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PubMed1994

Progressive muscle relaxation and guided imagery in cancer patients.

The aim of this study was to gather information on the immediate and long-term effects of six sessions of group Progressive Muscle Relaxation with Guided Imagery on the psychological distress of self-referred cancer patients. Patients' psychological distress and coping with cancer were assessed by three self-reports: the Multiple Locus of Control, the Impact of Events Scale (IES), and the Brief Symptom Inventory (BSI). Of the 123 patients who started group therapy, 37 dropped out during its course. The 86 patients who completed the intervention showed marked improvement on both BSI and IES, an improvement maintained over the next 6 months in 58 patients who continued assessment through the followup period.

Adaptation, Psychological↗
PubMed1990

Placebo-controlled evaluation of abbreviated progressive muscle relaxation and of relaxation combined with cognitive therapy in the treatment of tension headache.

Sixty-six tension headache patients were randomly assigned to one of four conditions for 8 weeks: (a) progressive muscle relaxation (PMR) alone; (b) PMR plus cognitive therapy (PMR + Cog); (c) pseudomeditation, a credible attention-placebo control; or (d) continued headache monitoring. A comparison of overall headache activity (headache index), derived from a daily headache diary, for 4 weeks before treatment to 4 weeks after treatment, revealed that active treatment (PMR and PMR + Cog) was superior to either control condition. Moreover, level of headache medication consumption decreased significantly for the active treatment groups. Although headache-index comparisons of the two active treatments showed no advantage for adding cognitive therapy to PMR, a measure of clinically significant change showed a trend for PMR + Cog to be superior to PMR alone.

Adult↗
PubMed1991

Haemodynamic interactions of muscle relaxants and sufentanil in coronary artery surgery.

The haemodynamic interactions between sufentanil (S) and muscle relaxants (MR) were studied in 40 ASA physical status III or IV patients (four groups of ten) scheduled for coronary artery bypass grafting (ABG). Group I received pancuronium (P) 0.08 mg.kg-1, Group II received vecuronium (V) 0.1 mg.kg-1, Group III received atracurium (A) 0.5 mg.kg-1 and Group IV metocurine 0.1 mg.kg-1 plus pancuronium 0.02 mg.kg-1 (M-P). Sufentanil, 20 micrograms.kg-1 was administered before sternotomy, 10 micrograms.kg-1 being injected before tracheal intubation and 10 micrograms.kg-1 afterwards. Heart rate (HR), ECG leadII and V5, systolic, diastolic and mean arterial and pulmonary blood pressures, central venous pressure (CVP) and pulmonary capillary wedge pressure (W) were measured and recorded at the time of seven strategic events between the pre-induction of anaesthesia period and sternotomy. Cardiac output (CO) and systemic vascular resistances (SVR) were also measured before induction of anaesthesia and after the administration of S 10 micrograms.kg-1 plus the MR. The HR decreased from baseline values in the post-tracheal intubation period in all groups except in P group. The mean arterial pressure also decreased significantly in all groups except in the P group. The CO did not change from baseline values but SVR decreased in all groups. There was no evidence of new myocardial ischaemia according to the ECG monitoring and there was no significant difference in the HR changes between patients who had or who had not received beta-blockers in any group. We conclude that within the present study conditions and design, HR and blood pressure changed least with pancuronium.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Propofol or sevoflurane anesthesia without muscle relaxants allow the early extubation of myasthenic patients.

PURPOSE: To compare two non-muscle relaxant anesthetic techniques in myasthenic patients undergoing trans-sternal thymectomy, evaluating the intra- and postoperative conditions including the early extubation in the operating room. METHODS: Sixty-eight consecutive myasthenic patients undergoing trans-sternal thymectomy were prospectively randomized in two groups: propofol and sevoflurane. In both groups anesthesia was induced with propofol (1-2 mg x kg(-1)) and intubation performed after topical anesthesia of the airway with lidocaine. Anesthesia was maintained in the propofol group (36 patients) with a continuous propofol infusion (3-6 mg x kg(-1) x hr(-1)) and nitrous oxide and, in the sevoflurane group (32 patients), with sevoflurane (end-tidal 1-1.5%) in O2:N2O. Intubating conditions, hemodynamic changes, neuromuscular transmission, postoperative intensive care unit and hospital length of stay and complications were evaluated. Data were analyzed with repeated measure two-way analysis of variance (ANOVA), Chi square test and Student's t test. RESULTS: Intubating conditions were good in all patients. There were no hemodynamic changes. All patients were extubated in the operating room and none had to be re-intubated for postoperative respiratory depression. Neuromuscular transmission showed minimal changes, more important in the sevoflurane group, and at the end of the procedure the recovery was complete in all patients. We did not observe any other significant differences between the two groups studied. CONCLUSION: Our data show that these two anesthetic techniques allow the early extubation of myasthenic patients in the operating room.

Adult↗
PubMed1999

Laryngeal mask airway insertion using propofol without muscle relaxants: a comparative study of pretreatment with midazolam or fentanyl.

We determined the effects of pretreatment with midazolam or fentanyl on the ease of laryngeal mask airway insertion using propofol without a muscle relaxant. One hundred and eighty ASA class I or II patients were randomly allocated to one of three groups, 60 patients per group, to receive either placebo (Group C), midazolam 0.05 mg kg-1 (Group M) or fentanyl 2 micrograms kg-1 (Group F), respectively. Following intravenous administration of these drugs, Group C received propofol 2.5 (Group C-2.5) or 3.0 mg kg-1 (Group C-3.0). Group M and Group F received propofol 2.0 or 2.5 mg kg-1 (Group M-2.0, M-2.5, F-2.0 and F-2.5, respectively). There was a smaller incidence of severe head and limb movements on LMA insertion in Group M-2.5, Group F-2.0 and Group F-2.5 than in Group C-2.5. Airway obstruction and inadequate jaw relaxation, which were occasionally recognized in Group C and Group F patients, were not observed in Group M-2.5. Overall the ease of LMA insertion was significantly better in Group M-2.0, Group M-2.5 and Group F-2.5 than in Group C-2.5, however, the blood pressure in Group F after LMA insertion was significantly lower than in Group M. We conclude that pretreatment with midazolam 0.05 mg combined with propofol 2.5 mg kg-1 provides safe and satisfactory conditions for LMA insertion.

Adult↗
PubMedDate not supplied

Physiological pharmacokinetics of a new muscle-relaxant, inaperisone, combined with its pharmacological effect on blood flow rate.

This study was designed to develop a physiologically-based pharmacokinetic/pharmacodynamic model for drugs whose pharmacokinetics are influenced by their dose-dependent pharmacological effects. Since blood flow rate is one of the important factors that determine the distribution and elimination processes of drugs, we used inaperisone [IPS, (+/-)-4'-ethyl-2-methyl-3-(1-pyrrolidinyl)-propiophenone hydrochloride], a novel centrally acting muscle relaxant that has been found by us to significantly alter muscle and fat blood flow rates in a dose-dependent manner, as a model compound. With regard to the changes in muscle blood flow rate exhibited by IPS, the brain was shown to be the major site of action based on changes in the observed blood flow rates, determined by the 51Cr-labeled microsphere method, in rats injected iv and intracerebroventricularly with various doses of IPS. Consequently, the blood flow rates in the muscle and fat were well correlated with the concentration of IPS in the brain using Hill's equation. Moreover, hepatic and renal intrinsic clearances of IPS at steady-state were determined by the constant iv infusion method. The saturation of in vivo hepatic and renal metabolisms of IPS was found at venous plasma concentrations higher than 1 microgram/ml. Taken all together, we developed a physiologically-based pharmacokinetic model of IPS combined with its pharmacological effect in rats, which could simulate the concentration-dependent changes in blood flow rates based on the drug concentrations at the site of action.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Inspiratory muscle relaxation rate assessed from sniff nasal pressure.

BACKGROUND: Slowing of the maximum relaxation rate (MRR) of inspiratory muscles measured from oesophageal pressure (POES) during sniffs has been used as an index of the onset and recovery of respiratory muscle fatigue. The purpose of this study was to measure MRR at the nose (PNASAL MRR), to investigate its relationship with POES MRR, and to establish whether PNASAL MRR slows with respiratory loading. METHODS: Five normal subjects were studied. Each performed sniffs before and after two minutes of maximal isocapnic ventilation (MIV). In a separate session the subjects performed submaximal sniffs. POES and PNASAL were recorded during sniffs and the MRR (% pressure fall/10 ms) for each sniff was determined. RESULTS: Before MIV mean POES MRR was 8.9 and PNASAL MRR was 9.3. The mean (SD) difference between PNASAL MRR and POES MRR during a maximal sniff was 0.48 (0.34) (n = 64) and during submaximal sniffs was 0.28 (0.46) (n = 526). The subjects showed a mean decrease in sniff POES MRR of 27.4% (range 22.5-36%) after MIV and a similar reduction in sniff PNASAL MRR of 28.5% (range 24.1-41.3%). Both returned to control values within 5-10 minutes. CONCLUSIONS: PNASAL MRR reflects POES MRR over a wide range of sniff pressures, PNASAL MRR of maximal sniffs reflects POES MRR in normal subjects at rest and following MIV, so measurement of PNASAL MRR may be a useful non-invasive method for measuring inspiratory muscle MRR, thereby providing an index of respiratory muscle fatigue.

Air Pressure↗
PubMedDate not supplied

An evaluation of progressive muscle relaxation on stress related symptoms in a geriatric population.

Ten highly anxious women, between the ages of sixty-nine and eighty-four, participated in a five month study designed to test the hypothesis that progressive muscle relaxation would reduce psychosocial stress in a group of high risk senior citizens. The women, who had lost their husbands within the last five years, responded to an offer extended to nervous senior citizens to participate in a relaxation study. Five women were assigned to the treatment group and five to a control group. The treatment group received two weeks of baseline evaluation, ten weeks of one hour in vivo relaxation training, and ten weeks of home practice using taped instructions. The control group had an identical schedule except instead of progressive relaxation training they received a pseudorelaxation procedure and had no home practice. All participants were evaluated prior to training, at the end of training, and ten weeks after training. Participants were also measured on the following factors: 1) state and trait anxiety, 2) self-report muscle tension, 3) hours to fall asleep, 4) number of nocturnal awakenings, and 5) headaches. Results indicate significant differences on all five measures between the experimental and control group. With the exception of trait anxiety, the experimental group manifested significant improvements on the remaining five measures from baseline to end of training. For state anxiety, a significant improvement continued during the ten weeks of home practice following the end of training.

Aged↗
PubMed2005

Efficacy of progressive muscle relaxation training and guided imagery in reducing chemotherapy side effects in patients with breast cancer and in improving their quality of life.

GOALS: This study was designed to assess the effectiveness of progressive muscle relaxation training (PMRT) and guided imagery (GI) in reducing the anticipatory nausea and vomiting (ANV) and postchemotherapy nausea and vomiting (PNV) of patients with breast cancer and to measure their effects on the patients' quality of life (QoL). PATIENTS AND METHODS: Thirty chemotherapy-naive patients with breast cancer were randomized to the PMRT and GI group and 30 to the control group. Before each of six cycles of adjuvant chemotherapy, each patient was administered a self-report Multiple Affect Adjective Checklist (MAACL), and incidents of ANV and PNV for the first three postchemotherapy days were recorded. All patients were administered the Functional Assessment of Cancer Therapy-Breast (FACT-B) at baseline and after 3 and 6 months. RESULTS: We found that the PMRT and GI group was significantly less anxious, depressive, and hostile than the control group. We also found that the PMRT and GI group experienced significantly less ANV and PNV and that 6 months after CT, the QoL of the PMRT and GI group was higher than that of the control group. CONCLUSION: These results indicate that PMRT and GI were associated with both the improvements in ANV and PNV and in the QoL of patients with breast cancer.

Adult↗
PubMed1992

Mechanisms of spinal reflex depressant effects of CS-722, a newly synthesized centrally acting muscle relaxant, in spinal rats.

The mechanisms of the depressant action of (R)-4-chloro-2-(2-hydroxy-3-morpholinopropyl)-5-phenyl-4-isoxaz olin-3-one hydrochloride (CS-722), a newly synthesized centrally acting muscle relaxant, on spinal reflexes were investigated in spinal rats. The drug CS-722 (50 mg/kg, i.v.) depressed the polysynaptic reflex but was less effective on the monosynaptic reflex. Eperisone-HCl (10 mg/kg, i.v.) and baclofen (2 mg/kg, i.v.) markedly decreased the monosynaptic and polysynaptic reflexes, with longer durations than CS-722; CS-722, eperisone and baclofen depressed the dorsal root reflex. The excitability of the motoneurone was reduced by CS-722 and eperisone. Excitability of the primary afferent fibres was reduced by CS-722, while eperisone and baclofen had no effect. Both CS-722 and eperisone did not have a depressant influence on the focal synaptic potential. These results suggest that CS-722 and eperisone but not baclofen, have a common motoneurone-membrane-stabilizing action and that this action may contribute, in part, to the spinal reflex depressant effects of CS-722 and eperisone.

Animals↗