1
|
Gui YK, Zeng XH, Xiao R, Xi WF, Zhang D, Liu Y, Zhu SH, Da X, Shi DW, Hu XD, Xu GH. The Effect of Dezocine on the Median Effective Dose of Sufentanil-Induced Respiratory Depression in Patients Undergoing Spinal Anesthesia Combined with Low-Dose Dexmedetomidine. Drug Des Devel Ther 2023; 17:3687-3696. [PMID: 38090026 PMCID: PMC10712329 DOI: 10.2147/dddt.s429752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/19/2023] [Indexed: 12/18/2023] Open
Abstract
Purpose The application of sedation and analgesia in spinal anesthesia has many benefits, but the risk of respiratory depression (RD) caused by opioids cannot be ignored. We aimed to observe the effect of dezocine, a partial agonist of μ-receptor, on the median effective dose (ED50) of sufentanil-induced RD in patients undergoing spinal anesthesia combined with low-dose dexmedetomidine. Patients and Methods Sixty-two patients were randomly assigned to dezocine group (DS) and control group (MS). After spinal anesthesia, mask oxygen (5 L/min) and dexmedetomidine (0.1 ug/kg) were given. Five minutes later, patients in the DS group received an Intravenous (IV) bolus of sufentanil and 0.05mg/kg dezocine, while patients in the MS group only received an IV bolus of sufentanil. Results ED50 of DS group was 0.342 ug/kg, 95% confidence interval (CI) was (0.269, 0.623) ug/kg, and the ED50 of MS group was 0.291 ug/kg, 95% CI was (0.257, 0.346) ug/kg. There was no difference in the type and treatment measures of RD and hemodynamic changes between the two groups, and no serious adverse reactions occurred in either group. Conclusion Dezocine can improve RD induced by sufentanil in patients with spinal anesthesia combined with low-dose dexmedetomidine, and increase the safety window of sufentanil use.
Collapse
Affiliation(s)
- Yong-Kang Gui
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China
| | - Xiao-Hui Zeng
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China
| | - Rui Xiao
- Department of Anesthesiology, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui, 236113, People’s Republic of China
| | - Wen-Feng Xi
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China
- Department of Anesthesiology, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui, 236113, People’s Republic of China
| | - Dan Zhang
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China
- Department of Anesthesiology, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui, 236113, People’s Republic of China
| | - Yang Liu
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China
| | - Si-Hui Zhu
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China
| | - Xin Da
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China
| | - De-Wen Shi
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China
| | - Xu-Dong Hu
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China
| | - Guang-Hong Xu
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China
| |
Collapse
|
2
|
Wang L, Yi Q, Ye C, Luo N, Wang E. Effects of Dezocine on the Reduction of Emergence Delirium after Laparoscopic Surgery: A Retrospective Propensity Score-Matched Cohort Study. J Pers Med 2023; 13:jpm13040590. [PMID: 37108976 PMCID: PMC10143985 DOI: 10.3390/jpm13040590] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
In China, dezocine is commonly employed as a partial agonist of mu/kappa opioid receptors during anesthesia induction for surgical patients, yet evidence supporting its causal association with emergence delirium is limited. The objective of this investigation was to evaluate the impact of intravenous dezocine administered during anesthesia induction on emergence delirium. The retrospective studied existing data containing medical records of patients undergoing an elective laparoscopy procedure and the study was conducted with ethics-board approval. The primary outcome was the incidence of emergence delirium. Secondary outcomes included the VAS in the PACU and 24 h after surgery, the RASS score in the PACU, postoperative MMSE, hospital stay, and ICU stay. A total of 681 patients were analyzed, after being propensity score-matched, the dezocine and non-dezocine group each had 245 patients. Emergence delirium occurred in 26/245 (10.6%) of patients who received dezocine and 41/245 (16.7%) of patients did not receive dezocine. Patients on whom dezocine was used were associated with a significantly lower incidence of emergence delirium (absolute risk difference, −6.1%, 95% CI, −12% to −0.2%; relative risk [RR], 0.63; 95% CI, 0.18–0.74). All secondary outcome measures and adverse outcomes were not significantly different. The use of dezocine during anesthesia induction was associated with a decreased incidence of emergence delirium after elective laparoscopic surgeries.
Collapse
Affiliation(s)
- Lu Wang
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha 410008, China
| | - Qiong Yi
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha 410008, China
| | - Chunyan Ye
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha 410008, China
| | - Ning Luo
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha 410008, China
| | - E Wang
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha 410008, China
- Correspondence: ; Tel./Fax: +86-0731-84327413
| |
Collapse
|
3
|
Goel H, Yu W, MacKerell AD. hERG Blockade Prediction by Combining Site Identification by Ligand Competitive Saturation and Physicochemical Properties. CHEMISTRY (BASEL, SWITZERLAND) 2022; 4:630-646. [PMID: 36712295 PMCID: PMC9881610 DOI: 10.3390/chemistry4030045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Human ether-a-go-go-related gene (hERG) potassium channel is well-known contributor to drug-induced cardiotoxicity and therefore an extremely important target when performing safety assessments of drug candidates. Ligand-based approaches in connection with quantitative structure active relationships (QSAR) analyses have been developed to predict hERG toxicity. Availability of the recent published cryogenic electron microscopy (cryo-EM) structure for the hERG channel opened the prospect for using structure-based simulation and docking approaches for hERG drug liability predictions. In recent time, the idea of combining structure- and ligand-based approaches for modeling hERG drug liability has gained momentum offering improvements in predictability when compared to ligand-based QSAR practices alone. The present article demonstrates uniting the structure-based SILCS (site-identification by ligand competitive saturation) approach in conjunction with physicochemical properties to develop predictive models for hERG blockade. This combination leads to improved model predictability based on Pearson's R and percent correct (represents rank-ordering of ligands) metric for different validation sets of hERG blockers involving diverse chemical scaffold and wide range of pIC50 values. The inclusion of the SILCS structure-based approach allows determination of the hERG region to which compounds bind and the contribution of different chemical moieties in the compounds to blockade, thereby facilitating the rational ligand design to minimize hERG liability.
Collapse
Affiliation(s)
- Himanshu Goel
- Computer Aided Drug Design Center, Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, 20 Penn St. Baltimore, MD 21201, United States
| | - Wenbo Yu
- Computer Aided Drug Design Center, Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, 20 Penn St. Baltimore, MD 21201, United States
| | - Alexander D. MacKerell
- Computer Aided Drug Design Center, Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, 20 Penn St. Baltimore, MD 21201, United States
| |
Collapse
|
5
|
Wilde JH, Smith JA, Dickie DA, Harman WD. Molybdenum-Promoted Synthesis of Isoquinuclidines with Bridgehead CF 3 Groups. J Am Chem Soc 2019; 141:18890-18899. [PMID: 31684729 DOI: 10.1021/jacs.9b10781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The preparation of the complex MoTp(NO)(DMAP)(4,5-η2-(2-trifluoromethyl)pyridine) (DMAP = 4-(dimethylamino)pyridine; Tp = tris(pyrazolyl)borate) is described. The CF3 substituent is found to preclude κ-N coordination, allowing for direct coordination without protection of the nitrogen. The dihapto-coordinate complex can be isolated as a single diastereomer, methylated, and reacted with a range of nucleophiles. Oxidative decomplexation affords the free dihydropyridines in good yield (75-90%). As a demonstration of synthetic utility, a series of novel bridgehead CF3-substituted isoquinuclidines was prepared from these decomplexed dihydropyridines.
Collapse
Affiliation(s)
- Justin H Wilde
- Department of Chemistry , University of Virginia , Charlottesville , Virginia 22904 , United States
| | - Jacob A Smith
- Department of Chemistry , University of Virginia , Charlottesville , Virginia 22904 , United States
| | - Diane A Dickie
- Department of Chemistry , University of Virginia , Charlottesville , Virginia 22904 , United States
| | - W Dean Harman
- Department of Chemistry , University of Virginia , Charlottesville , Virginia 22904 , United States
| |
Collapse
|
6
|
Risk factors for postoperative delirium after spine surgery in middle- and old-aged patients. Aging Clin Exp Res 2017; 29:1039-1044. [PMID: 27766513 DOI: 10.1007/s40520-016-0640-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 09/29/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Postoperative delirium is a common complication following various operative procedures with an incidence rate of 10-77 %. AIM To analyze various risk factors for postoperative delirium after spine surgery in the middle- and old-aged patients. METHODS This study retrospectively reviewed 451 patients (226 males and 225 females, an average age of 65.1 ± 18.3 years) who underwent spinal surgery in our hospital between January 2010 and August 2015. Patients who had features of acute onset and fluctuating course and any two of the other features were diagnosed with delirium. Cognitive tests consisting of Clinical Dementia Rating and Global Deterioration Scale were performed to evaluate delirium. T tests were used for statistical analysis of the difference between the two groups, and logistic regression analyses were used for determining the risk factors. RESULTS A total of 42 (9.3 %) patients were diagnosed with delirium. Delirious and non-delirious patients had no difference in age, gender, BMI, education level, drug treatment, comorbid disease history, surgical history, preoperative blood pressure, intraoperative blood loss, blood transfusion, use of surgical implants, surgical site, use of fentanyl and propofol, and preoperative VAS score. Intraoperative hypotension and use of dezocine were related to postoperative delirium (P = 0.03 and P = 0.07). The multiple regression equation was Y = -0.11 + 0.52 × X 0 + 0.21 × X 1, where X 0 = amount of dezocine, X 1 = instances of intraoperative hypotension. CONCLUSION Postoperative delirium commonly occurs after spine surgery. Intraoperative hypotension <80 mmHg and intraoperative use of dezocine represent valuable new predictors of the risk of delirium.
Collapse
|
7
|
Degnan AP, Tora GO, Han Y, Rajamani R, Bertekap R, Krause R, Davis CD, Hu J, Morgan D, Taylor SJ, Krause K, Li YW, Mattson G, Cunningham MA, Taber MT, Lodge NJ, Bronson JJ, Gillman KW, Macor JE. Biaryls as potent, tunable dual neurokinin 1 receptor antagonists and serotonin transporter inhibitors. Bioorg Med Chem Lett 2015; 25:3039-43. [DOI: 10.1016/j.bmcl.2015.04.098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/30/2015] [Indexed: 10/23/2022]
|
8
|
Abstract
BACKGROUND Although dezocine is a partial μ-opioid receptor agonist, it is not a controlled substance. Thus, the characterization of the molecular targets of dezocine is critical for scientific and clinical implications. The goal of this study is to characterize molecular targets for dezocine and determine their implications. METHODS A binding screen for dezocine was performed on 44 available receptors and transporter proteins. Functional assays for the novel targets were performed along with computation calculations to locate the binding site. A G protein activation study was performed for the human κ opioid receptor to determine whether dezocine is a κ-antagonist. Data are presented as mean ± standard error. RESULTS The affinities for dezocine were 3.7 ± 0.7 nM for the μ receptor, 527 ± 70 nM for the δ-receptor, and 31.9 ± 1.9 nM for the κ-receptor. Dezocine failed to induce G protein activation with κ-opioid receptor and concentration dependently inhibited κ-agonist (salvinorin A and nalbuphine)-induced receptor activation, indicating that dezocine is a κ-antagonist. Two novel molecular targets (norepinephrine transporter and serotonin transporter) were identified. Dezocine concentration-dependently inhibited norepinephrine and serotonin reuptake in vitro. The half maximal inhibitory concentrations (expressed as pIC50) were 5.68 ± 0.11 for norepinephrine transporter and 5.86 ± 0.17 for serotonin transporter. Dezocine occupied the binding site for known norepinephrine transporter and serotonin transporter inhibitors. CONCLUSIONS The unique molecular pharmacological profile of dezocine as a partial μ-receptor agonist, a κ-receptor antagonist, and a norepinephrine and serotonin reuptake inhibitor (via norepinephrine transporter and serotonin transporter) was revealed. These discoveries reveal potentially important novel clinical implications and drug interactions of dezocine.
Collapse
|
10
|
Risatti C, Natalie KJ, Shi Z, Conlon DA. Development of a Scalable Route to a Dual NK-1/Serotonin Receptor Antagonist. Org Process Res Dev 2013. [DOI: 10.1021/op300323k] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Christina Risatti
- Chemical Development, Research & Development, Bristol-Myers Squibb Co., One Squibb Drive, P.O. Box 191, New Brunswick, New Jersey 08903-0191, United States
| | - Kenneth J. Natalie
- Chemical Development, Research & Development, Bristol-Myers Squibb Co., One Squibb Drive, P.O. Box 191, New Brunswick, New Jersey 08903-0191, United States
| | - Zhongping Shi
- Chemical Development, Research & Development, Bristol-Myers Squibb Co., One Squibb Drive, P.O. Box 191, New Brunswick, New Jersey 08903-0191, United States
| | - David A. Conlon
- Chemical Development, Research & Development, Bristol-Myers Squibb Co., One Squibb Drive, P.O. Box 191, New Brunswick, New Jersey 08903-0191, United States
| |
Collapse
|