beta-endorphin and Rupture--Spontaneous

The opiate antagonist naloxone was suggested for the amelioration of cerebral ischemia after subarachnoid hemorrhage (SAH) following the 1981 report of clinical improvement of ischemic deficits in 2 patients. The deficit in 1 patient was exacerbated by morphine, suggesting that analgesics acting on opiate receptors should be avoided after SAH, and this would include codeine phosphate and dihydrocodeine, both widely used for post-SAH headache. We studied 21 consecutive patients with aneurysmal SAH whose condition was worse than Grade 1 on the Hunt and Hess scale. A single observer graded them to avoid interobserver error, and they were also given a score on the Glasgow coma scale. Each patient was then given an intravenous injection of 0.9% saline as placebo or 0.4 mg (7 patients) or 2.0 mg (14 patients) of naloxone. Five minutes later, the same observer regraded the patient. After 30 minutes, a second injection of placebo or naloxone was given, and the patient was regraded a third time. Each patient received placebo in one injection and naloxone in the other, but the order was randomized and unknown to the observer. There was no beneficial effect of 0.4 mg of naloxone after aneurysmal SAH, and we did not find an elevated level of the endogenous opiate beta-endorphin in the cerebrospinal fluid in the majority (6 of 8 of the patients in whom it was assayed). Five of the patients given 2.0 mg of naloxone did improve transiently, and none deteriorated after the drug, suggesting that naloxone in a high dose may have a place in the management of some post-SAH deficits.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; beta-Endorphin; Brain Ischemia; Cerebrospinal Fluid; Endorphins; Female; Humans; Intracranial Aneurysm; Male; Middle Aged; Naloxone; Rupture, Spontaneous; Subarachnoid Hemorrhage

A psychologic preparation program was developed for use prior to emergency surgery in children. The purpose of this study was to determine whether specific information prior to an emergency operation would reduce anxiety. The effect of the preparation program was evaluated with clinical and laboratory procedures. One group of children who received only general verbal information was compared with another group who received specific information. The subjects were 24 patients and their parents. The children were studied at four different clinical units prior to operation, using the Visual Analogue Scale and pulse rate and blood pressure measurements. Stress hormone levels were measured at three of these clinical units. Visual Analogue Scales were administered to parents three times prior to the child's operation. The results were analyzed for within-group differences from one clinical unit to the next and for between-group differences at the various clinical units. The results indicated less anxiety in the children who received specific information. Catecholamine and beta-endorphin measurements were not greatly different between the groups.

Topics: Acute Disease; Adolescent; Adrenocorticotropic Hormone; Anxiety; Appendectomy; Appendicitis; beta-Endorphin; Blood Pressure; Catecholamines; Child; Child, Preschool; Emergencies; Female; Humans; Hydrocortisone; Intestinal Perforation; Male; Parents; Patient Education as Topic; Preoperative Care; Psychiatric Status Rating Scales; Pulse; Rupture, Spontaneous