585CAN J ANESTH 2000 / 47: 6 / pp [585][586][587][588][589][590][591][592][593][594][595][596] Purpose: To review the clinical benefits of dextromethorphan (DM) in pain management, describe its neuropharmacological properties.Source: A Medline search was made for experimental and clinical data on DM use from 1967 to date using keywords nociception, acute and chronic pain control, N-methyl-D-aspartate, antagonists, dextromethorphan. Principle findings: The 930 DM citations mostly described its antitussive, metabolic and toxicological aspects, animal studies and its possible role in minimizing post-brain ischemia complications in humans. The use of DM in acute pain revealed eight original studies involving 443 patients, as well as two preliminary reports and our own unpublished data on 513 patients. Most of the 956 patients had general anesthesia. Eight studies (154 patients) and one case report dealt with chronic pain management. This N-methyl-D-aspartate (NMDA) receptor antagonist binds to receptor sites in the spinal cord and central nervous system, thereby blocking the generation of central acute and chronic pain sensations arising from peripheral nociceptive stimuli and enabling reduction in the amount of analgesics required for pain control. DM attenuated the sensation of acute pain at doses of 30-90 mg, without major side effects, and reduced the amount of analgesics in 73% of the postoperative DM-treated patients. Studies in secondary pain models in healthy volunteers and in various types of chronic pain showed DM to be associated with unsatisfactory pain relief.Conclusion: DM attenuates acute pain sensation with tolerable side effects. Its availability in oral form bestow advantages over other NMDA antagonists.Objectif : Passer en revue les bénéfices cliniques du dextrométhorphane (DM) et décrire ses propriétés neuropharmacologiques. Source : Une recherche dans Medline a fourni des données expérimentales et cliniques sur le DM, utilisé de 1967 à aujourd'hui, à l'aide des mots-clés nociception, soulagement de la douleur aiguë et chronique, N-méthyl-D-aspartate, antagonistes, dextrométhorphane.Constatations principales : Les 930 références trouvées décrivent surtout les aspects antitussifs, métaboliques et toxicologiques du DM, les études sur des animaux et le rôle possible dans la réduction des complications de l'ischémie cérébrale chez l'humain. Huit études originales auprès de 443 patients, deux rapports préliminaires et nos propres données non publiées sur 513 patients concernent le soulagement de la douleur aiguë. La majorité des 956 patients ont eu une anesthésie générale. Huit études (154 patients) et une observation portent sur le traitement de la douleur chronique. Cet antagoniste des récepteurs N-méthyl-D-aspartate (NMDA) se fixe sur les sites récepteurs dans la moelle épinière et le système nerveux central. Il empêche ainsi la propagation centrale des sensations de douleurs aiguës et chroniques provenant de stimuli nociceptifs périphériques, et contribue à la réduction de la quantité d'analgés...

This first report in humans shows to what extent anesthetists' wearing of antichemical protective gear slows the time to intubate but not to insert a laryngeal mask airway compared with wearing surgical attire. Laryngeal mask airway insertion is faster than tracheal intubation when wearing protective gear, indicating its advantage for airway management when anesthetists wear antichemical protective gear. If chances for rapid and successful tracheal intubation under such chaotic conditions are poor, laryngeal mask airway insertion is a viable choice for airway management until a proper secured airway is obtainable.

Both drugs afforded reliable, safe, and controllable long-term sedation in ICU patients and rapid weaning from mechanical ventilation. Midazolam depressed respiration, allowed better maintenance of sedation, and yielded complete amnesia at a lower cost, while propofol caused more cardiovascular depression during induction.

Lung treatment with NAC during its reperfusion with IR liver effluent prevented ALI. Lung GSH replenishment accounted for lung protection, but its content did not correlate directly with grade of protection; NAC itself seemingly afforded lung protection as well.