DOCSLIB.ORG

Small Dose of Midazolam Added to Fentanyl-Ropivacaine for Patient Controlled Epidural Analgesia After Subtotal Gastrectomy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Small Dose of Midazolam Added to Fentanyl-Ropivacaine for Patient Controlled Epidural Analgesia After Subtotal Gastrectomy Anesth Pain Med 2008; 3: 22～26 ￭임상연구￭ Small Dose of Midazolam Added to Fentanyl-Ropivacaine for Patient Controlled Epidural Analgesia after Subtotal Gastrectomy Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Daegu, Korea Kyunghwa Kwak, M.D., Sioh Kim, M.D., Younghoon Jeon, M.D., Jeongwon Suh, M.D., Youngsoo Kim, M.D., Jaehyun Ha, M.D., and Soohyun Lee, M.D. Background: Midazolam has been reported to have a spinally addition, intrathecal co--administration of midazolam and fentanyl mediated antinociceptive effect. In this randomized, double-blind produced better analgesia than either drug alone without increa- study, we evaluated whether a small dose of midazolam added to sing side effect.7) Therefore, we hypothesized that the addition fentanyl-ropivacaine mixture for PCEA (patient controlled epidural analgesia) improves epidural analgesia in patients underwent of small dose of midazolam into opioid-local anesthetic for elective subtotal gastrectomy. PCEA (patient controlled epidural analgesia) could provide Methods: Forty five patients, ASA physical status I and II, under- better postoperative analgesia. Therefore, this prospective, going subtotal gastrectomy were randomly allocated to receive 0.2% ropivacaine mixed with fentanyl 4μg/ml or 0.2% ropivacaine mixed randomized, double-blind, controlled trial was designed to with fentanyl 4μg/ml and midazolam 0.2 mg/ml. The infusion rate evaluate the analgesic efficacy and side effect of midazolam was set to deliver 4 ml/hr of the study solution, with a bolus of 2 added to fentanyl-ropivacaine for PCEA in patients undergoing ml per demand and a 20 minutes lockout time. elective subtotal gastrectomy. Results: Infused volume (P ＜ 0.05) and VAS scores (P ＜ 0.05) was significantly lower in the patients receiving midazolam. However, there were no differences in requiring rescue analgesics, MATERIALS AND METHODS PONV (postoperative nausea and vomiting), sedation scores, urinary retention, and pruritus between groups. This prospective, randomized, controlled study was approved Conclusions: Small dose of midazolam could augment analgesia without adverse effects when added to thoracic epidural infusion by our Hospital Ethics Committee. We enrolled forty five of fentanyl and ropivacaine. (Anesth Pain Med 2008; 3: 22∼26) ASA physical status I and II patients who were diagnosed with gastric cancer, undergoing elective subtotal gastrectomy. Key Words: fentanyl, midazolam, patient controlled epidural anal- Written informed consent was obtained from all patients. gesia, ropivacaine. Patients who had a history of alcohol or drug abuse, who had psychiatric problems, or who had respiratory, hepatic, circula- tory or renal dysfunction were excluded. On the night before surgery, all patients were instructed to use the PCEA device. INTRODUCTION No premedication was given, and the anesthetic regimen and A short-acting water soluble benzodiazepine, midazolam has postoperative pain management were standardized in all pa- been used for sedation or anesthesia. In recent years, midazo- tients. In the operating room patients were placed in the sitting lam has been shown to improve analgesia when added to an position and an epidural catheter was inserted via 18-gauge 1-6) intrathecal or epidural administration of local anesthetic. In Tuohy needle at the T8-T9 interspace and was advanced 3－4 cm into the epidural space in a cephalad direction. A test dose of 2 ml of lidocaine 2% with epinephrine 5μg/ml was in- 논문접수일：2007년 10월 8일 jected to rule out intrathecal or intravascular position of the 책임저자：김시오, 대구시 중구 삼덕 2가 50번지 경북대학교병원 마취통증의학과, 우편번호: 700-721 catheter. Sensory block (by pin prick test) covering the area of Tel: 053-420-5875, Fax: 053-426-2760 the proposed incision was induced by injecting 8 to 12 ml of E-mail: [email protected] 0.375% ropivacaine. General anesthesia was induced with This research was supported by Kyungpook National University Research Fund, 2002. propofol (2 mg/kg) and rocuronium (1.0 mg/kg) and main- 22 Kyunghwa Kwak, et al：Midazolam in Patient Controlled Epidural Analgesia 23 tained with 66% nitrous oxide in oxygen with a small Respiratory depression was defined as bradypnoeic episodes (a concentration (0.5－0.9%) of isoflurane. Within 30 minutes of ventilation frequency ＜ 10/min) lasting ＞ 10 minutes. A induction, a continuous epidural infusion of 0.375% ropivacaine sedation score 3 or respiratory depression was regarded as at 0.1 ml/kg/h was commenced. Ventilation was mechanically unacceptable complication in this context, and was to be controlled maintaining an end tidal carbon dioxide concen- assessed and reported by any health care personnel with the tration of 35 to 40 mmHg throughout surgery. No opioids subject then being switched to an alternate analgesic modality. were administered during surgery. An infusion of Ringer’s Occurrence of clinically relevant hemodynamic adverse events, solution (10 ml/kg/h) was given intravenously (i.v.) together including hypotension (systolic arterial blood pressure decrease with 4 mg boluses of ephedrine to maintain mean arterial ＜ 90 mmHg) and bradycardia (heart rate decrease ＜ 45 pressure within 20% of baseline values throughout surgery. At bpm), requiring treatment was recorded. In addition, patients the end of surgery, glycopyrrolate 7μg/kg and pyridostigmine were asked whether they had suffered from postoperative 30μg/ kg were administered i.v. for antagonism of residual nausea and vomiting (PONV), pruritus, urinary retention and neuromuscular blockade and the epidural infusion of 0.375% of any complication at any time point between the previous and ropivacaine was stopped. Postoperative pain relief was provided the present interview. PONV was scored on a three-stage (no, by using PCEA with a standard pump (Abbott Ambulatory feeling nauseated, retching or vomiting). Ⓡ Infusion Manager plus, Abbott Laboratories, North Chicago, Based on our experience of the need for epidural solution USA). According to computer-generated random number table, for postoperative pain, we calculated that to detect a 22% patients were randomly to receive 0.2% ropivacaine mixed difference in consumption of ropivacaine and fentanyl, 20 patients with fentanyl 4μg/ml (group FR) or 0.2% ropivacaine mixed in each group were required to obtain a 0.05 level of alpha with with fentanyl 4μg/ml and midazolam 0.2 mg/ml (group a power of 0.8. MFR). Analgesic solutions were prepared by one of the Data are presented as mean ± SD or number (%). authors not taking further part in data collection and patient Demographic data, intraoperative ropivacaine usage, and care. All patients also blinded to the drugs of PCEA. The duration of surgery were analyzed using the unpaired t-test. PCEA infusion was set to deliver 4 ml/hr of the study Statistical methods included 2-way analysis of variance solution, with a bolus of 2 ml per demand and a 20 minutes (ANOVA) for VAS values and consumption of PCEA solution. lockout time. Nishiyama et al6) have demonstrated that adding Ordinary data were analyzed by using the contingency table midazolam (10 mg to 20 mg for 12 hours) to continuous analysis with Chi square test or Fisher’s exact tests. P ＜ 0.05 epidural infusion of bupivacaine for postoperative pain provided was considered significant. a better analgesia than bupivacaine alone without deep sedative 6) effect. Therefore, based on a previous report, midazolam 0.2 RESULTS mg/ mL was chosen in our study. Assessments of pain, sedation, nausea, vomiting, pruritus, Of the 45 patients originally enrolled in the study, two and urinary retention as well as any noted side effects, were made at 2 and 6 hours after the end of surgery, and then at Table 1. Demographic Data, Intraoperative Usages of Ropivacaine, 08:00 and 20:00 on the first and second postoperative day by and Duration of Surgery a study-blinded anesthesiologist. Consumption of local Variables Group FR (n = 21) Group MFR (n = 21) anesthetic solution at 24, 48, 72 hours after operation was measured. The epidural catheter was removed on the third Age (yr) 57.1 ± 7.7 60.2 ± 7 postoperative day. Pain intensity scores during coughing were Sex (female/male) 13/8 11/10 Height (cm) 167.1 ± 4.4 168.4 ± 4.8 measured with a 100-mm visual analog scale (VAS). Rescue Weight (kg) 63.8 ± 8.2 62.8 ± 10.3 analgesia was provided with ketorolac 50 mg i.v if the pain Intraoperative ropivacaine (mg) 117.8 ± 17.9 111.9 ± 17.1 score was more than 4 or patient asked for rescue analgesics. Duration of surgery (min) 260.5 ± 37.6 249.1 ± 31.7 Sedation levels were assessed using a 4-point scale (0 = Values are expressed as means (SD) or numbers of patients. There awake, 1 = mildly sedated, easy to wake up when spoken to, were no significant differences between groups. Group FR: 0.2% 2 = moderately sedated, easy to wake up when slightly ropivacaine mixed with fentanyl 4μg/ml, Group MFR: 0.2% ropi- shaken, 3 = deep sedated, difficult to wake up when shaken). vacaine with fentanyl 4μg/ml and midazolam 0.2 mg/ml. 24 Anesth Pain Med Vol. 3, No. 1, 2008 Table 2. Consumption of Epidural Analgesic Solution and Side Effects Group FR (n = 21) Group MFR (n = 21) Infused volume of 423.8 ± 68.9 328.3 ± 34.2* PCEA solution (ml) Fentanyl consumption (μg) 1,695 ± 190.9 1,313.1 ± 136.7* Ropivacaine consumption (mg) 847.5 ± 95.4 656.6 ± 68.4* Patients requiring ketorolac 4 (19) 1 (5) PONV Absent 15 (71) 19 (90) Nausea 5 (24) 2 (10) Vomiting 1 (5) 0 Sedation (0/1/2/3) 19/2/0/0 17/4/0/0 Urinary retention 10 (48) 6 (29) Pruritus 9 (43) 5 (24) Fig. 1. Cumulative volume (ml) of epidurally administered study solutions. Group FR: 0.2% ropivacaine mixed with fentanyl 4μg/ml, Group MFR: Values are in mean ± SD or number (%) of patients.
Load more

Recommended publications
  • Chapter 11 Local Anesthetics
    Chapter LOCAL ANESTHETICS 11 Kenneth Drasner HISTORY MECHANISMS OF ACTION AND FACTORS ocal anesthesia can be defined as loss of sensation in AFFECTING BLOCK L a discrete region of the body caused by disruption of Nerve Conduction impulse generation or propagation. Local anesthesia can Anesthetic Effect and the Active Form of the be produced by various chemical and physical means. Local Anesthetic However, in routine clinical practice, local anesthesia is Sodium Ion Channel State, Anesthetic produced by a narrow class of compounds, and recovery Binding, and Use-Dependent Block is normally spontaneous, predictable, and complete. Critical Role of pH Lipid Solubility Differential Local Anesthetic Blockade Spread of Local Anesthesia after Injection HISTORY PHARMACOKINETICS Cocaine’s systemic toxicity, its irritant properties when Local Anesthetic Vasoactivity placed topically or around nerves, and its substantial Metabolism potential for physical and psychological dependence gene- Vasoconstrictors rated interest in identification of an alternative local 1 ADVERSE EFFECTS anesthetic. Because cocaine was known to be a benzoic Systemic Toxicity acid ester (Fig. 11-1), developmental strategies focused Allergic Reactions on this class of chemical compounds. Although benzo- caine was identified before the turn of the century, its SPECIFIC LOCAL ANESTHETICS poor water solubility restricted its use to topical anesthe- Amino-Esters sia, for which it still finds some limited application in Amino-Amide Local Anesthetics modern clinical practice. The
    [Show full text]
  • Pharmacology for Regional Anaesthesia
    Sign up to receive ATOTW weekly - email [email protected] PHARMACOLOGY FOR REGIONAL ANAESTHESIA ANAESTHESIA TUTORIAL OF THE WEEK 49 26TH MARCH 2007 Dr J. Hyndman Questions 1) List the factors that determine the duration of a local anaesthetic nerve block. 2) How much more potent is bupivocaine when compared to lidocaine? 3) How does the addition of epinephrine increase the duration of a nerve block? 4) What is the maximum recommended dose of: a) Plain lidocaine? b) Lidocaine with epinephrine 1:200 000? 5) What is the recommended dose of a) Clonidine to be added to local anaesthetic solution? b) Sodium bicarbonate? In this section, I will discuss the pharmacology of local anaesthetic agents and then describe the various additives used with these agents. I will also briefly cover the pharmacology of the other drugs commonly used in regional anaesthesia practice. A great number of drugs are used in regional anaesthesia. I am sure no two anaesthetists use exactly the same combinations of drugs. I will emphasise the drugs I use in my own practice but the reader may select a different range of drugs according to his experience and drug availability. The important point is to use the drugs you are familiar with. For the purposes of this discussion, I am going to concentrate on the following drugs: Local anaesthetic agents Lidocaine Prilocaine Bupivacaine Levobupivacaine Ropivacaine Local anaesthetic additives Epinephrine Clonidine Felypressin Sodium bicarbonate Commonly used drugs Midazolam/Temazepam Fentanyl Ephedrine Phenylephrine Atropine Propofol ATOTW 49 Pharmacology for regional anaesthesia 29/03/2007 Page 1 of 6 Sign up to receive ATOTW weekly - email [email protected] Ketamine EMLA cream Ametop gel Naloxone Flumazenil PHARMACOLOGY OF LOCAL ANAESTHETIC DRUGS History In 1860, cocaine was extracted from the leaves of the Erythroxylon coca bush.
    [Show full text]
  • Local Anesthetics
    Local Anesthetics Introduction and History Cocaine is a naturally occurring compound indigenous to the Andes Mountains, West Indies, and Java. It was the first anesthetic to be discovered and is the only naturally occurring local anesthetic; all others are synthetically derived. Cocaine was introduced into Europe in the 1800s following its isolation from coca beans. Sigmund Freud, the noted Austrian psychoanalyst, used cocaine on his patients and became addicted through self-experimentation. In the latter half of the 1800s, interest in the drug became widespread, and many of cocaine's pharmacologic actions and adverse effects were elucidated during this time. In the 1880s, Koller introduced cocaine to the field of ophthalmology, and Hall introduced it to dentistry Overwiev Local anesthetics (LAs) are drugs that block the sensation of pain in the region where they are administered. LAs act by reversibly blocking the sodium channels of nerve fibers, thereby inhibiting the conduction of nerve impulses. Nerve fibers which carry pain sensation have the smallest diameter and are the first to be blocked by LAs. Loss of motor function and sensation of touch and pressure follow, depending on the duration of action and dose of the LA used. LAs can be infiltrated into skin/subcutaneous tissues to achieve local anesthesia or into the epidural/subarachnoid space to achieve regional anesthesia (e.g., spinal anesthesia, epidural anesthesia, etc.). Some LAs (lidocaine, prilocaine, tetracaine) are effective on topical application and are used before minor invasive procedures (venipuncture, bladder catheterization, endoscopy/laryngoscopy). LAs are divided into two groups based on their chemical structure. The amide group (lidocaine, prilocaine, mepivacaine, etc.) is safer and, hence, more commonly used in clinical practice.
    [Show full text]
  • Estonian Statistics on Medicines 2016 1/41
    Estonian Statistics on Medicines 2016 ATC code ATC group / Active substance (rout of admin.) Quantity sold Unit DDD Unit DDD/1000/ day A ALIMENTARY TRACT AND METABOLISM 167,8985 A01 STOMATOLOGICAL PREPARATIONS 0,0738 A01A STOMATOLOGICAL PREPARATIONS 0,0738 A01AB Antiinfectives and antiseptics for local oral treatment 0,0738 A01AB09 Miconazole (O) 7088 g 0,2 g 0,0738 A01AB12 Hexetidine (O) 1951200 ml A01AB81 Neomycin+ Benzocaine (dental) 30200 pieces A01AB82 Demeclocycline+ Triamcinolone (dental) 680 g A01AC Corticosteroids for local oral treatment A01AC81 Dexamethasone+ Thymol (dental) 3094 ml A01AD Other agents for local oral treatment A01AD80 Lidocaine+ Cetylpyridinium chloride (gingival) 227150 g A01AD81 Lidocaine+ Cetrimide (O) 30900 g A01AD82 Choline salicylate (O) 864720 pieces A01AD83 Lidocaine+ Chamomille extract (O) 370080 g A01AD90 Lidocaine+ Paraformaldehyde (dental) 405 g A02 DRUGS FOR ACID RELATED DISORDERS 47,1312 A02A ANTACIDS 1,0133 Combinations and complexes of aluminium, calcium and A02AD 1,0133 magnesium compounds A02AD81 Aluminium hydroxide+ Magnesium hydroxide (O) 811120 pieces 10 pieces 0,1689 A02AD81 Aluminium hydroxide+ Magnesium hydroxide (O) 3101974 ml 50 ml 0,1292 A02AD83 Calcium carbonate+ Magnesium carbonate (O) 3434232 pieces 10 pieces 0,7152 DRUGS FOR PEPTIC ULCER AND GASTRO- A02B 46,1179 OESOPHAGEAL REFLUX DISEASE (GORD) A02BA H2-receptor antagonists 2,3855 A02BA02 Ranitidine (O) 340327,5 g 0,3 g 2,3624 A02BA02 Ranitidine (P) 3318,25 g 0,3 g 0,0230 A02BC Proton pump inhibitors 43,7324 A02BC01 Omeprazole
    [Show full text]
  • (12) United States Patent (10) Patent No.: US 8,828,437 B2 Sundberg Et Al
    USOO8828437B2 (12) United States Patent (10) Patent No.: US 8,828,437 B2 Sundberg et al. (45) Date of Patent: *Sep. 9, 2014 (54) THERMOGELLING ANAESTHETIC USPC .......................................................... 424/484 COMPOSITIONS (58) Field of Classification Search None (71) Applicant: Pharmanest AB, Solna (SE) See application file for complete search history. (72) Inventors: Mark Sundberg, Arsta (SE); Arne (56) References Cited Brodin, Sodertalje (SE); Nils Kallberg, Taby (SE) U.S. PATENT DOCUMENTS (73) Assignee: Pharmanest AB, Solna (SE) 8,663,688 B2* 3/2014 Fernandez et al. ............ 424/487 2004/O220283 A1 11/2004 Zhang et al. 2005/0O27.019 A1 2/2005 Zhang et al. (*) Notice: Subject to any disclaimer, the term of this 2007/0298.005 A1 12, 2007 Thibault patent is extended or adjusted under 35 2008. O15421.0 A1 6/2008 Jordan et al. U.S.C. 154(b) by 0 days. 2012fO294907 A1 11/2012 Zhang et al. This patent is Subject to a terminal dis claimer. FOREIGN PATENT DOCUMENTS AU 2006201233 B2 10, 2007 (21) Appl. No.: 14/172,794 EP O517160 A1 12, 1992 EP 1629852 A2 3, 2006 (22) Filed: Feb. 4, 2014 KR 2002OO13248 A 2, 2002 (65) Prior Publication Data (Continued) OTHER PUBLICATIONS US 2014/O155.434 A1 Jun. 5, 2014 Written Opinion, Intellectual Property Office of Singapore, from the Related U.S. Application Data corresponding Singapore Application No. 201206824-3, Jul. 19. (63) Continuation of application No. 13/638.511, filed as 2013. application No. PCT/EP2011/055009 on Mar. 31, Notification of First Office Action, China Intellectual Property 2011. Office, from the corresponding Chinese Application No.
    [Show full text]
  • Treatment for Acute Pain: an Evidence Map Technical Brief Number 33
    Technical Brief Number 33 R Treatment for Acute Pain: An Evidence Map Technical Brief Number 33 Treatment for Acute Pain: An Evidence Map Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov Contract No. 290-2015-0000-81 Prepared by: Minnesota Evidence-based Practice Center Minneapolis, MN Investigators: Michelle Brasure, Ph.D., M.S.P.H., M.L.I.S. Victoria A. Nelson, M.Sc. Shellina Scheiner, PharmD, B.C.G.P. Mary L. Forte, Ph.D., D.C. Mary Butler, Ph.D., M.B.A. Sanket Nagarkar, D.D.S., M.P.H. Jayati Saha, Ph.D. Timothy J. Wilt, M.D., M.P.H. AHRQ Publication No. 19(20)-EHC022-EF October 2019 Key Messages Purpose of review The purpose of this evidence map is to provide a high-level overview of the current guidelines and systematic reviews on pharmacologic and nonpharmacologic treatments for acute pain. We map the evidence for several acute pain conditions including postoperative pain, dental pain, neck pain, back pain, renal colic, acute migraine, and sickle cell crisis. Improved understanding of the interventions studied for each of these acute pain conditions will provide insight on which topics are ready for comprehensive comparative effectiveness review. Key messages • Few systematic reviews provide a comprehensive rigorous assessment of all potential interventions, including nondrug interventions, to treat pain attributable to each acute pain condition. Acute pain conditions that may need a comprehensive systematic review or overview of systematic reviews include postoperative postdischarge pain, acute back pain, acute neck pain, renal colic, and acute migraine.
    [Show full text]
  • Delivery System for Mefenamic Acid Based on the Nanocarrier Layered
    Materials Science and Engineering C 58 (2016) 629–638 Contents lists available at ScienceDirect Materials Science and Engineering C journal homepage: www.elsevier.com/locate/msec Delivery system for mefenamic acid based on the nanocarrier layered double hydroxide: Physicochemical characterization and evaluation of anti-inflammatory and antinociceptive potential Vanessa R.R. Cunha a, Viviane A. Guilherme b,EneidadePaulab, Daniele R. de Araujo b,c, Renan O. Silva d, Jand V.R. Medeiros d, José R.S.A. Leite d, Philippe A.D. Petersen e, Marianna Foldvari f, Helena M. Petrilli e, Vera R.L. Constantino a,⁎ a Departamento de Química Fundamental, Instituto de Química, Universidade de São Paulo, USP, Av. Prof. Lineu Prestes 748, 05508-000 São Paulo, São Paulo, Brazil b Departamento de Bioquímica, Instituto de Biologia, Universidade Estadual de Campinas, 13083-970, Campinas, São Paulo, Brazil c Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, 09210-170 Santo André, São Paulo, Brazil d Núcleo de Pesquisa em Biodiversidade e Biotecnologia, BIOTEC, Campus de Parnaíba, Universidade Federal do Piauí, UFPI, 64202020 Parnaíba, Piauí, Brazil e Departamento de Física dos Materiais e Mecânica, Instituto de Física, Universidade de São Paulo, USP, 05315-970 São Paulo, São Paulo, Brazil f School of Pharmacy, University of Waterloo, N2L 3G1 Waterloo, Ontario, Canada article info abstract Article history: Purpose: The anionic form of the drug mefenamic acid intercalated into the nanocarrier layered double hydroxide Received 7 June 2015 (LDH-Mef) was evaluated by anti-inflammatory and antinociceptive assays. Received in revised form 7 August 2015 Methods: The LDH-Mef material was characterized by a set of physicochemical techniques, which was supported Accepted 21 August 2015 by Density Functional Theory calculations.
    [Show full text]
  • A Brief History Behind the Most Used Local Anesthetics
    Tetrahedron xxx (xxxx) xxx Contents lists available at ScienceDirect Tetrahedron journal homepage: www.elsevier.com/locate/tet Tetrahedron report XXX A brief history behind the most used local anesthetics * Marco M. Bezerra, Raquel A.C. Leao,~ Leandro S.M. Miranda, Rodrigo O.M.A. de Souza Biocatalysis and Organic Synthesis Group, Chemistry Institute, Federal University of Rio de Janeiro, 21941-909, Brazil article info abstract Article history: The chemistry behind the discovery of local anesthetics is a beautiful way of understanding the devel- Received 13 April 2020 opment and improvement of medicinal/organic chemistry protocols towards the synthesis of biologically Received in revised form active molecules. Here in we present a brief history based on the chemistry development of the most 16 September 2020 used local anesthetics trying to draw a line between the first achievements obtained by the use of Accepted 18 September 2020 cocaine until the synthesis of the mepivacaine analogs nowadays. Available online xxx © 2020 Elsevier Ltd. All rights reserved. Keywords: Anesthetics Medicinal chemistry Organic synthesis Mepivacaíne Contents 1. Introduction . ............................. 00 1.1. Pain and anesthesia . ............................................... 00 1.2. Ancient techniques to achieve anesthesia . ............................... 00 1.3. The objective of this work . .......................................... 00 2. Cocaine .............................................................................................. ............................
    [Show full text]
  • Original Article Lidocaine May Contribute to General Anesthesia by Different Mechanisms in Mammalian Central Nervous System
    Int J Clin Exp Med 2017;10(9):13433-13439 www.ijcem.com /ISSN:1940-5901/IJCEM0049799 Original Article Lidocaine may contribute to general anesthesia by different mechanisms in mammalian central nervous system Mingyang Shi1, Guangbo Xie1,2, Xiaoshuai Fan3, Weidong Pan3, Xiaoshuang Zhou3, Jingbo Yuan3, Zeyi Chen3, Guo Chen3 1Department of Biotechnology, School of Life Science and Technology, University of Electronic Science and Tech- nology of China, Chengdu, China; 2Center for Informational Biology, University of Electronic Science and Technol- ogy of China, Chengdu, China; 3Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China Received October 27, 2016; Accepted June 6, 2017; Epub September 15, 2017; Published September 30, 2017 Abstract: Background: Systemic administration of local anesthetics can produce systemic actions, but the details of these actions and mechanisms are still unclear. We evaluated the systemic actions of three local anesthetics and their underlying mechanisms in this study. Methods: Lidocaine, bupivacaine and ropivacaine were injected into C57BL/6 mice through tail vein, alone or together with hyperpolarization-activated cyclic nucleotide-gated (HCN) channels blocker ZD 7288 or N-methyl-D-aspartic acid (NMDA) receptor blocker MK-801, and hypnotic actions of these local anesthetics, were evaluated by the length of loss of righting reflex (LORR). Results: All of these three lo- cal anesthetics directly produced hypnotic actions with half effective dose (ED50) of 19.0±2.4, 4.3±0.2 and 4.2±0.4 mg/kg. The effects of lidocaine on LORR were enhanced by ZD 7288, ED50 from 19.0±2.4 mg/kg to 14.1±1.0 mg/ kg (P<0.01) or to 13.1±0.8 mg/kg (P<0.01) by MK-801, respectively.
    [Show full text]
  • Interventions for Relieving Pain Associated with Panretinal
    Eye (2006) 20, 712–719 & 2006 Nature Publishing Group All rights reserved 0950-222X/06 $30.00 www.nature.com/eye 1 2 1 1 CLINICAL STUDY Interventions W-C Wu , K-H Hsu , T-L Chen , Y-S Hwang , K-K Lin1, L-M Li1, C-P Shih2 and C-C Lai1 for relieving pain associated with panretinal photocoagulation: a prospective randomized trial Abstract mefenamic acid, and acetaminophen (either alone or in combination with each other) are Purpose To evaluate the efficacy of pain relief not effective in preventing PRP treatment- by oral diazepam, acetaminophen, mefenamic associated pain. Intramuscular injection of 1Department of acid, intramuscular ketorolac tromethamine, ketorolac tromethamine is also not effective in Ophthalmology, Chang and peribulbar anaesthesia in panretinal reducing PRP-associated pain. Gung Memorial Hospital, photocoagulation (PRP). Eye (2006) 20, 712–719. doi:10.1038/sj.eye.6701989; Taoyuan, Taiwan Methods A total of 220 patients with published online 8 July 2005 proliferative diabetic retinopathy requiring 2The Department of Business Administration, PRP treatment were enrolled in this study. Keywords: peribulbar anesthesia; pain; Chang Gung University, Before laser treatment, the patients were panretinal photocoagulation Taoyuan, Taiwan allocated randomly to one of eight groups: group 1: diazepam (n ¼ 22), group 2: Introduction Correspondence: C-C Lai, acetaminophen (n ¼ 21), group 3: mefenamic Department of acid (n ¼ 21), group 4: diazepam and Panretinal photocoagulation (PRP) is an Ophthalmology, Chang Gung Memorial Hospital, acetaminophen (n ¼ 22), group 5: diazepam effective treatment in reducing severe visual 5 Fu-Hsin St, Kwei-Shan, and mefenamic acid (n ¼ 22), group 6: loss in patients with proliferative diabetic 333, Taoyuan, peribulbar anaesthesia with lidocaine (n ¼ 23), retinopathy (PDR).
    [Show full text]
  • Estonian Statistics on Medicines 2013 1/44
    Estonian Statistics on Medicines 2013 DDD/1000/ ATC code ATC group / INN (rout of admin.) Quantity sold Unit DDD Unit day A ALIMENTARY TRACT AND METABOLISM 146,8152 A01 STOMATOLOGICAL PREPARATIONS 0,0760 A01A STOMATOLOGICAL PREPARATIONS 0,0760 A01AB Antiinfectives and antiseptics for local oral treatment 0,0760 A01AB09 Miconazole(O) 7139,2 g 0,2 g 0,0760 A01AB12 Hexetidine(O) 1541120 ml A01AB81 Neomycin+Benzocaine(C) 23900 pieces A01AC Corticosteroids for local oral treatment A01AC81 Dexamethasone+Thymol(dental) 2639 ml A01AD Other agents for local oral treatment A01AD80 Lidocaine+Cetylpyridinium chloride(gingival) 179340 g A01AD81 Lidocaine+Cetrimide(O) 23565 g A01AD82 Choline salicylate(O) 824240 pieces A01AD83 Lidocaine+Chamomille extract(O) 317140 g A01AD86 Lidocaine+Eugenol(gingival) 1128 g A02 DRUGS FOR ACID RELATED DISORDERS 35,6598 A02A ANTACIDS 0,9596 Combinations and complexes of aluminium, calcium and A02AD 0,9596 magnesium compounds A02AD81 Aluminium hydroxide+Magnesium hydroxide(O) 591680 pieces 10 pieces 0,1261 A02AD81 Aluminium hydroxide+Magnesium hydroxide(O) 1998558 ml 50 ml 0,0852 A02AD82 Aluminium aminoacetate+Magnesium oxide(O) 463540 pieces 10 pieces 0,0988 A02AD83 Calcium carbonate+Magnesium carbonate(O) 3049560 pieces 10 pieces 0,6497 A02AF Antacids with antiflatulents Aluminium hydroxide+Magnesium A02AF80 1000790 ml hydroxide+Simeticone(O) DRUGS FOR PEPTIC ULCER AND GASTRO- A02B 34,7001 OESOPHAGEAL REFLUX DISEASE (GORD) A02BA H2-receptor antagonists 3,5364 A02BA02 Ranitidine(O) 494352,3 g 0,3 g 3,5106 A02BA02 Ranitidine(P)
    [Show full text]
  • Review of Existing Classification Efforts
    Project No. TREN-05-FP6TR-S07.61320-518404-DRUID DRUID Driving under the Influence of Drugs, Alcohol and Medicines Integrated Project 1.6. Sustainable Development, Global Change and Ecosystem 1.6.2: Sustainable Surface Transport 6th Framework Programme Deliverable 4.1.1 Review of existing classification efforts Due date of deliverable: (15.01.2008) Actual submission date: (07.02.2008) Start date of project: 15.10.2006 Duration: 48 months Organisation name of lead contractor for this deliverable: UGent Revision 1.0 Project co-funded by the European Commission within the Sixth Framework Programme (2002-2006) Dissemination Level PU Public X PP Restricted to other programme participants (including the Commission Services) RE Restricted to a group specified by the consortium (including the Commission Services) CO Confidential, only for members of the consortium (including the Commission Services) Task 4.1 : Review of existing classification efforts Authors: Kristof Pil, Elke Raes, Thomas Van den Neste, An-Sofie Goessaert, Jolien Veramme, Alain Verstraete (Ghent University, Belgium) Partners: - F. Javier Alvarez (work package leader), M. Trinidad Gómez-Talegón, Inmaculada Fierro (University of Valladolid, Spain) - Monica Colas, Juan Carlos Gonzalez-Luque (DGT, Spain) - Han de Gier, Sylvia Hummel, Sholeh Mobaser (University of Groningen, the Netherlands) - Martina Albrecht, Michael Heiβing (Bundesanstalt für Straßenwesen, Germany) - Michel Mallaret, Charles Mercier-Guyon (University of Grenoble, Centre Regional de Pharmacovigilance, France) - Vassilis Papakostopoulos, Villy Portouli, Andriani Mousadakou (Centre for Research and Technology Hellas, Greece) DRUID 6th Framework Programme Deliverable D.4.1.1. Revision 1.0 Review of Existing Classification Efforts Page 2 of 127 Introduction DRUID work package 4 focusses on the classification and labeling of medicinal drugs according to their influence on driving performance.
    [Show full text]