A Case of Amitraz Insecticide Intoxication after Ingestion of Large Amount

Amitraz is used as farm-animal insecticide. Its side effects in humans are related to its pharmacological activity on alpha 2-adrenergic receptors. The case describes a previously healthy 46-year-old woman who intentionally ingested approximately 250mL of liquid amitraz. She presented with vomiting, altered mental status, miosis, dry mouth, hypopnea, metabolic and respiratory acidosis, hypotension, hypothermia, polyuria, metabolic acidosis, elevated serum aminotransferase and abdominal distension. Supportive treatments including mechanical ventilation, hydration, dopamine infusion, bicarbonate infusion and gastric decompression resulted in improvement. By hospital day 3, she recovered with resolution of abdominal distension. It is paramount to recognize amitraz poisoning when apesticide-intoxicated patient presets with signs and symptoms consistent with organophosphate intoxicated patients but with greater alpha 2-adrenergic related symptoms such as decreased bowel motility and xerostomia.

The Effects of Dexmedetomidine on Hemodynamics and Plasma Catecholamine Concentrations during Coronary Artery Bypass Graft Surgery / 대한마취과학회지

BACKGROUND: Alpha-2 adrenergic agonists decrease the sympathetic tones of hemodynamic and endocrine responses to surgical stimuli. The goal of this study was to evaluate the hemodynamic and endocrinologic effects of intraoperatively administered dexmedetomidine, a highly selective alpha-2 adrenergic agonist, in patients undergoing coronary artery bypass graft surgery. METHODS: Fifty coronary artery bypass graft patients, in a double-blind, randomized manner, received a continuous infusion of normal saline placebo or dexmedetomidine, 10 ng/kg/min for 1 hr from 5 minutes after sternotomy. All patients received standardized anesthesia. Plasma catecholamine was measured at 5 minutes after sternotomy (T1), 30 minutes after drug infusion (T2), and 30 minutes after drug cessation (T3). Heart rate, blood pressure, pulmonary artery pressure and cardiac output were monitored. RESULTS: Compared with the placebo group, plasma norepinephrine concentrations decreased in the dexmedetomidine group Dexmedetomidine attenuated increased blood pressure on surgical stimuli and induced more hypotension. CONCLUSIONS: The intraoperative infusion of dexmedetomidine to patients undergoing coronary artery bypass graft surgery reduced sympathetic tone and attenuated hemodynamic responses to surgical stimuli.

Effects of Pentobarbital Sodium, Ketamine and Xylazine on Learning Impairment Induced by Transient Global Ischemia in Mongolian Gerbils / 대한마취과학회지

BACKGROUND: Transient global cerebral ischemia can cause selective hippocampal lesion and spatial learning impairment. To evaluate whether some commonly used laboratory animal anesthetics, pentobarbital, ketamine and xylazine, can affect ischemic brain injury, the effects of the anesthetics on Morris water maze task following transient global ischemia were investigated in Mongolian gerbils. METHODS: The ischemia was induced by bilateral carotid artery occlusion for 2 or 5 min. Morris water maze task was started 3 days later and performed for 15 days. RESULTS: Every animal acquired Morris water maze task as trial proceeded and there was no difference in the latency time on the last (15th) trial. However the ischemic groups (2 min and 5min) showed delayed acquisition of a Morris water maze task and the longer the ischemic time was the more the acquisition delayed. There were no differences in the acquisition of the maze task among pentobarbital-, ketamine- and ketamine/xylazine-anesthesia in either sham- or 2 min-ischemic group, but ketamine/ xylazine anesthesia significantly reduced the acquisition delay in 5 min-ischemic group compared with pentobarbital- or ketamine-anesthesia. CONCLUSIONS: These results suggest that ketamine/xylazine anesthesia have more neuroprotective effect on ischemia-induced brain injury, compared with pentobarbital- or ketamine-anesthesia, in gerbil global ischemia.