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Iwasaki Y, Shiga T, Hoshi N, Irimada D, Saito H, Konno D, Saito K, Yamauchi M. Sevoflurane administration from extracorporeal membrane oxygenation via the AnaConDa device for a patient with COVID-19: a breakthrough solution for the shortage of intravenous anesthetics. Heart Lung 2022; 56:70-73. [PMID: 35780572 PMCID: PMC9212718 DOI: 10.1016/j.hrtlng.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/12/2022] [Accepted: 06/14/2022] [Indexed: 11/28/2022]
Abstract
One of the major issues encountered during the coronavirus disease 2019 (COVID-19) pandemic has been the shortage of intravenous anesthetics. Moreover, patients undergoing extracorporeal membrane oxygenation (ECMO) need large quantities of intravenous anesthetics for sedation. We report the case of a 52-year-old man who was admitted to our hospital due to acute respiratory distress syndrome by COVID-19 and treated with ECMO. As controlling sedation with intravenous anesthetics was challenging, we attempted to administer inhaled anesthetics via the gas flow of ECMO. We decreased the quantity of intravenous anesthetics and opioids. This method might help overcome the shortage of intravenous anesthetics.
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Affiliation(s)
- Yudai Iwasaki
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan; Department of Intensive Care, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.
| | - Takuya Shiga
- Department of Intensive Care, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Naoki Hoshi
- Department of Clinical Engineering, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Daisuke Irimada
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan; Department of Intensive Care, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Hidehisa Saito
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan; Department of Intensive Care, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Daisuke Konno
- Department of Intensive Care, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Koji Saito
- Department of Intensive Care, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Masanori Yamauchi
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
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Li WX, Tong X, Yang PP, Zheng Y, Liang JH, Li GH, Liu D, Guan DG, Dai SX. Screening of antibacterial compounds with novel structure from the FDA approved drugs using machine learning methods. Aging (Albany NY) 2022; 14:1448-1472. [PMID: 35150482 PMCID: PMC8876917 DOI: 10.18632/aging.203887] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/28/2022] [Indexed: 11/25/2022]
Abstract
Bacterial infection is one of the most important factors affecting the human life span. Elderly people are more harmed by bacterial infections due to their deficits in immunity. Because of the lack of new antibiotics in recent years, bacterial resistance has increasingly become a serious problem globally. In this study, an antibacterial compound predictor was constructed using the support vector machines and random forest methods and the data of the active and inactive antibacterial compounds from the ChEMBL database. The results showed that both models have excellent prediction performance (mean accuracy >0.9 and mean AUC >0.9 for the two models). We used the predictor to screen potential antibacterial compounds from FDA-approved drugs in the DrugBank database. The screening results showed that 1087 small-molecule drugs have potential antibacterial activity and 154 of them are FDA-approved antibacterial drugs, which accounts for 76.2% of the approved antibacterial drugs collected in this study. Through molecular fingerprint similarity analysis and common substructure analysis, we screened 8 predicted antibacterial small-molecule compounds with novel structures compared with known antibacterial drugs, and 5 of them are widely used in the treatment of various tumors. This study provides a new insight for predicting antibacterial compounds by using approved drugs, the predicted compounds might be used to treat bacterial infections and extend lifespan.
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Affiliation(s)
- Wen-Xing Li
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou 510515, Guangdong, China.,Guangdong Provincial Key Laboratory of Single Cell Technology and Application, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Xin Tong
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming 650500, Yunnan, China
| | - Peng-Peng Yang
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming 650500, Yunnan, China
| | - Yang Zheng
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming 650500, Yunnan, China
| | - Ji-Hao Liang
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming 650500, Yunnan, China
| | - Gong-Hua Li
- State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, Yunnan, China
| | - Dahai Liu
- School of Medicine, Foshan University, Foshan 528000, Guangdong, China
| | - Dao-Gang Guan
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou 510515, Guangdong, China.,Guangdong Provincial Key Laboratory of Single Cell Technology and Application, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Shao-Xing Dai
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming 650500, Yunnan, China
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Achaerandio-de Nova A, Berenguer-Romero MD, Nam Cham S, Gómez-Juárez Sango M, Losa-Palacios S, Escudero-Jiménez A, Gerónimo-Pardo M. Clinical and histological safety assessment of repeated intra-articular sevoflurane injections into knee joints of Sprague-Dawley rats. EUR J INFLAMM 2022. [DOI: 10.1177/20587392211072639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives We investigated the effects of repeated intra-articular injections of liquid sevoflurane to articular structures, as this inhalational anesthetic is being repurposed as an antimicrobial agent, which would make sevoflurane a novel alternative for the treatment of septic arthritis. Methods The left knees of nine Sprague-Dawley rats were injected with 150 μL of liquid sevoflurane for five consecutive days, whereas the right knees were injected with the same volume of saline to serve as controls. Animals were examined daily for clinical signs of local and systemic toxic effects attributable to sevoflurane. Rats were euthanized in groups of three at days 7, 14, and 35 after the first injection, and left and right knees were sent for histological assessment. Results Local signs on knees consisted of transient bilateral scabs, and an unexpected subcutaneous emphysema affecting only left knees, which was attributed to sevoflurane. No rat presented with limp, and animal welfare was good during the study period. Two out of the three left knees from rats sacrificed at day 7 showed mild histological changes, specifically a mild infiltration of lymphocytes. All other seven left knees as well as all nine right knees were completely normal at histological examination. Conclusion We concluded that repeated intra-articular injections of sevoflurane seemed safe for articular structures in noninfected knees. Further studies focused on the safety of intra-articular sevoflurane in infected knees, as well as on its effectiveness for the treatment of septic arthritis are warranted.
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Affiliation(s)
| | | | - Syonghyun Nam Cham
- Department of Pathology, Gerencia de Atención Integrada, de Albacete, Spain
| | | | - Sergio Losa-Palacios
- Department of Orthopaedic and Trauma Surgery, Gerencia de Atención Integrada, de Albacete, Spain
| | - Angel Escudero-Jiménez
- Department of Microbiology and Parasitology, Gerencia de Atención Integrada, de Albacete, Spain
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Fernández-Ginés FD, Cortiñas-Saenz M, Agudo-Ponce D, Morales-Molina JA, Sánchez CF, Sierra-Garcia F. Pain management & opioid dose reduction with topical sevoflurane instillations in intractable venous ulcers: a case report. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902020000318681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Hidalgo-Doniga C, Lopez-Lopez C, Pajero Otero V, Garcia Manzanares ME, Collados-Gomez L, Zaragoza-García I, Aguilar Ortega JM, Del Valle Garzon Delgado M, Perez Garcia S. Use of topical sevoflurane in pressure ulcer treatment in a double-lung transplant patient. J Tissue Viability 2020; 30:124-127. [PMID: 32873458 DOI: 10.1016/j.jtv.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/10/2020] [Accepted: 07/16/2020] [Indexed: 11/29/2022]
Abstract
Pain caused by wounds of different etiology is usually treated with oral analgesics. New topical use of products such as the ether anesthetic sevoflurane shows good results for pain control and has additional benefits. Pressure ulcers are painful and patients may benefit from the use of sevoflurane. We present the case of a double-lung transplant patient with a long-standing sacral pressure ulcer with poor pain control, for which sevoflurane dressings were used. The number of pain-free hours after application, the amount of daily analgesics and the size of the wound were monitored with the mobile wound application MOWA. After several days of sevoflurane application, the patient reduced analgesic consumption, remained longer free of pain, and the size of the wound decreased. Unfortunately, the patient had serious complications due to multiple comorbidities and died before the wound healed completely. Topical use of sevoflurane in pressure ulcers may be a good option to treat pain and improve patient quality of life.
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Fernández-Ginés FD, Cortiñas-Sáenz M, Agudo-Ponce D, Navajas-Gómez de Aranda A, Morales-Molina JA, Fernández-Sánchez C, Sierra-García F, Mateo-Carrasco H. Pain reduction of topical sevoflurane vs intravenous opioids in pressure ulcers. Int Wound J 2019; 17:83-90. [PMID: 31762163 DOI: 10.1111/iwj.13235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/06/2019] [Accepted: 09/13/2019] [Indexed: 11/29/2022] Open
Abstract
Recently, it has been reported that topical irrigations of liquid sevoflurane on the bed of painful wounds produce a rapid, intense, and lasting analgesic effect. In this paper, A cohort of 112 patients with painful pressure ulcers who were refractory to opioids (or who exhibited undesirable adverse events to them) was treated with topical sevoflurane as per local institutional policy. These patients were recruited from an intensive care unit for a period of 3 years. The main aim was to determine the effectiveness of topical sevoflurane in reducing the pain of PUs and reducing the ulcer area. Study findings are reported and discussed herein and suggest that sevoflurane is a viable and promising treatment option for PUs.
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Affiliation(s)
| | - Manuel Cortiñas-Sáenz
- Anesthesiology and Pain Management Department, Torrecárdenas Hospital, Almería, Spain
| | - Desirée Agudo-Ponce
- Anesthesiology and Pain Management Department, Torrecárdenas Hospital, Almería, Spain
| | | | | | | | | | - Héctor Mateo-Carrasco
- Department of Clinical Pharmacy, Division of Oncology, University College London Hospital, London, UK
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Bui UT, Finlayson K, Edwards H. The diagnosis of infection in chronic leg ulcers: A narrative review on clinical practice. Int Wound J 2019; 16:601-620. [PMID: 30697930 PMCID: PMC7948879 DOI: 10.1111/iwj.13069] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/20/2018] [Accepted: 12/28/2018] [Indexed: 12/17/2022] Open
Abstract
This literature review aimed to provide a narrative review of evidence on validity of clinical and microbial indicators of infection and to gain insights into the diagnosis of infection in chronic leg ulcers (CLUs). A search was conducted in Cinahl, Medline, the Cochrane Library databases, Embase, Web of Science, ScienceDirect, Pubmed, PsycINFO, ProQuest dissertations, and Google Scholar from January 1990 to July 2017. The inclusion criteria were original studies, systematic reviews, and consensus documents focused on "infection" in CLUs, English language, clinical and community settings, and human. The reviewed studies were inconsistent in criteria for infection between investigated wound types and lack of specificity regarding wound types. There were few studies investigating the criteria for diagnosis of infection in leg ulcers. The identification of leg ulcer infection still remains problematic and relies on out-of-date and not uniform evidence. Literature in this area was mostly limited to level III and IV evidence based on The Australian National Health and Medical Research Council Levels of Evidence, or expert opinion. This literature review showed seven clinical signs and symptoms that could be diagnostic for infection in CLUs, including: new, increased, or altered ulcer pain; malodour; increased ulcer area; wound breakdown, delayed or non-healing; and erythema and increased local temperature, whilst the microbial indicators used to diagnose infected leg ulcers were varied and regarded as less important.
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Affiliation(s)
- Ut T. Bui
- School of Nursing, Institute of Health and Biomedical Innovation, Faculty of HealthQueensland University of TechnologyKelvin GroveQueenslandAustralia
| | - Kathleen Finlayson
- School of Nursing, Institute of Health and Biomedical Innovation, Faculty of HealthQueensland University of TechnologyKelvin GroveQueenslandAustralia
| | - Helen Edwards
- School of Nursing, Institute of Health and Biomedical Innovation, Faculty of HealthQueensland University of TechnologyKelvin GroveQueenslandAustralia
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Does volatile sedation with sevoflurane allow spontaneous breathing during prolonged prone positioning in intubated ARDS patients? A retrospective observational feasibility trial. Ann Intensive Care 2019; 9:41. [PMID: 30911854 PMCID: PMC6434001 DOI: 10.1186/s13613-019-0517-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/18/2019] [Indexed: 02/07/2023] Open
Abstract
Background Lung-protective ventilation and prolonged prone positioning (PP) are presented as essential in treating acute respiratory distress syndrome (ARDS). The optimal respirator mode, however, remains controversial. Pressure-supported spontaneous breathing (PS) during ARDS provides several advantages, but is difficult to achieve during PP because of respiratory depression as a side effect of sedative drugs. This study was designed to evaluate the feasibility and safety of PS during PP in ARDS patients sedated with inhaled sevoflurane. Results Overall, we have observed 4339 h of prone positioning in 62 patients who had a median of four prone episodes during treatment. Within 3948 h (91%), patients were successfully brought into a pressure-supported spontaneous breathing mode. The median duration of each prone episode was 17 h (IQR 3). Median duration of pressure-supported spontaneous breathing per episode was 16 h (IQR 5). Just one self-extubation occurred during 276 episodes of PP. Conclusions and implications Pressure-supported spontaneous breathing during prolonged prone positioning in intubated ARDS patients with or without ECMO can be achieved during volatile sedation with sevoflurane. This finding may provide a basis upon which to question the latest dogma in ARDS treatment. Our concept must be further investigated and compared to controlled ventilation with regard to driving pressure, lung-protective parameters, muscle weakness and mortality before it can be routinely applied.
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Martínez-Monsalve A, Selva-Sevilla C, Gerónimo-Pardo M. Analgesic effectiveness of topical sevoflurane to perform sharp debridement of painful wounds. J Vasc Surg 2019; 69:1532-1537. [PMID: 30612826 DOI: 10.1016/j.jvs.2018.08.175] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/08/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Analgesic topical options to perform wound debridement are scarce. The purpose of this study was to communicate our experience using topical sevoflurane as analgesic for wound debridement. METHODS After approval by our institutional review board, medical records were reviewed for those patients who had previously accepted to be treated with off-label topical sevoflurane (1 mL/cm2) as an analgesic for sharp debridement of painful wounds, because it was previously approved by our institutional Pharmacy Regulatory Commission and Medical Management. According to this protocol, pain scores were measured by using a numerical rating scale (from 0 to 10 points) over a 10-hour period. Wound debridement was performed following routine procedures. RESULTS Medical records from 152 patients were reviewed. Baseline pain was severe (median, 7 points). After topical sevoflurane application, the analgesic effect was rapid (median pain score of 2 points at 5 minutes), and full debridement was feasible in most wounds (93%). The initial intense analgesic effect lasted for 30 minutes and then it subsided gradually over time to nearly reach baseline values after 10 hours. The patients estimated that the analgesic effect lasted several hours (median, 9 hours), and their overall satisfaction was high (median of 8 points on a scale ranging from 0 to 10). Fifty-two patients (34%) experienced itching. CONCLUSIONS Topical application of sevoflurane to painful wounds produced a rapid, robust, and long-lasting analgesic effect, which allowed for a high degree of wound debridement.
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Affiliation(s)
- Angel Martínez-Monsalve
- Department of Angiology and Vascular Surgery, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Carmen Selva-Sevilla
- Department of Applied Economy, Facultad de Ciencias Económicas y Empresariales, Universidad de Castilla La Mancha, Albacete, Spain
| | - Manuel Gerónimo-Pardo
- Department of Anaesthesiology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
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