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Bojić MG, Treven M, Pandey KP, Tiruveedhula VVNPB, Santrač A, Đukanović Đ, Vojinović N, Amidžić L, Škrbić R, Scholze P, Ernst M, Cook JM, Savić MM. Vascular effects of midazolam, flumazenil, and a novel imidazobenzodiazepine MP-III-058 on isolated rat aorta. Can J Physiol Pharmacol 2024; 102:206-217. [PMID: 37909404 DOI: 10.1139/cjpp-2023-0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Hypotensive influences of benzodiazepines and other GABAA receptor ligands, recognized in clinical practice, seem to stem from the existence of "vascular" GABAA receptors in peripheral blood vessels, besides any mechanisms in the central and peripheral nervous systems. We aimed to further elucidate the vasodilatatory effects of ligands acting through GABAA receptors. Using immunohistochemistry, the rat aortic smooth muscle layer was found to express GABAA γ2 and α1-5 subunit proteins. To confirm the role of "vascular" GABAA receptors, we investigated the vascular effects of standard benzodiazepines, midazolam, and flumazenil, as well as the novel compound MP-III-058. Using two-electrode voltage clamp electrophysiology and radioligand binding assays, MP-III-058 was found to have modest binding but substantial functional selectivity for α5β3γ2 over other αxβ3γ2 GABAA receptors. Tissue bath assays revealed comparable vasodilatory effects of MP-III-058 and midazolam, both of which at 100 µmol/L concentrations had efficacy similar to prazosin. Flumazenil exhibited weak vasoactivity per se, but significantly prevented the relaxant effects of midazolam and MP-III-058. These studies indicate the existence of functional GABAA receptors in the rat aorta, where ligands exert vasodilatory effects by positive modulation of the benzodiazepine binding site, suggesting the potential for further quest for leads with optimized pharmacokinetic properties as prospective adjuvant vasodilators.
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Affiliation(s)
- Milica Gajić Bojić
- Faculty of Medicine, Center for Biomedical Research, University of Banja Luka, Banja Luka 78000, Republic of Srpska, Bosnia and Herzegovina
| | - Marco Treven
- Neurology Department, Medical University of Vienna, Vienna, Austria
| | - Kamal P Pandey
- Department of Chemistry and Biochemistry, Milwaukee Institute for Drug Discovery, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - V V N Phani Babu Tiruveedhula
- Department of Chemistry and Biochemistry, Milwaukee Institute for Drug Discovery, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Anja Santrač
- Department of Pharmacology, Faculty of Pharmacy, University of Belgrade, Belgrade 11000, Serbia
| | - Đorđe Đukanović
- Faculty of Medicine, Center for Biomedical Research, University of Banja Luka, Banja Luka 78000, Republic of Srpska, Bosnia and Herzegovina
| | - Nataša Vojinović
- Faculty of Medicine, Center for Biomedical Research, University of Banja Luka, Banja Luka 78000, Republic of Srpska, Bosnia and Herzegovina
| | - Ljiljana Amidžić
- Faculty of Medicine, Center for Biomedical Research, University of Banja Luka, Banja Luka 78000, Republic of Srpska, Bosnia and Herzegovina
| | - Ranko Škrbić
- Faculty of Medicine, Center for Biomedical Research, University of Banja Luka, Banja Luka 78000, Republic of Srpska, Bosnia and Herzegovina
| | - Petra Scholze
- Department of Pathobiology of the Nervous SystemCenter for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Margot Ernst
- Department of Pathobiology of the Nervous SystemCenter for Brain Research, Medical University of Vienna, Vienna, Austria
| | - James M Cook
- Department of Chemistry and Biochemistry, Milwaukee Institute for Drug Discovery, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Miroslav M Savić
- Department of Pharmacology, Faculty of Pharmacy, University of Belgrade, Belgrade 11000, Serbia
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Solanki B, Goel R, Gupta LK. Benzodiazepines Reduce Blood Pressure in Short Term: A Systematic Review and Meta-analysis. Curr Hypertens Rep 2023; 25:335-341. [PMID: 37581768 DOI: 10.1007/s11906-023-01256-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE OF REVIEW Benzodiazepines, due to their anxiolytic properties, are prescribed to reduce anxiety and insomnia. They might have hypotensive effect via potentiation of the inhibitory effect of gamma-amino butyric acid (GABA) in the central nervous system and vasodilatory properties. However, studies comparing the effect of benzodiazepines in lowering blood pressure (BP) are equivocal. This systematic review and meta-analysis was planned to assess the efficacy of benzodiazepines in reducing blood pressure in short term among hypertensive patients. RECENT FINDINGS Various trials and retrospective analysis conducted previously have reported that benzodiazepines cause short- as well as long-term BP reduction in patients with increased anxiety with hypertension. On the other hand, several studies investigating the efficacy of benzodiazepines in patients with hypertension have reported inconclusive results. The primary question about the effect of benzodiazepines in lowering BP remains unanswered. In this meta-analysis of seven studies, benzodiazepines were found comparable to standard drugs in reducing systolic and diastolic BP in patients having hypertension. Although, the mean difference in systolic BP with benzodiazepines and placebo was statistically not significant, the difference can be considered as clinically meaningful. The current review offers preliminary evidence that benzodiazepines may have antihypertensive properties and may be used as add-on antihypertensive in a subset of patients in short term. The existing data are encouraging, but more clinical trials and mechanistic research are required to ascertain the long-term benefits.
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Affiliation(s)
- Bhupinder Solanki
- Department of Pharmacology, Lady Hardinge Medical College & Smt. S.K. Hospital, New Delhi, 110001, India
- Department of Pharmacology, All India Institute of Medical Sciences, Rishikesh, India
| | - Ridhi Goel
- Department of Pharmacology, Lady Hardinge Medical College & Smt. S.K. Hospital, New Delhi, 110001, India
| | - Lalit K Gupta
- Department of Pharmacology, Lady Hardinge Medical College & Smt. S.K. Hospital, New Delhi, 110001, India.
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Elifranji ZO, Al-Ajlouni JM, Al-Saber MG, Hammad YS, Baniatta BA, Alshoubaki SN, Jabaiti MS, Alkhatib AM, Abu awad AM, Altarazi AE, Abdin AN, Al-Ani A, Alshrouf MA. Effect of Preoperative Antianxiety Medications on Blood Pressure and Blood Loss in Total Knee Arthroplasty: A Case-Control Study. Adv Orthop 2023; 2023:6355849. [PMID: 37456533 PMCID: PMC10349676 DOI: 10.1155/2023/6355849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/14/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023] Open
Abstract
Background The increasing number of canceled operations in patients undergoing total knee arthroplasty (TKA) due to high blood pressure readings has put a considerable burden on surgeons. In this study, we aim to assess the effect of giving antianxiety drugs preoperatively on maintaining blood pressure (BP) and blood loss for patients undergoing TKA surgery. Methods This retrospective case-control study included patients who underwent total knee arthroplasty and divided them into two main groups: those who had taken a 3 mg bromazepam oral tablet at the night preoperatively and the control group. The blood pressure of patients was then measured preoperatively (baseline), in the morning of surgery, in the operating room before anesthesia, and during the surgery. The percentage of measured BP was calculated by dividing the measured BP by the baseline, then multiplying by 100. Results 301 patients were included in our study: 137 received bromazepam and 164 as a control group. The ratio of systolic BP (SBP) in the morning of surgery to the baseline (percentage of morning SBP) decreased significantly in the bromazepam group compared with the controls. The ratio of SBP, in the operating room before anesthesia (percentage of preanesthesia SBP) also decreased significantly in the bromazepam group. However, the percentage of SBP in the middle of surgery did not change significantly. In addition, there was a significant difference change from the baseline in diastolic BP and mean arterial BP between the two groups in the morning of surgery, inside the theatre, and in the middle of the operation. The bromazepam group also showed a significant decrease in blood loss. Conclusion Preoperative oral antianxiety drugs (bromazepam) helps in controlling hemodynamic changes associated with anxiety, including maintaining BP in well-controlled hypertensive and healthy patients undergoing TKA, and it plays a role in decreasing the total blood loss.
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Affiliation(s)
- Zuhdi O. Elifranji
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Jihad M. Al-Ajlouni
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Munther G. Al-Saber
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Yazan S. Hammad
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Basel A. Baniatta
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Sara N. Alshoubaki
- Medical Internship, Jordan University Hospital, The University of Jordan, Amman 11942, Jordan
| | - Mohammad S. Jabaiti
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Ahmad M. Alkhatib
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Abdelrahman M. Abu awad
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Abdelrahman E. Altarazi
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Aseel N. Abdin
- Medical Internship, Jordan University Hospital, The University of Jordan, Amman 11942, Jordan
| | - Abdallah Al-Ani
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman 11942, Jordan
| | - Mohammad Ali Alshrouf
- Medical Internship, Jordan University Hospital, The University of Jordan, Amman 11942, Jordan
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Midazolam's Effects on Delayed-Rectifier K + Current and Intermediate-Conductance Ca 2+-Activated K + Channel in Jurkat T-lymphocytes. Int J Mol Sci 2021; 22:ijms22137198. [PMID: 34281255 PMCID: PMC8267671 DOI: 10.3390/ijms22137198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/17/2022] Open
Abstract
Midazolam (MDZ) could affect lymphocyte immune functions. However, the influence of MDZ on cell’s K+ currents has never been investigated. Thus, in the present study, the effects of MDZ on Jurkat T lymphocytes were studied using the patch-clamp technique. Results showed that MDZ suppressed the amplitude of delayed-rectifier K+ current (IK(DR)) in concentration-, time-, and state-dependent manners. The IC50 for MDZ-mediated reduction of IK(DR) density was 5.87 μM. Increasing MDZ concentration raised the rate of current-density inactivation and its inhibitory action on IK(DR) density was estimated with a dissociation constant of 5.14 μM. In addition, the inactivation curve of IK(DR) associated with MDZ was shifted to a hyperpolarized potential with no change on the slope factor. MDZ-induced inhibition of IK(DR) was not reversed by flumazenil. In addition, the activity of intermediate-conductance Ca2+-activated K+ (IKCa) channels was suppressed by MDZ. Furthermore, inhibition by MDZ on both IK(DR) and IKCa-channel activity appeared to be independent from GABAA receptors and affected immune-regulating cytokine expression in LPS/PMA-treated human T lymphocytes. In conclusion, MDZ suppressed current density of IK(DR) in concentration-, time-, and state-dependent manners in Jurkat T-lymphocytes and affected immune-regulating cytokine expression in LPS/PMA-treated human T lymphocytes.
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Bojić MG, Todorović L, Santrač A, Mian MY, Sharmin D, Cook JM, Savić MM. Vasodilatory effects of a variety of positive allosteric modulators of GABA A receptors on rat thoracic aorta. Eur J Pharmacol 2021; 899:174023. [PMID: 33722589 DOI: 10.1016/j.ejphar.2021.174023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/18/2021] [Accepted: 03/10/2021] [Indexed: 01/06/2023]
Abstract
Different subtypes of GABAA (gamma-aminobutyric acid A) receptors, through their specific regional and cellular localization, are involved in the manifestation of various functions, both at the central and peripheral levels. We hypothesized that various non-neuronal GABAA receptors are expressed on blood vessels, through which positive allosteric modulators of GABAA receptors exhibit vasodilatory effects. This study involved two parts: one to determine the presence of α1-6 subunit GABAA receptor mRNAs in the rat thoracic aorta, and the other to determine the vasoactivity of the various selective and non-selective positive GABAA receptor modulators: zolpidem (α1-selective), XHe-III-074 (α4-selective), MP-III-022 (α5-selective), DK-I-56-1 (α6-selective), SH-I-048A and diazepam (non-selective). Reverse transcription-polymerase chain reaction (RT-PCR) analysis data demonstrated for the first time the expression of α1, α2, α3, α4 and α5 subunits in the rat thoracic aorta tissue. Tissue bath assays on isolated rat aortic rings revealed significant vasodilatory effects of diazepam, SH-I-048A, XHe-III-074, MP-III-022 and DK-I-56-1, all in terms of achieved relaxations (over 50% of relative tension decrease), as well as in terms of preventive effects on phenylephrine (PE) contraction. Diazepam was the most efficient ligand in the present study, while zolpidem showed the weakest vascular effects. In addition, diazepam-induced relaxations in the presence of antagonists PK11195 or bicuculline were significantly reduced (P < 0.001 and P < 0.05, respectively) at lower concentrations of diazepam (10-7 M and 3 × 10-7 M). The present work suggests that the observed vasoactivity is due to modulation of "vascular" GABAA receptors, which after further detailed research may provide a therapeutic target.
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Affiliation(s)
- Milica Gajić Bojić
- Center for Biomedical Research, Faculty of Medicine, University of Banja Luka, 16 Save Mrkalja St, 78000, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Lidija Todorović
- Laboratory for Radiobiology and Molecular Genetics, Vinča Institute of Nuclear Sciences, National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Anja Santrač
- Department of Pharmacology, Faculty of Pharmacy, University of Belgrade, 450 Vojvode Stepe St, 11000, Belgrade, Serbia
| | - Md Yeunus Mian
- Department of Chemistry and Biochemistry, Milwaukee Institute for Drug Discovery, University of Wisconsin-Milwaukee, 3210 N. Cramer St., Milwaukee, WI, 53201, USA
| | - Dishary Sharmin
- Department of Chemistry and Biochemistry, Milwaukee Institute for Drug Discovery, University of Wisconsin-Milwaukee, 3210 N. Cramer St., Milwaukee, WI, 53201, USA
| | - James M Cook
- Department of Chemistry and Biochemistry, Milwaukee Institute for Drug Discovery, University of Wisconsin-Milwaukee, 3210 N. Cramer St., Milwaukee, WI, 53201, USA
| | - Miroslav M Savić
- Department of Pharmacology, Faculty of Pharmacy, University of Belgrade, 450 Vojvode Stepe St, 11000, Belgrade, Serbia.
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Kagota S, Morikawa K, Ishida H, Chimoto J, Maruyama-Fumoto K, Yamada S, Shinozuka K. Vasorelaxant effects of benzodiazepines, non-benzodiazepine sedative-hypnotics, and tandospirone on isolated rat arteries. Eur J Pharmacol 2021; 892:173744. [PMID: 33220270 DOI: 10.1016/j.ejphar.2020.173744] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 11/28/2022]
Abstract
Benzodiazepines (BDZs) and non-BDZ sedative-hypnotics are effective for the management of chronic insomnia; however, they are associated with adverse effects such as headache, dizziness, and palpitations. Furthermore, long-term use of these medications is associated with decreased blood pressure (BP) or depressed baroreflex function. Therefore, here, we assessed whether BDZs and non-BDZs cause vasorelaxation directly. Vasorelaxation in response to 22 BDZs, 2 non-BDZs, and tandospirone was determined by myograph methods using isolated Wistar rat thoracic aortas. All the drugs relaxed phenylephrine-contracted rat aortas in a concentration-dependent manner. Zolpidem and tandospirone caused over 80% relaxation at a concentration of 10 μM; diazepam, estazolam, etizolam, and tofisopam caused 60-70% relaxation; whereas 18 other BDZs (alprazolam, bromazepam, brotizolam, chlordiazepoxide, clobazam, clonazepam, clorazepate, ethyl loflazepate, flunitrazepam, flurazepam, lorazepam, lormetazepam, midazolam, nimetazepam, nitrazepam, oxazepam, temazepam, and triazolam) and zaleplon caused less than 50% relaxation. The relaxation was partially but significantly inhibited to the same extent by a nitric oxide (NO) synthase antagonist and after endothelium removal. Binding assay of gamma-aminobutyric acid type A receptors was performed using [3H]flunitrazepam. No correlation was observed between vasorelaxation at a concentration of 10 μM and the binding affinities for 23 drugs. The study demonstrated that zaleplon, zolpidem, tandospirone, and many BDZs cause vasorelaxation to different extents via endothelial NO-dependent and endothelium-independent pathways. In conclusion, the direct vasodilatory effects of these drugs may be involved in the mechanisms underlying their adverse effects. Additionally, the decreased BP observed in persons who take BDZs or non-BDZs may be partly due to direct vasodilation.
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Affiliation(s)
- Satomi Kagota
- Department of Pharmacology II, School of Pharmacy and Pharmaceutical Sciences, Mukogawa Women's University, Nishinomiya, Japan.
| | - Kana Morikawa
- Department of Pharmacology II, School of Pharmacy and Pharmaceutical Sciences, Mukogawa Women's University, Nishinomiya, Japan
| | - Hirotake Ishida
- Center for Pharma-Food Research, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Junko Chimoto
- Center for Pharma-Food Research, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Kana Maruyama-Fumoto
- Department of Pharmacology II, School of Pharmacy and Pharmaceutical Sciences, Mukogawa Women's University, Nishinomiya, Japan
| | - Shizuo Yamada
- Center for Pharma-Food Research, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Kazumasa Shinozuka
- Department of Pharmacology II, School of Pharmacy and Pharmaceutical Sciences, Mukogawa Women's University, Nishinomiya, Japan
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Whitehead NJ, Clark AL, Williams TD, Collins NJ, Boyle AJ. Sedation and Analgesia for Cardiac Catheterisation and Coronary Intervention. Heart Lung Circ 2020; 29:169-177. [DOI: 10.1016/j.hlc.2019.08.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 05/05/2019] [Accepted: 08/29/2019] [Indexed: 02/01/2023]
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Hasan A, Sharma V. Substance abuse and conscious sedation: theoretical and practical considerations. Br Dent J 2019; 227:923-927. [PMID: 31758135 DOI: 10.1038/s41415-019-0897-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Substance abuse is an issue that has been widely recognised both in the medical and dental professions. Many different recreational drugs exist and their use can have important consequences in relation to conscious sedation. As the use of illicit drugs is growing, it is important to have an understanding of the impact of substance abuse on determining if a patient is a suitable candidate for conscious sedation. It is important to appreciate that while human studies in this area are limited, animal studies and observation of the reactions of substance abusers to sedative agents demonstrate a potential link between illicit drug use and conscious sedation through drug interaction. This paper aims to discuss the importance of understanding substance abuse, the potential effects such substances can have in relation to conscious sedation and appropriate management techniques for substance abusers in order to provide optimum safe care when undergoing conscious sedation techniques.
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Affiliation(s)
- Aliya Hasan
- Former Dental Core Trainee in Paediatric Dentistry, Dental and Maxillofacial Department, Great Ormond Street Hospital, Great Ormond Street, WC1N 3JH, London, UK.
| | - Valmiki Sharma
- Consultant in Oral and Maxillofacial Surgery, Royal Free London NHS Foundation Trust, Hampstead, NW3 2QG, London, UK
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Colussi G, Catena C, Darsiè D, Sechi LA. Benzodiazepines: An Old Class of New Antihypertensive Drugs? Am J Hypertens 2018; 31:402-404. [PMID: 29186312 DOI: 10.1093/ajh/hpx205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- GianLuca Colussi
- Clinica Medica, Department of Medicine, University of Udine, Udine, Italy
| | - Cristiana Catena
- Clinica Medica, Department of Medicine, University of Udine, Udine, Italy
| | - Daniele Darsiè
- Clinica Medica, Department of Medicine, University of Udine, Udine, Italy
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Raut M, Mantri RR, Sharma M, Maheshwari A. Propofol to relieve radial artery spasm. Indian Heart J 2016; 68:364-5. [PMID: 27316492 PMCID: PMC4911462 DOI: 10.1016/j.ihj.2016.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 02/17/2016] [Accepted: 03/07/2016] [Indexed: 11/25/2022] Open
Affiliation(s)
- Monish Raut
- Department of Cardiac Anesthesia, Sir Ganga Ram Hospital, New Delhi, India.
| | - R R Mantri
- Department of Cardiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Manish Sharma
- Department of Cardiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Arun Maheshwari
- Department of Cardiac Anesthesia, Sir Ganga Ram Hospital, New Delhi, India
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Deftereos S, Giannopoulos G, Raisakis K, Hahalis G, Kaoukis A, Kossyvakis C, Avramides D, Pappas L, Panagopoulou V, Pyrgakis V, Alexopoulos D, Stefanadis C, Cleman MW. Moderate procedural sedation and opioid analgesia during transradial coronary interventions to prevent spasm: a prospective randomized study. JACC Cardiovasc Interv 2013; 6:267-73. [PMID: 23517838 DOI: 10.1016/j.jcin.2012.11.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 11/13/2012] [Accepted: 11/21/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of this study was to test the hypothesis that moderate procedural sedation can reduce the incidence of radial artery spasm. BACKGROUND Transradial access for left heart catheterization and percutaneous coronary intervention is increasingly used for emergent and elective procedures, in lieu of the femoral approach. However, increased rates of access site crossover have been reported, with radial artery spasm being a major contributor to this effect. METHODS Patients undergoing elective transradial percutaneous coronary intervention were prospectively randomized to receive fentanyl and midazolam during the procedure or no treatment (control subjects). The primary endpoint was angiographically confirmed radial artery spasm. Patient discomfort was quantified with a visual analogue scale. RESULTS Two thousand thirteen patients (age 64.5 ± 8.4 years) were randomized. Spasm occurred in 2.6% of the treatment group versus 8.3% of control subjects (p < 0.001; odds ratio [OR]: 0.29). The number needed to treat to avoid 1 case of spasm was 18 (95% confidence interval [CI]: 12.9 to 26.6). The access site crossover rate was 34% lower in the treatment group: 9.9% versus 15.0% (OR: 0.62; 95% CI: 0.48 to 0.82). Patient discomfort visual analogue scale score was 18.8 ± 12.5 in the treatment group versus 27.4 ± 17.4 in control subjects (p < 0.001). No significant differences were observed in the 30-day rate of death or repeat hospital stay for any cause: 4.6% versus 4.5% (OR: 1.02; 95% CI: 0.67 to 1.56). CONCLUSIONS Routine administration of relatively low doses of an opioid/benzodiazepine combination during transradial interventional procedures is associated with a substantial reduction in the rate of spasm, the need for access site crossover, and the procedure-related level of patient discomfort.
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Affiliation(s)
- Spyridon Deftereos
- Cardiology Department and Cardiac Catheterization Laboratory, Athens General Hospital G. Gennimatas, Athens, Greece
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Colussi GL, Di Fabio A, Catena C, Chiuch A, Sechi LA. Involvement of endothelium-dependent and -independent mechanisms in midazolam-induced vasodilation. Hypertens Res 2011; 34:929-34. [DOI: 10.1038/hr.2011.62] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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13
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Tsao CM, Wu CC, Liaw WJ, Ho ST. Effects of Midazolam on Organ Dysfunction in Rats with Endotoxemia Induced by Lipopolysaccharide. ACTA ACUST UNITED AC 2009; 47:10-6. [DOI: 10.1016/s1875-4597(09)60014-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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14
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Béchir M, Schwegler K, Chenevard R, Binggeli C, Caduff C, Büchi S, Buddeberg C, Lüscher TF, Noll G. Anxiolytic therapy with alprazolam increases muscle sympathetic activity in patients with panic disorders. Auton Neurosci 2007; 134:69-73. [PMID: 17363337 DOI: 10.1016/j.autneu.2007.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Revised: 01/16/2007] [Accepted: 01/23/2007] [Indexed: 10/23/2022]
Abstract
Anxiolytic therapy with the benzodiazepine alprazolam is an established therapy in patients with panic disorder. Normally, panic-like anxiety and its concomitant physical symptoms quickly disappear under such treatment. Therefore we investigated whether there is a difference in sympathetic nervous system in patients with panic disorder compared to healthy controls. Three groups of subjects were included: ten patients with panic disorder, who received alprazolam and 20 healthy control subjects who were given either alprazolam (n=10) or matching placebo (n=10). Muscle sympathetic nerve activity (MSNA) and heart rate did not differ at baseline but significantly increased both in patients and healthy controls after intake of alprazolam (1 mg). However, in both groups both MSNA and heart rate were significantly elevated when compared to both baseline and the placebo control group. This study demonstrates (1) that anxiolytic therapy with alprazolam increases muscle sympathetic nerve activity and heart rate not only in patients with panic disorder but also in healthy controls and (2) that a significant difference in sympathetic nervous system activity between patients and controls, at baseline and during the therapy with alprazolam could not be demonstrated.
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Affiliation(s)
- Markus Béchir
- Cardiovascular Center, Cardiology, University Hospital, Rämistrasse 100, 8091 Zürich, Switzerland.
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