength in the lower limbs was fully restored 40-140 min, on average, before the detrusor strength had completely recovered. There was good correlation between the time of full restoration of hip flexion and detrusor strength in the bupivacaine groups. Urethral pressure was reduced by a mean of 48% and returned to normal either at the same time as or slightly before complete recovery of detrusor strength.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Bladder function in spinal anaesthesia. 1884 Jan 22

The effect of a single small dose of alfentanil (6 micrograms/kg) on postoperative pain was compared with saline using a double blind study. Pain was assessed using a linear analogue scale and shown to decrease at 2, 5 and 10 minutes after injection of alfentanil (p less than 0.01). The PE'CO2 was increased at 2 and 15 minutes (p less than 0.05) and 5 and 10 minutes (p less than 0.01) after injection of alfentanil. There were no changes in pain or PE'CO2 in the control group throughout the study. Intravenous alfentanil given to patients in pain provides quick effective analgesia for a short period of time, but respiratory depression may occur.
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PMID:The analgesic effect of a low dose of alfentanil. 614 72

The respiratory depressant and analgesic effects of intravenous dezocine were evaluated in six healthy volunteers. Single 0.15 mg/kg doses were compared with identical amounts of morphine, and the two drugs were given in combination. Five successive 0.15 mg/kg doses of dezocine also were given to identify dose-effect relationships. Respiratory center sensitivity was monitored by carbon dioxide (CO2) rebreathing and mouth occlusion pressure (P0.1) measurement, while analgesia to experimental pain was tested with submaximal tourniquet ischemia. Single 0.15 mg/kg doses of dezocine produced significantly more tolerance to experimental pain and greater respiratory depression than a comparable dose of morphine in the first hour, but effects of both drugs were similar thereafter. Multiple doses of dezocine progressively increased pain tolerance from 46 +/- 14% above control with the first dose to 70 +/- 18% above control with the second dose (cumulative total 0.30 mg/kg). Additional dezocine doses did not result in significantly more analgesia. Depression of CO2 sensitivity followed a similar pattern. Morphine 0.15 mg/kg, when given to subjects who had received a prior dose of dezocine, produced no additional effect beyond that observed with dezocine. With the reverse sequence, dezocine increased the respiratory depression of morphine but also produced a dramatic increment in analgesia, which suggested an additive action. Dezocine is therefore an effective analgesic with morphine-like effects. In human subjects it appears to be a slightly more potent analgesic than morphine in identical clinical doses (0.15 mg/kg). Dezocine is similar to other agonist-antagonist analgesics in that it exhibits a ceiling effect for respiratory depression that parallels its analgesic activity.
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PMID:Ventilatory and analgesic effects of dezocine in humans. 615 Jun 61

Modifications of early endoscopes have overcome problems of uterine bleeding and maintenance of distention and have provided high-intensity light sources and lenses of great resolution and clarity to permit wider use in clinical diagnosis. The hysteroscope is a modified cystoscope with similar components. The 3 media most commonly used for uterine distention in panoramic hysteroscopy are dextran 32% weight volume in dextrose 10%, which offers excellent vision and minimal spillage but may harden around the instrument; CO2 gas, which permits excellent visualization because it does not interfere with the view or mix with the blood; and dextrose 5% in water which mixes less readily with blood than normal saline. In general, no one of the methods is better than the others as long as the operator is experienced and knows the properties and possible side effects of each. Some type of analgesia or anesthesia is required for the procedure. The present indications for hysteroscopy include abnormal uterine bleeding, diagnosis and possible removal of submucus leiomyomas or endometrial polyps, location and removal of lost IUDs, evaluation of infertile patients with abnormal hysterograms, diagnosis and treatment of uterine adhesions, and division of small uterine septa. Hysteroscopy is contraindicated by pregnancy, infection, profuse uterine bleeding, and cervical malignancy. With proper technique and patient selection few complications arise, but uterine perforation, infection, and bleeding are possible. Other complications related to the medium or to intrauterine operation may occur.
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PMID:Hysteroscopy for gynecologic diagnosis. 618 55

In a clinical study we compared two groups of healthy patients at term: - 10 patients received no analgesics or very small doses of pethidine (control group) during the course of labour, - 17 patients were given CO2-bupivacaine via epidural catheter because they asked for it and because their obstetricians prescribed it (CEDA-group). After giving the same infusion solution of 120 ml/h 5% half-isotonic fructose to all the parturients, the following biochemical parameters were measured at the beginning and at the end of the first stage of labour, at delivery, and two hours later: Blood gases and acid-base status, blood sugar, lactate, betahydroxybutyric acid, ACTH, cortisol, hematocrit, electrolytes, and serum osmolality. The above mentioned parameters, except electrolytes and serum osmolality, were also determined in umbilical-cord blood immediately after delivery. In the labour ward, infants were observed and their capillary blood gases, acid-bases status, and blood sugar were measured 30, 60, and 120 minutes after birth. Lactate, betahydroxybutyric acid, ACTH, and cortisol levels rose significantly until delivery in both of the groups; significant differences between the two groups could be seen in blood gases, blood sugar, and ACTH levels. In the umbilical cord there were only significant differences in blood sugar. In summary it can be concluded that although labour pain can be controlled by epidural analgesia, the stress of labour is only influenced by different analgesic methods to a certain degree.
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PMID:[Important metabolic parameters in the peripartum period as affected by peridural anesthesia]. 626 40

In a randomized double-blind study the influence of morphine 0.5 mg on the development and regression of spinal anaesthesia, the postoperative analgesia and the side effects were investigated. Forty-two patients received an isobaric spinal anaesthesia with tetracaine 20 mg without morphine (n = 19) or with morphine 0.5 mg (n = 23). The sensory blockade was tested by pinprick; the patients evaluated their postoperative pain with an analogue scale. Arterial blood gases, respiratory rate, blood pressure and heart rate were measured and side effects determined. In the test group the cranial level of anaesthesia was during the development (p greater than 0.05) and regression (p less than 0.05) half to three segments higher than in the control group. The postoperative analgesia was more intense and longer lasting with morphine than without (p less than 0.05). Following morphine, P art CO2 was higher (p less than 0.05), the respiratory rate lower (p less than 0.05). Pruritus, nausea, vomiting and disturbances of micturition were more frequent. Following spinal anaesthesia with a deeper level of anaesthesia at T8-T11 the postoperative analgesia was superior than following spinal anaesthesia with a higher level of anaesthesia at T3-T4 (p less than 0.05). Only following higher levels of anaesthesia there was evidence of respiratory depression (p less than 0.05). This is why the level of spinal anaesthesia with the addition of morphine must not be higher than necessary for surgery.
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PMID:[0.5 mg intrathecal morphine in spinal anesthesia. A double blind study on sensory block, postoperative analgesia and adverse effects]. 639 May 47

The combination of dextroamphetamine and morphine has been shown to be synergistic for analgesia and antagonistic for most other effects. However, the claim that dextroamphetamine antagonizes the respiratory depression caused by morphine has not been well substantiated. In this double-blind study, we investigated respiratory effects, including resting respiration, isohypercapnic ventilation, CO2 response, dose response, and duration of these effects with dextroamphetamine alone and in combination with morphine. Dextroamphetamine alone (0.215 mg/kg) caused increases in minute ventilation and a leftward shift of the CO2 response curve that lasted for less than 2 hours. Dextroamphetamine combined with low-dose morphine (0.15 mg/kg) antagonized respiratory depression throughout the 5-hour observation period. Dextroamphetamine combined with high-dose morphine (0.30 mg/kg) was unable to completely antagonize depressed ventilation, and some residual effects of morphine persisted at 23 hours.
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PMID:Dextroamphetamine with morphine: respiratory effects. 640 51


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