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

Some interventions in ENT surgery are very difficult or are even impossible if the slightest bleeding occurs. Microsurgery of the ear is the best example. For this reason we choose this particular intervention to test different anesthesia techniques. Bleeding in the surgical field is followed, while simultaneously respiratory, venous and arterial pressure tracings are recorded. These parameters are followed and changes can be attributed directly to observations by microscope of the surgical field. Successively neuroleptanalgesia in its pure form or with help of several drugs (trimetaphan, furosemide, enflurane) is studied. One conclusion can probably be made of the analysis of our series: an anesthesia with "light" analgesia gives better results than an anesthesia protecting completely the patient.
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PMID:Study on peroperative bleeding in ear, nose and throat surgery. 101 36

Three modes of administration of alfentanil were assessed in order to reduce pain on injection with propofol. Forty healthy children scheduled for ENT surgery were included in this double-blind randomized study. All patients received intrarectal premedication with midazolam and atropine. Pain was scored with a behavioral scale. The children experience pain when alfentanil was administered a few seconds before or just after propofol. An bolus injection reduced significantly discomfort in patients. Dosages of alfentanil in plasma might determine the right moment of propofol injection to obtain analgesia.
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PMID:[The effect of alfentanil on pain caused by the injection of propofol during anesthesia induction in children]. 177 64

This paper discusses the application of intravenous Kalipsol anesthesia in combination with Seduxen (Relanium) in 22 patients who underwent antro-mastoidectomy (expanded) and fronto-ethmoidectomy. No complications related to the method of anesthesia were identified. It is concluded that the use of Kalipsol anesthesia in urgent ENT operations provides better surgical intervention. This method ensures adequate analgesia during operation.
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PMID:[Intravenous kalipsol anesthesia in emergency otorhinolaryngology]. 253 49

This study compared both etomidate and methohexitone for intravenous anaesthesia with alfentanil and nitrous oxide/oxygen in 2 X 20 patients scheduled for ENT-surgery, in a double blind, random fashion. Apart from the alternative use of etomidate and methohexitone the anaesthetic procedure did not differ: After a small dose of alfentanil anaesthesia was induced by a bolus dose of the hypnotic followed by a continuous infusion of the drug. In case of inadequate analgesia alfentanil was injected. This technique provided a good quality of anaesthesia and a remarkable cardiovascular stability. Critical arterial pressures or heart rates never occurred. During the operation patients receiving etomidate exhibited a moderate rise in blood pressure and a significantly lower heart rate than patients anaesthetised with methohexitone. After some 90 min of anaesthesia patients awoke on the average 7 min after the end of the operation and could be extubated at once. During the first three postoperative hours there was no difference in recovery between groups. Whereas half an hour postoperatively the capacity of immediate memory was limited to 44 bit following etomidate and 48 bit following methohexitone, i.e. to 47 and 54% of its normal capacity, there was only a minimum but significant impairment of cerebral function after 3 h. There was no difference in the need for alfentanil. The dosage of etomidate and methohexitone was lowe than that reported in the literature. It proved to be impossible for the anaesthetist to decide which drug he was using. Hence both anaesthetic techniques compare favourably with each other.
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PMID:[Etomidate versus methohexital for intravenous anesthesia with alfentanyl and nitrous oxide-oxygen. A double-blind study of circulatory behavior and postoperative course]. 393 95

The total amount of cocaine used by ENT departments in the United Kingdom is about 960 kg. per year and this costs the Health Service in this country over 100,000 pounds. The majority of this cocaine is used intranasally prior to or during surgical procedures to provide mucosal vasoconstriction and analgesia. The techniques of applying cocaine vary from hospital to hospital. A comparison is made between two common methods of use, Moffett's solution and method, and 25 per cent cocaine paste applied on a wire and cotton wool probe. Cocaine serum levels were monitored and compared to known toxic dose levels.
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PMID:Intranasal topical cocaine: Moffett's method or topical cocaine paste? 395 Apr 96

Two groups of 100 children each who underwent adenoidectomy and/or tonsillectomy were anaesthetised by halothane 1% or by a neuroleptic technique (NLA) using fentanyl 0.0025 mg/kg and droperidol 0.125 mg/kg as a fixed combination (Thalamonal). Both techniques were supplemented with nitrous oxide/oxygen 4/2 l. All children were premedicated with atropine 0.015 mg/kg, fentanyl 0.0025 mg/kg and droperidol 0.125 mg/kg i.m. Quality of premedication and postoperative behaviour and analgesia were assessed by standardised criteria. 93% of the patients arrived at the theatre sleeping or detached, 75% showed almost no reactions to venipuncture. Heart rate during surgery in both groups increased by 13%, mean arterial blood pressure in the NLA group increased by 9% and in the halothane group dropped by 5%. Postoperatively blood pressure in NLA patients returned to normal, while in the halothane group there was a transient rise by 10%. Protective reflexes and consciousness were restored in the NLA group earlier. After halothane, stridor occurred in eight cases upon extubation. Postoperative analgesia scores in NLA patients were double those in the halothane group. Moderate metabolic acidosis and slight hypercapnia were postoperatively present in both groups twice. Modified neuroleptanaesthesia proved equal to halothane anaesthesia for ENT surgery. No respiratory depression was seen. Advantages like uncomplicated quick recovery and protracted postoperative analgesia are opposed by disadvantages like inferior vegetative blockade and inferior pharmacokinetics. Close postoperative supervision in a recovery room is a prerequisite to using this NLA technique.
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PMID:[The use of neuroleptanesthesia in adenotonsillectomy in children]. 643 37

1. Vomiting and restlessness following ENT and eye surgery are undesirable, and may be related to the emetic and analgesic effects of any analgesic given to augment anaesthesia during surgery. 2. To rationalise the choice of analgesic for routine ENT surgery we examined the intraoperative, recovery and postoperative effects following the administration of either buprenorphine (3.0 to 4.5 micrograms kg-1), diclofenac (1 mg kg-1), fentanyl (1.5 to 2.0 micrograms kg-1), morphine (0.1 to 0.15 mg kg-1), nalbuphine (0.1 to 0.15 mg kg-1), pethidine (1.0 to 1.5 mg kg-1) or saline (as control) given with the induction of anaesthesia in 374 patients. A standardised anaesthetic technique with controlled ventilation using 0.6-0.8% isoflurane in nitrous oxide and oxygen was employed. The study population constituted 7 similar groups of patients. 3. Intraoperatively, their effects on heart rate and blood pressure, airway pressure and intraocular pressure, were similar. This implies, most surprisingly, that neither their analgesic nor their histamine releasing effects were clinically evident during surgery. By prolonging the time to extubation at the end of anaesthesia, only buprenorphine, fentanyl, morphine and pethidine provided evidence of intraoperative respiratory depression. 4. Postoperatively, buprenorphine was associated with severe respiratory depression, prolonged somnolence, profound analgesia and the highest emesis rate. Diclofenac exhibited no sedative, analgesic, analgesic sparing, emetic or antipyretic effects. Fentanyl provided no sedative or analgesic effects, but was mildly emetic. Morphine provided poor sedation and analgesia, delayed the requirement for re-medication and was highly emetic. Nalbuphine and pethidine produced sedation with analgesia during recovery, a prolonged time to re-medication and a mild emetic effect. None provided evidence, from analysis of postoperative re-medication times and analgesic consumption, of any pre-emptive analgesic effect. 5. We conclude that nalbuphine (mean dose 0.13 mg kg-1) and pethidine (mean dose 1.35 mg kg-1), given individually as a single i.v. bolus during induction of anaesthesia, are the most efficacious analgesics for routine in-patient ENT surgery.
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PMID:Analgesics and ENT surgery. A clinical comparison of the intraoperative, recovery and postoperative effects of buprenorphine, diclofenac, fentanyl, morphine, nalbuphine, pethidine and placebo given intravenously with induction of anaesthesia. 788 92

There is little clinical data in the literature on the anaesthetic management of paediatric patients with Eisenmenger's syndrome undergoing non-cardiac surgery. This paper reviews our experiences with either such patients who underwent a total of 11 surgical procedures. Of the eight children, six had Down's syndrome and an atrio-ventricular septal defect, one had a ventricular septal defect and one an atrial septal defect. Nine of the eleven operations consisted of minor dental, plastic or ENT procedures, while one patient underwent two laparotomies. Premedication (trimeprazine/ meperidine combination or midazolam) was administered on three occasions. Induction of anaesthesia was achieved by either inhalation of halothane (2), or intravenously with thiopentone (6), ketamine (2) or propofol (1). Muscle relaxation and mechanical ventilation were employed only for both intra-abdominal procedures, otherwise patients were allowed to breathe spontaneously with, or without, manual assistance. Halothane (8), isoflurane (2) and enflurane (1) were all used for maintenance of anaesthesia. Non-invasive monitoring was applied intraoperatively for minor procedures, and arterial and central venous catheters inserted for the laparotomies. Postoperative analgesia for both these cases was provided by an epidural infusion of bupivacaine 0.125% and fentanyl 5 micrograms x ml(-1). A single im bolus of morphine was required following a dental clearance, otherwise pain relief for the rest of the cases was achieved by local anaesthetic infiltration and NSAIDS. With the exception of a single episode of bradycardia, induction, maintenance and recovery from anaesthesia were well tolerated in all cases. In conclusion, our experience suggests that despite theoretical risks, children with Eisenmenger's syndrome appear to tolerate a variety of anaesthetic techniques.
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PMID:The anaesthetic management of the child with Eisenmenger's syndrome. 870

Anecdotal evidence from several ENT departments suggests that pain following tonsillectomy is worst on the second and/or third days after surgery. This study tests this hypothesis. A pilot study with 19 subjects suggested this theory might well be true. A fuller study was then carried out on 91 subjects with standardised surgical and anaesthetic techniques, and standardised analgesia for five days postoperatively. Pain on the second and third postoperative days was compared with that eight hours after the operation and on the first, fourth and fifth postoperative days. No statistically significant difference was found. There is increasing pressure for early discharge from hospital after surgery. If pain following tonsillectomy is not going to become worse at home, this will tend to make early discharge more acceptable to patients.
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PMID:On which day is pain worst following adult tonsillectomy? 989 72

Since venous cannulation in children has become easier and extensive experience has been gained with total intravenous anaesthesia (TIVA) in adults, the interest in TIVA for children has recently increased. An intensified sensitivity of the operating room atmosphere to contamination with volatile anaesthetic agents is another important reason to choose intravenous techniques for paediatric anaesthesia. One of the most interesting agents for TIVA in paediatric anaesthesia is propofol. The pharmacokinetic and pharmacodynamic data for modern intravenous drugs is poor. Because the interpatient variability is relatively large, pharmacokinetic data can only provide guidelines for the dosage of propofol. Propofol has a rapid and smooth onset of action and is as easy to titrate in children as in adults. Propofol can be excellently controlled. Severe haemodynamic side-effects are missing in healthy children and plasma is cleared rapidly of propofol by redistribution and metabolism. There is no evidence of significant accumulation, not even after prolonged infusion times. Because propofol has no analgetic properties it must be combined with analgetics or a regional block for all painful procedures. The combination with the ultra-short acting remifentanil is a major advantage, but requires effective analgetic concepts for painful procedures. In comparison the combination of propofol with long acting opioids abolishes some of the favourable properties of propofol. Further studies of the kinetics and dynamics of propofol and other intravenous agents are needed in paediatrics which should focus on age, maturity and severity of illness. The whole importance of the propofol-infusion syndrome has to be cleared up urgently. TIVA has an important significance in paediatric anaesthesia for diagnostic and therapeutic procedures, especially where these have to be repeated. In day-case anaesthesia TIVA has advantages for all short procedures and for ENT and ophthalmic surgery: even after prolonged infusion children have an short recovery time. There is no evidence of agitation or other behavioural disorders after TIVA with propofol in paediatric anaesthesia. Propofol has anti-emetic properties. TIVA with propofol can be combined with regional anaesthesia advantageously to provide long-lasting analgesia after surgery. TIVA with propofol has been used successfully for sedation of spontaneously breathing children for MRI and CT and other procedures with open airways like bronchoscopy or endoscopy. Propofol facilitates endotracheal intubation without the use of muscle relaxants. Of course, in malignant hyperthermia TIVA will continue to be the technique of choice. Nothing is known about awareness under TIVA in paediatric patients. TIVA must be considered by comparison with the volatile agents. The use of ultra-short acting agents may cause problems such as awareness, vagal response, involuntary movements and in some cases slow recovery after prolonged infusion of propofol. But it is not known exactly how often this happens during paediatric anaesthesia. With TIVA an effective postoperative analgesia must be provided. Newer administration techniques such as the target-controlled infusions or closed-loop control systems are under development and will help to minimise the potential risk of overdosage with TIVA in paediatrics. At the present TIVA is an interesting and practicable alternative to volatile anaesthesia for pre-school and school children. TIVA with propofol in infants younger than 1 year old requires extensive experience with TIVA in older children and with the handling of this special age group and should be undertaken with maximum precautionary measures.
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PMID:[Total intravenous anesthesia. On the way to standard practice in pediatrics]. 1450 2


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