Articles: opioid-analgesics.
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Ann Fr Anesth Reanim · Jan 1990
Review Multicenter Study Clinical Trial[Anesthetics responsible for anaphylactic shock. A French multicenter study].
Combined allergological and anaesthetic consultations have been started in the last few years in eight French Teaching Hospitals so as to explore peranaesthetic anaphylactoid shocks. A survey was carried out in these centers in order to collect patients investigated with the same protocol, for the assessment of the incidence of anaphylaxis in France, as well as the involved drugs. Investigations were always carried out at least 6 to 8 weeks after the accident. ⋯ It would therefore seem mandatory to carry out after any anaphylactoid accident an assessment with sensitive and specific tests for anaphylaxis. Diagnosing anaphylaxis means that the involved drug should be used never again in that patient. Because muscle relaxants are by far the most involved drugs, anaesthetists should use them only when really required.
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Pain relief is one of medicine's most important challenges and the first aim of anaesthesia. The most common technique of postoperative analgesia remains intramuscular or subcutaneous opiates. There has been a better understanding of the mechanisms of action of opiates over the last decade, and new techniques and methods of administration have been developed especially their regional application. ⋯ Opiates and local anaesthetics given by the spinal route are compared. The clinical applications of intrathecal and epidural opiates are discussed, especially in the fields of postoperative analgesia, treatment of chest trauma, and cancer pain. Lastly, the few controlled studies concerning the use of opiates in peripheral nerve blocks, especially brachial plexus blocks, and the prospects of this new technique of giving opiates regionally are discussed.
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J. Pharmacol. Exp. Ther. · Jan 1990
Respiratory and locomotor stimulation by low doses of dermorphin, a mu1 receptor-mediated effect.
The selective opioid mu receptor agonist dermorphin increased the locomotor activity of rats dose dependently at 10 to 100 pmol/kg i.c.v. Respiratory rate, relative tidal volume and respiratory minute volume also increased unrelated to changes in locomotor activity. ⋯ The selective benzodiazepine antagonist flumazenil (5 mg/kg), which has been shown previously to antagonize catalepsy and respiratory depression produced by relatively high doses of dermorphin, did not antagonize the respiratory or locomotor stimulant effect of dermorphin. The data suggest that mu1-opioid receptors are responsible for the low dose stimulant effects of dermorphin on locomotor activity and respiration whereas mu2 receptors mediate the respiratory depressant effect of dermorphin.
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Comparative Study
Neuromuscular and cardiovascular effects of mivacurium chloride in surgical patients receiving nitrous oxide-narcotic or nitrous oxide-isoflurane anaesthesia.
The neuromuscular and cardiovascular effects of mivacurium chloride were studied during nitrous oxide-oxygen narcotic (fentanyl) (n = 90) and nitrous oxide-oxygen isoflurane (ISO) anaesthesia (n = 45). In addition, a separate group (n = 9) received succinylcholine during fentanyl anaesthesia to compare its neuromuscular effects with mivacurium. Mivacurium was initially administered as a single bolus in doses from 0.03 mg.kg-1 to 0.25 mg.kg-1 to study the dose-response relationships, as well as the cardiovascular effects of mivacurium. ⋯ There was minimal change in mean arterial pressure (MAP) or heart rate (HR) following bolus doses of mivacurium up to 0.15 mg.kg-1. Bolus administration of 0.20 mg.kg-1 or 0.25 mg.kg-1 of mivacurium decreased MAP from 78.2 +/- 2.5 to 64.0 +/- 3.2 mmHg (range 12-59 per cent of control) (P less than 0.05). The same doses when administered slowly over 30 sec produced minimal change in MAP or HR.