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1.
J Cardiothorac Vasc Anesth ; 37(10): 2006-2011, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37365071

RESUMO

OBJECTIVE: Dexmedetomidine as an adjuvant to local anesthetics (LAs) in regional anesthesia has demonstrated a positive effect on the quality of regional blocks, but there are no studies on usage in superficial cervical block (SCB) for carotid endarterectomy (CEA), in which the management of mean arterial pressure is essential. The authors designed a prospective, randomized, double-blinded study to investigate the effects of the addition of dexmedetomidine on the hemodynamic management and quality of SCB. DESIGN: A prospective, randomized, double-blinded study. SETTING: A single-center study at a university hospital center. PARTICIPANTS: Ultrasound-guided SCB was performed on 60 patients classified as American Society of Anesthesiologists Grades II and III undergoing elective CEA surgery who were assigned into 2 groups randomly. INTERVENTION(S): Both groups received 2 mg/kg of 0.5% levobupivacaine with 2 mg/kg of 2% lidocaine. The intervention group additionally received 50 µg of dexmedetomidine. MEASUREMENTS AND MAIN RESULTS: The onset and duration of sensory block and analgesia, hemodynamic parameters, and adverse effects were recorded. There were minimum effects on hemodynamic parameters and no differences in the incidence of adverse effects. The time to first analgesia was longer in the intervention group than in the control group (N = 30). There was no difference in the duration of the sensory block between groups. The log-rank test indicated a significant difference in the probability of the Numeric Pain Rating Scale <3. CONCLUSION: The addition of 50 µg of dexmedetomidine to 0.5% levobupivacaine and 2% lidocaine for SCB did not influence the hemodynamics and frequency of adverse effects. The median sensory block duration time showed no statistical difference between the groups, but the quality of analgesia postoperatively was much improved in the study group.


Assuntos
Dexmedetomidina , Endarterectomia das Carótidas , Humanos , Levobupivacaína/farmacologia , Estudos Prospectivos , Dexmedetomidina/efeitos adversos , Endarterectomia das Carótidas/efeitos adversos , Anestésicos Locais/farmacologia , Lidocaína , Hemodinâmica
2.
J Crit Care ; 75: 154276, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36774818

RESUMO

INTRODUCTION: Accurate and actionable diagnosis of Acute Kidney Injury (AKI) ahead of time is important to prevent or mitigate renal insufficiency. The purpose of this study was to evaluate the performance of Kinetic estimated Glomerular Filtration Rate (KeGFR) in timely predicting AKI in critically ill septic patients. METHODS: We conducted a retrospective analysis on septic ICU patients who developed AKI in AmsterdamUMCdb, the first freely available European ICU database. The reference standard for AKI was the Kidney Disease: Improving Global Outcomes (KDIGO) classification based on serum creatinine and urine output (UO). Prediction of AKI was based on stages defined by KeGFR and UO. Classifications were compared by length of ICU stay (LOS), need for renal replacement therapy and 28-day mortality. Predictive performance and time between prediction and diagnosis were calculated. RESULTS: Of 2492 patients in the cohort, 1560 (62.0%) were diagnosed with AKI by KDIGO and 1706 (68.5%) by KeGFR criteria. Disease stages had agreement of kappa = 0.77, with KeGFR sensitivity 93.2%, specificity 73.0% and accuracy 85.7%. Median time to recognition of AKI Stage 1 was 13.2 h faster for KeGFR, and 7.5 h and 5.0 h for Stages 2 and 3. Outcomes revealed a slight difference in LOS and 28-day mortality for Stage 1. CONCLUSIONS: Predictive performance of KeGFR combined with UO criteria for diagnosing AKI is excellent. Compared to KDIGO, deterioration of renal function was identified earlier, most prominently for lower stages of AKI. This may shift the actionable window for preventing and mitigating renal insufficiency.


Assuntos
Injúria Renal Aguda , Sepse , Humanos , Taxa de Filtração Glomerular , Estudos Retrospectivos , Estado Terminal , Injúria Renal Aguda/terapia , Sepse/diagnóstico , Creatinina
3.
Acta Clin Croat ; 62(1): 115-122, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38304358

RESUMO

The authors conducted a single-center retrospective study during the last 6.5 years. The study aimed to describe demographic data of burn patients in the Croatian Burn Center and investigate factors affecting mortality for the first time after the Center was established. The study included 109 severely burned patients with a total body surface area (TBSA) burned ≥20%, admitted to the burn intensive care unit. The relationship between the fatal outcome and age, sex, comorbidity, mechanism of injury, TBSA burned, and inhalation injury was investigated. The mean patient age was 54.50±20.21 years and the mean TBSA burned was 42.48±18.64%, with the mortality rate of 50%. The results demonstrated that patients with 2 or more comorbidities compared with those with no comorbidities had a higher chance of lethal outcome (p<0.0001). With an increase of TBSA by 1%, the odds of lethal outcome are expected to increase by 7% (p<0.0001). Other variables included in the analysis did not show statistical significance. TBSA percentage is a well-known predictor of mortality and numerous studies indicate an association between comorbidities and mortality but there are conflicting results about other demographic factors and injury characteristics.


Assuntos
Unidades de Queimados , Unidades de Terapia Intensiva , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Estudos Retrospectivos , Croácia/epidemiologia , Comorbidade , Tempo de Internação
4.
Respir Physiol Neurobiol ; 212-214: 9-19, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25850079

RESUMO

The preBötzinger (preBötC) complex has been suggested as the primary site where systemically administered selective serotonin agonists have been shown to reduce or prevent opioid-induced depression of breathing. However, this hypothesis has not been tested pharmacologically in vivo. This study sought to determine whether 5-HT1A receptors within the preBötC and ventral respiratory column (VRC) mediate the tachypneic response induced by intravenous (IV) (±)-8-Hydroxy-2-diproplyaminotetralin hydrobromide (8-OH-DPAT) in a decerebrated dog model. IV 8-OH-DPAT (19 ± 2 µg/kg) reduced both inspiratory (I) and expiratory (E) durations by ∼ 40%, but had no effect on peak phrenic activity (PPA). Picoejection of 1, 10, and 100 µM 8-OH-DPAT on I and E preBötC neurons produced dose-dependent decreases up to ∼ 40% in peak discharge. Surprisingly, microinjections of 8-OH-DPAT and 5-HT within the VRC from the obex to 9 mm rostral had no effect on timing and PPA. These results suggest that the tachypneic effects of IV 8-OH-DPAT are due to receptors located outside of the areas we studied.


Assuntos
Bulbo/metabolismo , Receptor 5-HT1A de Serotonina/metabolismo , Respiração , Taquipneia/patologia , 8-Hidroxi-2-(di-n-propilamino)tetralina/toxicidade , Potenciais de Ação/efeitos dos fármacos , Análise de Variância , Animais , Modelos Animais de Doenças , Cães , Relação Dose-Resposta a Droga , Feminino , Masculino , Bulbo/citologia , Bulbo/efeitos dos fármacos , Microinjeções , Neurônios/efeitos dos fármacos , Nervo Frênico/efeitos dos fármacos , Nervo Frênico/fisiologia , Respiração/efeitos dos fármacos , Serotonina/farmacologia , Agonistas do Receptor de Serotonina/toxicidade , Taquipneia/induzido quimicamente
5.
J Neurophysiol ; 108(9): 2430-41, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22875901

RESUMO

Life-threatening side effects such as profound bradypnea or apnea and variable upper airway obstruction limit the use of opioids for analgesia. It is yet unclear which sites containing µ-opioid receptors (µORs) within the intact in vivo mammalian respiratory control network are responsible. The purpose of this study was 1) to define the pontine region in which µOR agonists produce bradypnea and 2) to determine whether antagonism of those µORs reverses bradypnea produced by intravenous remifentanil (remi; 0.1-1.0 µg·kg(-1)·min(-1)). The effects of microinjections of agonist [D-Ala(2),N-Me-Phe(4),Gly-ol(5)]-enkephalin (DAMGO; 100 µM) and antagonist naloxone (NAL; 100 µM) into the dorsal rostral pons on the phrenic neurogram were studied in a decerebrate, vagotomized, ventilated, paralyzed canine preparation during hyperoxia. A 1-mm grid pattern of microinjections was used. The DAMGO-sensitive region extended from 5 to 7 mm lateral of midline and from 0 to 2 mm caudal of the inferior colliculus at a depth of 3-4 mm. During remi-induced bradypnea (~72% reduction in fictive breathing rate) NAL microinjections (~500 nl each) within the region defined by the DAMGO protocol were able to reverse bradypnea by 47% (SD 48.0%) per microinjection, with 13 of 84 microinjections producing complete reversal. Histological examination of fluorescent microsphere injections shows that the sensitive region corresponds to the parabrachial/Kölliker-Fuse complex.


Assuntos
Analgésicos Opioides/toxicidade , Anestésicos Intravenosos/toxicidade , Piperidinas/toxicidade , Ponte/efeitos dos fármacos , Receptores Opioides mu/metabolismo , Taxa Respiratória/efeitos dos fármacos , Animais , Mapeamento Encefálico , Diafragma/inervação , Cães , Ala(2)-MePhe(4)-Gly(5)-Encefalina/farmacologia , Hiperóxia , Infusões Intravenosas , Naloxona/farmacologia , Antagonistas de Entorpecentes/farmacologia , Nervo Frênico/fisiologia , Ponte/metabolismo , Ponte/fisiologia , Receptores Opioides mu/agonistas , Receptores Opioides mu/antagonistas & inibidores , Remifentanil , Taxa Respiratória/fisiologia
6.
J Neurophysiol ; 103(1): 409-18, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19906886

RESUMO

Systemic administration of mu-opioids at clinical doses for analgesia typically slows respiratory rate. Mu-opioid receptors (MORs) on pre-Bötzinger Complex (pre-BötC) respiratory neurons, the putative kernel of respiratory rhythmogenesis, are potential targets. The purpose of this study was to determine the contribution of pre-BötC MORs to the bradypnea produced in vivo by intravenous administration of clinically relevant infusion rates of remifentanil (remi), a short-acting, potent mu-opioid analgesic. In decerebrate dogs, multibarrel micropipettes were used to record pre-BötC neuronal activity and to eject the opioid antagonist naloxone (NAL, 0.5 mM), the glutamate agonist D-homocysteic acid (DLH, 20 mM), or the MOR agonist [D-Ala(2), N-Me-Phe(4), gly-ol(5)]-enkephalin (DAMGO, 100 microM). Inspiratory and expiratory durations (T(I) and T(E)) and peak phrenic nerve activity (PPA) were measured from the phrenic neurogram. The pre-BötC was functionally identified by its rate altering response (typically tachypnea) to DLH microinjection. During intravenous remi-induced bradypnea (approximately 60% decrease in central breathing frequency, f(B)), bilateral injections of NAL in the pre-BötC did not change T(I), T(E), f(B), and PPA. Also, NAL picoejected onto single pre-BötC neurons depressed by intravenous remi had no effect on their discharge. In contrast, approximately 60 microg/kg of intravenous NAL rapidly reversed all remi-induced effects. In a separate group of dogs, microinjections of DAMGO in the pre-BötC increased f(B) by 44%, while subsequent intravenous remi infusion more than offset this DAMGO induced tachypnea. These results indicate that mu-opioids at plasma concentrations that cause profound analgesia produce their bradypneic effect via MORs located outside the pre-BötC region.


Assuntos
Analgésicos Opioides/farmacologia , Tronco Encefálico/efeitos dos fármacos , Neurônios/efeitos dos fármacos , Piperidinas/farmacologia , Taxa Respiratória/efeitos dos fármacos , Potenciais de Ação/efeitos dos fármacos , Analgésicos Opioides/administração & dosagem , Animais , Tronco Encefálico/fisiologia , Estado de Descerebração , Cães , Ala(2)-MePhe(4)-Gly(5)-Encefalina/administração & dosagem , Ala(2)-MePhe(4)-Gly(5)-Encefalina/farmacologia , Agonistas de Aminoácidos Excitatórios/administração & dosagem , Agonistas de Aminoácidos Excitatórios/farmacologia , Feminino , Lateralidade Funcional , Homocisteína/administração & dosagem , Homocisteína/análogos & derivados , Homocisteína/farmacologia , Masculino , Microinjeções , Naloxona/administração & dosagem , Naloxona/farmacologia , Antagonistas de Entorpecentes/administração & dosagem , Antagonistas de Entorpecentes/farmacologia , Neurônios/fisiologia , Nervo Frênico/efeitos dos fármacos , Nervo Frênico/fisiologia , Piperidinas/administração & dosagem , Remifentanil , Taxa Respiratória/fisiologia , Fatores de Tempo
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