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PubMed1980

[Comparison of postoperative blood levels of prolactin and somatotropin after two methods of anesthesia].

Prolactin and somatotrophin were measured during the postoperative period in two series of 15 patients after gynaecological surgery. Samples were collected for four days at the same times during the 24 hours period. The anesthetic given in the first group was a neuroleptanalgesia of dextromoramide-droperidol type followed by postoperative analagesia using a noramidopyrine compound. In the second group, epidural anaesthesia was given, followed postoperatively by the injection of lidocain at constant rate interrupted between the final two samples. In the neuroleptanalgesia group, from a basal levels of 11 micrograms.l-1, prolactin rose to 22 micrograms.l-1 on the evening after surgery (p less than 0.001) to subsequently stay on a plateau between 6 and 8 micrograms.l-1 (p less than 0.025 to p less than 0.005). From a basal level of 2.8 micrograms.l-1, somatotrophin rose to 9 micrograms.l-1 (p less than 0.05) then fell progressively from 7.5 to 2 micrograms.l-1 (NS on D1, D2, D3). In the epidural group, from a basal level of 13.5 micrograms.l-1, prolactin rose to 23 micrograms.l-1 on the evening after surgery (NS) to fall sharply on D1 to 5.6 micrograms.l-1 (p less than 0.01) and then follow a plateau on D2 and D3 of the order of 11 to 12 micrograms.l-1 (NS). From a basal level of 1.9 micrograms.l-1, somatotrophin rose to 10 micrograms.l-1 (p less than 0.001) to fall again to 4.5 micrograms.l-1 on D1 (p less than 0.01) and to 2 micrograms.l-1 on D2 and D3 (NS). Comparison of these two groups showed a difference only on D2 with regard to somatotrophin (p less than 0.05) and on D2 and D3 with regard to prolactin (p less than 0.025 and p less than 0.05). These results are discussed. They do not indicate any fundamental difference in the endocrine response to aggression in relation to the two types of anaesthetic studies.

Anesthesia↗
PubMed1982

[Detoxication of a drug-dependent patient (author's transl)].

Use of synthetic analgesics after pancreatectomy led the patient, a known alcoholic, to become drug-dependent (pethidine, dextromoramide). After four years the patient was hospitalized and given noramidopyrine injections twice daily with tiapride in the dose of three tablets per day, gradually increased to six tablets per day. As early as the second day noramidopyrine could be discontinued. Tiapride dosage was brought down to four tablets per day. The patient feels no need for analgesics.

Adult↗
PubMed1981

Influence of opiates on ion transport across rabbit ileal mucosa.

Opiates are commonly used as antidiarrheal agents, and endogenous opioids have been demonstrated in the intestine. It seemed important therefore to investigate the effects of morphine on ion transport across intestinal mucosa. In rabbit ileum in vitro morphine (2 x 10(-5) M) induced a significant fall in potential difference and short circuit current but did not influence tissue resistance. Dextromoramide (10(-5) M), an active opiate, mimicked the action of morphine, whereas the inactive isomer levomoramide (10(-5) M) had no effect. Morphine caused a significant increase in chloride absorption, due predominantly to a decrease in the serosa to mucosa flux. No change in sodium transport was detected, but the residual ion flux, possibly representing bicarbonate secretion, was enhanced. Similar response were observed with a synthetic enkephalin analogue (Me-Tyr-D-Met-Gly-Phe-Pro-NH2); but this was more potent than morphine, a significant electrical response being observed at a concentration as low as 10(-8) M. These electrical and ion transport responses to morphine were blocked by naloxone, an effect shown to be competitive in nature. The results suggest that opiate receptors exist in rabbit ileal mucosa and that these influence electrical and ion transport changes across the mucosa.

Animals↗
PubMed1982

[Effects of clonidine on opiate withdrawal symptoms. Results - biochemical mechanisms (author's transl)].

Clonidine was administered to nineteen patients in an inpatient setting after abrupt discontinuation of chronic opiate addiction (morphine, héroin, dextromoramide). Clonidine produces a decrease sometimes very rapid in opiate withdrawal signs but does not suppress the whole affects associated with. These data support the hypothesis that clonidine has antiwithdrawal effect by replacing opiate-mediated inhibition with alpha 2 mediated inhibition of brain noradrenergic activity.

Adult↗
PubMed1984

[Midazolam combined with neuroleptanesthesia as a hypnotic].

Two groups of 20 women randomly distributed underwent general anaesthesia based on dextromoramide and droperidol. Midazolam was given 0.2 mg X kg-1 in the first group, 0.4 mg X kg-1 in the second. Induction was considered satisfactory in more than 90 p. cent of patients in both groups (NS). Midazolam produced a decrease of systolic blood pressure of 9 mm Hg in group I (p less than 0,001) and 11 mm Hg in group II (p less than 0,001) as well as a decrease in diastolic blood pressure of 5 mm Hg (p less than 0,025) and 7 mm Hg (p less than 0,005) respectively. Heart rate decreased significantly only in group II (by 4 c X mn-1, p less than 0,01). These alterations were similar in both groups and did not reach physiologic importance. Maintenance of anesthesia as well as recovery were uneventful in all cases. Higher doses of midazolam reduced only slightly the dose of the neuroleptic. Its is concluded that midazolam is a good induction agent neuroleptic-analgesic anaesthesia. The use of more than 0.2 mg X kg-1 is of no particular interest but is well tolerated.

Adult↗
PubMed1983

[Use of oral morphine in incurable pain].

Oral morphine sulphate is the strong narcotic of choice at most hospices. Administered in simple aqueous solution (e.g. 10 mg in 10 ml). No advantage in giving as "Brompton Cocktail." Usual starting dose 10 mg every 4 h. If patient has previously only had a weak narcotic analgesic, 5 mg may be adequate. If changing to morphine from alternative strong narcotic, such as dextromoramide, levorphanol, methadone, a considerably higher dose may be needed. With frail elderly patients, it may be wise to start on sub-optimal dose in order to reduce likelihood of initial drowsiness and unsteadiness. Adjust upwards after first dose if not more effective than previous medication. Adjust after 24 h "if pain not 90% controlled." Most patients are satisfactorily controlled on dose of between 5 and 30 mg 4 hourly; however, some patients need higher doses, occasionally up to 500 mg. Giving a larger dose at bedtime (1,5 or 2 x daytime dose) may enable a patient to go through the night without waking in pain. Use co-analgesic medication as appropriate. Eigher prescribe an antiemetic concurrently or supply (in anticipation) for regular use should nausea or vomiting develop. Prescribe laxative. Adjust dose according to response. Suppositories may be necessary. Unless carefully monitored, constipation may be more difficult to control than the pain. Write out regimen in detail with times to be taken, names of drugs and amounts to be taken. Warn patient of possibility of initial drowsiness. Arrange for close liaison and follow up.

Administration, Oral↗
PubMed1982

[Pharmacology of narcotics administered by the epidural or intrathecal route (author's transl)].

Owing to the presence of specific opiate receptors in the spinal cord, analgesia can be obtained with epidural or intrathecal injections of morphine derivatives. The duration of analgesia depends upon the degree of water solubility of the compound. Compounds with low coefficient of distribution in lipids (e.g. morphine) do not readily cross the blood-brain barrier and have a prolonged action, whereas the duration of analgesia induced by highly lipid-soluble compounds, such as dextromoramide and phenoperidine, is not very different from that obtained with more conventional routes of administration. The fact that large amounts of narcotics are taken up by the spinal cord explains that central effects are relatively rare. However, side-effects may be observed, and their frequency mainly depends upon the quantity of narcotic injected. These side-effects reduce the number of indications, which cannot yet be precisely determined. Epidural and intrathecal analgesia appears to be particularly useful during the post-operative period in patients liable to respiratory complications.

Analgesia↗
PubMed1981

Effects of diltiazem therapeutic plasma levels on cardiac conduction and refractoriness.

The effects of diltiazem, a new slow channel inhibitor, on the cardiac conduction and refractoriness have been studied using His bundle recordings and the extrastimulus method. In order to determine the role played by possible changes in vagal tone, diltiazem (0.15 mg.kg-1, followed immediately by a 30 min infusion of 0.01 mg.kg-1.min-1) has been administered intravenously to six atropinized dogs, anesthetized with chloralose (100 mg.kg-1) ("atropine group") and to six others which were given chloralose (80 mg.kg-1) and dextromoramide (0.1 mg.kg-1) to ensure the persistence of vagal tone ("vagal tone group"). In the "atropine group", atrioventricular (AV) nodal conduction time increased by 137% and AV node effective refractory period by 55%. Heart rate was slowed down by 15% and arterial pressure fell slightly. In the "vagal tone group", the only significant changes were a 26% increase in AV nodal conduction time and a slight fall in arterial pressure. Inhibition of the slow channel accounts for the effects of diltiazem within the "atropine group". A reflex decrease in vagal tone is probably responsible for the somewhat different results observed in the "vagal tone group". Diltiazem resembles verapamil and should share its antiarrhythmic properties.

Animals↗
PubMed1981

[Nurseling and children general anaesthesia in brain neuroradiology: from gaz tomoencephalography to brain computer tomography (author's transl)].

The authors give their experiences in nurseling and children brain neuroradiology anaesthesia. Sodium gammahydroxybutyrate has been definitively adopted after multiples anaesthesial protocoles for the gaz tomoencephalographic exam, known for its technical risks. The gamma OH gives a perfect cardiac and pulmonary stability in difficult conditions, with normal intracranial pression, even in children anaesthesia with Halothane (0.5%) for complementary analgesic effect or with fractionate injections of dextromoramide. Pneumoencephalography has been releguated in second place by the even of brain computer tomography except some particular indications. But this exam qualified as painless is usually indicated in fragile and deficient childrens. Though the intravenous iodated contrasted substance injection can improve the scan image quality and may induce secondary effects at 2 cm3/kg dose. It's again gamma OH after correct premedication that gives stable, perfect immobility, cardiac and pulmonary stability in an ideal anaesthesia for non ventilated patients. The only critical aspect of this method consists on a prolonged and imprevisible delay to awake so that it cannot be an ambulatory anaesthesial method. Therefore it appears that gamma OH in spite of brain computer tomographic event, is an interesting anaesthesic drug but non definitive in brain neuroradiological exam for childrens.

Adolescent↗
PubMed1980

[Head-injured child: neuro-surgical anesthesia (author's transl)].

Our first care when anesthetizing a child having a head injury treated by neurosurgery is to preserve a correct blood perfusion pressure, by using anesthetic agents without vasodilator potency and to control cerebral oedema. The most suitable anesthetic agents are thiopentone, dextromoramide or fentanyl, diazepam and pancuronium. Artificial ventilation is used nearly systematically trying to obtain mild hypocapnia (PaCO2:30-35 Hg pH 7.45) inducing a benefic cerebral vasoconstriction. About the antiedematous agents, mannitol gives best results in case of emergency.

Adolescent↗
PubMed1997

[More of the Surinam and Antilles drug addicts involved in the GG&GD (Community Medical and Health Service) methadone program in Amsterdam should be referred to the family physician for their methadone maintenance].

OBJECTIVE: To study the possibility of referring Surinam and Netherlands Antillean drug users from a 'low-threshold' municipal methadone programme to general practice for methadone maintenance treatment. (Methadone maintenance treatment for drug users leads to a more regulated life and makes it possible to implement measures to ameliorate their living conditions.) Fewer Surinam and Netherlands Antillean drug users are referred to general practice than native Dutch drug users. DESIGN: Descriptive. SETTING: Municipal Health Service, Department of Mental Health, Unit on Drugs, Amsterdam, the Netherlands. METHOD: 141 Surinam and Netherlands Antillean drug users participating in the 'low-threshold' methadone programme were examined on the following items: psychiatric status, drug and alcohol abuse, judicial problems, relationships, personal care, insurance and housing. With these items the level of regulated drug use was assessed and the possible reference to general practice evaluated. RESULTS: 21% of the drugs user group was found to be well regulated. They could have been referred to general practice immediately. Another 18% were also well regulated but they received methadone on a daily basis at the moment of investigation; when they would have proven to manage methadone prescription on a weekly basis, they could also be referred to general practice. 61% could not be referred because they were addicted to benzodiazepines (22%) or alcohol (33%), lived in unsuitable housing (45%), had judicial problems (53%), psychiatric problems (30%) or no insurance (15%), or were very problematic drug users receiving Palfium (dextromoramide) through the 'low-threshold' municipal methadone programme (15%). CONCLUSION: Of Surinam and Netherlands Antillean drug users from a municipal methadone programme, approximately 20% could have been directly referred to general practice for their methadone maintenance treatment and 20% at a later stage, and 60% could not.

Adult↗
PubMed1976

Discrimination of narcotic drugs on 3H-fentanyl receptor binding.

Stereospecific opiate receptor binding was measured using specifically labeled fentanyl in the presence of an excess of either dextromoramide or levomoramide, only the former being the analgesic isomer. In a very large series of chemically related drugs, but of different pharmacological activity, it was possible to recognize compounds endowed with a potential morphine-like activity. Attempts were made to localize the opiate receptors within the neuronal cell.

Animals↗
PubMed1963

ANTITUSSIVE DRUGS.

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Antipsychotic Agents↗
PubMed1964

QUANTITATIVE STUDIES OF THE ANTAGONISM BY NALORPHINE OF SOME OF THE ACTIONS OF MORPHINE-LIKE ANALGESIC DRUGS.

A quantitative investigation has been made of the antagonism by nalorphine of the analgesia and lenticular opacity produced in mice by a number of compounds. ED50 values have been obtained for each drug in the absence and in the presence of increasing doses of nalorphine, and from these, appropriate dose-ratios have been calculated. It has been possible to derive the equivalent of a pA(2) value for each drug with nalorphine and, since these are almost identical, it may be concluded that all the drugs combine with similar receptors. Nalorphine antagonizes both actions by competing for the receptors. It was not possible to antagonize quantitatively the analgesic action of pethidine with nalorphine, although the lenticular effect could be abolished. The effect of nalorphine on the change in skin temperature in mice induced by some of the analgesic drugs was also investigated.

Analgesics↗