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)

Forty-two children (aged 2-16 years) were randomly assigned to receive either sevoflurane (n = 21) or halothane (n = 21) in nitrous oxide/oxygen. After pre-medication with midazolam, anaesthesia was induced by facemask and the anaesthetic concentration was increased until loss of eyelash reflex (sevoflurane, 6%; halothane, 2.5%). Thereafter, 1-1.5 MAC of the inhalational agents were maintained until skin closure. Intra-operative analgesia was provided either by intermittent intravenous (i.v.) bolus doses of fentanyl (2-3 micrograms kg-1) or by a regional blockade. Induction was smooth and the time to loss of eyelash reflex was slightly shorter with sevoflurane than with halothane, the difference not quite reaching statistical significance (P = 0.06). In both groups, heart rate remained stable and blood pressure decreased significantly during induction. Haemodynamic parameters remained stable during anaesthetic maintenance; no cardiac dysrhythmias were observed. Emergence time with sevoflurane was 12.9 min vs. 16.3 min with halothane, but this difference was not statistically significant. It is concluded that sevoflurane is as suitable for paediatric patients as halothane. The slightly faster emergence time offered by sevoflurane over halothane was of no clinical significance in the present study.
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PMID:Sevoflurane anaesthesia in paediatric patients: better than halothane? 964 85

We have compared the analgesic potency of MAC-equivalent concentrations of xenon (10, 20, 30 and 40%) and nitrous oxide (15, 30, 45 and 60%) in humans using a multimodal experimental pain testing and assessment technique. We tested 12 healthy volunteers in a randomized, single-blind, crossover study. The following experimental pain tests were used: nociceptive reflex to repeated stimuli; pain tolerance to maximal effort tourniquet ischaemia; electrical stimulation; mechanical pressure; and cold. Reaction time was also measured. Xenon and nitrous oxide produced analgesia to ischaemic, electrical and mechanical stimulation, but not to cold pain. There was no difference in MAC-equivalent concentrations of xenon and nitrous oxide. Both increased reaction time in a similar manner. Xenon and nitrous oxide evoked nausea and vomiting in a large number of volunteers.
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PMID:Comparison of the analgesic potency of xenon and nitrous oxide in humans evaluated by experimental pain. 1019 87

Remifentanil (R) is a novel short-acting mu-receptor opioid. R is in the same structural family as fentanyl and the other phenylpiperidines, but it differs from fentanyl because of its pharmacokinetic profile and its metabolism: R undergoes extrahepatic metabolism by blood and tissue nonspecific esterases. For these reasons the time required for decreases of any percentage plasmatic concentrations of R after termination of the infusion is independent of infusion duration. The pharmacokinetic profile of R is organ-independent and the dosing regimen must be regulated in elderly patients by reducing the bolus and infusion doses, and in obese subjects by calculating the intravenous dosages as a function of age and lean body mass. The placental transfer of R doesn't affect the newborn as recently described in literature but further and wider clinical experiences are needed for assessing the use of R in obstetric anesthesia. R causes either a reduction in the MAC of volatile anesthetics or a decrease in propofol requirements but it cannot be used as a sole anesthetic agent. R can be utilized to facilitate tracheal intubation without using muscle relaxants, to manage analgesia and sedation also in association with midazolam and/or propofol, furthermore as analgesic agent for monitored anesthesia care, for the critical patient in ICU and for the postoperative analgesia if a proper analgesic strategy had not been planned.
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PMID:[Remifentanil in anesthesia and intensive care]. 1096 28

Tramadol is a centrally acting opioid-like analgesic commonly used for analgesia during surgery. It has been stated that the use of tramadol increases the risk of awareness during anaesthesia. We studied 29 patients under steady state anaesthesia, ventilated via a laryngeal mask airway with 0.6 MAC isoflurane in 50% nitrous oxide, and with no surgical stimulus. The electroencephalogram (EEG) and auditory-evoked response (AER) were recorded throughout the study period, as were pulse and arterial pressure. Patients were given randomly a bolus of either saline (S), tramadol 100 mg (T1), or tramadol 200 mg (T2). Significant increases in systolic arterial pressure and decreases in heart rate were seen in the tramadol groups compared to the saline group. Significant, dose-related activation in all EEG variables (median power frequency, spectral edge, Delta Power and Alpha/Delta ratio) but no significant change in Pa or Nb amplitudes or latencies were noted. The EEG changes were not at levels thought to be associated with awareness. This study indicates that tramadol, whilst causing EEG activation, has no effect on depth of anaesthesia as measured by the AER.
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PMID:Effect of tramadol on electroencephalographic and auditory-evoked response variables during light anaesthesia. 1109 84

Recovery characteristics, haemodynamic profile, analgesic requirement and costs were evaluated and compared in patients undergoing elective lumbar discectomy with remifentanil-based anaesthesia using either desflurane or sevoflurane as the volatile anaesthetic agent. Sixty-two patients (ASA I/II status) were randomly assigned to receive either desflurane and remifentanil or sevoflurane and remifentanil (in oxygen/air) for anaesthesia. After induction with 0.5 microgram/kg/min remifentanil, 4 to 5 mg/kg thiopentone and 0.5 mg/kg atracurium, the patients received 0.25 microgram/kg/min remifentanil and 0.5 +/- 0.05 MAC of one of the volatile anaesthetic agents for further maintenance of anaesthesia. At the end of surgery, early emergence from anaesthesia was recorded by assessing the time to sufficient spontaneous respiration, eye opening and tracheal extubation. The total demand of piritramide in the postoperative period was determined using patient-controlled analgesia (PCA device). Quality of pain therapy was assessed via a verbal ranking scale (VRS). Side-effects such as postoperative nausea, vomiting or shivering were recorded in the postanaesthetic care unit. In both groups, the haemodynamic profile was nearly identical. Mean arterial pressure (-18%) and heart rate (-23%) were significantly reduced throughout anaesthesia in both groups. All recovery parameters were significantly shorter in the desflurane group in comparison with the sevoflurane group (e.g. time to tracheal extubation: 8.5 +/- 3.0 min vs. 11.9 +/- 4.6 min). No significant differences between the groups were observed concerning the amount of piritramide required, side-effects such as nausea and vomiting or the total cost of anaesthesia. In conclusion, both anaesthetic techniques provide adequate haemodynamic stability and postoperative pain control in a surgical procedure with minimal trauma. Incidence and severity of side-effects such as nausea, vomiting or shivering did not differ between the groups and were acceptable under clinical conditions. Costs for desflurane were significantly higher than those for sevoflurane, but total costs were not different between the groups. Concerning recovery profile, desflurane/remifentanil seems to have small advantages over sevoflurane/remifentanil in patients undergoing lumbar vertebral disc resection.
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PMID:[Anesthesia with remifentanil combined with desflurane or sevoflurane in lumbar intervertebral disk operations]. 1119 83

In this randomized study we compared the efficacy of ondansetron 4 mg with ondansetron 8 mg for the prevention of postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy with sevoflurane and remifentanil infusion anaesthesia. Sixty patients were randomized to receive ondansetron 8 mg (30 pts) or ondansetron 4 mg (30 pts) before the induction of anaesthesia with thiopental and remifentanil. Anaesthesia was maintained with sevoflurane (0.5 MAC), oxygen and remifentanil infusion (0.25, 0.35, 0.5 microg/kg/min). Postoperative analgesia was provided by intravenous ketorolac 60 mg. The incidence of PONV, the pain score, and the analgesic requirement were recorded for 24 hours. There was no difference among groups in patient characteristics, risk factors for PONV, or side effects. During the first 6 h postoperatively, the incidence of PONV after ondansetron 4 mg and 8 mg were similar (p < 0.001). After 6 h the incidence of PONV increased significantly in patients who had received ondansetron 4 mg (p = 0.01) and was greater than that in patients who had received ondansetron 8 mg (p = 0.001). We conclude that single-dose ondansetron 8 mg is more effective than ondansetron 4 mg in the prevention of PONV after laparoscopic cholecystectomy. This surgery is associated with a high incidence of postoperative nausea and vomiting. A single dose of IV ondansetron 8 mg is well tolerated and decrease the number of nausea and vomiting episodes after surgery.
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PMID:Efficacy of a single-dose ondansetron for preventing post-operative nausea and vomiting after laparoscopic cholecystectomy with sevoflurane and remifentanil infusion anaesthesia. 1186 20

Volatile inhaled anesthetics and nitrous oxide (N2O) are often used together in clinical practice to produce analgesia. Because the analgesic effect of N2O is, at least in part, mediated by norepinephrine (NE) release in the spinal cord, we examined the interaction between isoflurane (ISO) and NE in the adult rat spinal cord with respect to central nociceptive information processing. The effects of clinically relevant concentrations of ISO (1 MAC) and NE (20 microM) on spontaneous inhibitory transmission in substantia gelatinosa (SG) neurons were examined using the blind whole-cell patch-clamp method. ISO prolonged the decay time and increased the total charge transfer of spontaneous inhibitory postsynaptic currents. NE increased the frequency and mean amplitude of inhibitory postsynaptic currents and the charge transfer as well. Coapplication of both drugs led to an additive increase of the charge transfer and frequent temporal summation of inhibitory postsynaptic currents. We conclude that both ISO and NE enhance the inhibitory synaptic transmission in the rat SG neurons and their interaction is additive, suggesting that ISO may add to the analgesic action of N2O at the spinal cord dorsal horn level.
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PMID:Actions of norepinephrine and isoflurane on inhibitory synaptic transmission in adult rat spinal cord substantia gelatinosa neurons. 1636 16

The transient hyperemic response (THR) test is a simple, noninvasive technique to evaluate cerebral autoregulation using transcranial Doppler. It has not yet been used in studies involving children. In this study we evaluated this response in children undergoing general anesthesia using sevoflurane. Twenty ASA physical status I children undergoing elective urological surgery sequentially received sevoflurane at 0.5, 1.0, and 1.5 MAC in a randomized order. Analgesia was solely provided by caudal anesthesia. The right middle cerebral artery flow velocities before (F1), during (F2), and after (F3) a 10-s ipsilateral carotid artery compression were recorded. The THR ratios (THRR) (+/- sd) for 0.5 MAC, 1.0 MAC, and 1.5 MAC were 1.24 +/- 0.11, 1.16 +/- 0.09, and 1.13 +/- 0.07, respectively. The THRR was significantly different between 0.5 MAC versus 1.0 and 1.5 MAC, respectively (P < 0.05). However, no difference was detected between 1.0 and 1.5 MAC. A THRR of more than 1.09 has previously been accepted as the lower limit of a positive response. The results in this study suggest that THR is affected by sevoflurane in a dose-dependent fashion but is maintained at up to 1.5 MAC. This suggests cerebral autoregulation is preserved in children anesthetized with up to 1.5 MAC sevoflurane.
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PMID:The effect of sevoflurane on cerebral autoregulation in young children as assessed by the transient hyperemic response. 1655 97

The use of anesthetics to stabilize animals for the purpose of electroacupuncture (EA) analgesic studies can be problematic because of the interference of differential physiological responses to EA and pain. In this study, EA-induced physiological profiles were surveyed under a sub-minimal alveolar concentration (sub-MAC) of two different anesthetics in a previously proposed minimal stress model. First, to select an adequate concentration, compliance with EA and tail-flick stimulation was evaluated under various concentrations of halothane and isoflurane. Second, using the chosen concentrations, low- (4-Hz) and high-frequency (100-Hz) EA were conducted on the right hind limb. The EA effects of the two gases were compared by tail-flick latency (TFL), hemodynamic variables, and individual variations in analgesic sensitivity. The optimal concentrations for halothane and isoflurane were 0.5% and 0.75%, respectively. TFLs were stable under these anesthetic levels, but rats under 0.75% isoflurane had better compliance than those under 0.5% halothane. EA inhibited TFLs with distinct analgesic patterns when comparing high- and low-frequency EA, but TFL suppression did not differ between the two gases. Heart rate and blood pressure showed temporal and differential responses to low- vs. high-frequency EA, but were comparable between groups under the two anesthetics. The ratios of EA non-responders in the isoflurane and halothane groups were 32.4% and 26.7%, respectively, without statistical difference. We concluded that sub-MAC halothane and isoflurane provide optimal conditions for the study of EA-induced analgesia in rats. In this model, 0.75% isoflurane appears to be a better choice than 0.5% halothane in terms of EA compliance.
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PMID:Electroacupuncture analgesia, stress responses, and variations in sensitivity in rats anesthetized with different sub-MAC anesthetics. 2113 69

The research is based on the analysis of 50 cases of anesthesia during reconstructive surgeries in children. The anesthesia was based on inhalation of sevolflurane and injection of fentanyl by the bolus infusion scheme. During the different stages of anesthesia the opioid concentration in plasma was measured. Analysis of hemodynamic parameters showed no statistically significant differences in changes in performance, indicating the steady flow of anesthesia. Infusion of fentanyl provided a smooth, gradual decrease in its concentration in plasma, while analgesia remained adequate. The combination of sevoflurane in a concentration of 1.3 MAC and infusion of fentanyl to a total dose 6 mkg/kg/h was effective in provisioning stable anesthesia in the given category of patients with surgical pathology.
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PMID:[Pharmacokinetics of fentanyl during sevoflurane based general anesthesia in children]. 2151 66


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