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PubMed1976

Tardive dyskinesia.

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Antipsychotic Agents↗
PubMed1975

[Drugs most frequently used during pregnancy and labor and their effects].

It is rather difficult to draw up a list of the drugs most frequently used during pregnancy, and to specify their action on the mother, the uterus ans the fetus bearing in mind the differences between them. This difficulty results in particular from the high number of drugs owing to: the frequency of prescriptions and selfmedication in the pregnant woman who suffers from numerous disorders, and the possibility of a pathology associated with the pregnancy or a pathology due to the pregnancy itself thereby defining the "high risk" pregnancy. On this background already modified by pregnancy, under the hold of numerous drugs, an anesthetic can be necessary in addition during labour or delivery, the frequency of which can be estimated as being approximately 20 per cent. It is not possible to study all therapeutic agents in a single communication. One can only evoke the influence of the most currently used drugs; analgesics, antibiotics, diuretics, sleeping tablets, anti-hypertensives and those aimed at the neuropsychiatric system (anti-depression agents, neuroleptics, tranquillizers) which are so frequently used at present. Finally, during labour the number of parturients who receive no drugs is rare: ocytocic and anti-spasmodic agents can also interfere with an anesthetic. All of these ideas which are more and more difficult to acquire are important to know. In fact the person in charge of the delivery must prescribe as little drugs as possible (in order to avoid multiple drug interference which is rather difficult to predict) knowing the possible action of drugs on the fetus (in order to allow best adaptation to life in our atmosphere after delivery) and foreseeing the possible necessity for an anesthetic. In his turn, the anesthetist should have a good knowledge of obstetrical physiology and pathology and the drugs capable of being used during pregnancy and labour in order to be able to choose the best adapted anesthetic. This emphasized the importance of a well integrated obstetrico-anesthetic team in which each member knows the problems of the other, with the aim of being the least possible noxious for the mother, and the future newborn, the fetus. This also emphasizes the necessity for anesthetists attached to the ostetrical unit, knowing like the obstetrician the histories of those women with "high risk" pregnancies. Obstetrical anesthetics cannot be improvised.

Analgesics↗
PubMed1975

Effect of anesthetics on the heart.

In man, high doses of the "group 1" inhalation anesthetics (diethylether, cyclopropane, and fluroxene) produce relatively minor depression of ventricular function, although it is possible to depress the heart if the dose is great enough. The "group 2" drugs (halothane, methoxyflurane, etc.) produce dose-related depression in cardiac function, but reasonable caridac outputs and blood pressure can be maintained at light anethetic levels. Much the same can also be said for the intravenous barbiturates and other hypnotics. If ventilation is supported and hypovolemia avoided, large doses of the narcotic analgesics appear to produce minimal cardiac effects. The only intravenous drug which stimulates the heart is the dissociative anesthetic ketamine, and this is probably an autonomic, reflex phenomenon (as with group 1 inhalation anesthetics). Regional anesthesia and the neuromuscular blocking drugs appear to have relatively little effect on ventricular function. Most of the work in man on the effect of anesthetics has been in healthy patients or volunteers. The effects on patients with severe heart or other systemic disease may well be different. In fact, low concentrations of fluroxene have been shown to produce significant depression of stroke volume in patients with aortic vavular disease in contrast to the effects on healthy volunteers. All potent central nervous system depressant drugs possess the potential for significant cardiac depression. If such depression is undersirable in a particular patient, the only safe way to administer anesthesia is by careful titration of the dose against the best measurement of cardiac function which is available. At the present time, this would mean measuring at least direct arterial pressure, central venous pressure, and a continuous electrocardiogram. The optimal management would prpbably include recording systolic time intervals, pulmonary capillary wedge pressure, and some measure of cardiac output as well. All the skill and pharmacologic knowledge available connot substitute for vigilant monitoring and carful tiration of drug dose in the clinical situation.

Adrenergic beta-Agonists↗
PubMed1977

The interaction between clonidine and various neuroleptic agents and some benzodiazepine tranquillizers.

The central hypotensive action of clonidine, infused into the vertebral artery of chloralose-anaesthetized cats was antagonized by several phenothiazine-neuroleptics (chlorpromazine, promazine, promethazine, thiethylperazine, thioridazine), by chlorprothixene and to a limited extent by haloperidol administered via the same route. Pimozide and some benzodiazepines (chlordiazepoxide, diazepam and flurazepam) hardly influenced the central hypotensive response to clonidine. The antagonism between clonidine and the psychotropic drugs is probably associated with central alpha-adrenoceptors, clonidine being the agonist and the neuroleptic agents the antagonists at these receptors. Virtually the same type of antagonism was observed in conscious, spontaneously hypertensive rats where both clonidine and the neuroleptic drugs were injected intravenously. The phenothiazines and also piperoxane effectively diminished the centrally induced hypotensive response to clonidine, whereas the initial pressor effect to clonidine was not reduced.

Anesthesia↗
PubMed1976

On the supersensitivity of dopamine receptors, induced by neuroleptics.

Different neuroleptics caused dopamine receptor blockade (antagonism against methylphenidate-induced compulsive gnawing) for varying lengths of time. When the receptor blockade had expired, supersensitivity to dopamine agonists (occurrence of apomorphine-induced compulsive gnawing and enhancement of methylphenidate-induced gnawing) developed and persisted for varying periods of time. The degree and duration of supersensitivity was related to the degree and duration of the preceding receptor blockade. Inhibition of catecholamine or 5-HT synthesis had no influence on development of supersensitivity. Stimulation with a dopamine agonist, apomorphine, during the period of the development of supersensitivity did not modify the enhanced receptor supersensitivity. A cholinergic-dopaminergic balance was shown to be involved in the manifestation of compulsive behavior during the supersensitivity phase. Tolerance to the dopamine antagonistic effect of a neuroleptic also developed after a single neuroleptic treatment, most likely due to increased sensitivity of the receptors for the dopamine agonist. It is concluded, that the dopamine receptor blockade induced by a single dose of a neuroleptic agent is a dynamic phenomenon which in the course of time is replaced by an increased sensitivity of the receptors to dopamine agonists. Noradrenergic or 5-HT neuron systems do not seem to be involved in the neuroleptic-induced supersensitivity, whereas a dopaminergic-cholinergic balance is operative in the supersensitivity situation.

Animals↗