Hypnotic analgesia

Since there was some evidence that these compounds owe their action to interference with the action of histamine, this class has earned the soubriquet "antihistamines." This class of drugs is further characterized by a spectrum of side effects which occur to a greater or lesser degree in various members. These include antispasmodic action, sedative action, analgesia, and antiemetic effects. The side effects of some of these agents are sufficiently pronounced so that the compounds are prescribed for that effect proper. Antihistamines, for example, are used as the sedative-hypnotic component in some over-the-counter sleeping pills. 

Small doses of trazodone (25 to 50 mg) at bedtime may be useful as a sedative-hypnotic. More data are required on pain control and analgesia using low-dose opioids on a short-term basis, which may also benefit anxiety. For example, the use of morphine in patients with advanced disease has been found to be particularly helpful in decreasing their associated anxiety. 

The question of its ultimate reality is difficult, if one starts from the conservative view of the mind, where awareness is no more than a product of the nervous system and brain, the degree of independence or objectivity of the observer can only be relative. The Observer may be a semi-independent system with fewer characteristics than the overall system of consciousness as a whole, but it is dependent on the operation of neurologically based structures and so is ultimately limited and shaped by them it is also programmed to some extent in the enculturation process. Hilgard 26 has found the concept of such a partially dissociated observer useful in understanding hypnotic analgesia. 

Naloxone (Narcan) and naltrexone hydrochloride (Trexan) reverse the respiratory depressant action of narcotics related to morphine, meperidine, and methadone. They differ from other narcotic analgesics in several respects. Naloxone does not cause respiratory depression, pupillary constriction, sedation, or analgesia. However, it does antagonize the actions of pentazocine. Naloxone neither antagonizes the respiratory depressant effects of barbiturates and other hypnotics nor aggravates their depressant effects on respiration. Similar to nalorphine, naloxone precipitates an abstinence syndrome when administered to patients addicted to opiate-like drugs. 

Propofol [pro POF ol] is an IV sedative/hypnotic used in the induction or maintenance of anesthesia. Onset is smooth and occurs within about 40 seconds of administration. Supplemenation with narcotics for analgesia is required. While propofol facilitates depression in the CNS, high plasma levels can cause excitation. Propofol decreases blood pressure without depressing the myocardium. It also reduces intracranial pressure. 

Opium is used for analgesia, sedative-hypnotic narcosis, antiperistalsis, and in the treatment of neonatal withdrawal. It is also a drug of abuse. 

Ketamine (Ketalar, others) has unique properties that make it useful for anesthetizing patients at risk for hypotension and bronchospasm and for certain pediatric procednres. However, significant side effects limit its rontine nse. Ketamine rapidly produces a hypnotic state qnite distinct from that of other anesthetics. Patients have profonnd analgesia, nnresponsiveness to commands, and amnesia bnt may have their eyes open, move their limbs involnntarily, and breathe spontaneously. This cataleptic state has been termed dissociative anesthesia. 

Thiopental has been shown to act synergistically with midazolam at induction of anaesthesia in two studies. " In one of these studies, midazolam reduced the dose of thiopental required to produce anaesthesia by 50%." In a further double-blind, placebo-controlled study in 23 patients, premedication with intravenous midazolam 50 micrograms/kg, given 20 minutes before the induction of anaesthesia, reduced the thiopental dose requirements for multiple anaesthetic end-points, including hypnotic, motor, EEG and analgesia. Potentiation was greatest for the motor endpoint (about 40%) and smallest for analgesia (18%). ... 

Breen D, Karabinis A, Malbrain M, Morais R, Albrecht S, Jarnvig IL, Parkinson P, Kirkham AJ. Decreased duration of mechanical ventilation when comparing analgesia-based sedation using remifentanil with standard hypnotic-based sedation for up to 10 days in intensive care unit patients a randomised trial. Grit Care 2005 9(3) R200-10. 

Hypnotic Analgesia. Hypnosis and shamanistic trance rituals have been used as analgesia. Hypnosis has been employed successfully to achieve relaxation and reduce anxiety, fear, discomfort, and pain before and during childbirth, in dental settings, and also during minor surgery. Hypnosis does not reduce the physical reception of pain, but its perception can be manipulated by hypnotic suggestions, whether administered by a hypnotist or the self. 

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