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PubMed1998

Renal excretory function in conscious Long Evans and vasopressin deficient (Brattleboro) rats after endothelin-A receptor inhibition.

All experiments were performed on conscious, freely moving male Long Evans as well as Diabetes incipidus (Brattleboro) rats (300-320 g). The endothelin-A (ETA) receptor antagonist BQ-123 (Neosystem) was administered through femoral vein cannula. Arterial blood pressure was measured trough femoral artery catheter. The bladder was cannulated for urine collection via a small suprapubic incision. After a 40 min control period BQ-123 infusion (16.4 nmol/kg/min, 25 microliters/min) was started and continued for 50 min. The effect of 32.8 nmol/kg/min BQ-123 infused in conscious Brattleboro rats was also investigated. Plasma and urine concentrations of sodium, potassium and chloride as well as osmolality were determined. Glomerular filtration rate (GFR) was estimated using the clearance of endogenous creatinine. Endothelin-A receptor inhibition by 16.4 nmol/kg/min BQ-123 infusion in conscious Long-Evans rats decreased urine flow rate by 38.4% (p < 0.02) and increased urine osmolality by 30.3% (p < 0.05). Sodium, potassium, chloride excretion did not alter. Endothelin-A receptor inhibition by 16.4 nmol/kg/min and by 32.8 nmol/kg/min BQ-123 infusion in conscious Brattleboro rats did not produce any change in urine flow rate, urine osmolality or excretion of the electrolytes studied. Endothelins acting via ETA receptors may function as an inhibitor of water reabsorption in the kidneys of conscious rats.

Animals↗
PubMedDate not supplied

Conscious sedation experiences in graduate pediatric dentistry programs.

PURPOSE: Conscious sedation is a behavior modification adjunct taught in all postgraduate pediatric dental residency programs. It has been a decade since the last survey was done specifically related to didactic and clinical aspects of conscious sedation in postgraduate pediatric dental programs. The aim of the study was to determine the clinical and didactic experiences associated with conscious sedation in these programs and to compare some of the findings to those collected a decade ago. METHODS: A 31-item survey similar to that of a decade ago was constructed and sent to all pediatric dentistry program directors of accredited postgraduate and residency programs in the United States. The items covered several didactics including didactic topics, sedative agents, monitoring, and emergency policy among others. A follow-up mailing was done involving those who had not responded 6 weeks following the initial mailing. RESULTS: Fifty-four of 58 (93%) program directors returned the 31-item survey. The following are highlighted findings. Conscious sedation among residency programs was achieved most commonly with a combination of sedative agents used with N2O. Midazolam was more popular than chloral hydrate. The oral route was the predominant route of administration. More lecture hours were spent on conscious sedation than 10 years ago. The pre-cordial stethoscope, pulse oximeter, and blood pressure cuff were the most commonly used monitors. Sedative agent and anticipated depth of sedation were the factors most often considered in choosing monitors used during the sedation of a patient. The capnograph was being used more frequently than it was 10 years ago. Programs did not report an increase in sedation emergencies but practiced emergency drills more often and had increased numbers of individuals certified in Advanced Cardiac Life Support (ACLS) or Pediatric Advanced Life Support (PALS). The percent of the total patient population which required sedation is about 1-20%, with most directors reporting an increase in the numbers of sedations done in the past few years. CONCLUSIONS: While many factors remained unchanged or slightly modified when compared to the survey done a decade ago, the results of this study suggest that there has been significant changes in several key factors including the most frequently used sedative (i.e., midazolam) and increased preparation in the area of emergency preparedness.

Administration, Oral↗
PubMed2002

The relations among body consciousness, somatic symptom report, and information processing speed in chronic fatigue syndrome.

OBJECTIVE: The aim of this study was to assess the potential influence of body consciousness and levels of somatic symptom report upon information processing speed in patients with chronic fatigue syndrome (CFS). BACKGROUND: According to a model of a fixed information processing capacity, it was predicted that in a group of patients with CFS, high body consciousness in combination with a high report of somatic symptoms would affect information-processing speed negatively. METHODS: Information- and motor-processing speed were simultaneously measured with a simple- and a choice-reaction time task, whereas cognitive complaints were rated with two questionnaires. The hypothesized influence of private body consciousness and somatic symptom report upon information-processing speed was tested in a model. A symptom-validity test was used to screen for possible illness behavior. RESULTS: Private body consciousness was directly related to information-processing speed and somatic symptom report. Somatic symptom report was related to both test performance and memory and concentration complaints. CONCLUSIONS: Levels of private body consciousness directly affected somatic symptom report and information-processing speed. This finding supports the role of attentive processes in CFS, and offers, besides possible cerebral dysfunction, an alternative explanation for slowing of information processing in CFS.

Adolescent↗
PubMed2005

[Psychopathology of self-consciousness in acute alcoholic hallucinosis].

To study self-consciousness changes in initial, manifesting and final stages of acute alcoholic hallucinosis, 60 patients have been examined. In 51 of them, the disease developed on the background of pseudo-dipsomania or constant hard drinking and in 9--of abstinent state. Initial stage of acute alcoholic hallucinosis was characterized by negative type of self-consciousness reaction. In manifesting stage the following variants of self-consciousness were detected: disturbation (vital, somatophysical, autopsychic), suppression (harmonic, dissociated), depersonalization and hyperactivity. In final stage, there were disactualization, nosognosia (adequate-, hypo- and hypernosognosia, anosognosia), partial and total reintegration of self-consciousness. These disorders of self-consciousness appear to be of prognostic and diagnostic value.

Acute Disease↗
PubMed2006

[Cerebral ischemia manifested as recurrent loss of consciousness].

OBJECTIVE: To demonstrate the clinical characteristics of cerebral ischemia that mainly manifested as recurrent loss of consciousness and to explore the pathogenesis of these incidents. METHODS: Twelve patients who had cerebral ischemia that manifested mainly as recurrent loss of consciousness were retrospectively studied. Their risk factors, clinical characteristics, cranial MRIs, angiograms and perfusion images were recorded in detail. The patients were followed up for at least 90 days. RESULTS: Every patient had at least one risk factor for cerebrovascular disease. The clinical manifestations in most of the patients are syncope-like incidents, but the duration was longer, lasting for minutes to hours, but mostly less than 24 hours. These patients could be sorted into three types according to the angiographic data: type A severe stenosis in anterior circulation (mostly on both sides); type B severe stenosis in posterior circulation; and type C multiple severe stenosis (in both anterior and posterior circulation). Cerebral blood flow was severely reduced in the stenotic arteries as shown by angiogram. The perfusion studies in type A patients also showed diffuse hypoperfusion of cerebrum. In one case, the patient lost his consciousness when the Angioguard (a protective guidewire) passed through the stenosis, and he regained consciousness when the stent was fully-opened in a few minutes. All the 12 patients received medical therapy. Four patients who were ineffective with medical treatment along received stent angioplasty and there was no incident during the follow-up. Six of the remaining eight patients with medical treatment alone had ischemic strokes within 90 days, including two with disabling strokes. CONCLUSIONS: Recurrent loss of consciousness is a rare manifestation of large cerebral artery stenosis. The probable mechanism may be diffuse hypoperfusion in cerebrum or brainstem. These patients are in high risk of stroke. Interventional therapy to revascularize the cerebral circulation may be a rational treatment.

Aged↗
PubMedDate not supplied

Pressor responses to intracisternal administration of hypertonic NaCl in conscious normotensive and spontaneously hypertensive rats.

We evaluated the mechanisms of pressor responses to hypertonic NaCl solution administered intracisternally (i.c.) to conscious normotensive Wistar-Kyoto (WKY) and spontaneously hypertensive rats (SHR). In conscious rats of both strains, increases in mean arterial pressure (MAP) and heart rate (HR) induced by i.c. NaCl appeared immediately after the injection and MAP returned rapidly to the basal levels. In the urethane-anesthetized animals, the increases in MAP and HR occurred gradually and persisted. The early phase of the pressor actions of i.c. NaCl was considered to be mostly abolished by blockade of the sympathetic nervous system (SNS), and to be partly diminished by the vascular receptor blockade of vasopressin (AVP), in the conscious animals. The following phase of pressor responses to i.c. NaCl was not suppressed by the blockade of ganglionic transmission, alpha-adrenergic receptor, AVP or angiotensin II (AII). However, bilateral adrenalectomy practically abolished the pressor action of both early and late phases, thereby suggesting that catecholamines (CA), released from the adrenal gland, may play a major role in this pressor response to i.c. NaCl. The pressor responses to i.c. NaCl in conscious or anesthetized animals were slightly but significantly greater in SHR than in WKY. It is concluded that an early phase of increase in MAP, as induced by hypertonic NaCl administered i.c. to conscious SHR and WKY, may be attributed mainly to the increased activity of the SNS and partly to the increased release of AVP. The major part of the pressor effect of i.c. NaCl, including the late phase, may result from an enhanced secretion of CA from the adrenal gland. The present study also shows that the pressor action of i.c. NaCl in rats may be altered when the animals are anesthetized with urethane.

Anesthesia↗
PubMed1989

[Accomplishments of health consciousness on nutrition behavior. results of a representative inquiry].

Interviews of 1000 probands - representative of the Austrian population - on the subject of health consciousness/nutrition show the following results: --about a quarter (26%) of the population is health-conscious and acts in accordance with this viewpoint --almost half of the Austrians (47%) characterize themselves as being health-conscious, but do not live according to this attitude --the rest of the population, nearly a quarter (22%), has not developed a health-conscious attitude. Health-conscious persons would welcome the introduction of new "more healthy" foods on the market. They would like to have more products of high-fibre foods (60%), skimmed or semi-skimmed milk (56%), low-fat sausages and cheese (51%), special vegetable fat for cooking (50%), drinks with less sugar/alcohol (48%), low fat spread (43%), special margarines (43%) and cheese, sausages and bread with less salt (40%). Persons lacking a health-conscious attitude do not believe that it is essential for such products to be available. They think that similar effects could be reached if probands modified their eating behaviour accordingly more economic nutrition.

Adult↗
PubMedDate not supplied

[Transient loss of consciousness: a frequent and difficult problem in emergency service. Retrospective analysis of 391 cases].

The present study was designed to evaluate the patients with transient loss of consciousness who are seen in the emergency room and the ways in which they are currently triaged and evaluated, to determine the risk factors influencing their prognosis, and to analyze the aspects of diagnostic evaluation that are most useful. We made a retrospective study of 391 patients with transient loss of consciousness seen at the emergency room of S. Martino hospital. The causes of loss of consciousness, admission decision, diagnostic tests ordered, initial and final diagnoses and mortality are evaluated. The admission decision was influenced by three factors: cause of loss of consciousness, presence of chronic disease, and patient age. The same factors were shown to influence mortality. Full concordance between initial and final diagnosis was only 50 per cent. In 18.6 per cent of patients the cause of loss of consciousness was not identified at dismissal. The history and physical examination were crucial elements in the evaluation of most patients, and only in selected cases did tests such as electrocardiogram, Holter monitoring, electroencephalogram, computerized tomography scan provide diagnostic information.

Adolescent↗
PubMed1984

Adolescent self-consciousness and the imaginary audience.

An Adolescent Social Behavior Scale (ASBS) was developed to measure the imaginary audience construct and aspects of adolescent self-consciousness in social situations. There were 60 Ss (30 male, 30 female) at each of three grade levels, 8, 10, and 12, and 26 adults (9 male, 15 female) in the sample. Results show that younger Ss gave significantly more imaginary audience behavior and externally self-conscious responses than older Ss, while only moderate age differences were apparent for internally motivated self-consciousness. High anxiety was generally associated with high self-consciousness of both types, but not with imaginary audience behavior. The need for clarity in operationalizing the concepts of imaginary audience behavior and self-consciousness is emphasized.

Adolescent↗
PubMed1981

Unconscious and conscious processes during visual perception.

Ongoing unconscious processes may be influenced by related conscious processes without self-awareness. (a) When the conscious semantic interpretation of physically identical shapes changes due to their angular rotation, the sequence of saccadic movements arid the localization of eye fixations over the shapes change as well. (b) The amplitude of the P 300 wave of visual evoked potentials is related to the conscious cognitive interpretation of identical stimuli. (c) The instants of figure reversals are influenced by conscious cognitive programs delineated by means of corresponding experimental instructions. It is assumed that unconscious and conscious processes may be considered functional manifestations of the same complex and specific neuronal network at different levels of its hierarchical organization and that mutual interactions between both types of processes do not require the existence of any mediating "interface" system.

Awareness↗
PubMedDate not supplied

Conscious sedation in a specialty hospital.

1. The patient under i.v. conscious sedation retains the ability to independently maintain a patent airway and respond appropriately to verbal commands and physical stimulation. He or she also has a depressed level of consciousness, and decreased pain and anxiety. 2. For a nurse to administer conscious sedation, conscious sedation policies, procedures and protocols must be in place within the institution. 3. Patients receiving conscious sedation must be monitored for physical changes in blood pressure, cardiac rate and rhythm, oxygen saturation, skin condition, pain, emotional status, and cognitive ability.

Procedural Sedation↗
PubMedDate not supplied

Comparison of a conscious versus anesthetized canine model in response to milrinone, hydralazine and nitroprusside.

The purpose of this study was to demonstrate, based on previous and new data, that the differences between a conscious and anesthetized canine model in the cardiovascular responses to cardiovasoactive agents were beyond their difference in the sensitivity of the compensatory mechanisms. In both conscious and anesthetized canine models, mean arterial pressure (MAP) was decreased by hydralazine (at 1-3 mg/kg and 0.3-3 mg/kg; by -26.5 +/- 4.5 and -18.8 +/- 11.7% [max. changes expressed as mean +/- SEM], respectively). MAP was also decreased by nitroprusside (both at 0.01-0.1 mg/kg, by 54.6 +/- 2.8 and -60.5 +/- 3.0%, respectively) in the conscious and anesthetized models. However, the differential MAP responses to hydralazine and nitroprusside between the two models are inconsistent with a difference in the sensitivity of the two models. Hydralazine at 1 mg/kg decreased MAP greater in the conscious than anesthetized model, whereas nitroprusside decreased MAP similarly in the two models. In conclusion, not all differential responses to hydralazine and nitroprusside between conscious and anesthetized canine models can be explained by a difference in the sensitivity of their compensatory mechanisms.

Anesthesia↗
PubMed1993

Long-term consequences of minimal brain injury: loss of consciousness does not predict memory impairment.

This study evaluated the memory and intellectual function of 32 adults following minimal brain injury. All patients had a Glasgow Coma Scale score of 15 upon evaluation in the Emergency Room, negative findings on radiographic examination, and negative history of prior neurologic disease or injury. Seventeen of these had experienced a loss of consciousness. Patients suffering a loss of consciousness postinjury obtained significantly lower mean verbal intelligence quotients than those obtained by patients who remained conscious following their accidents. Both groups exhibited memory impairments. This could indicate that loss of consciousness predicts intellectual impairment, but not degree of memory dysfunction. An alternative interpretation of these data is that patients referred for examination after a head injury that did not involve a loss of consciousness included a disproportionate number of patients from upper socioeconomic levels who have greater access to medical delivery systems or greater sophistication regarding cognitive function.

Adult↗
PubMed1995

Effects of the ETB-selective antagonist IRL 2500 in conscious spontaneously hypertensive and Wistar-Kyoto rats.

The pharmacologic profile of a novel and selective ETB antagonist, IRL 2500 (N-(3,5-dimethylbenzoyl)-N-methyl-(D)-(4-phenylphenyl)-alany l-L-tryptophan) was examined in conscious spontaneously hypertensive rats (SHRs) and Wistar-Kyoto (WKY) rats. The initial vasodepressor response to endothelin-1 (ET-1) and IRL 1620 (0.5 nmol/kg, i.v.) was significantly reduced in conscious WKY rats pretreated with IRL 2500 (10 mg/kg, i.v.). The secondary and sustained pressor response to these agonists, however, was not altered by IRL 2500. The linear peptide antagonist BQ 788, although also inhibiting the initial depressor responses, attenuated the secondary pressor response to IRL 1620 and potentiated the pressor response to ET-1. IRL 2500, administered alone to naive conscious SHRs produced a -37 +/- 8 mm Hg reduction in blood pressure, followed by a secondary pressor response (+38 +/- 7 mm Hg) with a duration exceeding 90 min. Pretreatment with either the ETA-selective antagonist BQ 123 or with the nonselective ETA/ETB antagonist SB 209670 resulted in marked potentiation of the depressor response and significant attenuation of the secondary rise in pressure. These results indicate that in the conscious rat, IRL 2500 acts as an ETB1-selective antagonist. In addition, ETA receptor activation contributes to the sustained pressore response to IRL 2500 in the conscious SHR. Furthermore, IRL 2500 may also exert a non-ET receptor-mediated vasodilation in the SHR.

Animals↗
PubMed1995

[Causes of disorders of consciousness in internal medicine intensive care units].

The present study on 5330 patients admitted to the internal intensive care unit over the five year period (1990-1994) indicated that consciousness disorders are most frequently associated with poisoning. On admission, the state of consciousness of 665 of these 5330 patients was retrospectively evaluated. Poisoning by drugs was most common among intoxications (93 patients of 154 cases of poisoning). Coma, which is the most severe manifestation of consciousness disorder, occurred very often in these patients. Poisoning caused by other agents was connected with other forms of consciousness disorders. Low Glasgow Coma Score (GCS) was a severe predictor, while the number of deaths among patients with GCS > 10 was low. Sepsis was the next most common cause of consciousness disorder among our patients (88 patients). Death rate in these patients was high, amounting to almost 50%, regardless of GCS on admission, suggesting that the severity of main event determines the outcome. Glycemia disorders, including hypoglycemia, hyperglycemia as well as hyperosmotic state, did not result in lethal outcome, regardless of GCS on admission. The highest death rate was registered in patients with cardiopulmonary arrest and lowest GCS on admission. Patients with cardiogenic shock, despite high GCS on admission, had high death rate.

Coma↗
PubMed1996

Ventilatory effects of angiotensin and vasopressin in conscious rats.

Angiotensin II (ANG II) stimulates ventilation (V), when ventilatory baroreceptor reflexes are taken into account, and arginine vasopressin (AVP) causes baroreflex inhibition of V in conscious and anesthetized dogs. To study mechanisms of hormonal modulation of V, a conscious rat model was investigated. V and metabolism were measured during steady-state intravenous infusions of ANG II and AVP in Sprague-Dawley rats (mean arterial pressure (MAP) increased 20 mmHg (1 mmHg = 133.3 Pa)). These data were compared with observations during equal pressor infusions of phenylephrine (PE), an agent classically used to study baroreceptor reflexes. V, respiratory frequency (f), and tidal volume (Vt) were maintained during the increased MAP associated with ANG II infusions, a response identical with that reported in conscious dogs. However, unlike dogs, AVP infusion did not depress V and metabolism in rats. PE in conscious rats caused an unexpected increase in Vt and V in association with increased metabolism. None of the pressor agents affected breath timing when the latter was binned by breath f. Since there was no obvious baroreflex inhibition of V with AVP and PE, potential stimulatory effects of ANG II on respiration could not be discerned. As well, the ventilatory baroreceptor pressure threshold may be higher or adaptation of the reflex may be faster in conscious rats than in dogs.

Angiotensin II↗
PubMedDate not supplied

The role of the nurse during intravenous conscious sedation.

Intravenous conscious sedation is being administered more frequently in both inpatient and outpatient settings for a wide variety of procedures. The registered nurse and physician have distinct yet collaborative roles in the management and care of the patient receiving conscious sedation. It is imperative that the nurse be aware of her/his role in caring for the patient before, during, and after the administration of intravenous conscious sedation. Nurses need to be familiar with policies on intravenous conscious sedation held by their state board of nursing and their institute or agency. They need to know what is covered in their scope of practice and the necessary training or validations required to care for a patient receiving conscious sedation.

Procedural Sedation↗
PubMedDate not supplied

Comparing the behavior of children treated using general anesthesia with those treated using conscious sedation.

This study compared the dental behavior of young children previously treated using general anesthesia (GA) with those treated with conscious sedation (CS). The sample included healthy children, two to four years of age, treated in private practice. The general anesthesia group included twenty-four children (mean age at time of treatment = 31 months) who were evaluated twelve to thirty-six months later (mean = 25 months). The conscious sedation group included thirty children (mean age at time of treatment = 35 months) who were evaluated twelve to thirty-eight months later (mean = 21 months). Both groups were subjected to a standard recall examination during which behavior and anxiety measures were used to assess the subjects' responses to the dental setting. Behavior was evaluated by the dentist and parent independently. Children were asked about their dental fears, recall of previous treatment and willingness to return to the dental clinic. Parents were asked to report any suspected psychologic trauma they attributed to the previous treatment. Behavior in both groups was positive or definitely positive as rated with the Frankl scale in the overwhelming majority of subjects (92 percent general anesthesia, 93 percent conscious sedation) as evaluated by the dentist. Parents rated their child's behavior more negatively, 33 percent and 27 percent of the time, respectively, in both groups. Seventeen percent of the children reported being afraid of the dentist in the general anesthesia group and 20 percent in the conscious sedation group. In both groups, fewer than 10 percent of the parents reported that they felt their child was traumatized by the initial dental treatment. The results support the hypothesis that there is no difference in the expected future dental behavior or anxiety of children who experience conscious sedation compared with general anesthesia for dental treatment at a young age.

Anesthesia, Dental↗