Dexmedetomidine vs. propofol sedation reduces the duration of mechanical ventilation after cardiac surgery - a randomized controlled trial.

OBJECTIVE: The aim of our study was to compare the clinical effects of sedation with dexmedetomidine vs. propofol in patients undergoing cardiac surgery and analyze their effects on the duration of mechanical ventilation (MV), length of stay in the intensive care unit (ICU), and total hospital stay. PATIENTS AND METHODS: The study included 120 patients who were randomized in a 1:1 ratio into two groups of 60 patients. The first group was sedated with continuous dexmedetomidine in doses 0.2-0.7 mcg/kg/h. The second group was sedated with propofol in doses 1-2 mg/kg/h. RESULTS: Patients sedated with dexmedetomidine required 2.2 hours less time on MV (p<0.001). There was a positive correlation between the duration of MV and the ICU length of stay (r=0.368; p<0.001), as well as between the duration of MV and the total hospital stay (r=0.204; p=0.025). Delirium occurred in the postoperative period in 25% of patients sedated with propofol, while in the dexmedetomidine group it was only 11.7% (p=0.059). Patients who developed delirium had a significantly longer duration of MV (12.6±5.4 vs. 9.3±2.5 hours, p=0.010). CONCLUSIONS: Postoperative sedation with dexmedetomidine, compared to propofol, reduces the duration of MV, but does not influence the length of stay in the ICU and length of hospitalization after open heart surgery.

Strain differences and the role for HSP47 and HSP70 in adjuvant arthritis in rats.

Because of high sequence homology between microbial and endogenous heat shock proteins (HSP), immunological cross-reactivity to microbial HSP has been suggested as a possible cause of the development of autoimmune diseases, such as rheumatoid arthritis. The present study aimed to determine a potential role of HSP47, a molecular chaperone involved in the synthesis and assembly of collagen molecules, and microbial HSP71 (mHSP71) in adjuvant arthritis (AA) in two rat strains: Dark Agouti (DA), susceptible to AA induction and Albino Oxford (AO), which is resistant to AA induction. Immunization with complete Freund's adjuvant (CFA) induced an increased expression of HSP47 in joints of DA rats, which exhibited severe clinical signs of AA at the time of disease peak, while this protein was not detectable in joints of AO rats. In contrast, no strain differences in HSP72 (rat analogue of mHSP71) expressions in joints were observed. The increased levels of anti-HSP47 antibodies were detected in sera of DA rats during the AA peak, while the immunization with CFA increased levels of anti-mHSP71 antibodies in sera of AO rats. HSP47 and mHSP71 reduced proliferation of draining inguinal lymph node cells (LNC) in resistant AO rat strain, leading to a hypothesis that both HSP participated in AA control. Finally, mHSP71 potentiated the apoptotic response of LNC in susceptible DA rat strain. In conclusion, our findings indicate involvement of HSP47 in the development of AA in the rat, and point out to the regulatory role for both HSP47 and mHSP71.

Suppression of adjuvant arthritis by kappa-opioid receptor agonist: effect of route of administration and strain differences.

It is well established that kappa-opioid receptor agonists exert antiinflammatory and antihyperalgesic effects during nonspecific inflammation as well as suppressive effects on the development of humoral and cell-mediated immune responses to foreign antigens. The aim of this study was to investigate the ability of the kappa-opioid receptor agonist MR 2034 to modulate adjuvant arthritis in the rat. In the first series of experiments, treatments of Wistar rats were performed using several routes of drug administration: intraperitoneal (ip), intracaudal (ic), intracerebroventricular (icv) and intraplantar (ipl). MR 2034 significantly suppressed joint swelling after ip and ic treatment, slightly reduced inflammation after ipl treatment, and did not produce any effect after icv treatment. In the second series of experiments, the suppressive effect of ip injected MR 2034 was investigated using Wistar, Dark August (DA) and Lewis rats. In Wistar rats, MR 2034 significantly decreased the incidence of adjuvant arthritis, and suppressed mean joint score and aggregate joint score. Similarly, in DA rats treated with MR 2034, mean arthritic score was significantly suppressed, but other clinical parameters were not affected. In Lewis rats, however, ip treatment with MR 2034 failed to produce any suppressive effect on joint disease and even potentiated the initial development of arthritis. These data suggest that immunosuppressive and antiinflammatory action of MR 2034 markedly depend on the route of drug administration and strain susceptibility to opioids.

Opioid receptor-mediated suppression of humoral immune response in vivo and in vitro: involvement of kappa opioid receptors.

The selective kappa opioid receptor agonist MR 2034 exerted pronounced suppression of plaque-forming cell (PFC) response following intraperitoneal (i.p.) administration in the rat. Pretreatment with preferential kappa and mu opioid receptor antagonists MR 2266 and naloxone, respectively, revealed that this effect was mediated mainly by kappa, and to a low extent by mu opioid receptors. Intracerebroventricular (i.c.v.) administration of quaternary naltrexone (QNtx) moderately attenuated, whereas i.p. given QNtx completely prevented the suppressive effect of MR 2034, suggesting a peripheral mechanism of action, and only minor involvement of brain opioid receptors. MR 2034 markedly decreased the PFC response of spleen cells obtained from in vivo immunized rats, treated in vitro with the opiate. The immunosuppressive action of MR 2034 in vitro was completely and partially blocked by equimolar concentrations of MR 2266 and naloxone, respectively. Antagonists alone produced stimulation of PFC following i.p. administration in the rat, but did not affect PFC response upon in vitro treatment. These results suggest that peripheral kappa opioid receptors down-regulate primary humoral immune response in the rat, and that this effect may be produced by direct interference with plasma cell activity.