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)

Respiratory depression is a limiting factor in the therapeutic use of opioid analgesics. It has been suggested that respiratory depression is mediated by mu rather than kappa receptors and may involve a decrease in central nervous system sensitivity to hypercapnia. This study investigated opioid receptor mechanisms underlying respiratory depression in unanesthetized rhesus monkeys (n = 3) breathing air or 5% CO2 in air into a pressure displacement head plethysmograph. Apparent pA2 analyses of s.c. quadazocine (a mu-selective antagonist) were carried out on the effects of cumulative doses of s.c. bremazocine, ethylketocyclazocine (EKC) and (+/-)-(1-R/S,5-R/S,2 = R/S)-5,9-dimethyl-2'-hydroxy-2- tetrahydrofurfuryl-6,7-benzomorphan (Mr2033) (compounds with kappa agonist effects in other in vivo assays), alfentanil and etonitazene (compounds with mu agonist effects in other in vivo assays). Alfentanil, bremazocine, EKC and Mr2033 were approximately equipotent in causing dose-dependent depression of respiratory minute volume of CO2-stimulated and air respiration, whereas etonitazene was approximately 10-fold more potent than the above compounds. Dose-effect curves for respiratory frequency, tidal volume and respiratory minute volume for all of the agonists except bremazocine were shifted to the right by increasing quadazocine doses. Together with data previously obtained in drug discrimination and analgesia assays, results of the present study demonstrating homogeneous pA2 values for quadazocine with alfentanil, etonitazene, EKC and Mr2033 strongly suggest that the latter two compounds decrease respiratory function in rhesus monkeys by acting on mu receptors.
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PMID:Apparent pA2 analysis on the respiratory depressant effects of alfentanil, etonitazene, ethylketocyclazocine (EKC) and Mr2033 in rhesus monkeys. 809 21

Introduction of anaesthesia with CO2/O2 (60% to 40%) is possible within 90 and 120 seconds. There are moderate to excessive excitations occurring as part of state II of anaesthesia. Anaesthesia (during castration) in CO2/O2-atmosphere produces excellent analgesia and relaxation. The duration of castration surgery is much shorter under CO2-anaesthesia than without anaesthesia. Blood cortisol levels are significantly higher after castration without CO2-anaesthesia. About 5 minutes after CO2/O2-anaesthesia and castration surgery, piglets are already awake and standing.
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PMID:[CO2/O2 anesthesia for the castration of male piglets (preliminary results)]. 820 51

Although minimally invasive, urological laparoscopic surgery is still a major surgery and has special characteristics which should not be ignored. Our protocol includes: premedication with diazepam and atropine, preinduction with fentanyl, induction with propofol, followed by atracurium or succinylcholine for tracheal intubation. Anesthesia is sustained with continuous pump infusion of propofol at gradually lower doses and is discontinued on removing the abdominal trocars. Muscle relaxation throughout the operation is maintained with atracurium in continuous infusion and is discontinued at the same time as propofol. Intraoperative analgesia is achieved with bolus administration of fentanyl. We routinely use vesical and nasogastric catheters; the latter is removed at the end of the operation. Similarly, compressive bandaging is done for the lower limbs in all patients. Intraoperative monitoring includes ECG, heart rate, arterial blood pressure (noninvasive method), end expiratory CO2, O2 saturation, minute/volume, tidal volume and respiratory rate, airway pressures, temperature and diuresis. Pulmonary ventilation is by IPPV with a mixture of oxygen and air, maintaining FiO2 at 0.4. Nitrous oxide is not utilized, therefore the airways were only used for lung ventilation and not for the administration of inhalatory anesthetic agents. The higher increments of end expiratory CO2 of up to 48 mm Hg were observed at the end of the procedure following peritoneal desufflation. In summary, the technique of choice is total i.v. anesthesia with propofol and monitoring as complete as possible (noninvasive). Furthermore, capnographic and capnometric control of end expiratory CO2 is warranted.
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PMID:[Anesthesia in urologic laparoscopic surgery]. 823 32

Organic calcium (Ca++) channel antagonists enhance opiate-induced analgesia and antagonize respiratory depression produced by morphine in rodents. Our preliminary data indicated that verapamil reduces the subjective effects of morphine in humans. We therefore assessed morphine-verapamil interactions in 12 experienced, male polydrug users with histories of heroin abuse by using a double-blind, cross-over study design. Treatments consisted of two drug infusions. Either verapamil, 2.5 or 10 mg, or saline was infused, 30 ml i.v. over 2 min; half way through this infusion either 10 mg of morphine or saline was infused, 3 ml i.v. over 10 sec, via a second catheter. Autonomic parameters, responsiveness to pain and subjective self-reports of mood and feeling state were measured over 4 hr. Analgesia was measured using a finger pressure test and hand immersion in ice water. Respiration was measured by using respiratory inductive plethysmography and transcutaneous CO2 levels. The Addiction Research Center Inventory (ARCI) was used to measure the subjective effects. Morphine had a liminal effect on pain threshold, but verapamil potentiated this effect to elevate pain threshold significantly. Verapamil did not affect the ability of morphine to increase pain endurance or to produce respiratory depression. Morphine produced positive affective responses, as demonstrated by elevated scores on the Morphine-Benzedrine Group subscale of the ARCI. Verapamil alone produced no effects on any ARCI subscales; however, 10 mg of verapamil significantly reduced morphine-elevated MBG scores over a 3-hr period. The results suggest the euphorigenic and analgesic effects of opioids may be differentiated by using Ca++ channel blockers.
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PMID:Effects of verapamil on morphine-induced euphoria, analgesia and respiratory depression in humans. 826

Anesthesia was induced and maintained in 6 Suffolk wethers by continuous i.v. infusion of guaifenesin (50 mg/ml), ketamine (1 mg/ml), and xylazine (0.1 mg/ml) in 5% dextrose in water (triple drip) to assess the anesthetic and cardiopulmonary effects. All sheep were positioned in right lateral recumbency. Dosages of triple drip used for induction and maintenance of anesthesia were 1.2 +/- 0.02 ml/kg and 2.6 ml/kg/h, respectively. Lack of gross purposeful movement of sheep to electrical stimulation indicated that analgesia and muscular relaxation induced by triple trip were adequate for surgical procedures. Heart rates and arterial blood pressure remained unchanged from baseline values during a 1-hour period of anesthesia. Arterial blood pressures were measured indirectly, using an inflation cuff placed over the metatarsal artery at the heart level. Significant decrease in arterial partial pressure of O2 (PaO2), coupled with an increase in arterial partial pressure of CO2 (PaCO2), from baseline values was observed throughout the course of the study. Decrease in PaO2 was observed concomitantly with significant (P < 0.05) increase in respiration rate. Changes in arterial blood gas tensions observed in this study were attributed to respiratory depressant effect induced by anesthetic drugs and right-to-left shunting, perfusion/ventilation mismatch, or both caused by right lateral recumbency. Administration of 100% O2 via the endotracheal tube reduced the magnitude of the decrease in PaO2. All sheep recovered smoothly and stood within 96.3 +/- 48.9 minutes after termination of triple drip administration.
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PMID:Effects of anesthesia induced and maintained by continuous intravenous administration of guaifenesin, ketamine, and xylazine in spontaneously breathing sheep. 829 72

Recently it is claimed that the drainage procedure may be a useful method for giant pulmonary bulla in compromised patients. We reported the anesthetic managements of three patients with giant bulla for these procedures. We chose epidural anesthesia in order to prepare for the postoperative analgesia and the expansion of surgical procedure. In selecting circulatory support method, care was taken to choose dobutamine that would cause no suppression of hypoxic ventilatory drive. There is no doubt that right ventricular function is particularly important in patients with chronic obstructive lung disease. We measured right ventricular ejection fraction by thermodilution method and end-tidal CO2 by nasal cannula. These measurements may be useful methods for perioperative monitoring.
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PMID:[Anesthetic management of a patient for giant pulmonary bulla drainage]. 835 Apr 76

We present a patient with myasthenia gravis who was safely managed by epidural anesthesia during and after thymectomy. An epidural catheter was inserted via the C7-T1 intervertebral space and 2% lidocaine was used during the surgery. The level of analgesia as determined by pinprick extending from C5 to T6. Epidural morphine or morphine and bupivacaine were used for postoperative pain relief. We evaluated ventilatory responses to CO2 and hypoxia after epidural anesthesia with lidocaine or morphine, and during continuous epidural infusion of the mixture of morphine and bupivacaine. Ventilatory responses to CO2 and hypoxia were both depressed following epidural injection of morphine. However, depression of ventilatory responses was not demonstrated following continuous epidural infusion of a mixture of morphine and bupivacaine. This case report suggests that epidural anesthesia is useful as a primary anesthetic and for postoperative pain control in patients with myasthenia gravis.
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PMID:Epidural anesthesia in a patient with myasthenia gravis. 835 67

We determined the dose-response relationship, the onset time, the duration, and the recovery time of a rocuronium neuromuscular block under four anesthesia techniques. Patients were equally randomized to four different groups (n = 20) receiving 0.5%-1% halothane, 1.5%-2% enflurane, 1.2%-1.8% isoflurane end-tidal concentration in 34%/66% O2/N2O, or 6.0 mg.kg-1 x h-1 propofol without N2O for anesthesia and alfentanil for analgesia. Strength of thumb adduction in response to single and train-of-four stimulation of the ulnar nerve was quantitated. Rocuronium 0.15, 0.2, 0.25, and 0.3 mg/kg were given intravenously. When maximal depression of twitch tension occurred, supplemental doses up to a total of 0.5 mg/kg were given. If required, additional doses of 0.15 mg/kg were given at 25% recovery of control twitch tension. Standard hemodynamics, end-tidal CO2, and anesthetic gas concentrations were monitored continuously. The mean ED50 (SD) was 0.133 (+/- 0.009) mg/kg for the halothane group, 0.118 (+/- 0.012) mg/kg for the enflurane group, 0.069 (+/- 0.026) mg/kg for the isoflurane group, and 0.167 (+/- 0.007) mg/kg for the total intravenous anesthesia (TIVA) group, respectively. There was a statistically significant difference between the halothane and TIVA, and between the enflurane and TIVA groups (P < 0.05). Rocuronium has a short onset time and an intermediate duration of action. The neuromuscular blocking potency and pharmacodynamic profile are moderately influenced by volatile anesthetics.
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PMID:Muscle paralysis by rocuronium during halothane, enflurane, isoflurane, and total intravenous anesthesia. 836 58

Isoflurane, an inhalation agent often used for general anesthesia during craniotomy, has been reported to suppress spike activity in the intraoperative electrocorticogram (ECoG) during epilepsy surgery. We studied the effect of isoflurane concentrations of 0.25, 0.5, 0.75, 1, and 1.25% on the number of spike bursts per 5-min epochs in 15 patients undergoing ECoG during epilepsy surgery. N2O in O2 was maintained at 50% in 10 patients, at 60% in 2, and at 70% in 3. End tidal CO2 concentration was maintained in the hypocarbic range, and analgesia was maintained with the narcotic alfentanil in the range of 0.5-2 micrograms/min. The median number of spikes for each isoflurane concentration was 29 (range 3-107) at 0.25%, 27 (range 2-73) at 0.5%; 29 (range 5-90) at 0.75%, 33 (range 2-100) at 1%, and 40 (range 32-140) in 5 patients who tolerated 1.25% without occurrence of burst suppression pattern. No significant difference (Student's paired t test) was noted in the number of spikes for each isoflurane concentration. Therefore, if isoflurane concentrations are maintained between 0.25 and 1.25% or before burst suppression pattern occurs and N2O/O2 is maintained in the 50-70% range, isoflurane has no significant effect on spike activity.
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PMID:Effect of isoflurane (Forane) on intraoperative electrocorticogram. 840 43

The purpose of this study was to describe the physiologic and behavioral responses of children receiving intermittent intravenous morphine following orthopaedic surgery. The nonrandomized sample was made up of 29 children between the ages of 6 months and 11 years. Subjects received morphine IV push over 5 minutes (0.1 mg/kg body weight) every 3-4 hours prn. Heart rate, respiratory rate, transcutaneous CO2 and oxygen saturation were collected prior to administration and then at 5-minute intervals for a total of 25 minutes. Pain cue behaviors were assessed prior to morphine and at 25 minutes after intravenous injection, the time of peak analgesia. Subjects received a total of 199 doses of morphine. Physiologic data were analyzed using repeated measures of variance with Waller-Duncan multiple comparison procedures. The results of this study support the safe and effective use of intravenous morphine in children 6 months to 11 years following orthopaedic surgery.
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PMID:Physiologic and behavioral responses of children receiving intermittent intravenous morphine following orthopaedic surgery. 849 47


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