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Rufiange M, Leung VSY, Simpson K, Pang DSJ. Pre-warming following premedication limits hypothermia before and during anesthesia in Sprague-Dawley rats (Rattus norvegicus). Can J Vet Res 2021; 85:106-111. [PMID: 33883817 PMCID: PMC7995546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/07/2020] [Indexed: 06/12/2023]
Abstract
In humans and other mammals, general anesthesia impairs thermoregulation, leading to warm core blood redistributing to the periphery. This redistribution is an important contributor to hypothermia that can be reduced with pre-warming before anesthesia. Additionally, sedation following premedication has been associated with hypothermia in dogs. In a prospective, randomized, cross-over study, 8 adult male and female rats (weighing 388 to 755 g) were sedated with intramuscular ketamine-midazolam-hydromorphone, then placed in an unwarmed cage or warmed box for 14 minutes, followed by 30 minutes of isoflurane anesthesia with active warming. Core body temperature was monitored throughout. After sedation, warmed rats gained 0.28°C ± 0.13°C and unwarmed rats lost 0.19°C ± 0.43°C, a significant difference between groups (P = 0.004). After anesthesia, warmed rats maintained higher core temperatures (P < 0.0001) with 2/8 and 6/8 of warmed and unwarmed rats becoming hypothermic, respectively. Pre-warming during sedation and active warming during general anesthesia is effective in minimizing hypothermia.
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Affiliation(s)
- Maxime Rufiange
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Québec (Rufiange, Leung, Pang); Groupe de Recherche de Pharmacologie Animale du Québec, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Québec (Rufiange, Leung, Pang); Vetronic Services, Abbotskerwell, England (Simpson); Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta (Pang)
| | - Vivian S Y Leung
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Québec (Rufiange, Leung, Pang); Groupe de Recherche de Pharmacologie Animale du Québec, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Québec (Rufiange, Leung, Pang); Vetronic Services, Abbotskerwell, England (Simpson); Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta (Pang)
| | - Keith Simpson
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Québec (Rufiange, Leung, Pang); Groupe de Recherche de Pharmacologie Animale du Québec, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Québec (Rufiange, Leung, Pang); Vetronic Services, Abbotskerwell, England (Simpson); Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta (Pang)
| | - Daniel S J Pang
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Québec (Rufiange, Leung, Pang); Groupe de Recherche de Pharmacologie Animale du Québec, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Québec (Rufiange, Leung, Pang); Vetronic Services, Abbotskerwell, England (Simpson); Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta (Pang)
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Witkin JM, Cerne R, Davis PG, Freeman KB, do Carmo JM, Rowlett JK, Methuku KR, Okun A, Gleason SD, Li X, Krambis MJ, Poe M, Li G, Schkeryantz JM, Jahan R, Yang L, Guo W, Golani LK, Anderson WH, Catlow JT, Jones TM, Porreca F, Smith JL, Knopp KL, Cook JM. The α2,3-selective potentiator of GABA A receptors, KRM-II-81, reduces nociceptive-associated behaviors induced by formalin and spinal nerve ligation in rats. Pharmacol Biochem Behav 2019; 180:22-31. [PMID: 30825491 PMCID: PMC6529285 DOI: 10.1016/j.pbb.2019.02.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/24/2019] [Accepted: 02/25/2019] [Indexed: 02/03/2023]
Abstract
Clinical evidence indicates that positive allosteric modulators (PAMs) of GABAA receptors have analgesic benefit in addition to efficacy in anxiety disorders. However, the utility of GABAA receptor PAMs as analgesics is compromised by the central nervous system side effects of non-selective potentiators. A selective potentiator of GABAA receptors associated with α2/3 subunits, KRM-II-81(5-(8-ethynyl-6-(pyridin-2-yl)-4H-benzo[f]imidazo[1,5-a][1,4]diazepin-3-yl)oxazole), has demonstrated anxiolytic, anticonvulsant, and antinociceptive effects in rodents with reduced motoric side effects. The present study evaluated the potential of KRM-II-81 as a novel analgesic. Oral administration of KRM-II-81 attenuated formalin-induced flinching; in contrast, diazepam was not active. KRM-II-81 attenuated nociceptive-associated behaviors engendered by chronic spinal nerve ligation (L5/L6). Diazepam decreased locomotion of rats at the dose tested in the formalin assay (10 mg/kg) whereas KRM-II-81 produced small decreases that were not dose-dependent (10-100 mg/kg). Plasma and brain levels of KRM-II-81 were used to demonstrate selectivity for α2/3- over α1-associated GABAA receptors and to define the degree of engagement of these receptors. Plasma and brain concentrations of KRM-II-81 were positively-associated with analgesic efficacy. GABA currents from isolated rat dorsal-root ganglion cultures were potentiated by KRM-II-81 with an ED50 of 32 nM. Measures of respiratory depression were reduced by alprazolam whereas KRM-II-81 was either inactive or produced effects with lower potency and efficacy. These findings add to the growing body of data supporting the idea that α2/3-selective GABAA receptor PAMs will have efficacy and tolerability as pain medications including those for neuropathic pain. Given their predicted anxiolytic effects, α2/3-selective GABAA receptor PAMs offer an additional inroad into the management of pain.
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Affiliation(s)
- J M Witkin
- The Lilly Research Labs, Eli Lilly and Company, Indianapolis, IN, USA; Department of Chemistry & Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, WI, USA; Laboratory of Antiepileptic Drug Discovery, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - R Cerne
- The Lilly Research Labs, Eli Lilly and Company, Indianapolis, IN, USA
| | | | - K B Freeman
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - J M do Carmo
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, USA
| | - J K Rowlett
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - K R Methuku
- Department of Chemistry & Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - A Okun
- The Lilly Research Labs, Eli Lilly and Company, Indianapolis, IN, USA
| | - S D Gleason
- The Lilly Research Labs, Eli Lilly and Company, Indianapolis, IN, USA
| | - X Li
- The Lilly Research Labs, Eli Lilly and Company, Indianapolis, IN, USA
| | - M J Krambis
- The Lilly Research Labs, Eli Lilly and Company, Indianapolis, IN, USA
| | - M Poe
- Department of Chemistry & Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - G Li
- Department of Chemistry & Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - J M Schkeryantz
- The Lilly Research Labs, Eli Lilly and Company, Indianapolis, IN, USA
| | - R Jahan
- Department of Chemistry & Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - L Yang
- The Lilly Research Labs, Eli Lilly and Company, Indianapolis, IN, USA
| | - W Guo
- The Lilly Research Labs, Eli Lilly and Company, Indianapolis, IN, USA
| | - L K Golani
- Department of Chemistry & Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - W H Anderson
- The Lilly Research Labs, Eli Lilly and Company, Indianapolis, IN, USA
| | - J T Catlow
- The Lilly Research Labs, Eli Lilly and Company, Indianapolis, IN, USA
| | - T M Jones
- The Lilly Research Labs, Eli Lilly and Company, Indianapolis, IN, USA
| | - F Porreca
- Department of Pharmacology, University of Arizona, Tucson, AZ, USA
| | - J L Smith
- Laboratory of Antiepileptic Drug Discovery, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - K L Knopp
- The Lilly Research Labs, Eli Lilly and Company, Indianapolis, IN, USA
| | - J M Cook
- Department of Chemistry & Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Soares JH, Henao-Guerrero N, Pavlisko ND, Williamson EJ, Giannella-Neto A. The effect of two doses of fentanyl on chest wall rigidity at equipotent doses of isoflurane in dogs. Vet Anaesth Analg 2019; 46:360-364. [PMID: 30772260 DOI: 10.1016/j.vaa.2019.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the effect of two doses of fentanyl upon chest wall rigidity of dogs anesthetized at equipotent doses of isoflurane [1.3 minimum alveolar concentration (MACISO) of each dose of fentanyl]. STUDY DESIGN Prospective crossover randomized study. ANIMALS A group of eight male Beagle dogs, approximately 1 year old and weighing 12.1 ± 1.6 kg (mean ± standard deviation). METHODS The dogs were anesthetized with isoflurane and instrumented for the measurement of esophageal pressure (PESO), flow (V˙) and volume (V). Chest wall elastance (ECW) was estimated by multiple linear regression of the model. PESO(t) = V˙(t) × RCW + V(t) × ECW + EEPESO where t is time, RCW is chest wall resistance and EEPESO is end-expiratory PESO. Chest wall compliance (CCW) was calculated as 1/ECW and normalized to the body weight of each dog (mL cmH2O-1 kg-1). Anesthesia was maintained at 1.3 MACISO for at least 15 minutes and CCW recorded (CCW-ISO). The dogs were randomly assigned to the lower fentanyl dose [loading dose (33 μg kg-1) and infusion (0.2 μg kg-1 minute-1)] or the higher fentanyl dose [loading dose (102 μg kg-1) and infusion (0.8 μg kg-1 minute-1)]. After 60 minutes of fentanyl infusion, CCW was recorded for each dose (CCW-FENT). During fentanyl infusion, the dogs were maintained at equipotent doses of isoflurane (1.3 MACISO for each fentanyl dose). A two-way analysis of variance followed by a Bonferroni test was used to compare CCW-ISO and CCW-FENT in both treatments and CCW-FENT between treatments. A p value <0.05 was considered significant. RESULTS Neither of the fentanyl doses decreased CCW and there was no difference in CCW-FENT between doses. CONCLUSIONS AND CLINICAL RELEVANCE Fentanyl at the studied doses did not result in chest wall rigidity in dogs anesthetized with equipotent doses of isoflurane (1.3 MACISO).
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Affiliation(s)
- João Hn Soares
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA.
| | - Natalia Henao-Guerrero
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA
| | - Noah D Pavlisko
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA
| | - Ellen J Williamson
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA
| | - Antonio Giannella-Neto
- Laboratory of Pulmonary Engineering, Biomedical Engineering Program/COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Wu C, Engler C, Norton R. Growth of Staphylococcus epidermidis in Anaesthetic Resuscitative Drugs: Implications for Potential Contamination. Anaesth Intensive Care 2019; 33:69-72. [PMID: 15957694 DOI: 10.1177/0310057x0503300111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This controlled laboratory study investigated the survival of Staphylococcus epidermidis (S. epidermidis) over a 24 hour period in four commonly drawn-up anaesthetic resuscitative drugs: suxamethonium, atropine, metaraminol and ephedrine. These drugs were prepared in typical therapeutic concentrations and then inoculated with S. epidermidis. Samples of the inoculated drug preparations were cultured on horse blood agar plates at 0, 2, 6, 12 and 24 hourly intervals and incubated for 24 hours. Colony counts were performed at the end of the incubation period. Suxamethonium, atropine and metaraminol all showed an inhibitory effect on colony counts within the first six hours. There was a more gradual decline of colony counts over a 24 hour period in the ephedrine solution. This decline was similar to that occurring in the normal saline. It is concluded that suxamethonium, atropine and metaraminol do not support the survival of the common skin contaminant, S. epidermidis over a 24 hour period.
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Affiliation(s)
- C Wu
- Departments of Anaesthesia and Microbiology, The Townsville Hospital, Townsville, Queensland
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Goh PK, Chiu CL, Wang CY, Chan YK, Loo PL. Randomized Double-blind Comparison of Ketamine-Propofol, Fentanyl-Propofol and Propofol-Saline on Haemodynamics and Laryngeal Mask Airway Insertion Conditions. Anaesth Intensive Care 2019; 33:223-8. [PMID: 15960405 DOI: 10.1177/0310057x0503300211] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this prospective, double-blind, randomized, placebo-controlled clinical trial was to investigate whether the administration of ketamine before induction with propofol improves its associated haemodynamic profile and laryngeal mask airway (LMA) insertion conditions. Ninety adult patients were randomly allocated to receive either ketamine 0.5 mg.kg-1 (n=30), fentanyl 1 μg.kg-1 (n=30) or normal saline (n=30), before induction of anaesthesia with propofol 2.5 mg.kg-1. Insertion of the LMA was performed 60s after injection of propofol. Arterial blood pressure and heart rate were measured before induction (baseline), immediately after induction, immediately before LMA insertion, immediately after LMA insertion and every minute for three minutes after LMA insertion. Following LMA insertion, the following six subjective endpoints were graded by a blinded anaesthestist using ordinal scales graded 1 to 3: mouth opening, gagging, swallowing, movement, laryngospasm and ease of insertion. Systolic blood pressure was significantly higher following ketamine than either fentanyl (P=0.010) or saline (P=0.0001). The median (interquartile range) summed score describing the overall insertion conditions were similar in the ketamine [median 7.0, interquartile range (6.0–8.0)] and fentanyl groups [median 7.0, interquartile range (6.0–8.0)]. Both appeared significantly better than the saline group [median 8.0, interquartile range (6.75–9.25); P=0.024]. The incidence of prolonged apnoea (>120s) was higher in the fentanyl group [23.1% (7/30)] compared with the ketamine [6.3% (2/30)] and saline groups [3.3% (1/30)]. We conclude that the addition of ketamine 0.5 mg.kg–1 improves haemo-dynamics when compared to fentanyl 1 μg.kg–1, with less prolonged apnoea, and is associated with better LMA insertion conditions than placebo (saline).
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Affiliation(s)
- P K Goh
- Department of Anaesthesia and Intensive Care, Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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Chen Q, An R, Zhou J, Yang B. Clinical analgesic efficacy of dexamethasone as a local anesthetic adjuvant for transversus abdominis plane (TAP) block: A meta-analysis. PLoS One 2018; 13:e0198923. [PMID: 29902215 PMCID: PMC6002066 DOI: 10.1371/journal.pone.0198923] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/29/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Perineural dexamethasone has been shown to prolong the duration of local anesthetic (LA) effect in regional anesthesia; however, the use of perineural dexamethasone as an adjuvant to to the transversus abdominis plane (TAP) block remains controversial. This meta-analysis sought to assess the efficacy of dexamethasone in prolonging the TAP block and enhancing recovery after abdominal surgery. METHODS We identified and analyzed 9 RCTs published on or before September 30, 2017, regardless of the original language, after searching the following 6 bibliographic databases: PubMed, EMBASE, Medline, Springer, Ovid, and the Cochrane Library. databases. These studies compared the effects of perineural dexamethasone mixed with local anesthetic versus local anesthetic alone in the TAP block. The Cochrane Collaboration's Risk of Bias Tool was used to evaluate the methodological quality of each RCT. The primary outcomes were the time until the first request for postoperative analgesics and the analog pain scores at 2, 6, 12, and 24 h after surgery. The secondary outcomes were the analgesic consumption and the incidence of nausea and vomiting on the first day after surgery. We used Trial Sequential Analysis (TSA) to control for random errors. RESULTS Perineural dexamethasone prolonged the duration of LA effect in the TAP block [mean difference (MD): 2.98 h; 95% confidence interval (CI): 2.19 to 3.78] and reduced analog pain scores at 2 h [MD: -1.15; 95% CI: -2.14 to -0.16], 6 h [MD: -0.97; 95% CI: -1.51 to -0.44], and 12 h [MD: -0.93; 95% CI: -1.14 to -0.72] postoperatively. Furthermore, the use of perineural dexamethasone was associated with less analgesic consumption [standard mean difference: -1.29; 95% CI: -1.88 to -0.70] and a lower incidence of nausea and vomiting [odds ratio: 0.28; 95% CI: 0.16 to 0.49] on the first day after surgery. CONCLUSION Dexamethasone prolongs the LA effect when used as an adjuvant in the TAP block and improves the analgesic effects of the block.
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Affiliation(s)
- Qi Chen
- Department of Anesthesiology, Chongqing University Cancer Hospital/Chongqing Cancer Institute, Chongqing, China
| | - Ran An
- Department of Anesthesiology, Chongqing University Cancer Hospital/Chongqing Cancer Institute, Chongqing, China
| | - Ju Zhou
- Department of Anesthesiology, Chongqing University Cancer Hospital/Chongqing Cancer Institute, Chongqing, China
| | - Bin Yang
- Department of Anesthesiology, Chongqing University Cancer Hospital/Chongqing Cancer Institute, Chongqing, China
- * E-mail:
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Durrmeyer X, Breinig S, Claris O, Tourneux P, Alexandre C, Saliba E, Beuchée A, Jung C, Levy C, Marchand-Martin L, Marcoux MO, Dechartres A, Danan C. Effect of Atropine With Propofol vs Atropine With Atracurium and Sufentanil on Oxygen Desaturation in Neonates Requiring Nonemergency Intubation: A Randomized Clinical Trial. JAMA 2018; 319:1790-1801. [PMID: 29715354 PMCID: PMC6583687 DOI: 10.1001/jama.2018.3708] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Propofol or a combination of a synthetic opioid and muscle relaxant are both recommended for premedication before neonatal intubation but have yet to be compared. OBJECTIVE To compare prolonged desaturation during neonatal nasotracheal intubation after premedication with atropine-propofol vs atropine-atracurium-sufentanil treatment. DESIGN, SETTING, AND PARTICIPANTS Multicenter, double-blind, randomized clinical trial (2012-2016) in 6 NICUs in France that included 173 neonates requiring nonemergency intubation. The study was interrupted due to expired study kits and lack of funding. INTERVENTIONS Eighty-nine participants were randomly assigned to the atropine-propofol group and 82 to the atropine-atracurium-sufentanil group before nasotracheal intubation. MAIN OUTCOMES AND MEASURES The primary outcome was prolonged desaturation (Spo2 <80% lasting > 60 seconds), using intention-to-treat analysis using mixed models. Secondary outcomes assessed the characteristics of the procedure and its tolerance. RESULTS Of 173 neonates randomized (mean gestational age, 30.6 weeks; mean birth weight, 1502 g; 71 girls), 171 (99%) completed the trial. Of 89 infants, 53 (59.6%) in the atropine-propofol group vs 54 of 82 (65.9%) in the atropine-atracurium-sufentanil group achieved the primary outcome (adjusted RD, -6.4; 95% CI, -21.0 to 8.1; P = .38). The atropine-propofol group had a longer mean procedure duration than did the atropine-atracurium-sufentanil group (adjusted RD, 1.7 minutes; 95% CI, 0.1-3.3 minutes; P = .04); a less frequent excellent quality of sedation rate, 51.7% (45 of 87) vs 92.6% (75 of 81; P < .001); a shorter median time to respiratory recovery, 14 minutes (IQR, 8-34 minutes) vs 33 minutes (IQR, 15-56 minutes; P = .002), and shorter median time to limb movement recovery, 18 minutes (IQR, 10-43 minutes) vs 36 minutes (IQR, 19-65 minutes; P = .003). In the 60 minutes after inclusion, Spo2 was preserved significantly better in the atropine-propofol group (time × treatment interaction P = .02). Of the atropine-propofol group 20.6% had head ultrasound scans that showed worsening intracranial hemorrhaging (any or increased intraventricular hemorrhage) in the 7 days after randomization vs 17.6% in the atropine-atracurium-sufentanil group (adjusted RD, 1.2; 95% CI, -13.1 to 15.5, P = .87). Severe adverse events occurred in 11% of the atropine-propofol group and in 20% of the atropine-atracurium-sufentanil group. CONCLUSIONS AND RELEVANCE Among neonates undergoing nonemergency nasotracheal intubation, the frequency of prolonged desaturation did not differ significantly between atropine used with propofol or atropine used with atracurium and sufentanil. However, the study may have been underpowered to detect a clinically important difference, and further research may be warranted. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01490580, EudraCT number: 2009-014885-25.
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Affiliation(s)
- Xavier Durrmeyer
- Neonatal Intensive Care Unit, CHI Créteil, CRETEIL, France
- INSERM, U1153, Obstetrical, Perinatal and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne, Paris Descartes University, France
| | - Sophie Breinig
- Pediatric and Neonatal Intensive Care Unit, CHU Toulouse, Toulouse, France
| | - Olivier Claris
- Neonatal Intensive Care Unit, Hospices civils de Lyon, Lyon, France
| | | | | | - Elie Saliba
- Neonatal Intensive Care Unit, CHU Tours, Tours, France
| | - Alain Beuchée
- Neonatal Intensive Care Unit, CHU Rennes, Rennes, France
| | - Camille Jung
- Clinical Research Center, CHI Créteil, Créteil, France
| | - Corinne Levy
- ACTIV, St Maur, France
- IMRB- GRC GEMINI, Université Paris Est, Créteil, France
| | - Laetitia Marchand-Martin
- INSERM, U1153, Obstetrical, Perinatal and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne, Paris Descartes University, France
| | | | - Agnes Dechartres
- INSERM, U1153, METHODS Team, Epidemiology and Statistics Sorbonne Paris Cité Research Center, Paris Descartes University, Hotel-Dieu Hospital (AP-HP), France
| | - Claude Danan
- Neonatal Intensive Care Unit, CHI Créteil, CRETEIL, France
- Clinical Research Center, CHI Créteil, Créteil, France
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Salla KM, Tuns CI, Bennett RC, Raekallio MR, Scheinin M, Kuusela E, Vainio OM. Cardiovascular effects of premedication with medetomidine alone and in combination with MK-467 or glycopyrrolate in dogs subsequently anesthetized with isoflurane. Am J Vet Res 2018; 78:1245-1254. [PMID: 29076369 DOI: 10.2460/ajvr.78.11.1245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare cardiovascular effects of premedication with medetomidine alone and with each of 3 doses of MK-467 or after glycopyrrolate in dogs subsequently anesthetized with isoflurane. ANIMALS 8 healthy purpose-bred 5-year-old Beagles. PROCEDURES In a randomized crossover study, each dog received 5 premedication protocols (medetomidine [10 μg/kg, IV] alone [MED] and in combination with MK-467 at doses of 50 [MMK50], 100 [MMK100], and 150 [MMK150] μg/kg and 15 minutes after glycopyrrolate [10 μg/kg, SC; MGP]), with at least 14 days between treatments. Twenty minutes after medetomidine administration, anesthesia was induced with ketamine (0.5 mg/kg, IV) and midazolam (0.1 mg/kg, IV) increments given to effect and maintained with isoflurane (1.2%) for 50 minutes. Cardiovascular variables were recorded, and blood samples for determination of plasma dexmedetomidine, levomedetomidine, and MK-467 concentrations were collected at predetermined times. Variables were compared among the 5 treatments. RESULTS The mean arterial pressure and systemic vascular resistance index increased following the MED treatment, and those increases were augmented and obtunded following the MGP and MMK150 treatments, respectively. Mean cardiac index for the MMK100 and MMK150 treatments was significantly greater than that for the MGP treatment. The area under the time-concentration curve to the last sampling point for dexmedetomidine for the MMK150 treatment was significantly lower than that for the MED treatment. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated concurrent administration of MK-467 with medetomidine alleviated medetomidine-induced hemodynamic changes in a dose-dependent manner prior to isoflurane anesthesia. Following MK-467 administration to healthy dogs, mean arterial pressure was sustained at acceptable levels during isoflurane anesthesia.
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Fink AM, Dean C, Piano MR, Carley DW. The pedunculopontine tegmentum controls renal sympathetic nerve activity and cardiorespiratory activities in nembutal-anesthetized rats. PLoS One 2017; 12:e0187956. [PMID: 29121095 PMCID: PMC5679551 DOI: 10.1371/journal.pone.0187956] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 10/30/2017] [Indexed: 11/18/2022] Open
Abstract
Elevated renal sympathetic nerve activity (RSNA) accompanies a variety of complex disorders, including obstructive sleep apnea, heart failure, and chronic kidney disease. Understanding pathophysiologic renal mechanisms is important for determining why hypertension is both a common sequelae and a predisposing factor of these disorders. The role of the brainstem in regulating RSNA remains incompletely understood. The pedunculopontine tegmentum (PPT) is known for regulating behaviors including alertness, locomotion, and rapid eye movement sleep. Activation of PPT neurons in anesthetized rats was previously found to increase splanchnic sympathetic nerve activity and blood pressure, in addition to altering breathing. The present study is the first investigation of the PPT and its potential role in regulating RSNA. Microinjections of DL-homocysteic acid (DLH) were used to probe the PPT in 100-μm increments in Nembutal-anesthetized rats to identify effective sites, defined as locations where changes in RSNA could be evoked. A total of 239 DLH microinjections were made in 18 rats, which identified 20 effective sites (each confirmed by the ability to evoke a repeatable sympathoexcitatory response). Peak increases in RSNA occurred within 10–20 seconds of PPT activation, with RSNA increasing by 104.5 ± 68.4% (mean ± standard deviation) from baseline. Mean arterial pressure remained significantly elevated for 30 seconds, increasing from 101.6 ± 18.6 mmHg to 135.9 ± 36.4 mmHg. DLH microinjections also increased respiratory rate and minute ventilation. The effective sites were found throughout the rostal-caudal extent of the PPT with most located in the dorsal regions of the nucleus. The majority of PPT locations tested with DLH microinjections did not alter RSNA (179 sites), suggesting that the neurons that confer renal sympathoexcitatory functions comprise a small component of the PPT. The study also underscores the importance of further investigation to determine whether sympathoexcitatory PPT neurons contribute to adverse renal and cardiovascular consequences of diseases such as obstructive sleep apnea and heart failure.
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Affiliation(s)
- Anne M. Fink
- Center for Narcolepsy, Sleep, and Health Research, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, Illinois, United States of America
- * E-mail:
| | - Caron Dean
- Department of Anesthesiology, Medical College of Wisconsin and Zablocki VA Medical Center, Milwaukee, Wisconsin, United States of America
| | - Mariann R. Piano
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - David W. Carley
- Center for Narcolepsy, Sleep, and Health Research, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, United States of America
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Quan LX, An HX, Wang DX. [Impact of dexmedetomidine-sevoflurane anesthesia on intraoperative wake-up test in children patients undergoing scoliosis surgery]. Beijing Da Xue Xue Bao Yi Xue Ban 2016; 48:855-859. [PMID: 27752170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To observe the effects of 0.4 μg/(kg×h) dose of dexmedetomidine on intra-operative wake-up test in children patients undergoing scoliosis surgery. METHODS Sixty patients for posterior scoliosis correction (ASA I-II, aged 5-16 years) from March 2013 to April 2015 were enrolled in this prospective, double-blinded, randomized, placebo-controlled study, The patients were randomly classified into two groups to receive dexmedetomidine (group RD, n=30) or saline solution (group R, n=30). In group RD, dexmedetomidine [0.4 μg/(kg×h)] was administered after tracheal intubation, while the equal volume saline solution was given instead in group R. Anesthesia was induced with midazolam, propofol, sufentanyl and cisatracurium, and anesthesia was maintained with sevoflurane inhalation and a continuous intravenous infusion of remifentanil in the both groups.BIS (bispectral index, BIS) value was maintained at 40-60,and mean arterial pressure (MAP) was maintained at ≥ 60 mmHg before the wake-up test.When the wake-up test was performed, immediately the dexmedetomidine and remifentanil infusion were stopped, and the end-tidal concentration of sevoflurane was adjusted to 0. Mean arterial pressure, and heart rate (HR) were recorded before anesthesia and at 5-minute intervals during the wake-up test. The wake-up test time, arousal quality and sedation scores were recorded also.In addition, the data were also gathered on the dosage of ephedrine and atropine were used, as well as the intraoperative awareness in the patients who were followed up on the first day after the operation. RESULTS There were no differences between group RD and group R with regard to HR and MAP at getting into the operation room (t=-1.460, P=0.150;t =-1.015, P=0.315). In group RD, no evidence was found for a difference in HR and MAP at awakening up versus at getting into the operation room (t=0.974, P=0.340; t=-1.449, P=0.161), while in group R, an increase in HR and MAP occurred at awakening versus at getting into the operation room (t=-2.106, P=0.044; t=-2.352, P=0.026). There were no significant differences in sedation scores and wake-up test time between the two groups (t=1.986, P=0.052; t=0.392, P=0.697). The wake-up test quality was significantly better in group RD than in group R (t=-2.098,P=0.041). HR in group RD was significantly lower than that in group R at any time point during the wake-up test (P<0.05). Four patients had awareness occurrence during the operation in group R, and no awareness occurrence in group RD. CONCLUSION Dexmedetomidine, when administered at a rate of 0.4 μg/(kg×h) as an adjuvant of sevoflurane inhalational anesthesia, could improve the wake-up test quality, and maintain hemodynamic stability during scoliosis surgery.
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Affiliation(s)
- L X Quan
- Department of Anesthesiology, Zhengzhou Orthopedic Hospital, Zhengzhou 450052,China
| | - H X An
- Department of Anesthesiology, Zhengzhou Orthopedic Hospital, Zhengzhou 450052,China
| | - D X Wang
- Department of Anesthesiology, Peking University First Hospital, Beijing 100034, China
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Kwak HJ, Kwak YL, Oh YJ, Shim YH, Kim SH, Hong YW. Effect of Angiotensin-converting Enzyme Inhibitors on Phenylephrine Responsiveness in Patients with Valvular Heart Disease. J Int Med Res 2016; 33:150-9. [PMID: 15790126 DOI: 10.1177/147323000503300202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We studied patients with valvular heart disease to investigate whether chronic pre-operative treatment with angiotensin-converting enzyme (ACE) inhibitors modulates the effect of phenylephrine (PE) on anaesthesia-induced hypotension. Sixty-five patients were enrolled in the study and hypotension developed after anaesthesia in 36 (18 in the control group and 18 in the ACE inhibitor group). These patients received PE infusions, which were increased in a stepwise fashion at 10-min intervals. Increased mean arterial pressure due to PE infusion was significant only in the control group. There was no significant difference in pressor response or change in haemodynamic variables with PE infusion between the two groups. Treatment with ACE inhibitors did not increase the incidence of hypotensive episodes or significantly modify pressor response after anaesthesia in patients with valvular heart disease.
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Affiliation(s)
- H J Kwak
- Department of Anaesthesiology and Pain Medicine, Gachon Medical School, Gil Hospital, Incheon, Korea.
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Malavasi LM, Nyman G, Augustsson H, Jacobson M, Jensen-Waern M. Effects of epidural morphine and transdermal fentanyl analgesia on physiology and behaviour after abdominal surgery in pigs. Lab Anim 2016; 40:16-27. [PMID: 16460586 DOI: 10.1258/002367706775404453] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of this work was to evaluate the physiological and behavioural effects of opioid analgesic treatment in pigs subjected to abdominal surgery. Ten Swedish Landrace × Yorkshire pigs (20 ± 4 kg b.w.) were submitted for intestinal cannulation. The pigs were allocated into two groups during one preoperative, one surgical and two postoperative days. All pigs were anaesthetized with medetomidine, tiletamine and zolazepam. One group was treated with epidural morphine (0.1 mg/kg) preoperatively, and transdermal fentanyl patches (50 μg/kg/h) were applied behind the ear immediately after surgery. The other group received epidural saline (equivalent volume) and placebo patches. All pigs were regularly weighed and clinically examined and repeated blood samples were analysed for serum concentrations of cortisol, β-endorphin and fentanyl. Pre- and postoperative behaviours were evaluated by a swine specialist blinded to the treatment, three times a day, and were also videotape recorded for a total of 84 h per pig. No differences in behaviour were noted by the observer. During the first postoperative 12 h, treated pigs did not differ in activity compared with preoperative recordings, while untreated pigs were found to be less active. The treated group started to show interest in eating immediately after anaesthesia recovery, whereas the placebo group did not. During the 12–60 h postoperative period, the treated group had lower activity levels compared with the preoperative levels, which were similar to those in the placebo group. Treated pigs gained 0.5 ± 0.2 kg during the subsequent two postoperative days, whereas the untreated pigs lost weight throughout the experiment. Cortisol concentration differed immediately after the surgery: Group P had 325 ± 120 nmol/L and Group M 159 ± 49 nmol/L. β-endorphin concentration did not differ between groups. The highest serum fentanyl concentration (0.37 ± 0.3 ng/mL) was measured 24 h postoperatively. Preoperative epidural morphine in combination with postoperative transdermal fentanyl resulted in earlier return to normal activity levels and an immediate weight gain after surgery.
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Affiliation(s)
- L M Malavasi
- Department of Large Animal Clinical Sciences, Faculty of Veterinary Medicine, Swedish University of Agricultural Sciences, Uppsala, Sweden.
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Sayre RS, Lepiz MA, Horsley KT, Pashmakova MB, Barr JW, Washburn SE. Effects of oxymorphone hydrochloride or hydromorphone hydrochloride on minimal alveolar concentration of desflurane in sheep. Am J Vet Res 2016; 76:583-90. [PMID: 26111087 DOI: 10.2460/ajvr.76.7.583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To establish the minimum alveolar concentration (MAC) of desflurane and evaluate the effects of 2 opioids on MAC in sheep. ANIMALS 8 adult nulliparous mixed-breed sheep. PROCEDURES A randomized crossover design was used. Each sheep was evaluated individually on 2 occasions (to allow assessment of the effects of each of 2 opioids), separated by a minimum of 10 days. On each occasion, sheep were anesthetized with desflurane in 100% oxygen, MAC of desflurane was determined, oxymorphone (0.05 mg/kg) or hydromorphone (0.10 mg/kg) was administered IV, and MAC was redetermined. Physiologic variables and arterial blood gas and electrolyte concentrations were measured at baseline (before MAC determination, with end-tidal desflurane concentration maintained at 10%) and each time MAC was determined. Timing of various stages of anesthesia was recorded for both occasions. RESULTS Mean ± SEM MAC of desflurane was 8.6 ± 0.2%. Oxymorphone or hydromorphone administration resulted in significantly lower MAC (7.6 ± 0.4% and 7.9 ± 0.2%, respectively). Cardiac output at MAC determination for desflurane alone and for desflurane with opioid administration was higher than that at baseline. No difference was identified among hematologic values at any point. Effects of oxymorphone and hydromorphone on durations of various stages of anesthesia did not differ significantly. CONCLUSIONS AND CLINICAL RELEVANCE MAC of desflurane in nulliparous adult sheep was established. Intravenous administration of oxymorphone or hydromorphone led to a decrease in MAC; however, the clinical importance of that decrease was minor relative to the effect in other species.
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Oh CH, Ji GY, Yoon SH, Hyun D, Park HC, Kim YJ. Paralytic Ileus and Prophylactic Gastrointestinal Motility Medication after Spinal Operation. Yonsei Med J 2015; 56:1627-31. [PMID: 26446646 PMCID: PMC4630052 DOI: 10.3349/ymj.2015.56.6.1627] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 12/16/2014] [Accepted: 01/03/2015] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To investigate the prevalence of paralytic ileus after spinal operation in the supine or prone operative position and to determine the efficacy of prophylactic gastrointestinal motility medications in preventing symptomatic paralytic ileus after a spinal operation. MATERIALS AND METHODS All patients received spinal surgery in the supine or prone operative position. The study period was divided into two phases: first, to analyze the prevalence of radiographic and symptomatic paralytic ileus after a spinal operation, and second, to determine the therapeutic effects of prophylactic gastrointestinal motility medications (postoperative intravenous injection of scopolamine butylbromide and metoclopramide hydrochloride) on symptomatic paralytic ileus after a spinal operation. RESULTS Basic demographic data were not different. In the first phase of this study, 27 patients (32.9%) with radiographic paralytic ileus and 11 patients (13.4%) with symptomatic paralytic ileus were observed. Radiographic paralytic ileus was more often noted in patients who underwent an operation in the prone position (p=0.044); whereas the occurrence of symptomatic paralytic ileus was not different between the supine and prone positioned patients (p=0.385). In the second phase, prophylactic medications were shown to be ineffective in preventing symptomatic paralytic ileus after spinal surgery [symptomatic paralytic ileus was observed in 11.1% (4/36) with prophylactic medication and 16.7% (5/30) with a placebo, p=0.513]. CONCLUSION Spinal surgery in the prone position was shown to increase the likelihood of radiographic paralytic ileus occurrence, but not symptomatic paralytic ileus. Unfortunately, the prophylactic medications to prevent symptomatic paralytic ileus after spine surgery were shown to be ineffective.
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Affiliation(s)
- Chang Hyun Oh
- Department of Neurosurgery, Guro Teun Teun Hospital, Seoul, Korea
| | - Gyu Yeul Ji
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hwan Yoon
- Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea.
| | - Dongkeun Hyun
- Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea
| | - Hyeong-chun Park
- Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea
| | - Yeo Ju Kim
- Department of Radiology, Inha University College of Medicine, Incheon, Korea
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Ma D, Yoon SI, Yang CH, Marcy G, Zhao N, Leong WY, Ganapathy V, Han J, Van Dongen AMJ, Hsu KS, Ming GL, Augustine GJ, Goh ELK. Rescue of Methyl-CpG Binding Protein 2 Dysfunction-induced Defects in Newborn Neurons by Pentobarbital. Neurotherapeutics 2015; 12:477-90. [PMID: 25753729 PMCID: PMC4404443 DOI: 10.1007/s13311-015-0343-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Rett syndrome is a neurodevelopmental disorder that usually arises from mutations or deletions in methyl-CpG binding protein 2 (MeCP2), a transcriptional regulator that affects neuronal development and maturation without causing cell loss. Here, we show that silencing of MeCP2 decreased neurite arborization and synaptogenesis in cultured hippocampal neurons from rat fetal brains. These structural defects were associated with alterations in synaptic transmission and neural network activity. Similar retardation of dendritic growth was also observed in MeCP2-deficient newborn granule cells in the dentate gyrus of adult mouse brains in vivo, demonstrating direct and cell-autonomous effects on individual neurons. These defects, caused by MeCP2 deficiency, were reversed by treatment with the US Food and Drug Administration-approved drug, pentobarbital, in vitro and in vivo, possibly caused by modulation of γ-aminobutyric acid signaling. The results indicate that drugs modulating γ-aminobutyric acid signaling are potential therapeutics for Rett syndrome.
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Affiliation(s)
- Dongliang Ma
- Programme in Neuroscience and Behavioral Disorders, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Su-In Yoon
- Programme in Neuroscience and Behavioral Disorders, Duke-NUS Graduate Medical School, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Chih-Hao Yang
- Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Guillaume Marcy
- Programme in Neuroscience and Behavioral Disorders, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Na Zhao
- Programme in Neuroscience and Behavioral Disorders, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Forensic Medicine, Key Laboratory of Health Ministry for Forensic Science, Xi’an Jiaotong University School of Medicine, Xi’an, Shaanxi People’s Republic of China
| | - Wan-Ying Leong
- Programme in Neuroscience and Behavioral Disorders, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Vinu Ganapathy
- Programme in Neuroscience and Behavioral Disorders, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Ju Han
- Programme in Neuroscience and Behavioral Disorders, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Antonius M. J. Van Dongen
- Programme in Neuroscience and Behavioral Disorders, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kuei-Sen Hsu
- Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Guo-Li Ming
- Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - George J. Augustine
- Programme in Neuroscience and Behavioral Disorders, Duke-NUS Graduate Medical School, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Center for Functional Connectomics, Korea Institute of Science and Technology, Seoul, Republic of Korea
- Institute of Molecular and Cell Biology, A*STAR, Proteos, Singapore, Singapore
| | - Eyleen L. K. Goh
- Programme in Neuroscience and Behavioral Disorders, Duke-NUS Graduate Medical School, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- KK Research Center, KK Women’s and Children’s Hospital, Singapore, Singapore
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Devroe S, Lemiere J, Van de Velde M, Gewillig M, Boshoff D, Rex S. Safety and feasibility of xenon as an adjuvant to sevoflurane anaesthesia in children undergoing interventional or diagnostic cardiac catheterization: study protocol for a randomised controlled trial. Trials 2015; 16:74. [PMID: 25886748 PMCID: PMC4350978 DOI: 10.1186/s13063-015-0587-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 02/02/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Xenon has minimal haemodynamic side effects when compared to volatile or intravenous anaesthetics. Moreover, in in vitro and in animal experiments, xenon has been demonstrated to convey cardio- and neuroprotective effects. Neuroprotection could be advantageous in paediatric anaesthesia as there is growing concern, based on both laboratory studies and retrospective human clinical studies, that anaesthetics may trigger an injury in the developing brain, resulting in long-lasting neurodevelopmental consequences. Furthermore, xenon-mediated neuroprotection could help to prevent emergence delirium/agitation. Altogether, the beneficial haemodynamic profile combined with its putative organ-protective properties could render xenon an attractive option for anaesthesia of children undergoing cardiac catheterization. METHODS/DESIGN In a phase-II, mono-centre, prospective, single-blind, randomised, controlled study, we will test the hypothesis that the administration of 50% xenon as an adjuvant to general anaesthesia with sevoflurane in children undergoing elective cardiac catheterization is safe and feasible. Secondary aims include the evaluation of haemodynamic parameters during and after the procedure, emergence characteristics, and the analysis of peri-operative neuro-cognitive function. A total of 40 children ages 4 to 12 years will be recruited and randomised into two study groups, receiving either a combination of sevoflurane and xenon or sevoflurane alone. DISCUSSION Children undergoing diagnostic or interventional cardiac catheterization are a vulnerable patient population, one particularly at risk for intra-procedural haemodynamic instability. Xenon provides remarkable haemodynamic stability and potentially has cardio- and neuroprotective properties. Unfortunately, evidence is scarce on the use of xenon in the paediatric population. Our pilot study will therefore deliver important data required for prospective future clinical trials. TRIAL REGISTRATION EudraCT: 2014-002510-23 (5 September 2014).
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Affiliation(s)
- Sarah Devroe
- Department of Anaesthesiology, University Hospitals of the KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Jurgen Lemiere
- Department of Child and Adolescent Psychiatry, University Hospitals of the KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
- Department of Paediatric Haemato-Oncology, University Hospitals of the KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Marc Van de Velde
- Department of Anaesthesiology, University Hospitals of the KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Marc Gewillig
- Department of Paediatric and Congenital Cardiology, University Hospitals of the KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Derize Boshoff
- Department of Paediatric and Congenital Cardiology, University Hospitals of the KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Steffen Rex
- Department of Anaesthesiology, University Hospitals of the KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
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Fernández Hurst N, Bibolini MJ, Roth GA. Diazepam Inhibits Proliferation of Lymph Node Cells Isolated from Rats with Experimental Autoimmune Encephalomyelitis. Neuroimmunomodulation 2015; 22:293-302. [PMID: 25721617 DOI: 10.1159/000369277] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 10/22/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Experimental autoimmune encephalomyelitis (EAE) is an inflammatory demyelinating disease with similarities to human multiple sclerosis involving peripheral activation of autoreactive T cells which infiltrate the central nervous system and react to self antigens leading to damage. In previous studies, we have demonstrated that treatment with diazepam decreases the incidence and histological signs associated with the disease and diminishes immunological responses. The aim of the present work was to evaluate direct effects of diazepam on isolated T cells involved in immune responses during the development of EAE. METHODS Animals were sensitized with whole myelin to induce EAE and sacrificed during the acute phase of the disease. In mononuclear cells isolated from popliteal lymph nodes, cell viability, apoptosis induction, proliferation and cytokine production were evaluated. RESULTS Diazepam did not have a toxic or proapoptotic effect on the cells, at least up to the concentration of 25 μM, but proliferation, CD8+ T-cell activation and proinflammatory cytokine production were dose-dependently decreased. CONCLUSIONS Diazepam has a direct inhibitory effect on the proliferation and activation of T lymphocytes isolated from the main lymphoid organ involved in disease onset and this could be one of the mechanisms that contribute to the beneficial effect previously observed with diazepam in vivo during EAE development.
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Affiliation(s)
- Nicolás Fernández Hurst
- Departamento de Química Biológica, Centro de Investigaciones en Química Biológica de Córdoba (CIQUIBIC, UNC-CONICET), Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
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Negi S, Sen I, Arya V, Sharma A. Dexmedetomidine versus fentanyl as coadjuvants of balanced anaesthesia technique in renal transplant recipients. Middle East J Anaesthesiol 2014; 22:549-557. [PMID: 25668998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Ideal anesthetic technique for renal allograft recipients should provide hemodynamic stability, optimum graft reperfusion and adequate analgesia. Balanced anesthesia is preferred because renal nociception is conducted multi-segmentally and chronically ill ESRD patients have labile psychological profile. Present study compared the efficacy ofdexmedetomidine with fentanyl administered via intravenous and epidural route before induction of general anesthesia. METHODS Prospective, double blind randomized study, recruited sixty hemo-dynamically stable ESRD adults, 18-55 years, scheduled for elective live related renal transplantation. Patients randomly received intravenous dexmedetomidine 0.5 μg/kg followed by epidural dexmedetomidine 0.5 μg/kg alongwith 5 ml; 0.25% ropivacaine or intravenous fentanyl 1 μg/kg followed by epiduralfentanyl 1 μg/kg alongwith 5 ml; 0.25% ropivacaine. All patients received standardized general anaesthesia and continuous epidural ropivacaine 0.25%; 4-8 ml/hr. Preoperative sedation, peri-operative haemodynamics, end tidal anaesthetic agent requirement, peri-operative fluid requirement, need for vasopressors, blood loss and early graft function was assessed. RESULTS 80% patients receiving intravenous dexmedetomidine did not require rescue midazolam for achieving satisfactory sedation before induction of general anaesthesia. Dexmedetomidine significantly reduced propofol and end tidal inhalational agents requirement and need for rescue analgesics. Early renal graft function (onset time of diuresis after declamping, 24 hours urine output and serum creatinine levels) was comparable. There were no adverse sequelae. CONCLUSION Dexmedetomidine-based anaesthetic regimen versus fentanyl-based anaesthesia provided appropriate anxiolysis and analgesia for conducting invasive procedures and subsequent epidural administration of these agents reduced anaesthetic requirement and prolonged postoperative analgesia without compromising hemodynamics and respiratory parameters. Further dose finding studies can be conducted in kidney transplant recipients.
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Abstract
Enterostatin (VPDPR), an anorexigenic peptide derived from the amino terminus of procolipase, significantly inhibited analgesia induced by the mu-opioid agonist morphine (5 mg/kg, s.c.) after i.c.v. administration to mice at a dose of 100 nmol. On the other hand, VPDPR (approximately 200 nmol, i.c.v.) did not attenuate analgesia induced by the kappa-opioid agonist D-Phe-D-Phe-D-Nle-D-Arg-NH2 (100 microg/mouse, i.c.v.) or delta-opioid agonist DTLET (4 nmol/mouse, i.c.v.). VPDPR (100 nmol, i.c.v.) significantly improved amnesia induced by scopolamine (0.2 mg/kg, i.p.) in mice. However, VPDPR did not enhance memory in normal mice at the same dose.
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Affiliation(s)
- Y Takenaka
- Research Institute for Food Science, Kyoto University, Uji, Japan
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Abstract
γ-Hydroxybutyric acid (GHB) is an endogenous compound and a drug used clinically to treat the symptoms of narcolepsy. GHB is known to be an agonist of GABAB receptors with millimolar affinity, but also binds with much higher affinity to another site, known as the GHB receptor. While a body of evidence has shown that GHB does not bind to GABAA receptors widely, recent evidence has suggested that the GHB receptor is in fact on extrasynaptic α4β1δ GABAA receptors, where GHB acts as an agonist with an EC50 of 140 nM. We investigated three neuronal cell types that express a tonic GABAA receptor current mediated by extrasynaptic receptors: ventrobasal (VB) thalamic neurons, dentate gyrus granule cells and striatal medium spiny neurons. Using whole-cell voltage clamp in brain slices, we found no evidence that GHB (10 µM) induced any GABAA receptor mediated current in these cell types, nor that it modulated inhibitory synaptic currents. Furthermore, a high concentration of GHB (3 mM) was able to produce a GABAB receptor mediated current, but did not induce any other currents. These results suggest either that GHB is not a high affinity agonist at native α4β1δ receptors, or that these receptors do not exist in classical areas associated with extrasynaptic currents.
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Affiliation(s)
- William M. Connelly
- Neuroscience Division, Cardiff School of Biosciences, Cardiff University, Cardiff, United Kingdom
- * E-mail: (WMC); (VC)
| | - Adam C. Errington
- Neuroscience Division, Cardiff School of Biosciences, Cardiff University, Cardiff, United Kingdom
| | - Vincenzo Crunelli
- Neuroscience Division, Cardiff School of Biosciences, Cardiff University, Cardiff, United Kingdom
- * E-mail: (WMC); (VC)
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Mishra SK, Kang JH, Lee CW, Oh SH, Ryu JS, Bae YS, Kim HM. Midazolam induces cellular apoptosis in human cancer cells and inhibits tumor growth in xenograft mice. Mol Cells 2013; 36:219-26. [PMID: 24008365 PMCID: PMC3887981 DOI: 10.1007/s10059-013-0050-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 07/03/2013] [Accepted: 07/03/2013] [Indexed: 12/18/2022] Open
Abstract
Midazolam is a widely used anesthetic of the benzodiazepine class that has shown cytotoxicity and apoptosisinducing activity in neuronal cells and lymphocytes. This study aims to evaluate the effect of midazolam on growth of K562 human leukemia cells and HT29 colon cancer cells. The in vivo effect of midazolam was investigated in BALB/c-nu mice bearing K562 and HT29 cells human tumor xenografts. The results show that midazolam decreased the viability of K562 and HT29 cells by inducing apoptosis and S phase cell-cycle arrest in a concentration-dependent manner. Midazolam activated caspase-9, capspase-3 and PARP indicating induction of the mitochondrial intrinsic pathway of apoptosis. Midazolam lowered mitochondrial membrane potential and increased apoptotic DNA fragmentation. Midazolam showed reactive oxygen species (ROS) scavenging activity through inhibition of NADPH oxidase 2 (Nox2) enzyme activity in K562 cells. Midazolam caused inhibition of pERK1/2 signaling which led to inhibition of the anti-apoptotic proteins Bcl-XL and XIAP and phosphorylation activation of the pro-apoptotic protein Bid. Midazolam inhibited growth of HT29 tumors in xenograft mice. Collectively our results demonstrate that midazolam caused growth inhibition of cancer cells via activation of the mitochondrial intrinsic pathway of apoptosis and inhibited HT29 tumor growth in xenograft mice. The mechanism underlying these effects of midazolam might be suppression of ROS production leading to modulation of apoptosis and growth regulatory proteins. These findings present possible clinical implications of midazolam as an anesthetic to relieve pain during in vivo anticancer drug delivery and to enhance anticancer efficacy through its ROS-scavenging and pro-apoptotic properties.
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Affiliation(s)
| | - Ju-Hee Kang
- Division of Cancer Biology, National Cancer Center, Goyang 410-769, Korea
- Department of Food and Nutrition, Division of Natural Sciences, Chung-Ang University, Ansung 456-756, Korea
| | - Chang Woo Lee
- Bioevaluation Center, Korea Research Institute of Bioscience and Biotechnology, Cheongwon 363-883, Korea
| | - Seung Hyun Oh
- Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon 406-840, Korea
| | - Jun Sun Ryu
- Head and Neck Oncology Clinic, Center for Specific Organs Cancer, Center for Thyroid Cancer, National Cancer Center, Goyang 410-769, Korea
| | - Yun Soo Bae
- Department of Life Science, College of Natural Sciences, Ewha Womans University, Seoul 120-750, Korea
| | - Hwan Mook Kim
- Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon 406-840, Korea
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22
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Ide S, Nishizawa D, Fukuda KI, Kasai S, Hasegawa J, Hayashida M, Minami M, Ikeda K. Association between genetic polymorphisms in Ca(v)2.3 (R-type) Ca2+ channels and fentanyl sensitivity in patients undergoing painful cosmetic surgery. PLoS One 2013; 8:e70694. [PMID: 23940630 PMCID: PMC3734060 DOI: 10.1371/journal.pone.0070694] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 06/21/2013] [Indexed: 01/12/2023] Open
Abstract
Individual differences in the sensitivity to fentanyl, a widely used opioid analgesic, lead to different proper doses of fentanyl, which can hamper effective pain treatment. Voltage-activated Ca(2+) channels (VACCs) play a crucial role in the nervous system by controlling membrane excitability and calcium signaling. Ca(v)2.3 (R-type) VACCs have been especially thought to play critical roles in pain pathways and the analgesic effects of opioids. However, unknown is whether single-nucleotide polymorphisms (SNPs) of the human CACNA1E (calcium channel, voltage-dependent, R type, alpha 1E subunit) gene that encodes Cav2.3 VACCs influence the analgesic effects of opioids. Thus, the present study examined associations between fentanyl sensitivity and SNPs in the human CACNA1E gene in 355 Japanese patients who underwent painful orofacial cosmetic surgery, including bone dissection. We first conducted linkage disequilibrium (LD) analyses of 223 SNPs in a region that contains the CACNA1E gene using genomic samples from 100 patients, and a total of 13 LD blocks with 42 Tag SNPs were observed within and around the CACNA1E gene region. In the preliminary study using the same 100 genomic samples, only the rs3845446 A/G SNP was significantly associated with perioperative fentanyl use among these 42 Tag SNPs. In a confirmatory study using the other 255 genomic samples, this SNP was also significantly associated with perioperative fentanyl use. Thus, we further analyzed associations between genotypes of this SNP and all of the clinical data using a total of 355 samples. The rs3845446 A/G SNP was associated with intraoperative fentanyl use, 24 h postoperative fentanyl requirements, and perioperative fentanyl use. Subjects who carried the minor G allele required significantly less fentanyl for pain control compared with subjects who did not carry this allele. Although further validation is needed, the present findings show the possibility of the involvement of CACNA1E gene polymorphisms in fentanyl sensitivity.
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Affiliation(s)
- Soichiro Ide
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Department of Pharmacology, Graduate School of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
| | - Daisuke Nishizawa
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Ken-ichi Fukuda
- Department of Oral Health and Clinical Science, Division of Dental Anesthesiology (Orofacial Pain Center/Suidoubashi Hospital), Tokyo Dental College, Tokyo, Japan
| | - Shinya Kasai
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Junko Hasegawa
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Masakazu Hayashida
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Masabumi Minami
- Department of Pharmacology, Graduate School of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
| | - Kazutaka Ikeda
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- * E-mail:
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23
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Shi GN, Liu YL, Lin HM, Yang SL, Feng YL, Reid PF, Qin ZH. Involvement of cholinergic system in suppression of formalin-induced inflammatory pain by cobratoxin. Acta Pharmacol Sin 2011; 32:1233-8. [PMID: 21841815 PMCID: PMC4010082 DOI: 10.1038/aps.2011.65] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 04/21/2011] [Indexed: 11/09/2022] Open
Abstract
AIM To investigate the analgesic effect of cobratoxin (CTX), a long-chain α-neurotoxin from Thailand cobra venom, in a rat model of formalin-induced inflammatory pain. METHODS Inflammatory pain was induced in SD rats via injecting 5% formalin (50 μL) into the plantar surface of their right hind paw. CTX and other agents were ip administered before formalin injection. The time that the animals spent for licking the injected paw was counted every 5 min for 1 h. RESULTS CTX (25, 34, and 45 μg/kg) exhibited a dose-dependent analgesic effect during the phase 1 (0-15 min) and phase 2 (20-60 min) response induced by formalin. Pretreatment with naloxone (0.5 or 2.5 mg/kg) did not block the analgesic effect of CTX. Pretreatment with atropine at 5 mg/kg, but not at 2.5 mg/kg, antagonized the analgesic effect of CTX. Treatment with the nonselective nAChR antagonist mecamylamine (3 mg/kg) inhibited the analgesic effects of CTX in Phase 1 and Phase 2 responses, while with the selective α7-nAChR antagonist methyllycaconitine (3 mg/kg) antagonized the effect of CTX only in the Phase 1 response. Treatment with the α7-nAChR agonist PNU282987 (3 mg/kg) significantly reduced the formalin-induced phase 2 pain response, but only slightly reduced the Phase 1 pain response. CONCLUSION The results suggest that CTX exerts an antinociceptive effect in formalin-induced inflammatory pain, which appears to be mediated by mAChR and α7-nAChR.
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Affiliation(s)
- Gao-na Shi
- Department of Pharmacology, Soochow University School of Pharmacy, Suzhou 215123, China
| | - Yan-li Liu
- Department of Pharmacology, Soochow University School of Pharmacy, Suzhou 215123, China
| | - Hai-ming Lin
- Department of Pharmacology, Soochow University School of Pharmacy, Suzhou 215123, China
| | - Shi-lin Yang
- Department of Pharmacology, Soochow University School of Pharmacy, Suzhou 215123, China
| | - Yu-lin Feng
- Jiangxi University of Chinese Traditional Medicine, Nanchang 330004, China
| | - Paul F Reid
- ReceptoPharm Inc, Fortlaudale, Florida 33336, USA
| | - Zheng-hong Qin
- Department of Pharmacology, Soochow University School of Pharmacy, Suzhou 215123, China
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24
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Boku A, Koyama S, Kishimoto N, Nakatani K, Kurita S, Nagata N, Niwa H. [Examination of the optimal midazolam dose required for loss of puncture memory at the time of spinal anesthesia]. Masui 2011; 60:913-919. [PMID: 21861415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND We examined midazolam ED50 according to age that was necessary for loss of puncture memory at the time of spinal anesthesia and determined whether we could estimate the presence of puncture memory from the degree of sedation after midazolam administration. METHODS We enrolled patients with ASA PS 1 or 2 and patients from 50 to 80 years of age who had been planned for surgery with spinal anesthesia. We divided the patients into groups according to their age--50s, 60s, and 70s as L, M, and H groups, respectively. We evaluated the degree of sedation with six phases of scores after intravenous administration of midazolam and spinal anesthesia was performed. The midazolam dose was based on the ups and downs method. RESULTS The midazolam ED50s required for the loss of puncture memory in groups L, M, and H were 0.043, 0.035, and 0.026 mg x kg(-1), respectively. We estimated the association between the sedation degree score after midazolam administration and the puncture memory from ROC curve, but AUC was 0.56 for all cases. CONCLUSIONS The midazolam ED50 required for the loss of puncture memory decreased with age but it was difficult to estimate puncture memory from the degree of sedation.
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Affiliation(s)
- Aiji Boku
- Department of Dental Anesthesiology, Osaka University Graduate School of Dentistry, Suita 565-0871
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25
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Donjacour CEHM, Aziz NA, Frölich M, Roelfsema F, Overeem S, Lammers GJ, Pijl H. Sodium oxybate increases prolactin secretion in narcolepsy patients and healthy controls. Eur J Endocrinol 2011; 164:363-70. [PMID: 21148631 DOI: 10.1530/eje-10-0913] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Hypocretin deficiency causes narcolepsy and may affect neuroendocrine systems, including TSH, ACTH and LH secretion. Symptoms can be treated effectively with sodium oxybate (SXB) in many patients. This study was performed to compare prolactin (PRL) secretion in patients and matched controls and establish the effect of SXB administration on PRL and sleep in both the groups. DESIGN Open label intervention. Blood was sampled before and after 5 days of SXB treatment. The study was performed at the Leiden University Medical Centre, Leiden, The Netherlands. METHODS Subjects were admitted to the clinical research centre on both occasions. PATIENTS OR PARTICIPANTS Eight male hypocretin-deficient narcolepsy with cataplexy patients and eight controls matched for sex, age, body mass index, waist-to-hip ratio and fat percentage were enrolled. INTERVENTIONS SXB two times 3 g per night for five consecutive nights. RESULTS Patients and controls underwent 24 h blood sampling at 10 min intervals for measurement of PRL concentrations. The PRL concentration time series was analysed with a new deconvolution programme, approximate entropy (ApEn) and Cosinor analysis. Sleep was polygraphically recorded. Basal and pulsatile PRL secretion, as well as pulse regularity and frequency, ApEn and diurnal parameters were similar in patients and controls. SXB treatment caused similar nocturnal increase in PRL secretion, advance of the acrophase and decrease in ApEn in patients and controls. Slow wave sleep was increased to a similar extent in patients and controls. CONCLUSION This detailed study did not demonstrate altered PRL secretion in hypocretin-deficient narcolepsy patients during the basal state or during SXB administration. Therefore, hypocretin signalling is unlikely to be a regulator of the lactotrophic system.
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Affiliation(s)
- Claire E H M Donjacour
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Centre, Postal Zone J3-R 151, PO Box 9600, 2300 RC Leiden, The Netherlands.
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26
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Ramadhyani U, Park JL, Carollo DS, Waterman RS, Nossaman BD. Dexmedetomidine: clinical application as an adjunct for intravenous regional anesthesia. Anesthesiol Clin 2010; 28:709-722. [PMID: 21074747 DOI: 10.1016/j.anclin.2010.08.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The selective α-2 adrenoceptor agonist, dexmedetomidine, has been shown to be a useful, safe adjunct in perioperative medicine. Intravenous regional anesthesia is one of the simplest forms of regional anesthesia and has a high degree of success. However, intravenous regional anesthesia is limited by the development of tourniquet pain and its inability to provide postoperative analgesia. To improve block quality, prolong postdeflation analgesia, and decrease tourniquet pain, various chemical additives have been combined with local anesthetics, although with limited success. The antinociceptive effects of α-2 adrenoceptor agonists have been shown in animals and in humans. However, less is known about the clinical effects of dexmedetomidine when coadministered with local anesthetics in patients undergoing intravenous regional anesthesia. This review examines what is currently known to improve our understanding of the properties and application of dexmedetomidine when used as an adjunct in intravenous regional anesthesia.
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Affiliation(s)
- Usha Ramadhyani
- Department of Anesthesiology, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70121, USA
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27
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Farran I, McCarthy-Suárez I, Río-Manterola F, Mansilla C, Lasarte JJ, Mingo-Castel AM. The vaccine adjuvant extra domain A from fibronectin retains its proinflammatory properties when expressed in tobacco chloroplasts. Planta 2010; 231:977-90. [PMID: 20108000 DOI: 10.1007/s00425-010-1102-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Accepted: 01/08/2010] [Indexed: 05/28/2023]
Abstract
We previously showed that recombinant extra domain A from fibronectin (EDA) purified from Escherichia coli was able to bind to toll-like receptor 4 (TLR4) and stimulate production of proinflammatory cytokines by dendritic cells. Because EDA could be used as an adjuvant for vaccine development, we aimed to express it from the tobacco plastome, a promising strategy in molecular farming. To optimize the amount of recombinant EDA (rEDA) in tobacco leaves, different downstream sequences were evaluated as potential fusion tags. Plants generated by tobacco plastid transformation accumulated rEDA at levels up to 2% of the total cellular protein (equivalent to approximately 0.3 mg/g fresh weight) when translationally fused to the first 15 amino acids of green fluorescence protein (GFP). The recombinant adjuvant could be purified from tobacco leaves using a simple procedure, involving ammonium sulfate precipitation and anion exchange chromatography. Purified protein was able to induce production of tumour necrosis factor-alpha (TNF-alpha) either by bone marrow-derived dendritic cells or THP-1 monocytes. The rEDA produced in tobacco leaves was also able to induce upregulation of CD54 and CD86 maturation markers on dendritic cells, suggesting that the rEDA retains the proinflammatory properties of the EDA produced in E. coli and thus could be used as an adjuvant in vaccination against infectious agents and cancer. Taken together, these results demonstrate that chloroplasts are an attractive production vehicle for the expression of this protein vaccine adjuvant.
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Affiliation(s)
- Inmaculada Farran
- Instituto de Agrobiotecnología, Universidad Pública de Navarra-CSIC-Gobierno de Navarra, Campus Arrosadía, 31006 Pamplona, Spain,
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28
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Noguchi M, Ikarashi Y, Yuzurihara M, Kase Y, Takeda S, Aburada M. Significance of measured elevation of skin temperature induced by calcitonin gene-related peptide in anaesthetized rats. J Pharm Pharmacol 2010; 55:1547-52. [PMID: 14713366 DOI: 10.1211/0022357022142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
To assess whether peripheral changes related to skin temperature rise were induced by ovarian hormone deficiency, we investigated the effects of anaesthesia on calcitonin gene-related peptide (CGRP)- or luteinizing hormone-releasing hormone (LH-RH)-induced elevation of skin temperature in female rats. CGRP was used as an inducer of peripherally-mediated elevation of skin temperature, whereas LH-RH was used as an inducer of centrally-mediated elevation of skin temperature. Intravenous (i.v.) but not intracerebroventricular injection of CGRP (10 μg kg−1) or intracerebroventricular but not intravenous injection of LH-RH (10 μg/rat) elevated the skin temperature of unanaesthetized rats restrained in a Ballman's cage. The elevation with LH-RH was completely inhibited by urethane anaesthesia, whereas the elevation with CGRP was not. These results suggested that changes in skin temperature measured under anaesthesia reflected a peripherally rather than a centrally mediated mechanism. The CGRP (1.0–30 μg kg−1, i.v.)-induced elevation of skin temperature was potentiated in ovariectomized rats and inhibited by pretreatment with a CGRP receptor antagonist CGRP8–37 (1000 μg kg−1, i.v.), suggesting that the potentiation may participate in peripheral factors such as a postsynaptic hypersensitivity to CGRP following ovarian hormone deficiency. Thus, measurement of skin temperature in the anaesthetized rat was a useful procedure to seek the peripheral mechanism of potentiation of skin temperature induced by CGRP, thought to be closely related to menopausal hot flashes.
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Affiliation(s)
- Masamichi Noguchi
- Tsumura Research Institute Medical Evaluation Laboratory, 3586 Yoshiwara, Ami-machi, Inashiki-gun, Ibaraki 300-1192, Japan.
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Kajiyama S, Nakagawa I, Hidaka S, Okada H, Kubo T, Nao Y. [Effect of dexmedetomidine on intraoperative somatosensory evoked potential monitoring]. Masui 2009; 58:966-970. [PMID: 19702209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Intraoperative somatosensory-evoked potential (SEP) monitoring has become a part of neurosurgical procedures. In this study, we evaluated the effect of dexmedetomidine on SEP monitoring during neurosurgical anesthesia. METHODS Eight patients scheduled for neurosurgery were studied. Anesthesia was maintained with continuous infusion of propofol at 2 microg x ml(-1) concentration using target controlled infusion (TCI). A loading dose of dexmedetomidine was infused at 6 microg x kg(-1) hr(-1) for 10 min and SEP was recorded. Infusion of dexmedetomidine was continued at 0.5 microg x kg(-1) x min(-1) for 10 min and SEP was recorded. We measured the change of amplitude and latency of SEP (N20-P25) and compared to baseline values. RESULTS There was no statistically significant change in the cortical SEP amplitude (98.0 +/- 18.1% after a loading dose of dexmedetomidine and 112.7 +/- 16.8% at 0.5 microg x kg(-1) x min(-1) of dexmedetomidine, respectively) or latency (101.5 +/- 1.7% after a loading dose of dexmedetomidine and 101.9 +/- 1.7% at 0.5 microg x kg(-1) x min(-1) of dexmedetomidine, respectively). Mean blood pressure rose from 81 mmHg to 95 mmHg after initiation of dexmedetomidine infusion. Heart rate did not change. CONCLUSIONS These findings suggest that dexmedetomidine has possibilities to produce an ideal environment as an anesthetic adjunct in patients requiring intrapoerative SEP monitoring.
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Affiliation(s)
- Seiji Kajiyama
- Department of Anesthesia, Chugoku Rosai General Hospital, Kure 737-0193
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30
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Saadawy I, Boker A, Elshahawy MA, Almazrooa A, Melibary S, Abdellatif AA, Afifi W. Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in pediatrics. Acta Anaesthesiol Scand 2009; 53:251-6. [PMID: 19076110 DOI: 10.1111/j.1399-6576.2008.01818.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dexmedetomidine (DEX) is a highly selective alpha(2)-adrenoceptor agonist that has been used increasingly in children. However, the effect of caudal DEX has not been evaluated before in children. This prospective randomized double-blinded study was designed to evaluate the analgesic efficacy of caudal DEX with bupivacaine in providing pain relief over a 24-h period. METHODS Sixty children (ASA status I) aged 1-6 years undergoing unilateral inguinal hernia repair/orchidopexy were allocated randomly to two groups (n = 30 each). Group B received a caudal injection of bupivacaine 2.5 mg/ml, 1 ml/kg; Group BD received the same dose of bupivacaine mixed with DEX 1 microg/kg during sevoflurane anesthesia. Processed electroencephalogram (bispectral index score), heart rate, blood pressure, pulse oximetry and end-tidal sevoflurane were recorded every 5 min. The characteristics of emergence, objective pain score, sedation score and quality of sleep were recorded post-operatively. Duration of analgesia and requirement for additional analgesics were noted. RESULTS The end-tidal sevoflurane concentration and the incidence of agitation were significantly lower in the BD group (P < 0.05). The duration of analgesia was significantly longer (P < 0.001) and the total consumption of rescue analgesic was significantly lower in Group BD compared with Group B (P < 0.01). There was no statistically significant difference in hemodynamics between both groups. However, group BD had better quality of sleep and a prolonged duration of sedation (P < 0.05). CONCLUSION Caudal DEX seems to be a promising adjunct to provide excellent analgesia without side effects over a 24-h period. It has the advantage of keeping the patients calm for a prolonged time. Implications statement: Caudally administered DEX (1 microg/kg), combined with bupivacaine, was associated with an extended duration of post-operative pain relief.
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MESH Headings
- Adjuvants, Anesthesia/administration & dosage
- Adjuvants, Anesthesia/pharmacology
- Adrenergic alpha-Agonists/pharmacokinetics
- Adrenergic alpha-Agonists/therapeutic use
- Analgesics, Non-Narcotic/therapeutic use
- Anesthesia, Caudal/methods
- Anesthetics, Local/administration & dosage
- Anesthetics, Local/pharmacology
- Bupivacaine/administration & dosage
- Bupivacaine/pharmacology
- Child
- Child, Preschool
- Dexmedetomidine/administration & dosage
- Dexmedetomidine/pharmacology
- Double-Blind Method
- Drug Synergism
- Hernia, Inguinal/surgery
- Humans
- Hypnotics and Sedatives/administration & dosage
- Hypnotics and Sedatives/pharmacology
- Infant
- Male
- Pain, Postoperative/drug therapy
- Prospective Studies
- Psychomotor Agitation/prevention & control
- Receptors, Adrenergic, alpha-2/drug effects
- Sleep/drug effects
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Affiliation(s)
- I Saadawy
- Department of Anesthesia, Cairo University, Cairo, Egypt.
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31
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Rózańska D. Evaluation of medetomidine-midazolam-atropine (MeMiA) anesthesia maintained with propofol infusion in New Zealand White rabbits. Pol J Vet Sci 2009; 12:209-216. [PMID: 19645351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
An anesthetic combination of medetomidine-midazolam-atropine and propofol was investigated in twenty New Zealand White rabbits. Each rabbit received combined medetomidine at a dosage of 0.2 mg/kg (b.w.), midazolam (0.5 mg/kg b.w.) and atropine (0.5 mg/kg b.w.) intramuscularly for induction of anesthesia. Propofol was administered intravenously - given to effect, and after that by an infusion pump to maintain anesthesia. The influence of the anesthetic combination on the cardiopulmonary system was evaluated by monitoring respiratory and heart rates, blood pressure, and arterial blood gas tensions. The results obtained showed that propofol infusion at a rate of 0.5 mg/kg b.w./min maintained general anesthesia effectively with few side effects on the cardiopulmonary system during 30 minutes. However, slight hypotension, hypercapnia, and respiratory acidosis were associated with infusion of this anesthetic. The recovery of the rabbits from the anesthesia was smooth. Two rabbits died 20 to 24 hours after anesthesia. In conclusion, an anesthetic combination with medetomidine-midazolam-atropine and propofol at the investigated doses was shown to be a safe method to induce and maintain general anesthesia enabling short-term surgical procedures in healthy animals.
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Affiliation(s)
- D Rózańska
- Department and Clinic of Animal Surgery, Faculty of Veterinary Medicine, University of Life Sciences in Lublin, Lublin.
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Abstract
AIMS Volatile anaesthetics prevent experimental myocardial ischaemia-reperfusion injury (I/R) in several species, but this finding is partially inconsistent with clinical evidence. Some experimental models may not accurately represent the complex signal transduction pathways triggered by volatile anaesthetics. We therefore investigated sevoflurane I/R prevention in vivo in a porcine model with greater likeness to human physiology than models previously used and compared it with neutral anaesthetic. METHODS AND RESULTS Myocardial infarct size [IS/AAR] was compared in three groups of pigs (N=35) randomised to Control anaesthesia (pentobarbital infusion, n=12), sevoflurane inhalation alone (end-tidal concentration 3.2%) (Sevo, n=9), or both Combined (n=14), throughout ischaemia and reperfusion. Anterior/septal myocardial infarcts resulted from distal LAD coronary artery occlusion by balloon catheter for 45 min followed by 120 min of reperfusion. [IS/AAR] was measured in tetrazolium-stained heart slices after standardised image processing with computer-assisted planimetry. Measurements included full invasive monitoring. Control animals developed infarction in 55.0 +/- 3.9% (SEM) of the area at risk, Sevo in 17.5 +/- 4.4% (P=0.0002), and Combined with pentobarbital in 24.3 +/- 3.8% (P=0.0001) of the AAR, sevoflurane reducing infarct size significantly (68% and 60%, respectively). CONCLUSIONS Sevoflurane markedly decreased myocardial infarct size after prolonged coronary occlusion in a porcine model. In addition to novel sevoflurane cardioprotection in the closed-chest model, which is more comparable to normal human hearts than models previously used, sevoflurane cardioprotection is substantiated in the juvenile intact organism. The perspectives underline recommending volatile anaesthetics in risk patients and in cardiac surgery.
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Affiliation(s)
- J R Larsen
- Department of Anaesthesiology-Intensive Care, Aarhus University Hospital, Skejby, Aarhus N, Denmark.
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Chaplin RL, Jedynak J, Johnson D, Heiter D, Shovelton L, Garrett N. The effects of valerian on the time course of emergence from general anesthesia in Sprague-Dawley rats (Rattus norvegicus). AANA J 2007; 75:431-435. [PMID: 18179003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Herbal use may be associated with increased morbidity and mortality as a consequence of interactions with anesthetic agents. The purpose of this study was to investigate the effects on emergence from isoflurane anesthesia using a combination of the herb valerian and midazolam compared with valerian alone, midazolam alone, and no additional drug-herb treatment in Sprague-Dawley rats. We assigned 32 male Sprague-Dawley rats to 1 of 4 groups: (1) isoflurane alone, (2) isoflurane plus valerian, (3) isoflurane plus midazolam, and (4) isoflurane plus a combination of valerian and midazolam. Thirty minutes after treatment, animals underwent a standard laparotomy. The time in seconds from discontinuation of isoflurane to the time the animal righted itself and took I step was recorded as emergence time. A 1-way analysis of variance with a post hoc Scheffe procedure revealed that animals given a combination of midazolam and valerian took significantly longer to emerge from anesthesia (F = 58.21; P < .00) compared with all other groups. Awareness of possible interactions of herbals with conventional anesthetics is important so that potential problems may be recognized and treated. These data demonstrate the need for continued research concerning the effects of herbals and their potential for interaction with anesthetics.
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Derossi R, Medeiros U, de Almeida RG, Righetto FR, Frazílio FO. Meperidine prolongs lidocaine caudal epidural anaesthesia in the horse. Vet J 2007; 178:294-7. [PMID: 17892957 DOI: 10.1016/j.tvjl.2007.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 07/24/2007] [Accepted: 08/02/2007] [Indexed: 11/20/2022]
Abstract
The aim of the study was to evaluate and compare the effects of caudal epidural administration of meperidine (MP), lidocaine (LD), and a combination of the two (MPLD) in six mature saddle horses. Horses were randomly assigned to receive three treatments (MP 0.3 mg/kg; LD 0.2 mg/kg; and MPLD: MP 0.3 mg/kg and LD 0.2 mg/kg), with at least 1 week between treatments. Drugs were injected into the epidural space between the first and second coccygeal areas in conscious standing horses. Analgesia, ataxia, sedation, cardiovascular and respiratory effects, and rectal temperature were recorded at different intervals before (baseline) and after administration. Epidural administration of MPLD resulted in a longer duration of analgesia of the tail, perineum, and upper hind limb regions than did administration of MP or LD alone.
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Affiliation(s)
- Rafael Derossi
- Department of Veterinary Medicine, Surgery and Anaesthesiology, Faculty of Veterinary Medicine, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil.
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Shafton AD, Bogeski G, Kitchener PD, Sanger GJ, Furness JB, Shimizu Y. Effects of NMDA receptor antagonists on visceromotor reflexes and on intestinal motility, in vivo. Neurogastroenterol Motil 2007; 19:617-24. [PMID: 17539896 DOI: 10.1111/j.1365-2982.2007.00942.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Antagonists of NMDA receptors can inhibit both the transmission of pain signals from the intestine and enteric reflexes. However, it is unknown whether doses of the NMDA antagonist, ketamine, that are used in anaesthetic mixtures suppress motility reflexes and visceromotor responses (VMRs). In fact, whether intestinal motility is affected by NMDA receptor blockers in vivo has been little investigated. We studied the effects of ketamine and memantine, administered intravenously or intrathecally. Rats were maintained under alpha-chloralose plus xylazine or pentobarbitone anaesthesia; VMR and jejunal motility were measured. Under alpha-chloralose/xylazine anaesthesia, i.v. ketamine inhibited VMRs at 6 mg kg h(-1), but not at 3 mg kg h(-1). It did not inhibit propulsive reflexes in the jejunum at 10 mg kg h(-1), but reduced them by 30% at 20 mg kg h(-1). Under alpha-chloralose/pentobarbitone anaesthesia, i.v. ketamine reduced propulsive reflexes at 40 mg kg h(-1) and VMR at 10 mg kg h(-1). Memantine inhibited VMRs at 20 mg kg h(-1) and propulsion at 2 mg kg h(-1). Ketamine and memantine, intrathecally, prevented VMRs, but not jejunal propulsion. We conclude that peripherally administered ketamine reduces both VMR and motility reflexes, but not at doses used in anaesthetic mixes (1.8-2.4 mg kg h(-1)). Effects on motility reflexes are likely to be due to non-NMDA receptor actions, possibly on nicotinic receptors.
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Affiliation(s)
- A D Shafton
- Department of Anatomy and Cell Biology, Centre for Neuroscience, University of Melbourne, Parkville, VIC, Australia
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Heurich M, Mousa SA, Lenzner M, Morciniec P, Kopf A, Welte M, Stein C. Influence of pain treatment by epidural fentanyl and bupivacaine on homing of opioid-containing leukocytes to surgical wounds. Brain Behav Immun 2007; 21:544-52. [PMID: 17174527 DOI: 10.1016/j.bbi.2006.10.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Revised: 10/17/2006] [Accepted: 10/19/2006] [Indexed: 11/22/2022] Open
Abstract
Endogenous opioids released from leukocytes extravasating into injured tissue can interact with peripheral opioid receptors to inhibit nociception. Animal studies have shown that the homing of opioid-producing leukocytes to the injured site is modulated by spinal blockade of noxious input. This study investigated whether epidural analgesia (EDA) influences the migration of beta-endorphin (END) and/or met-enkephalin (ENK)-containing leukocytes into the subcutaneous wound tissue of patients undergoing abdominal surgery. In part I patients received general anesthesia combined either with intra- and postoperative EDA (with bupivacaine and fentanyl) or with postoperative patient controlled intravenous analgesia (PCIA; with the opioid piritramide). In part II patients received general anesthesia combined with either epidural fentanyl or bupivacaine which was continued postoperatively. Samples of cutanous and subcutanous tissue were taken from the wound site at the beginning, at the end and at various times after surgery, and were examined by immunohistochemistry for the presence of END and ENK. We found that (i) epidural bupivacaine, fentanyl and PCIA provided similar and clinically acceptable postoperative pain relief; (ii) compared to PCIA, epidural bupivacaine or fentanyl did not change the gross inflammatory reaction within the surgical wound; (iii) opioid-containing leukocytes were almost absent in normal subcutaneous tissue but migrated to the inflamed wound tissue in ascending numbers within a few hours, reaching a peak at about 24 h after surgery; (iv) compared to PCIA, EDA resulted in significantly decreased homing of END-containing leukocytes to the injured site at 24 h after surgery; and (v) the magnitude of this decrease was similar regardless of the epidural medication. These findings suggest that nociceptive but not sympathetic neurons are primarily involved in the attraction of opioid-containing leukocytes during early stages of inflammation.
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MESH Headings
- Adjuvants, Anesthesia/immunology
- Adjuvants, Anesthesia/pharmacology
- Aged
- Analgesia, Patient-Controlled
- Analgesics, Opioid/immunology
- Analgesics, Opioid/therapeutic use
- Anesthesia, Epidural
- Anesthetics, Local/immunology
- Anesthetics, Local/therapeutic use
- Bupivacaine/immunology
- Bupivacaine/therapeutic use
- Cell Movement/drug effects
- Cell Movement/immunology
- Enkephalin, Methionine/drug effects
- Enkephalin, Methionine/immunology
- Enkephalin, Methionine/metabolism
- Female
- Fentanyl/immunology
- Fentanyl/therapeutic use
- Humans
- Leukocytes/drug effects
- Leukocytes/immunology
- Leukocytes/metabolism
- Longitudinal Studies
- Male
- Middle Aged
- Nociceptors/drug effects
- Nociceptors/immunology
- Pain, Postoperative/immunology
- Pain, Postoperative/prevention & control
- Pirinitramide/therapeutic use
- Subcutaneous Tissue/immunology
- Sympathetic Fibers, Postganglionic/drug effects
- Sympathetic Fibers, Postganglionic/immunology
- Wound Healing/drug effects
- Wound Healing/immunology
- beta-Endorphin/drug effects
- beta-Endorphin/immunology
- beta-Endorphin/metabolism
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Affiliation(s)
- Martin Heurich
- Klinik für Anaesthesiologie und operative Intensivmedizin, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, D-12200 Berlin, Germany.
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Deady KA, Smith KM, Kuhn RJ. Clinical pearls for procedural sedation. Orthopedics 2007; 30:527-31. [PMID: 17672151 DOI: 10.3928/01477447-20070701-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Kimberly A Deady
- University of Kentucky HealthCare, Lexington, KY 40536-0293, USA
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Wang LZ, Zhang YF, Tang BL, Yao KZ. Effects of intrathecal and i.v. small-dose sufentanil on the median effective dose of intrathecal bupivacaine for Caesarean section. Br J Anaesth 2007; 98:792-6. [PMID: 17478452 DOI: 10.1093/bja/aem101] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Spinal anaesthesia with bupivacaine combined with sufentanil has been widely used for Caesarean section. However, the main site of action (spinal vs central) of intrathecal (IT) sufentanil is controversial. The aim of this study was to examine the predominant mechanism of action of IT, small-dose sufentanil when added to bupivacaine for Caesarean section, by comparing the effects of IT and i.v. sufentanil 2.5 microg on the median effective dose (ED50) of bupivacaine. METHODS Ninety parturients undergoing elective Caesarean section with a combined spinal-epidural technique were enrolled into this prospective, double-blind, up-down sequential allocation study. According to the up-down sequential allocation, parturients received varying doses of bupivacaine alone (C group) or co-administered with i.v. sufentanil 2.5 microg group (IVS group; n = 30) or IT sufentanil 2.5 microg group (ITS group; n = 30). The possible maternal or neonatal adverse effects were also recorded. RESULTS The ED(50) of bupivacaine was 6.3 mg (95% CI 6.2-6.5) in the C group, 5.2 mg (95% CI 5.1-5.4) in the IVS group, and 3.0 mg (95% CI 2.9-3.1) in the ITS group. The ED50 in the ITS group was significantly lower as compared with the other two groups (P < 0.0005). With the exception of pruritus that exclusively occurred in the ITS group (P = 0.011, compared with the other two groups), no significant differences among groups were observed regarding the frequencies of the maternal or neonatal adverse effects. CONCLUSIONS Compared with an equal dose of sufentanil i.v., intrathecally administered sufentanil 2.5 microg has a significant local anaesthetic-sparing effect via a predominantly spinal mechanism for Caesarean section.
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Affiliation(s)
- L Z Wang
- Department of Anesthesiology, Jiaxing Maternity and Child Care Hospital, Jiaxing Municipal Sanyi Hospital, Jiaxing 314000, Zhejiang Province, China.
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Abstract
1. Ketamine and xylazine (KX) mixture is the most commonly used anaesthetic drug during echocardiography in mice to induce sedation and immobility. Nevertheless, the doses of KX reported in the literature vary substantially with associated significant difference in cardiac function. To explore the optimal KX dosage and observation time for murine echocardiography, we compared the effects of various KX combinations on echocardiographic measurement. 2. Mice were anaesthetized with ketamine (50 or 100 mg/kg) and xylazine (0-10 mg/kg). Echocardiography was performed 5, 10, 20 and 40 min after induction of anaesthesia. Also, cardiac function was assessed in mice with and without pressure-overload induced left ventricle (LV) hypertrophy and dysfunction, either under anaesthesia with KX or whilst conscious. 3. Ketamine at 100 mg/kg alone or together with xylazine at 0.1 mg/kg was associated with a high and stable heart rate (HR), a high fractional shortening (FS) and produced the least effect on LV inner dimension at end of diastole (LVIDd). Ketamine and xylazine at 100 and 10 mg/kg, respectively, produced a lower and stable FS, but with a low and unstable HR. All other combinations resulted in depressed and unstable cardiac function during this period. 4. The dose-dependent suppression of FS by xylazine was counteracted partly by ketamine. 5. Although in the chronic pressure-overload model LV hypertrophy can be detected accurately in both the anaesthetized or conscious state, systolic dysfunction was masked partially by higher doses of xylazine (2.5 or 10 mg/kg) combined with ketamine at 100 mg/kg. 6. With KX anaesthesia, both the dose of xylazine and the anaesthetic duration are critical in achieving an ideal condition for murine echocardiography. Ketamine at 100 mg/kg alone produces acceptable anaesthesia, stable cardiac function with a minimal depressant effect and is therefore recommended if single-dose anaesthetic is to be used.
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Affiliation(s)
- Qi Xu
- Experimental Cardiology Laboratory, Baker Heart Research Institute and Alfred Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia.
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Abstract
OBJECTIVES To quantify the change in the minimum alveolar concentration (MAC) of isoflurane (ISO) associated with oxymorphone (OXY) or hydromorphone (HYDRO) in dogs. DESIGN Randomized crossover study with at least 1 week between assessments. ANIMALS Six young, healthy, mixed-breed dogs (1-3 years old), weighing 24.7 +/- 4.70 kg. METHODS Following mask induction, anesthesia was maintained with ISO in 100% O(2) using mechanical ventilation. The dogs received 0.05 mg kg(-1) OXY, 0.1 mg kg(-1) HYDRO, or 1 mL saline (control) IV. Following equilibration (15 minutes) at each percentage ISO tested, a supramaximal electrical stimulus was applied to the toe web and the response was assessed. Two separate MAC determinations were carried out during 4.5 hours of anesthesia, with completion of the evaluations at 1.5-2 and 4-4.5 hours after drug administration. A two-factor anova was used to determine whether there was a time or treatment effect on MAC and a Tukey test compared the drug effects at each time. Significance is reported at p < 0.05. RESULTS The mean MAC values (+/-SD) were 1.2 +/- 0.18 and 1.2 +/- 0.16% for control, 0.7 +/-0.15 and 1.0 +/- 0.15% for OXY, and 0.6 +/- 0.14 and 0.8 +/- 0.17% for HYDRO. The initial MAC with OXY and the MAC determined at both times with HYDRO were significantly different from the control MAC values. CONCLUSIONS Both OXY and HYDRO significantly reduced the MAC of ISO in dogs at 2 hours. At approximately 4.5 hours, HYDRO had a significant MAC-sparing effect, whereas OXY did not. CLINICAL RELEVANCE Although both OXY and HYDRO resulted in a significant reduction in the MAC of ISO at approximately 2 hours, HYDRO may be preferred for procedures of long duration and rarely needs repeated dosing before 4.5 hours.
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Affiliation(s)
- Carmen E G Machado
- Department of Clinical Studies, Ontario Veterinary College, Guelph, ON, Canada
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Kothare SV, Adams R, Valencia I, Faerber EC, Grant ML. Improved sleep and neurocognitive functions in a child with thalamic lesions on sodium oxybate. Neurology 2007; 68:1157-8. [PMID: 17404202 DOI: 10.1212/01.wnl.0000258658.00692.36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- S V Kothare
- Division of Neurology, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA 19134, USA.
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Archer DP, Nguyen KQ, Samanani N, Roth SH. Pentobarbital Enhances γ-Aminobutyric Acid-Mediated Excitation Without Altering Synaptic Plasticity in Rat Hippocampus. Anesth Analg 2007; 104:840-6. [PMID: 17377091 DOI: 10.1213/01.ane.0000256874.33810.3a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Synaptic plasticity is thought to provide a molecular mechanism for learning and memory. N-methyl-d-aspartate receptor-mediated plasticity requires that N-methyl-d-aspartate receptor activation coincides with postsynaptic depolarizing potentials (DPSP(A)'s). Pentobarbital, in high concentrations, enhances DPSP(A)'s, but high concentrations suppress synaptic plasticity, probably by impairing glutamatergic transmission. Here we tested the hypothesis that low concentrations of pentobarbital can enhance DPSP(A)'s and modify the induction of synaptic plasticity. METHODS Studies were performed in vitro on rat hippocampal slices. With glutamate transmission blocked, intracellular recording from CA1 neurons was used to investigate the influence of 5 microM pentobarbital on DPSP(A)'s and neuron excitability evoked by high frequency (100 Hz) stimulation. With glutamate transmission intact, extracellular recording was used to examine the effect of 5 microM pentobarbital on the induction of long-term depression and long-term potentiation of synaptic transmission by conditioning stimuli applied to the Schaffer collateral pathway. RESULTS High frequency stimulation generated typical DPSP(A)'s that were mediated by gamma-aminobutyric acid(A) receptors and dependent upon HCO3-. Pentobarbital (5 microM) increased the amplitude, but not the width, at half-maximal amplitude of DPSPA's (P < 0.01). Pentobarbital increased the probability of action potential generation during the DPSP(A)'s. Pentobarbital did not alter the induction of long-term depression or long-term potentiation. CONCLUSIONS Despite increasing the amplitude of DPSP(A)'s, 5 microM pentobarbital did not alter the induction of synaptic plasticity by a range of conventional conditioning stimuli. These results do not support the hypothesis that excitatory effects of pentobarbital may alter synaptic plasticity.
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Affiliation(s)
- David P Archer
- Department of Anesthesiology, Faculty of Medicine, University of Calgary, Calgary, Canada.
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Abstract
BACKGROUND We explored the sympatholytic property of dexmedetomidine, especially its role in intraocular pressure (IOP) reduction, haemodynamic stability, and attenuation of extubation response. METHOD In this double-blind, randomized, controlled trial approved by the Hospital Ethics Committee, 60 patients undergoing elective vitreoretinal surgery were allocated to two groups, receiving either placebo or dexmedetomidine. A loading dose of dexmedetomidine 2.5 microg kg(-1) h(-1) (or placebo in same volume) was infused for 10 min immediately before induction of anaesthesia with propofol, followed by a maintenance dexmedetomidine or placebo infusion at 0.4 microg kg(-1) h(-1) till 30 min before the end of the operation. Anaesthesia was maintained with isoflurane, oxygen, and air mixture. IOP was measured before the loading dose and 1 min after tracheal intubation. The mean arterial pressure (MAP) and heart rate (HR) during loading, induction, maintenance, extubation, and recovery period were measured. The degree of strain on extubation was graded from 0 to 5. RESULTS The use of vasopressor/labetalol/atropine and the reduction in IOP were comparable between the two groups. There was a significant variation in MAP and HR over time within group, but not between groups. The median degree of strain was significantly lower (P = 0.049), and the time to reach Aldrete score of 10 shorter (P = 0.031) in the dexmedetomidine group. CONCLUSION Dexmedetomidine can be used without undue haemodynamic fluctuation and can decrease the excitatory response during extubation. The reduction in IOP with dexmedetomidine was comparable with placebo.
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Affiliation(s)
- Y Y S Lee
- Department of Anaesthesia, Queen Elizabeth Hospital, Hong Kong, China.
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Abstract
BACKGROUND The current study was designed to assess the effect of magnesium sulphate infusion on hemodynamic parameters, neuromuscular blocking, propofol consumption, serum concentration of magnesium ions, and recovery from anesthesia during total intravenous anesthesia. METHODS For this study, 60 patients undergoing septorhinoplasty operations were randomly allocated to receive magnesium sulphate (group M) or saline (group C) intravenously. The patients in group M received 15% magnesium sulphate 50 mg/kg in 100 ml of saline, and those in group C received an equal volume of saline before induction of anesthesia followed by 8 mg/kg/h infusion of either magnesium sulphate (group M) or an equal volume of saline (group C) until the end of surgery. Anesthesia was induced and maintained with propofol, remifentanil infusions, and vecuronium in both groups. RESULTS Propofol requirements were significantly lower in group M than in group C (p < 0.05). The hemodynamic variables were similar in the two groups. The neuromuscular potency of vecuronium was greater in group M than in group C (p < 0.05). The verbal numeric scale values for pain were found to be significantly lower in group M than in group C (p < 0.05). Whereas the serum magnesium was in the normal range at the induction of anesthesia in the both groups, it was significantly lower in group C than in group M postoperatively (p < 0.05). CONCLUSION Magnesium sulphate can be used safely as an adjuvant to total intravenous anesthesia for day case surgeries, with the effect from potentialization of neuromuscular blockade taken into consideration.
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Affiliation(s)
- Pelin Cizmeci
- Department of Anesthesiology and Reanimation, Gazi University School of Medicine, 06500, Besevler, Ankara, Turkey
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Pang DSJ, Rondenay Y, Measures L, Lair S. The effects of two dosages of midazolam on short-duration anesthesia in the harp seal (Phoca groenlandica). J Zoo Wildl Med 2007; 37:27-32. [PMID: 17312808 DOI: 10.1638/05-052.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The purpose of this study was to provide safe anesthesia for bronchoalveolar lavage and assess the utility of premedication with i.m. midazolam for short-duration anesthesia with isoflurane in harp seals (Phoca groenlandica). Fourteen yearling harp seal pups were anesthetized three times each as part of a prospective, cross-over, blinded study. Each animal received i.m. premedication with saline, low-dose, or high-dose midazolam (respectively 0.1 and 0.2 mg/ kg). Following premedication, anesthesia was induced with 4% isoflurane in oxygen delivered through a mask and connected to a Bain non-rebreathing system. A significantly longer time was taken from the end of general anesthesia to head movement in the high-dose group compared with the saline group (P = 0.002). A significantly longer time was taken from the end of general anesthesia to ambulation in the high-dose group compared with the saline group (P = 0.006). There were no significant differences between groups in the subjective assessment of anesthetic quality or ease of intubation. Premedication with i.m. midazolam at the dosages used did prolong recovery from anesthesia, although to a degree unlikely to be significant clinically.
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Affiliation(s)
- Daniel S J Pang
- Département de sciences cliniques, Faculté de médecine vétérinaire, Université de Montréal
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Abstract
CONCLUSION General anesthesia induced by sodium pentobarbital reduces temporal resolution as represented by an increase in the threshold of gap-evoked auditory responses in guinea pigs. OBJECTIVES To explore the potential impact of general anesthesia by sodium pentobarbital (PB), a common anesthetic used in animal research, on gap-evoked responses. MATERIALS AND METHODS The evoked potentials in response to gaps formed by bursts of broadband noise were recorded from electrodes implanted in the inferior colliculus (IC) and the auditory cortex (AC) of guinea pigs. The gap responses were compared in three conditions: unanesthetized and anesthetized with two doses of sodium pentobarbital (40 mg/kg and 20 mg/kg). RESULTS PB increased the gap response thresholds, especially when applied at the higher dose. The threshold shift induced by PB was greater in the AC than in the IC. In addition, the higher dose of PB significantly increased the gap response latency in both IC and AC, and decreased response amplitude in IC only.
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Affiliation(s)
- Yanmei Feng
- Department of Otolaryngology, No 6 People's Hospital, Shanghai JiaoTong University Shanghai, China
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Charles KA, Rivory LP, Brown SL, Liddle C, Clarke SJ, Robertson GR. Transcriptional Repression of Hepatic Cytochrome P450 3A4 Gene in the Presence of Cancer. Clin Cancer Res 2006; 12:7492-7. [PMID: 17189422 DOI: 10.1158/1078-0432.ccr-06-0023] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Many chemotherapeutic drugs have an inherent lack of safety due to interindividual variability of hepatic cytochrome P450 (CYP) 3A4 drug metabolism. This reduction in CYP3A4 in cancer patients is possibly mediated by cytokines associated with tumor-derived inflammation. We sought to examine this link by using an explant sarcoma in a novel transgenic mouse model of human CYP3A4 regulation. EXPERIMENTAL DESIGN Engelbreth-Holm-Swarm sarcoma cells were injected into the hindlimb of transgenic CYP3A4/lacZ mice. Hepatic expression of the human CYP3A4 transgene was analyzed by direct measurement of the reporter gene product, beta-galactosidase enzyme activity. Hepatic expression of murine Cyp3a was analyzed at the mRNA, protein, and function levels. The acute phase response was assessed by examining cytokines [interleukin-6 (IL-6) and tumor necrosis factor] in serum, liver, or tumor as well as hepatic expression of serum amyloid protein P. RESULTS Engelbreth-Holm-Swarm sarcoma elicited an acute phase response that coincided with down-regulation of the human CYP3A4 transgene in the liver as well as the mouse orthologue Cyp3a11. The reduction of murine hepatic Cyp3a gene expression in tumor-bearing mice resulted in decreased Cyp3a protein expression and consequently a significant reduction in Cyp3a-mediated metabolism of midazolam. Circulating IL-6 was elevated and IL-6 protein was only detected in tumor tissue but not in hepatic tissue. CONCLUSIONS The current study provides a mechanistic link between cancer-associated inflammation and impaired drug metabolism in vivo. Targeted therapy to reduce inflammation may provide improved clinical benefit for chemotherapy drugs metabolized by hepatic CYP3A4 by improving their pharmacokinetic profile.
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Affiliation(s)
- Kellie A Charles
- Department of Pharmacology, University of Sydney, Sydney, New South Wales, Australia
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Contreras-Domínguez V, Carbonell-Bellolio P, Sanzana Salamanca E, Ojeda-Grecie A. [Addition of sodium bicarbonate and/or clonidine to mepivacaine: influence on axillary brachial plexus block characteristics]. Rev Esp Anestesiol Reanim 2006; 53:532-7. [PMID: 17297828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND AND OBJECTIVE The axillary brachial plexus block is a frequently performed anesthetic technique. Adding a variety of coadjuvant drugs has been shown to improve results. This study evaluated the addition of sodium bicarbonate (NaHCO3) and/or clonidine to mepivacaine for performing the block. MATERIAL AND METHODS Sixty patients between 18 and 70 years old, ASA 1-3 in stable condition received axillary brachial plexus blocks in a randomized controlled study. Four groups of 15 patients each were formed: group I (control group) received 40 mL of 1% mepivacaine with adrenaline plus 5 mL of saline; group II, 40 mL of 1% mepivacaine with adrenaline plus 4 mL of NaHCO3 and 1 mL of saline; group III, 40 mL of 1% mepivacaine with 150 microg of clonidine plus 4mL of saline; and group IV, 40 mL of 1% mepivacaine with adrenaline plus 4 mL of NaHCO3 and 150 microg of clonidine. RESULTS The onset time was significantly shorter in groups 2 and 4. The duration of the block was longer in group 3 and the analgesic effect was significantly better. CONCLUSIONS Adding NaHCO3 to mepivacaine shortens the time of onset of an axillary brachial plexus block. Including clonidine prolongs the duration of anesthesia and analgesia. The addition of both NaHCO3 and clonidine shortens time to onset but does not prolong duration of anesthesia or analgesia.
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Affiliation(s)
- V Contreras-Domínguez
- Servicio de Anestesiología, Hospital Clínico Regional de Concepción, Facultad de Medicina, Universidad de Concepción, Chile.
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Abstract
We describe the successful anesthetic management of a patient with stiff-person syndrome (SPS) undergoing a right inguinal hernia repair, using a somatic paravertebral block supplemented with conscious sedation. We also present the implications of general anesthesia in patients with SPS. The use of regional anesthetic techniques in patients with SPS has the advantage of avoiding exposure to muscle relaxants. The use of general anesthesia in patients with SPS carries the risk of postoperative hypotonia due to enhancement of gamma-aminobutyric acid action on synaptic transmission by drugs that have a gamma-aminobutyric acid agonistic action.
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Affiliation(s)
- Nabil Elkassabany
- Department of General Anesthesiology and Critical Care Medicine, The Cleveland Clinic Foundation, OH 44195, USA
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Yamaguchi M, Shibata O, Nishioka K, Makita T, Sumikawa K. Propofol attenuates ovalbumin-induced smooth muscle contraction of the sensitized rat trachea: inhibition of serotonergic and cholinergic signaling. Anesth Analg 2006; 103:594-600. [PMID: 16931667 DOI: 10.1213/01.ane.0000229853.01875.60] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Propofol is considered suitable for induction of anesthesia in patients with bronchial asthma. However, the mechanisms of its action on bronchi are not fully understood. We examined the effects of propofol on ovalbumin (OA)-induced contraction of OA-sensitized rat trachea. Male Wistar rats were sensitized by a single intraperitoneal injection of OA 10 microg mixed with aluminum hydroxide, 10 mg, as adjuvant. Fourteen days later, the experiment was performed using the tracheal rings. We observed the effects of ketanserin, a 5-HT2 receptor antagonist, and atropine on OA-induced contraction. Next, the effects of propofol on OA-, serotonin (5-HT)-, acetylcholine-, or electrical field stimulation-induced contractions were observed. OA-induced contraction was 90% attenuated by the combination of ketanserin and atropine. Propofol significantly attenuated OA-induced contraction in a dose-dependent manner. Propofol abolished 5-HT-induced contraction, attenuated acetylcholine-induced contraction, and also almost completely attenuated the enhancement by 5-HT of electrical field stimulation-induced contraction. These results suggest that the mechanism involved in the attenuation by propofol of OA-induced contraction is inhibition of the actions of 5-HT. Propofol should be a useful anesthetic in patients with immunoglobulin E-related asthma.
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Affiliation(s)
- Masakazu Yamaguchi
- Department of Anesthesiology, Nagasaki University School of Medicine, Nagasaki, Japan
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