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Y-27152, a long-acting K+ channel opener with less tachycardia: antihypertensive effects in hypertensive rats and dogs in conscious state.

(+)-(3S,4R)-4-(N-Acetyl-N-benzyloxyamino)-6-cyano-3,4-dihydro-2,2- dimethyl- 2H-1-benzopyran-3-ol (Y-27152) is a new K+ channel opener with a long duration of action and less tachycardia. In this study, Y-27152 was compared with a K+ channel opener lemakalim and a Ca++ channel blocker nifedipine for antihypertensive activity in conscious spontaneously hypertensive rats (SHR) and two-kidney, one-clip renal hypertensive dogs (RHD). In conscious SHR, Y-27152 (0.1-1 mg/kg, p.o.) produced long-lasting dose-related decreases in systolic blood pressure. At 1 mg/kg, the maximum response occurred 5 to 7 hr after dosing, and 24 hr later, the pressure was still significantly reduced. Heart rate was not changed by these doses of Y-27152, whereas equihypotensive doses of lemakalim or nifedipine were strongly tachycardic. The cardiovascular effects of Y-27152 were antagonized by glibenclamide (20 mg/kg, i.v.). In conscious unrestrained RHD, Y-27152 at doses of 0.01, 0.03 and 0.1 mg/kg lowered blood pressure with a slow onset and long duration of action and had only a minimal effect on heart rate, whereas both lemakalim and nifedipine reduced blood pressure and markedly increased heart rate. No tolerance to the antihypertensive effect of Y-27152 (0.1 mg/kg) occurred during an 8-week repeated daily dosing to RHD and plasma renin activity, and aldosterone levels were not elevated during this period. In rat aortic rings contracted with 20 mM KCl, Y-27152 did not modify the tension; however, its desbenzyl form (Y-26763) produced vasorelaxation, and this effect was antagonized competitively by glibenclamide.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗

Oral health impact in patients wearing removable prostheses: relations to somatization, pain sensitivity, and body consciousness.

PURPOSE: Previous studies investigating associations between patient personality traits and complaints related to wearing dental prostheses have been inconclusive. From the perspective of cognitive behavioral theory, the current study investigated whether pain sensitivity, body consciousness, and somatization affected the oral health of patients wearing removable dentures. MATERIALS AND METHODS: Eighty-eight patients were supplied with removable partial and complete dentures. The Oral Health Impact Profile (OHIP), with six subscales measuring oral health impairment and disability during daily living, the Pain Sensitivity Index, the Private Body Consciousness scale, and the Somatization Scale of the SCL-90-R, were used. RESULTS: The variables pain sensitivity, body consciousness, and somatization correlated significantly with all six OHIP subscales in removable denture wearers. In multiple hierarchic regression analyses, patient personality accounted for 38.0% of functional limitation and 41.5% of physical pain. CONCLUSION: Pain sensitivity and bodily preoccupation might be important factors in explaining the subjective oral health effects of removable denture wearing.

Activities of Daily Living↗

Neurologic complications of critical illness: part I. Altered states of consciousness and metabolic encephalopathies.

OBJECTIVE: To review the metabolic encephalopathies and neuromuscular abnormalities commonly found in the critically ill patient in a two-part presentation. DATA SOURCES: A review of articles reported from 1980 to 2002 and identified through a MEDLINE search on metabolic encephalopathy, polyneuropathy and myopathy in critical illness. SUMMARY OF REVIEW: An alteration in the conscious state can be caused by space occupying lesions or infections of the central nervous system. However, in the critically ill patient a metabolic encephalopathy is often the cause of an acute confusional state or a reduced state of consciousness. There is no specific treatment for the metabolic encephalopathies as they commonly resolve when the underlying disorders (e.g. sepsis, renal failure, hepatic failure, electrolyte disturbance) are corrected. Management may also require judicious pharmacological and/or physical restraint in the case of the acute confusional states and ensuring an adequate airway, ventilation and circulation in the case of a reduced state of consciousness, while the underlying disorder is corrected and the encephalopathy resolves. CONCLUSIONS: In the critically ill patient a metabolic encephalopathy is commonly the cause of confusion, disorientation, agitation, drowsiness or coma. Sedative agents and tranquilisers may be required as well as management of the airway, ventilation and circulation while the underlying disorder is corrected to allow the encephalopathy to resolve.

Journal Article↗

CNS oxygen toxicity in closed-circuit diving: signs and symptoms before loss of consciousness.

INTRODUCTION: There is a dearth of information regarding CNS oxygen toxicity accidents in closed-circuit oxygen diving. The aims of the present study were to report the sensations and symptoms that accompany CNS oxygen toxicity accidents, and to evaluate whether loss of consciousness can occur without any warning signs. METHODS: We documented 36 CNS oxygen toxicity accidents in closed-circuit oxygen diving. The full accident inquiry included the first report from the diving unit, an interview of the victim and his buddy by the researchers, and an examination of the diving equipment. RESULTS: The symptoms that appeared before termination of a dive, as reported by the victim or his buddy, were as follows (in descending order of frequency): limb convulsions; hyperventilation; difficulty maintaining a steady depth; headache; and visual disturbances. The symptoms that appeared after detachment from the mouthpiece were, in descending order of frequency: headache; loss of consciousness; confusion; weakness; dizziness; and facial muscle twitching and limb convulsions. A high inspired CO2 [mean 4.2 kPa (29.9 mmHg)] was connected with loss of consciousness. No dive was terminated before at least two symptoms (mean 3.4) had been noted a minimum of 5 min before termination. DISCUSSION: Symptoms that are accepted as being related to CNS oxygen toxicity, as well as others such as headache, difficulty maintaining a steady depth, hyperventilation, weakness, and a choking sensation, were more frequent among the O2 accident victims compared with divers who did not interrupt their dives. CONCLUSION: Awareness of any unusual sensation can prevent a potentially dangerous situation from arising.

Accidents↗

Conscious sedation and analgesia with rectal ketamine in the Macaca fuscata monkey.

Conscious sedation is commonly utilized in pediatric dentistry. Although opioid analgesics are often employed, patient safety would be enhanced if nonopioid drugs were used. The purpose of this study was to determine if rectal ketamine could produce plasma concentrations that would achieve both conscious sedation and analgesia to gingival needle puncture. Five 2-year-old male Macaca fuscata monkeys were given rectal ketamine at a dosage of 60 mg/kg and 90 mg/kg one week apart. Blood was drawn at selected times after administration, and vital signs, level of sedation, and consciousness were assessed. Plasma ketamine concentrations ranged from 240 to 820 ng/mL and from 390 to 3120 ng/mL after rectal administration at doses of 60 mg/kg and 90 mg/kg, respectively. Two monkeys after the high dose showed analgesia to a gingival needle puncture at plasma ketamine concentrations that ranged from 1390 to 3120 ng/mL. A good level of sedation was consistently observed in four monkeys (80%) following rectal ketamine at a dosage of 90 mg/kg, whereas one monkey showed a consistently good level at a dosage of 60 mg/kg. Sedation and dose were significantly (P less than 0.001) associated with plasma ketamine concentrations; physiologic parameters were not (P greater than 0.05). The results of this study suggest that rectal ketamine can produce plasma concentrations of the drug sufficient to achieve sedation in the monkey. The attainment of concomitant analgesia to a gingival needle puncture was not as predictable.

Analysis of Variance↗

Dual effects of baclofen on gastric acid secretion depending on the basal secretory activity in conscious and anesthetized rats.

Effects of baclofen, a GABAB agonist, on gastric acid secretion were studied from a viewpoint that baclofen may stimulate or inhibit gastric acid secretion depending on the basal secretory activity in conscious or anesthetized rats. In conscious pylorus-ligated rats, baclofen (2-16 mg/kg, s.c.) depressed acid secretion, while in urethane-anesthetized pylorus-ligated rats, baclofen (4-16 mg/kg, s.c.) stimulated acid secretion. Basal acid secretion was much higher in the conscious rats than in the urethane-anesthetized rats. When gastric secretion was measured by the stomach-perfusion method, baclofen (s.c.) significantly increased acid at 2-4 mg/kg in urethane-anesthetized rats but decreased acid at 0.5-2 mg/kg in pentobarbital- and alpha-chloralose-anesthetized rats. Basal acid secretion was markedly higher in the latter rats than in the former. Moreover, baclofen did not affect acid secretion elicited by peripheral vagal stimulation in alpha-chloralose-anesthetized rats. These results suggest that acid secretion is centrally stimulated by baclofen in rats with low basal secretory activity, and vice versa, and moreover, these dual effects are closely associated with tone of the central vagal center.

Anesthesia↗

5-Hydroxytryptamine3 receptors mediate tachycardia in conscious instrumented dogs.

Intravenously administered 5-HT and the 5-HT3 selective agonist, 2CH3-5-HT, and the 5-HT2 selective agonist, alpha-CH3-5-HT, transiently increased heart rate in conscious, instrumented dogs. 5-HT, alpha-CH3-5-HT and 2CH3-5-HT increased systolic blood pressure in conscious dogs. The increase in blood pressure produced by alpha-CH3-5-HT was blocked by the 5-HT2 selective antagonist, LY53857, supporting a role for vascular 5-HT2 receptors in the pressor response to these amines. In contrast, LY53857 did not antagonize tachycardia produced by 2CH3-5-HT. Furthermore, propranolol also did not block 2CH3-5-HT-induced tachycardia, indicating that an indirect neuronal effect to release norepinephrine cannot explain the increase in heart rate to 2CH3-5-HT. Tachycardia to 2CH3-5-HT (as well as to isoproterenol) was modestly inhibited, but never abolished by interruption of the autonomic nervous system with atropine or hexamethonium. 5-HT3 receptor antagonists, zacopride, ICS 205-930 and GR38032F, dose-dependently blocked the tachycardia and pressor response to 2CH3-5-HT. These data establish the presence of a 5-HT3 receptor mediating a direct positive chronotropic effect of 5-HT in conscious dogs, an effect that depends, only minimally, on the presence of an intact autonomic nervous system.

Animals↗

Music ability and altered states of consciousness: an experimental study.

Some theoretical researchers have hypothesized links between music and altered states of consciousness. Music can influence the induction and maintenance of hypnosis. In addition, some altered states of consciousness may stimulate the musical creativity and musical production of mankind. In this research, the relationship between music and altered states of consciousness is studied from an experimental point of view. The experiments were conducted with 30 university students divided into two groups: the Hypnosis Group and the Control Group. The "Test di abilita musicale" was applied. The first group did the retest after post-hypnotic suggestions and the second in waking conditions. The statistical analysis proved that the Hypnosis Group had better results in the retest than the Control Group, especially in the rhythm test with F(1,28) = 25.60, p less than 0.0001.

Adult↗

Basal and spontaneous exocrine pancreatic secretion in conscious and anaesthetized chickens, Gallus domesticus.

Basal exocrine pancreatic secretion was studied in anaesthetized and conscious chickens and spontaneous secretion was studied in anaesthetized chickens. Results are compared with those of other vertebrates to estimate the specific pattern of this secretion in birds. The flow of pancreatic juice was greater in conscious chickens than when anaesthetized (Table 1). Amylase activity was greater than that of the other species and was of the same order in anaesthetized and conscious birds (Table 1). A spontaneous exocrine pancreatic secretion was seen to remain after eliminating a large part of the tonic influences (Table 2).

Amylases↗

Inadequate blockade by hexamethonium of the baroreceptor heart rate response in anesthetized and conscious rats.

The ability of hexamethonium (HEX) alone or in combination with atropine methylbromide (AMB) to block the heart rate (HR) response to baroreceptor activation by phenylephrine (PE) or angiotensin II (AII)-evoked increments in blood pressure was evaluated in rats. A highly significant negative correlation existed under control conditions between the changes in MAP and HR. HEX (10-20 mg/kg) did not influence the baroreceptor HR response of anesthetized and conscious rats, suggesting anesthesia was not involved in the failure of HEX to abolish the baroreceptor HR response. A combination of HEX and AMB (full ganglionic blockade) substantially attenuated but did not abolish the HR response to baroreceptor activation, but this effect was not significantly different from that produced by AMB alone. In a marked contrast to HEX, chlorisondamine (CHL) abolished the baroreceptor HR response both in anesthetized and in conscious rats. Efficacy of ganglionic blockade was tested by examining the effects of HEX or CHL on the frequency-bradycardic response relationship evoked by electrical stimulation of the peripheral end of the right vagus; HEX only attenuated the response whereas CHL abolished it. It is concluded that, even in doses which lower blood pressure, HEX: 1) does not adequately block the baroreceptor HR response; 2) when combined with a muscarinic blocker to induce full ganglionic blockade, the decrease in baroreceptor HR response is largely, if not totally, attributable to muscarinic blockade; 3) is much weaker than CHL in blocking ganglionic transmission and, even when combined with a muscarinic blocker, it does not abolish the baroreceptor HR response whereas CHL does, and 4) CHL represents a better choice for studies that require complete ganglionic blockade in anesthetized or conscious rats.

Anesthesia↗

[Consciousness-restoring effect of angong-niuhuang pills in craniopathy].

104 patients of craniopathy with unconsciousness were treated with Angong-Niuhuang Pills (ANP) for a prospective random study. In 104 patients of Group A, ANP seemed to be an efficient drug to 79 patients (76%). 13 of them were on the mend with degree I consciousness. 4, 23, 24, 10 and 5 of the patients with degree II, III, IV, V and VI consciousness respectively. 25 patients failed to respond to medical treatment (24%). In 104 patients of Group B without ANP treatment, only 43 patients responded to other medical treatment (41%). 8, 4, 18, 9, and 4 patients took a turn for the better and got degree I, II, III, IV and V consciousness respectively. Inefficiency was observed among 61 patients (59%). Thus, there was a significant difference between the two groups statistically (P less than 0.005).

Adolescent↗

[Drugs and short losses of consciousness in the elderly. A case/control study].

To study the possible role of multiple medications and different types of drugs prescribed to the elderly as a risk factor for short-term loss of consciousness, we compared the drug consumption by 188 patients (65 and over) hospitalized for short-term loss of consciousness to that by 188 controls (65 and over) taken from the general population. The two groups were age- and sex-matched. We took into consideration the evolution of drug consumption due to the time-lag between the two studies. There was no significant difference between the mean number of drugs taken per group. Beta-blocker and anti-angina drug usage was significantly increased in the patient group. For diuretics, tranquilizers and anti-depressants, a large difference was noted but it was not significant. Use of vasodilators, hypnotic drugs and antihypertensive agents was similar in both groups. We discuss the possible lack of statistical potency for several drugs and the fact that it is sometimes difficult to distinguish between the respective roles of certain medications and the underlying disease in the etiology of the loss of consciousness.

Aged↗

Cardiovascular changes in chronically adrenalectomized conscious rats.

Mean arterial blood pressure (MABP), heart rate (HR), stroke volume index (SVI), cardiac index (CI), systemic vascular resistance index (SVRI), and central venous pressure (CVP) were measured in conscious, freely moving, sham-operated (SO) and chronically adrenalectomized (ADX) rats. After 3 weeks of ADX, the rats exhibited hypotension, tachycardia, and diminished SVI and CI. From 3 to 6 weeks after surgery, the HR decreased and SVRI increased. These changes were obscured when the same measurements were obtained in the same rats under enflurane anesthesia. Cardiovascular responses to an epinephrine (0.4 microgram/kg/min) infusion were measured in conscious SO and ADX rats. The magnitude of change from baseline to peak was similar in all groups, indicating that ADX did not alter the responsiveness of the cardiovascular system to epinephrine. The peak MABP response to epinephrine in ADX rats was significantly below that of SO control rats, suggesting that ADX impaired the ability of the cardiovascular system to maintain normal arterial blood pressure. No differences were found in plasma concentrations of Na+, K+, Cl-, PO4 =, or hematocrit that would help to explain the effect of long-term adrenalectomy. The data underscore the cardio-depressant effect of enflurane anesthesia, demonstrate the importance of a conscious rat model in studying the effects of ADX on the cardiovascular system, and emphasize that the full effects of ADX occur over a period of several weeks.

Adrenal Insufficiency↗

Effects of fenoldopam on regional vascular resistance in conscious spontaneously hypertensive rats.

The effects of fenoldopam, a selective dopamine-1 agonist, on regional blood flow and vascular resistance were examined in conscious unrestrained spontaneously hypertensive rats (SHR). Rats were instrumented chronically with pulsed Doppler flow probes to allow measurement of renal, mesenteric and hindquarters blood flow. Maximal changes in mean arterial pressure, heart rate and regional blood flow were recorded after i.v. administration of fenoldopam (1-1000 micrograms/kg). Fenoldopam produced a dose-dependent reduction in arterial pressure and increased heart rate in the conscious SHR. Significant increases in mesenteric (maximal = 69 +/- 10%) and renal (maximal = 42 +/- 4%) blood flows were observed at all doses of fenoldopam. In the hindquarters, vascular resistance was increased after low doses of fenoldopam (1-30 micrograms/kg), but decreased with higher doses (100-1000 micrograms/kg). After ganglionic blockade, hindquarter vasodilation was observed with fenoldopam at low (10 micrograms/kg) and high (500 micrograms/kg) doses. Pretreatment with metoclopramide (20 mg/kg) or SCH 23390 (30 micrograms/kg), a new selective dopamine-1 antagonist, significantly attenuated the vasodilator responses to fenoldopam in all three vascular beds. Pretreatment with propranolol failed to alter the vascular effects of fenoldopam, but reduced the tachycardia markedly. This study indicates that fenoldopam decreased regional vascular resistance in the renal, mesenteric and hindquarters vascular beds of the conscious SHR with the mesenteric vascular bed demonstrating the greatest reactivity. The vasodilation induced by fenoldopam in these vascular beds appeared to be due to stimulation of vascular dopamine-1 receptors.

Animals↗

Conscious sedation in predoctoral pediatric dentistry programs.

A survey of predoctoral pediatric dentistry programs in American dental schools was conducted to determine the extent of didactic and clinical training in pediatric conscious sedation. Fifty-four of 59 programs (92 percent) returned usable surveys. The results indicated that there exists a wide range of teaching practices, both in numbers and types of sedations experienced. Fifty-six percent of the respondents reported that students received some degree of clinical experience. Sedation was achieved most commonly with chloral hydrate or hydroxyzine administered orally. Predoctoral programs without an affiliated postdoctoral program were much more likely to practice conscious sedation than those that trained postdoctoral students. The reason most frequently listed for the nonuse of sedation in the predoctoral clinic was philosophical opposition to pharmacological management at this level of training. A majority of the respondents believed that improved monitoring practices and documentation of cases would result from the recent adoption by the American Academy of Pediatric Dentistry of guidelines for conscious sedation.

Anesthesia, Dental↗

Role of vasopressin in the cardiovascular effects of LY171555, a selective dopamine D2 receptor agonist: studies in conscious Brattleboro and Long-Evans rats.

To elucidate the role of central and peripheral arginine vasopressin (AVP) in the cardiovascular action of LY171555 in conscious rats, we have examined the effects of LY171555 on mean arterial pressure, heart rate, plasma AVP and catecholamine levels in conscious, congenitally AVP-deficient Brattleboro (DI) rats and Long-Evans (LE) control rats. Administration of LY171555 (1 mg/kg i.v.) increased heart rate without altering mean arterial pressure in DI rats but increased both mean arterial pressure and heart rate in LE rats. After pretreatment with domperidone, LY171555 induced both a pressure response and a tachycardia in DI rats. Domperidone pretreatment enhanced the pressor action of LY171555 and attenuated the LY171555-induced tachycardia in LE rats. After pretreatment with phenoxybenzamine, LY171555 induced a depressor and bradycardic response that could be blocked by pretreatment with domperidone in DI rats. Pressor and bradycardic responses to LY171555 were attenuated by phenoxybenzamine pretreatment in LE rats. LY171555 administration increased plasma norepinephrine and epinephrine levels in both DI and LE rats but increased plasma AVP only in LE rats. The vasopressor effect of the alpha-1 adrenoceptor agonist phenylephrine was significantly attenuated in DI rats compared with LE rats, whereas the pressor action of angiotensin II was similar in both groups. These results suggest that the pressor action of LY171555 in conscious LE rats is mediated by an increase in plasma AVP and by activation of sympathetic outflow through the central D2 dopaminergic system but not through the central vasopressinergic system.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiotensin II↗

Nifedipine attenuates both alpha-1 and alpha-2 adrenoceptor-mediated pressor and vasoconstrictor responses in conscious dogs and primates.

Effects of the calcium channel blocker, nifedipine, were examined on the pressor and vasoconstrictor responses to stimulation of alpha-1 and alpha-2-adrenoceptors in chronically instrumented conscious dogs and Rhesus monkeys. Norepinephrine (NE), a mixed alpha-1 and alpha-2 adrenoceptor agonist, phenylephrine (PE) and methoxamine (M), selective alpha-1 adrenoceptor agonists, and B-HT 920, a selective alpha-2 adrenoceptor agonist, were injected i.v. after ganglionic (hexamethonium), beta adrenoceptor (propranolol) and muscarinic receptor (atropine methyl bromide) blockade. In the dog, NE (0.1 microgram/kg i.v.), PE (1 microgram/kg i.v.), M (20 micrograms/kg i.v.) and B-HT 920 (1 microgram/kg i.v.) produced similar increases in mean arterial pressure (NE, 52 +/- 4 mmHg; PE, 42 +/- 4 mm Hg; M, 43 +/- 7 mm Hg; B-HT 920, 45 +/- 6 mm Hg) and total peripheral resistance (NE, 20.8 +/- 5.8 mm Hg/l/min; PE, 23.1 +/- 4.2 mm Hg/l/min; M, 18.2 +/- 2.1 mm Hg/l/min; B-HT 920, 24.8 +/- 7.1 mm Hg/l/min). Nifedipine (0.5 microgram/kg/min i.v.) caused a similar attenuation of the pressor (NE, -54 +/- 8%; PE, -43 +/- 8%; M, -49 +/- 6%; B-HT 920, -56 +/- 8%) and vasoconstrictor (NE, -66 +/- 11%; PE, -52 +/- 9%; M, -60 +/- 13%; B-HT 920, -57 +/- 10%) responses to each of the alpha-adrenoceptor agonists. Nifedipine also attenuated pressor responses to alpha-1 and alpha-2 adrenoceptor agonists similarly in conscious monkeys. Thus, in conscious dogs and monkeys, calcium channel blockade attenuates similarly both alpha-1 and alpha-2 adrenoceptor-mediated vasoconstriction.

Animals↗

Confession and signification: the systematic inscription of body consciousness.

Formulas designed to reduce the overweight body flourish in American culture, yet 98% of all weight loss efforts end in failure. Numerous experts note that women, more frequently than men, are overweight and have greater difficulty adhering to reducing diets. I analyze the discourse of weight loss by taking up Foucault's concepts of confession and surveillance. Specifically, I argue that reducing techniques weave the language of science, deviance, and theology to fuel the perpetuation of a wholly transparent female subject. The weight conscious woman is divided within herself (mind versus body), and must, ironically, become and remain body conscious to alleviate body consciousness. Foucault's work, by describing the means by which bodies are inscribed in discursive practice, provides the diagnostic tools needed to assess the relation of dogma (reducing discourse) and individual (female body in need of alteration).

Body Image↗