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1.
J Anesth ; 37(6): 835-840, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37566231

RESUMO

PURPOSE: Perioperative shivering is common and can occur as a result of hypothermia or changes in the threshold of thermoregulation. Droperidol usage for anesthesia is currently limited to its sedative and antiemetic effects. We investigated the effects of high and low doses of droperidol on the shivering threshold in rabbits. METHODS: Forty-two male Japanese white rabbits were anesthetized with isoflurane and randomly assigned to the control, high-dose, or low-dose group. Rabbits in the high-dose group received a 5 mg/kg droperidol bolus followed by continuous infusion at 5 mg/kg/h, those in the low-dose group received a 0.5 mg/kg droperidol bolus, and those in the control group received the same volume of saline as the high-dose group. Body temperature was reduced at a rate of 2-3 °C/h, and the shivering threshold was defined as the subject's core temperature (°C) at the onset of shivering. RESULTS: The shivering thresholds in the control, high-dose, and low-dose groups were 38.1 °C ± 1.1 °C, 36.7 °C ± 1.2 °C, and 36.9 °C ± 1.0 °C, respectively. The shivering thresholds were significantly lower in the high-dose and low-dose groups than in the control group (P < 0.01). The thresholds were comparable between the high-dose and low-dose groups. CONCLUSIONS: Droperidol in high and low doses effectively reduced the shivering threshold in rabbits. Droperidol has been used in low doses as an antiemetic. Low doses of droperidol can reduce the incidence of shivering perioperatively and during the induction of therapeutic hypothermia.


Assuntos
Hipotermia , Isoflurano , Animais , Coelhos , Masculino , Estremecimento/fisiologia , Droperidol/farmacologia , Temperatura Corporal/fisiologia , Isoflurano/farmacologia , Hipotermia/tratamento farmacológico
3.
Mediators Inflamm ; 2018: 4638437, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30002599

RESUMO

Lung fibrosis is characterized by abnormal accumulation of Thy-deficient fibroblasts in the interstitium of the alveolar space. We have previously shown in bleomycin-treated chimeric Thy1-deficient mice with wild-type lymphocytes that Thy1-deficient fibroblasts accumulate and promote fibrosis and an "inflammation-free" environment. Here, we aimed to identify the critical effects of Thy1, or the absence of Thy1, in lung myofibroblast profibrotic functions, particularly proliferation and collagen deposition. Using specific Thy1 siRNA in Thy1-positive cells, Thy1 knockout cells, Thy1 cDNA expression vector in Thy1-deficient cells, and Thy1 cross-linking, we evaluated cell proliferation (assessed by cell mass and BrdU uptake), differentiation (using immunofluorescence), and collagen deposition (using Sircol assay). We found that myofibroblast Thy1 cross-linking and genetic manipulation modulate cell proliferation and expression of Fgf (fibroblast growth factor) and Angtl (angiotensin) receptors (using qPCR) that are involved in myofibroblast proliferation, differentiation, and collagen deposition. In conclusion, lung myofibroblast downregulation of Thy1 expression is critical to increase proliferation, differentiation, and collagen deposition.


Assuntos
Pulmão/citologia , Miofibroblastos/efeitos dos fármacos , Miofibroblastos/metabolismo , Antígenos Thy-1/metabolismo , Animais , Bleomicina/farmacologia , Ciclo Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Células Cultivadas , Droperidol/farmacologia , Citometria de Fluxo , Ketamina/farmacologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Microscopia Confocal
4.
Nature ; 547(7664): 468-471, 2017 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-28678776

RESUMO

The cannabinoid receptor 1 (CB1) is the principal target of the psychoactive constituent of marijuana, the partial agonist Δ9-tetrahydrocannabinol (Δ9-THC). Here we report two agonist-bound crystal structures of human CB1 in complex with a tetrahydrocannabinol (AM11542) and a hexahydrocannabinol (AM841) at 2.80 Å and 2.95 Å resolution, respectively. The two CB1-agonist complexes reveal important conformational changes in the overall structure, relative to the antagonist-bound state, including a 53% reduction in the volume of the ligand-binding pocket and an increase in the surface area of the G-protein-binding region. In addition, a 'twin toggle switch' of Phe2003.36 and Trp3566.48 (superscripts denote Ballesteros-Weinstein numbering) is experimentally observed and appears to be essential for receptor activation. The structures reveal important insights into the activation mechanism of CB1 and provide a molecular basis for predicting the binding modes of Δ9-THC, and endogenous and synthetic cannabinoids. The plasticity of the binding pocket of CB1 seems to be a common feature among certain class A G-protein-coupled receptors. These findings should inspire the design of chemically diverse ligands with distinct pharmacological properties.


Assuntos
Agonistas de Receptores de Canabinoides/química , Dronabinol/análogos & derivados , Droperidol/análogos & derivados , Receptor CB1 de Canabinoide/agonistas , Receptor CB1 de Canabinoide/química , Sítios de Ligação , Agonistas de Receptores de Canabinoides/síntese química , Agonistas de Receptores de Canabinoides/farmacologia , Cristalografia por Raios X , Dronabinol/síntese química , Dronabinol/química , Dronabinol/farmacologia , Droperidol/síntese química , Droperidol/química , Droperidol/farmacologia , Proteínas Heterotriméricas de Ligação ao GTP/metabolismo , Humanos , Ligantes , Simulação de Acoplamento Molecular , Ligação Proteica , Conformação Proteica , Receptor CB1 de Canabinoide/antagonistas & inibidores , Receptor CB1 de Canabinoide/metabolismo
5.
Rev Esp Anestesiol Reanim ; 62(9): 495-501, 2015 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-25887095

RESUMO

BACKGROUND AND OBJECTIVE: Droperidol and ondansetron prolong QT interval, a circumstance that has raised some concerns regarding the possibility of inducing torsades de pointes (TdP). However drug-induced spatial dispersion of ventricular repolarization has been shown to be the principal arrhythmogenic substrate for TdP. The aim of this study is to explore the effects of droperidol and ondansetron on the dispersion of repolarization, measured using the T peak-to-end interval (Tp-e) and Tp-e/QT and Tp-e/RR(1/2) ratios in surgical anesthetized patients. METHODS: A randomized, double-blind study carried out on sixty-three adult patients without cardiac disease or factors favoring QT prolongation and undergoing non-cardiac surgery were randomly assigned to the droperidol or ondansetron group. Under propofol anesthesia, a 12-lead EKG was obtained, and 1.25mg droperidol or 4mg ondansetron was injected. Five minutes later, a new 12-lead EKG was recorded. EKG analyses were independently performed by two cardiologists blinded to the state of the traces or group allocation. QT, RR and Tp-e intervals were measured by averaging five successive beats in leadII (QT) or V5 (Tp-e). The mean value for each measurement was calculated for statistical analysis. RESULTS: Thirty-two patients (19 women) received droperidol, and 31 (22 women) ondansetron. Droperidol and ondansetron prolonged the QTcF interval (Fridericia formula) by 6.8 and 7.2ms (mean values) respectively, but neither droperidol nor ondansetron increased the Tp-e interval or Tp-e/QT and Tp-e/RR(1/2) ratios. CONCLUSION: At antiemetic doses, neither ondansetron (4mg) nor droperidol (1.25mg) increases the dispersion of ventricular repolarization in healthy adult patients anesthetized with propofol.


Assuntos
Antieméticos/farmacologia , Droperidol/farmacologia , Eletrocardiografia/efeitos dos fármacos , Sistema de Condução Cardíaco/efeitos dos fármacos , Ondansetron/farmacologia , Adulto , Anestesia Geral , Anestesia Intravenosa , Antieméticos/uso terapêutico , Método Duplo-Cego , Droperidol/uso terapêutico , Feminino , Sistema de Condução Cardíaco/fisiologia , Ventrículos do Coração/efeitos dos fármacos , Humanos , Masculino , Potenciais da Membrana/efeitos dos fármacos , Potenciais da Membrana/fisiologia , Pessoa de Meia-Idade , Condução Nervosa/efeitos dos fármacos , Condução Nervosa/fisiologia , Ondansetron/uso terapêutico , Náusea e Vômito Pós-Operatórios/prevenção & controle
6.
Masui ; 64(10): 1076-9, 2015 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-26742414

RESUMO

A patient developed acute dystonia following intravenous administration of metocroplamide 20 mg. A 34-year-old woman underwent right hepatectomy, under general anesthesia managed with desflurane, remifentanil, and rocuronium. At the start of surgery, droperidol 1.5 mg was given intravenously for anti-emetic prophylaxis. Operation was completed uneventfully. Intravenous patient-controlled analgesia (i.v.-PCA) with fentanyl, containing droperidol, was selected for postoperative pain management The patient showed a reasonable postoperative course; however, around 15 hours post-operatively, she complained of nausea, although droperidol 2.625 mg had been administrated (maximum dose). Nausea subsequently disappeared following intravenous metocroplamide 20 mg, and i.v.-PCA was terminated. The patient gradually complained of excessive sleepiness. Finally, she showed akinesis and bilateral oculomotor disturbance 140 minutes after metocroplamide administration. However, her vital signs remained stable. Examinations including magnetic resonance imaging, electroencephalogram, and blood test did not show abnormalities. She was diagnosed with acute dystonia. She recovered without medications 300 minutes after the onset of akinesis. She could communicate with her eyes, opening/closing, throughout this episode. The effects of antiemetics acting on different receptors are additive. However, we should remember that coadministration of metocroplamide and butyrophenone induces extrapyramidal signs like acute dystonia. Intraoperative management extending beyond postoperative antiemetic therapy is necessary.


Assuntos
Analgesia Controlada pelo Paciente , Antieméticos/efeitos adversos , Droperidol/farmacologia , Distonia/induzido quimicamente , Metoclopramida/efeitos adversos , Doença Aguda , Adulto , Feminino , Humanos
7.
Eksp Klin Farmakol ; 77(8): 7-10, 2014.
Artigo em Russo | MEDLINE | ID: mdl-25335383

RESUMO

We have studied the effects of chlorpromazine, acepromazine, droperidol, and transcranial electroanesthesia upon evacuation function of the stomach in piglets and the effects of leu-enkephalin and glycyl-proline upon secretory activity of the stomach in dogs and rats during surgical stress to optimize anesthetic dosage. All pharmaceutical and nonpharmaceutical methods of anesthesia used in the experiments were implemented by actiovating stress-limiting systems in post-operational period. Leu-enkephalin, apart from stimulating the stress-limiting factors of neurohumoral systems of the organism, shifted the vector ratio of aggressive and protective factors of gastric mucosa toward strengthening of the latter. The opposite trends of changes in the secretory activity of the stomach of rats in response to surgical stress can be leveled using glycyl-proline as a component of anesthesia.


Assuntos
Antipsicóticos/farmacologia , Dipeptídeos/farmacologia , Encefalina Leucina/farmacologia , Neurotransmissores/farmacologia , Dor/prevenção & controle , Estresse Fisiológico/efeitos dos fármacos , Acepromazina/farmacologia , Animais , Clorpromazina/farmacologia , Cães , Droperidol/farmacologia , Esvaziamento Gástrico/efeitos dos fármacos , Mucosa Gástrica/efeitos dos fármacos , Mucosa Gástrica/cirurgia , Laparoscopia , Masculino , Dor/fisiopatologia , Medição da Dor , Ratos , Ratos Wistar , Estômago/efeitos dos fármacos , Estômago/cirurgia , Suínos , Estimulação Elétrica Nervosa Transcutânea
8.
Basic Clin Pharmacol Toxicol ; 113(6): 385-90, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23957272

RESUMO

The study aimed at validating an increasing-temperature water bath suitable for determining the noxious heat threshold for use in mice. The noxious heat threshold was determined by immersing the tail of the gently held awake mouse into a water container whose temperature was near-linearly increased at a rate of 24°C/min. until the animal withdrew its tail, that is, heating attained the noxious threshold. The effects of standard analgesic, neuroleptic and anxiolytic drugs were investigated in a parallel way on both the noxious heat threshold and the psychomotor activity assessed by the open field test. Morphine, diclofenac and metamizol (dipyrone) elevated the heat threshold of mice with minimum effective doses of 6, 30 and 1000 mg/kg i.p., respectively. These doses of morphine and diclofenac failed to induce any remarkable effect on psychomotor activity in the open field test while that of metamizol exerted a profound inhibition. The anxiolytic diazepam and the neuroleptic droperidol at doses evoking a mild and moderate, respectively, psychomotor inhibition failed to alter the heat threshold. Combination of a subliminal dose of morphine (regarding both antinociceptive and psychomotor inhibitory action) with diclofenac, metamizol, diazepam or droperidol at doses also subliminal regarding the thermal antinociceptive effect elevated the noxious heat threshold without major additional effects in the open field test. It is concluded that the increasing-temperature water bath is suitable for studying the thermal antinociceptive effects of morphine and diclofenac as well as the morphine-sparing action of diclofenac, metamizol, droperidol and diazepam. Behavioural testing is recommended when testing analgesics.


Assuntos
Analgésicos/farmacologia , Psicotrópicos/farmacologia , Limiar Sensorial/efeitos dos fármacos , Sensação Térmica/efeitos dos fármacos , Animais , Diazepam/farmacologia , Diclofenaco/farmacologia , Dipirona/farmacologia , Relação Dose-Resposta a Droga , Droperidol/farmacologia , Feminino , Temperatura Alta/efeitos adversos , Camundongos , Morfina/farmacologia , Atividade Motora/efeitos dos fármacos
10.
Eur J Pharmacol ; 698(1-3): 200-5, 2013 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-23123346

RESUMO

N-methyl-d-aspartate (NMDA) receptors can be inhibited by inhalational anesthetics in vitro at clinically relevant concentrations. Here, to clarify the role of NMDA receptors in anesthetic-induced unconsciousness, we examined the hypnotic properties of isoflurane, sevoflurane and nitrous oxide in NMDA receptor GluN2A subunit knockout mice. The hypnotic properties of inhalational anesthetics were evaluated in mice in the loss of righting reflex (LORR) assay by measuring the 50% concentration for LORR (LORR ED(50)). Knockout mice displayed isoflurane and sevoflurane LORR ED(50) values similar to wild-type controls, indicating no significant contribution of these receptors to the hypnotic action of halogenated anesthetics. However, compared with wild-type controls, mutant mice displayed larger isoflurane LORR ED(50) values in the presence of nitrous oxide, indicating a resistance to this gaseous anesthetic. Knockout mice have enhanced brain monoaminergic activity which occurs secondary to NMDA receptor dysfunction, and the observed resistance to the isoflurane LORR ED(50)-sparing effect of nitrous oxide could be abolished by pretreatment with the dopamine D(2) receptor antagonist droperidol or with the serotonin 5-HT(2A) receptor antagonist ketanserin. Thus, resistance to nitrous oxide in knockout mice appears to be a secondary phenomenon of monoaminergic origin and not a direct result of impaired NMDA receptor function. Our results indicate that NMDA receptors are not critically involved in the hypnotic action of conventionally-used inhalational anesthetics. Also, they suggest that increased brain monoaminergic tone can diminish the effects of general anesthesia. Finally, they provide further evidence that changes secondary to genetic manipulation can explain the results obtained in global knockouts.


Assuntos
Monoaminas Biogênicas/metabolismo , Encéfalo/efeitos dos fármacos , Encéfalo/metabolismo , Resistência a Medicamentos/genética , Óxido Nitroso/farmacologia , Receptores de N-Metil-D-Aspartato/deficiência , Receptores de N-Metil-D-Aspartato/genética , Anestésicos/química , Anestésicos/farmacologia , Animais , Monoaminas Biogênicas/antagonistas & inibidores , Droperidol/farmacologia , Técnicas de Inativação de Genes , Halogenação , Hipnóticos e Sedativos/química , Hipnóticos e Sedativos/farmacologia , Ketanserina/farmacologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Óxido Nitroso/química , Reflexo de Endireitamento/efeitos dos fármacos , Inconsciência/induzido quimicamente
11.
Anesthesiology ; 115(4): 791-803, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21934407

RESUMO

BACKGROUND: Although accumulating evidence suggests that arousal pathways in the brain play important roles in emergence from general anesthesia, the roles of monoaminergic arousal circuits are unclear. In this study, the authors tested the hypothesis that methylphenidate (an inhibitor of dopamine and norepinephrine transporters) induces emergence from isoflurane general anesthesia. METHODS: Using adult rats, the authors tested the effect of intravenous methylphenidate on time to emergence from isoflurane general anesthesia. They then performed experiments to test separately for methylphenidate-induced changes in arousal and changes in minute ventilation. A dose-response study was performed to test for methylphenidate-induced restoration of righting during continuous isoflurane general anesthesia. Surface electroencephalogram recordings were performed to observe neurophysiological changes. Plethysmography recordings and arterial blood gas analysis were performed to assess methylphenidate-induced changes in respiratory function. Intravenous droperidol was administered to test for inhibition of methylphenidate's actions. RESULTS: Methylphenidate decreased median time to emergence from 280 to 91 s. The median difference in time to emergence without methylphenidate compared with administration of methylphenidate was 200 [155-331] s (median, [95% CI]). During continuous inhalation of isoflurane, methylphenidate induced return of righting in a dose-dependent manner, induced a shift in electroencephalogram power from delta (less than 4 Hz) to theta (4-8 Hz), and induced an increase in minute ventilation. Administration of intravenous droperidol (0.5 mg/kg) before intravenous methylphenidate (5 mg/kg) largely inhibited methylphenidate-induced emergence behavior, electroencephalogram changes, and changes in minute ventilation. CONCLUSIONS: Methylphenidate actively induces emergence from isoflurane general anesthesia by increasing arousal and respiratory drive, possibly through activation of dopaminergic and adrenergic arousal circuits. The authors' findings suggest that methylphenidate may be useful clinically as an agent to reverse general anesthetic-induced unconsciousness and respiratory depression at the end of surgery.


Assuntos
Período de Recuperação da Anestesia , Anestesia Geral , Estimulantes do Sistema Nervoso Central/farmacologia , Metilfenidato/farmacologia , Adjuvantes Anestésicos/farmacologia , Algoritmos , Alcalose Respiratória/sangue , Alcalose Respiratória/induzido quimicamente , Anestésicos Inalatórios , Animais , Nível de Alerta/efeitos dos fármacos , Gasometria , Pressão Sanguínea/efeitos dos fármacos , Droperidol/farmacologia , Eletroencefalografia/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Hemodinâmica/efeitos dos fármacos , Isoflurano , Masculino , Pletismografia , Equilíbrio Postural/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Mecânica Respiratória/efeitos dos fármacos
13.
Anesth Analg ; 111(3): 638-46, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20601449

RESUMO

BACKGROUND: Droperidol is a highly potent butyrophenone used for the therapy of postoperative nausea and vomiting. Its cardiac safety in cardiovascular-healthy patients and those with long QT (LQT) syndrome is a matter of debate. In this study, we investigated whether droperidol has subtype-specific effects in cellular and computational models of LQT syndrome. METHODS: Left ventricular cardiac myocytes were isolated from adult guinea pig hearts. LQT1-like behavior was pharmacologically induced by chromanol 293B (10 micromol/L) and LQT2-like states by E4031 (10 micromol/L). Computational analysis was performed using the Luo-Rudy dynamic model. Data are given as mean + or - SEM. RESULTS: In control myocytes, droperidol lengthened action potentials in a concentration-dependent manner with a maximal prolongation of 37% + or - 13% (n = 4) at a concentration of 0.6 micromol/L. In LQT1-like myocytes, droperidol (0.6 micromol/L) further prolonged action potentials by 31% + or - 6% (n = 6) but shortened action potentials of LQT2-like myocytes by 11% + or - 2% (n = 8). Computational modeling supported the concept that droperidol, in addition to the rapid component of the delayed K(+) current, blocks depolarizing targets, such as the L-type Ca(2+) current, the Na(+)-Ca(2+) exchanger, and the Na(+)-K(+) adenosine triphosphatase. CONCLUSIONS: Droperidol has more detrimental effects on cardiac repolarization of LQT1-like than of LQT2-like myocytes suggesting subtype-specific cardiotoxic effects in patients with LQT syndrome. The subtype specificity of droperidol seems to be caused by a complex interaction of droperidol with several different molecular targets. This interaction deserves further investigation to establish the feasibility of a subtype-directed approach in the perioperative management of patients with LQT syndrome.


Assuntos
Potenciais de Ação/efeitos dos fármacos , Antieméticos/farmacologia , Droperidol/farmacologia , Síndrome do QT Longo/patologia , Adulto , Animais , Antiarrítmicos , Soluções Cardioplégicas , Separação Celular , Cromanos , Simulação por Computador , Interpretação Estatística de Dados , Cobaias , Humanos , Síndrome do QT Longo/induzido quimicamente , Modelos Estatísticos , Miócitos Cardíacos/efeitos dos fármacos , Técnicas de Patch-Clamp , Piperidinas , Bloqueadores dos Canais de Potássio , Piridinas , Sulfonamidas
14.
BMC Emerg Med ; 10: 14, 2010 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-20584282

RESUMO

BACKGROUND: Acute behavioural disturbance (ABD) is an increasing problem in emergency departments. This study aimed to determine the impact of a structured intramuscular (IM) sedation protocol on the duration of ABD in the emergency department. METHODS: A historical control study was undertaken comparing 58 patients who required physical restraint and parenteral sedation with the structured IM sedation protocol, to 73 historical controls treated predominantly by intravenous sedation, according to individual clinician preference. The primary outcome was the duration of the ABD defined as the time security staff were required. Secondary outcomes were the requirement for additional sedation, drug related-adverse effects and patient and staff injuries. RESULTS: The median duration of the ABD in patients with the new sedation protocol was 21 minutes (IQR: 15 to 35 minutes; Range: 5 to 78 minutes) compared to a median duration of 30 minutes (IQR: 15 to 50 minutes; Range: 5 to 135 minutes) in the historical controls which was significantly different (p = 0.03). With IM sedation only 27 of 58 patients (47%; 95% CI: 34% to 60%) required further sedation compared to 64 of 73 historical controls (88%; 95%CI: 77% to 94%). There were six (10%) drug-related adverse events with the new IM protocol [oxygen desaturation (5), oxygen desaturation/airway obstruction (1)] compared to 10 (14%) in the historical controls [oxygen desaturation (5), hypoventilation (4) and aspiration (1)]. Injuries to staff occurred with three patients using the new sedation protocol and in seven of the historical controls. Two patients were injured during the new protocol and two of the historical controls. CONCLUSION: The use of a standardised IM sedation protocol was simple, more effective and as safe for management of ABD compared to predominantly intravenous sedation.


Assuntos
Transtornos de Deficit da Atenção e do Comportamento Disruptivo/tratamento farmacológico , Protocolos Clínicos , Sedação Consciente , Antagonistas de Dopamina/administração & dosagem , Droperidol/administração & dosagem , Serviço Hospitalar de Emergência , Hipnóticos e Sedativos/administração & dosagem , Injeções Intramusculares , Midazolam/administração & dosagem , Adulto , Sedação Consciente/métodos , Antagonistas de Dopamina/farmacologia , Droperidol/farmacologia , Feminino , Humanos , Hipnóticos e Sedativos/farmacologia , Masculino , Midazolam/farmacologia , Estudos Prospectivos , Adulto Jovem
15.
Digestion ; 82(2): 80-3, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20407249

RESUMO

Sedation for gastrointestinal endoscopies is obtained by opioids, benzodiazepines, propofol, ketamine and/or droperidol. The pharmacokinetic profile of some sedatives/anesthetics renders them advantageous over others. Opioids, mainly pethidine and fentanyl, are the most popular. Though newer opioids provide a faster recovery, fentanyl is safe and advantageous due to its lower cost. Remifentanil, due to its pharmacokinetic profile (elimination half-life: 9 min), is advantageous for ambulatory patients, though it is not known whether the high cost compensates the benefits. Midazolam is the benzodiazepine of choice as it has a shorter duration of action and a better pharmacokinetic profile than diazepam. Propofol, an intravenous anesthetic, has become very popular for gastrointestinal endoscopies in sedative doses. The opioid and benzodiazepine antagonists, naloxone and flumazenil, are indicated only in particular circumstances, like deep sedation with threatening respiratory depression. Ketamine and droperidol are not popular agents for sedation in the modern endoscopic practice.


Assuntos
Endoscopia Gastrointestinal/métodos , Hipnóticos e Sedativos/antagonistas & inibidores , Hipnóticos e Sedativos/farmacologia , Adjuvantes Anestésicos/farmacologia , Analgésicos Opioides/antagonistas & inibidores , Analgésicos Opioides/farmacologia , Anestésicos Dissociativos/farmacologia , Anestésicos Intravenosos/farmacologia , Benzodiazepinas/antagonistas & inibidores , Benzodiazepinas/farmacologia , Droperidol/farmacologia , Humanos , Hipnóticos e Sedativos/farmacocinética , Hipnóticos e Sedativos/uso terapêutico , Ketamina/farmacologia , Propofol/farmacologia
16.
J Neural Transm (Vienna) ; 117(5): 585-91, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20358234

RESUMO

Dopamine (DA) regulates pain perception in the central nervous system (CNS). However, the mechanism of the action of DA in pain-related neurons of the parafascicular nucleus (Pf) is not clear. The present study aimed to determine the effect of DA and its receptor antagonist, droperidol on the pain-evoked responses of the pain-excited neurons (PEN) and pain-inhibited neurons (PIN) in the Pf of rats and to analyze the mechanisms underlying this effect. The trains of electric impulses applied to the sciatic nerve were used as noxious stimulation. The discharges of PEN and PIN in the Pf were recorded by using a glass microelectrode. The results showed that, in the Pf, intra-Pf microinjection of DA (5 microg/0.5 microl) increased the frequency of noxious stimulation-induced discharges of the PEN and decreased the frequency of those of the PIN, while the intra-Pf administration of droperidol (0.15 microg/0.5 microl) produced an opposite effect. On the basis of the above-mentioned findings, we could conclude that DA and its receptors in the Pf are involved in the modulation of the nociceptive response by regulating the discharges of PEN and PIN.


Assuntos
Dopamina/metabolismo , Núcleos Intralaminares do Tálamo/metabolismo , Neurônios/metabolismo , Nociceptores/metabolismo , Dor/metabolismo , Potenciais de Ação/efeitos dos fármacos , Potenciais de Ação/fisiologia , Animais , Modelos Animais de Doenças , Dopamina/farmacologia , Antagonistas de Dopamina/farmacologia , Droperidol/farmacologia , Estimulação Elétrica/métodos , Feminino , Núcleos Intralaminares do Tálamo/efeitos dos fármacos , Masculino , Microinjeções , Neurônios/efeitos dos fármacos , Nociceptores/efeitos dos fármacos , Dor/fisiopatologia , Medição da Dor/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Receptores Dopaminérgicos/efeitos dos fármacos , Nervo Isquiático/fisiopatologia
17.
Anesth Analg ; 110(2): 461-5, 2010 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-19933527

RESUMO

BACKGROUND: Until recently, the N-methyl-D-aspartate (NMDA) receptor was considered to possibly mediate the immobility produced by inhaled anesthetics such as isoflurane and nitrous oxide. However, new evidence suggests that the role of this receptor in abolition of the movement response may be less important than previously thought. To provide further evidence supporting or challenging this view, we examined the anesthetic potencies of isoflurane and nitrous oxide in genetically modified animals with established NMDA receptor dysfunction caused by GluRepsilon1 subunit knockout. METHODS: The immobilizing properties of inhaled anesthetics in mice quantitated by the minimum alveolar anesthetic concentration (MAC) were evaluated using the classic tail clamp method. RESULTS: Compared with wild-type controls, NMDA receptor GluRepsilon1 subunit knockout mice displayed larger isoflurane MAC values indicating a resistance to the immobilizing action of isoflurane. Knockout mice were previously shown to have enhanced monoaminergic tone as a result of genetic manipulation, and this increase in MAC could be abolished in our experiments by pretreatment with the serotonin 5-hydroxytryptamine type 2A receptor antagonist ketanserin or with the dopamine D2 receptor antagonist droperidol at doses that did not affect MAC values in wild-type animals. Mutant mice also displayed resistance to the isoflurane MAC-sparing effect of nitrous oxide, but this resistance was similarly abolished by ketanserin and droperidol. Thus, resistance to the immobilizing action of inhaled anesthetics in knockout mice seems to be secondary to increased monoaminergic activation after knockout rather than a direct result of impaired NMDA receptor function. CONCLUSIONS: Our results confirm recent findings indicating no critical contribution of NMDA receptors to the immobility induced by isoflurane and nitrous oxide. In addition, they demonstrate the ability of changes secondary to genetic manipulation to affect the results obtained in global knockout studies.


Assuntos
Anestésicos Inalatórios/farmacologia , Técnicas de Inativação de Genes , Isoflurano/farmacologia , Movimento/efeitos dos fármacos , Óxido Nitroso/farmacologia , Receptores de N-Metil-D-Aspartato/genética , Animais , Antagonistas de Dopamina/farmacologia , Relação Dose-Resposta a Droga , Droperidol/farmacologia , Isoflurano/farmacocinética , Ketanserina/farmacologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Limiar da Dor , Alvéolos Pulmonares/química , Antagonistas da Serotonina/farmacologia
18.
Fundam Clin Pharmacol ; 23(6): 719-26, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19678851

RESUMO

Droperidol and ondansetron are potent anti-emetic agents which are often administered together. Although both drugs prolong QT interval in man by inhibition of Human Ether-a-go-go Related Gene-coded potassium channels, only droperidol was tested using more integrated experimental models. Therefore, we studied the effects of both compounds and their combination on action potentials (AP) of rabbit Purkinje fibers using conventional intracellular glass microelectrode. Purkinje fibers, driven at 1 Hz, were exposed to increasing concentrations (from 0.001 to 10 microm) of droperidol (n = 7) or ondansetron (n = 8) at 30 min intervals at 36.5 degrees C. Other fibers were exposed to a constant droperidol concentration (0.1 microm) alone (n = 7) or together with the same increasing concentrations of ondansetron (n = 6). Droperidol increased AP duration measured at 90% repolarization (APD90) in a concentration-dependent manner from 4.4 +/- 0.8% (mean +/- SEM) after 1 nm to a maximum of 158 +/- 72% after 1 microm. Ondansetron significantly increased APD90 by 5.3 +/- 2.1% at 100 nm up to 76 +/- 14% after 10 microm. Early after-depolarization occurred in 6/7 fibers exposed to droperidol and 1/8 fibers exposed to ondansetron. When given together, pure additive effects were observed. The concentrations that increased APD90 by 50% were 0.25 +/- 0.25 microm droperidol, 3.8 +/- 2.4 microm ondansetron and 1.5 +/- 0.8 microm ondansetron when given together with droperidol. Both ondansetron and droperidol prolong AP duration in Purkinje fibers, droperidol being 10 times more potent than ondansetron. Combination of ondansetron and droperidol exhibits an additive effect on AP duration. However, within clinically relevant concentrations, ondansetron does not further increase the AP prolongation caused by droperidol alone.


Assuntos
Potenciais de Ação/efeitos dos fármacos , Antieméticos/farmacologia , Droperidol/farmacologia , Ondansetron/farmacologia , Ramos Subendocárdicos/efeitos dos fármacos , Animais , Combinação de Medicamentos , Interações Medicamentosas , Eletrofisiologia , Canais de Potássio Éter-A-Go-Go/antagonistas & inibidores , Feminino , Técnicas In Vitro , Masculino , Ramos Subendocárdicos/fisiologia , Coelhos
19.
Anesthesiology ; 109(2): 206-12, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18648229

RESUMO

BACKGROUND: Droperidol and ondansetron have previously been found to prolong the QT interval in the treatment of postoperative nausea and vomiting. However, this adverse effect has never been confirmed and compared with both drugs under controlled conditions. The objective was to study the effects of droperidol and ondansetron alone or in combination on QT interval duration in healthy subjects. METHODS: Sixteen healthy volunteers, eight males and eight females, were enrolled in this prospective, double-blind, randomized, placebo-controlled study. Subjects received 1 mg droperidol, 4 mg ondansetron, 1 mg droperidol plus 4 mg ondansetron, or a placebo, intravenously in a crossover design. Fridericia-corrected QT interval (QTcF) and plasma concentrations were measured repeatedly during 10 h at each study period. The primary endpoint was the maximal placebo time-matched and baseline-subtracted QTcF prolongation (DeltaDeltaQTcF). RESULTS: Compared with placebo, both droperidol and ondansetron significantly prolonged the QTcF interval. DeltaDeltaQTcF prolongation was 25 +/- 8 ms after droperidol, significantly greater than the 17 +/- 10-ms prolongation with ondansetron (P = 0.014). The combination of droperidol and ondansetron significantly increased the mean maximal DeltaDeltaQTcF by 28 +/- 10 ms. The combination induced greater QTcF prolongation compared with ondansetron alone (P = 0.001), but not with droperidol alone (P = 0.33). There was no significant pharmacokinetic interaction between droperidol and ondansetron. CONCLUSIONS: Under controlled conditions, both droperidol and ondansetron either alone or in combination induced significant marked QTc interval prolongation. However, the combination of both drugs did not significantly increase QTc prolongation compared with that induced by droperidol alone.


Assuntos
Antieméticos/farmacologia , Droperidol/farmacologia , Eletrocardiografia/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Síndrome do QT Longo/induzido quimicamente , Ondansetron/farmacologia , Adulto , Antieméticos/efeitos adversos , Antieméticos/farmacocinética , Área Sob a Curva , Estudos Cross-Over , Método Duplo-Cego , Droperidol/efeitos adversos , Droperidol/farmacocinética , Interações Medicamentosas , Feminino , Meia-Vida , Humanos , Modelos Lineares , Masculino , Taxa de Depuração Metabólica , Ondansetron/efeitos adversos , Ondansetron/farmacocinética
20.
Biochem Biophys Res Commun ; 372(1): 179-85, 2008 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-18474221

RESUMO

Droperidol causes the blockage of the dopamine receptors in the central nervous system that are involved in pain transmission. However, the mechanism of action of droperidol in pain-related neurons is not clear, and it is still unknown whether opioids are involved in the modulation of this processing. The present study examines the effect of droperidol on the pain-evoked response of pain-excitation neurons (PENs) and pain-inhibition neurons (PINs) in the caudate nucleus (Cd) of rats. The trains of electric impulses applied to the sciatic nerve were used as noxious stimulation. Our results revealed that droperidol decreased the frequency of PEN discharge, and increased the frequency PIN discharge evoked by the noxious stimulation in the Cd of normal rats, while administration of droperidol to morphine-dependent rats produced the opposite response. Those demonstrated that droperidol is involved in the modulation of nociceptive information transmission in Cd, and there were completely opposite responses to painful stimulation between normal and morphine-dependent rats after administration of droperidol.


Assuntos
Núcleo Caudado/efeitos dos fármacos , Núcleo Caudado/fisiopatologia , Antagonistas de Dopamina/farmacologia , Droperidol/farmacologia , Dependência de Morfina/fisiopatologia , Dor/fisiopatologia , Animais , Núcleo Caudado/citologia , Eletrofisiologia , Potenciais Evocados , Feminino , Masculino , Neurônios/efeitos dos fármacos , Ratos , Ratos Wistar
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