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2.
Health Qual Life Outcomes ; 19(1): 120, 2021 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-33849571

RESUMO

OBJECTIVES: Moral distress occurs when professionals cannot carry out what they believe to be ethically appropriate actions because of constraints or barriers. We aimed to assess the validity and reliability of the Japanese translation of the Measure of Moral Distress for Healthcare Professionals (MMD-HP). METHODS: We translated the questionnaire into Japanese according to the instructions of EORTC Quality of Life group translation manual. All physicians and nurses who were directly involved in patient care at nine departments of four tertiary hospitals in Japan were invited to a survey to assess the construct validity, reliability and factor structure. Construct validity was assessed with the relation to the intention to leave the clinical position, and internal consistency was assessed with Cronbach's alpha. Confirmatory factor analysis was conducted. RESULTS: 308 responses were eligible for the analysis. The mean total score of MMD-HP (range, 0-432) was 98.2 (SD, 59.9). The score was higher in those who have or had the intention to leave their clinical role due to moral distress than in those who do not or did not have the intention of leaving (mean 113.7 [SD, 61.3] vs. 86.1 [56.6], t-test p < 0.001). The confirmatory factor analysis and Cronbach's alpha confirmed the validity (chi-square, 661.9; CMIN/df, 2.14; GFI, 0.86; CFI, 0.88; CFI/TLI, 1.02; RMSEA, 0.061 [90%CI, 0.055-0.067]) and reliability (0.91 [95%CI, 0.89-0.92]) of the instrument. CONCLUSIONS: The translated Japanese version of the MMD-HP is a reliable and valid instrument to assess moral distress among physicians and nurses.


Assuntos
Atenção à Saúde/ética , Pessoal de Saúde/ética , Pessoal de Saúde/psicologia , Princípios Morais , Psicometria/normas , Inquéritos e Questionários/normas , Traduções , Adulto , Grupo com Ancestrais do Continente Asiático/psicologia , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Análise Fatorial , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Psicometria/instrumentação , Reprodutibilidade dos Testes , Estresse Psicológico
3.
J Infect Chemother ; 26(8): 865-869, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32405245

RESUMO

We investigated the clinical course of individuals with 2019 novel coronavirus disease (COVID-19) who were transferred from the Diamond Princess cruise ship to 12 local hospitals. The conditions and clinical courses of patients with pneumonia were compared with those of patients without pneumonia. Among 70 patients (median age: 67 years) analyzed, the major symptoms were fever (64.3%), cough (54.3%), and general fatigue (24.3%). Forty-three patients (61.4%) had pneumonia. Higher body temperature, heart rate, and respiratory rate as well as higher of lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and C-reactive protein (CRP) levels and lower serum albumin level and lymphocyte count were associated with the presence of pneumonia. Ground-glass opacity was found in 97.7% of the patients with pneumonia. Patients were administered neuraminidase inhibitors (20%), lopinavir/ritonavir (32.9%), and ciclesonide inhalation (11.4%). Mechanical ventilation and veno-venous extracorporeal membrane oxygenation was performed on 14 (20%) and 2 (2.9%) patients, respectively; two patients died. The median duration of intubation was 12 days. The patients with COVID-19 transferred to local hospitals during the outbreak had severe conditions and needed close monitoring. The severity of COVID-19 depends on the presence of pneumonia. High serum LDH, AST and CRP levels and low serum albumin level and lymphocyte count were found to be predictors of pneumonia. It was challenging for local hospitals to admit and treat these patients during the outbreak of COVID-19. Assessment of severity was crucial to manage a large number of patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Surtos de Doenças , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Idoso , COVID-19 , Infecções por Coronavirus/complicações , Complicações do Diabetes/complicações , Feminino , Humanos , Hipertensão/complicações , Japão , Masculino , Pessoa de Meia-Idade , Pandemias , Gravidade do Paciente , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Prognóstico , SARS-CoV-2 , Navios
4.
JA Clin Rep ; 5(1): 73, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-32026077

RESUMO

BACKGROUND: Information on epidemiology of prolonged mechanical ventilation (PMV) patients in the acute care setting in Japan is totally lacking. We aimed to investigate clinical features, impact, and long-term outcomes of PMV patients. METHODS: This was a retrospective observational study conducted in a tertiary care hospital. Adult patients who were admitted to our intensive care unit (ICU) from April 2009 to March 2014 and required mechanical ventilation (MV) for ≥ 2 days were included. PMV was defined as having MV for ≥ 21 consecutive days. RESULTS: Among 1282 MV patients, 93 (7.3%) required PMV, and median duration of MV was 37.0 days. Compared with the non-PMV patients, PMV patients had longer total ICU and high care unit (HCU) stay (34.0 vs. 7.0 days, p < 0.001), longer hospital stay (74.0 vs. 35.0 days, p < 0.001), and higher hospital mortality (54.8 vs. 21.4%, p < 0.001). In multivariable logistic regression analysis, emergency ICU admission and steroid use during MV were associated with PMV. The Kaplan-Meier curves for MV withdrawal and ICU/HCU discharge were almost identical. Among PMV patients, 52 (55.9%) died, 29 (31.2%) were successfully liberated from MV during hospitalization, and 12 (12.9%) still required MV at discharge. CONCLUSION: In this investigation, 7.3% of the patients with MV required PMV. Most PMV patients were liberated from MV during hospitalization, while occupying critical care beds for an extended period. A nationwide survey is required to further elucidate the overall picture of PMV patients and to discuss whether specialized weaning centers to treat PMV patients are required in Japan.

5.
BMJ Open ; 8(5): e019998, 2018 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-29730622

RESUMO

INTRODUCTION: We examined the effectiveness of early rehabilitation for the prevention of postintensive care syndrome (PICS), characterised by an impaired physical, cognitive or mental health status, among survivors of critical illness. METHODS: We performed a systematic literature search of several databases (Medline, Embase and Cochrane Central Register of Controlled Trials) and a manual search to identify randomised controlled trials (RCTs) comparing the effectiveness of early rehabilitation versus no early rehabilitation or standard care for the prevention of PICS. The primary outcomes were short-term physical-related, cognitive-related and mental health-related outcomes assessed during hospitalisation. The secondary outcomes were the standardised, long-term health-related quality of life scores (EuroQol 5 Dimension (EQ5D) and the Medical Outcomes Study 36-Item Short Form Health Survey Physical Function Scale (SF-36 PF)). We used the Grading of Recommendations Assessment, Development and Evaluation approach to rate the quality of evidence (QoE). RESULTS: Six RCTs selected from 5105 screened abstracts were included. Early rehabilitation significantly improved short-term physical-related outcomes, as indicated by an increased Medical Research Council scale score (standardised mean difference (SMD): 0.38, 95% CI 0.10 to 0.66, p=0.009) (QoE: low) and a decreased incidence of intensive care unit-acquired weakness (OR 0.42, 95% CI 0.22 to 0.82, p=0.01, QoE: low), compared with standard care or no early rehabilitation. However, the two groups did not differ in terms of cognitive-related delirium-free days (SMD: -0.02, 95% CI -0.23 to 0.20, QoE: low) and the mental health-related Hospital Anxiety and Depression Scale score (OR: 0.79, 95% CI 0.29 to 2.12, QoE: low). Early rehabilitation did not improve the long-term outcomes of PICS as characterised by EQ5D and SF-36 PF. CONCLUSIONS: Early rehabilitation improved only short-term physical-related outcomes in patients with critical illness. Additional large RCTs are needed.


Assuntos
Cuidados Críticos , Estado Terminal/reabilitação , Nível de Saúde , Hospitalização , Unidades de Terapia Intensiva , Adolescente , Adulto , Cognição , Delírio , Humanos , Saúde Mental , Avaliação de Resultados em Cuidados de Saúde , Qualidade de Vida , Sobreviventes , Síndrome
6.
Acute Med Surg ; 5(2): 129-132, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29657723

RESUMO

Aims: The smaller superior mesenteric vein (SMV) sign is a well-known computed tomography (CT) parameter for acute superior mesenteric artery (SMA) occlusion. This CT sign is potentially beneficial for the early diagnosis of acute SMA occlusion; however, few reports have documented this sign. The present study aimed to determine the accuracy of the smaller SMV sign for the detection of acute SMA occlusion. Methods: We retrospectively reviewed CT images from 20 patients with acute SMA occlusion and 1,216 controls. We measured the external diameters of the SMV and SMA, and calculated the SMV/SMA diameter ratio. A ratio ≤1 indicated a positive smaller SMV sign. Results: Of the 20 patients, 14 had the smaller SMV sign, whereas of the 1,216 controls, 88 had the smaller SMV sign. Of the 88 controls with a positive sign, 79 had apparent reasons for the decreased flow in the SMA and nine patients had no reason for the decreased flow. The sensitivity and specificity of the smaller SMV sign for acute SMA occlusion were 70% and 99.2%, respectively. Conclusion: The smaller SMV sign is an accurate and important CT parameter for the detection of acute SMA occlusion.

7.
Acute med. surg ; 5(1): [1-87], 2018.
Artigo em Inglês | BIGG - guias GRADE | ID: biblio-1088028

RESUMO

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (JSSCG 2016), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. Members of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within eachteam were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a twothirds (>66.6%) majority vote of each of the 19 committee members. A total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J-SSCG 2012). The approval rate obtained through committee voting, in additionto ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement.We conducted meta-analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.Based on the evidence gathered, we were able to formulate Japanese-specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non-specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.


Assuntos
Humanos , Choque Séptico/prevenção & controle , Pessoal de Saúde/organização & administração , Sepse/prevenção & controle , Pesquisa sobre Serviços de Saúde/organização & administração , Japão
8.
BMJ Open ; 7(3): e013828, 2017 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-28249850

RESUMO

INTRODUCTION: Postintensive care syndrome (PICS) is defined as a new or worsening impairment in cognition, mental health and physical function after critical illness. There is little evidence regarding treatment of patients with PICS; new directions for effective treatment strategies are urgently needed. Early physiotherapy may prevent or reverse some physical impairments in patients with PICS, but no systematic reviews have investigated the effectiveness of early rehabilitation on PICS-related outcomes. The purpose of this systematic review is to evaluate whether early rehabilitative interventions in critically ill patients can prevent PICS and decrease mortality. METHODS: We will conduct a systematic review and meta-analysis of early rehabilitation for the prevention of PICS in critically ill adults. We will search PubMed, EMBASE and the Cochrane Central Register of Controlled Trials for published randomised controlled trials. We will screen search results and assess study selection, data extraction and risk of bias in duplicate, resolving disagreements by consensus. We will pool data from clinically homogeneous studies using a random-effects meta-analysis; assess heterogeneity of effects using the χ2 test of homogeneity; and quantify any observed heterogeneity using the I2 statistic. We will use the Grading of Recommendations Assessment, Development and Evaluation approach to rate the quality of evidence. DISCUSSION: This systematic review will present evidence on the prevention of PICS in critically ill patients with early rehabilitation. ETHICS: Ethics approval is not required. DISSEMINATION: The results will be disseminated via peer-reviewed journal publication, conference presentation(s) and publications for patient information. TRIAL REGISTRATION NUMBER: CRD42016039759.


Assuntos
Disfunção Cognitiva/prevenção & controle , Cuidados Críticos , Estado Terminal/psicologia , Estado Terminal/reabilitação , Adulto , Nível de Saúde , Humanos , Saúde Mental , Modalidades de Fisioterapia , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
9.
Clin Case Rep ; 5(3): 260-263, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28265386

RESUMO

This case highlights the probable association of significantly displaced posterior first-rib fracture and jagged edges of the fracture line following blunt chest trauma with delayed ipsilateral subclavian artery rupture. Early angiography and first-rib repair should promptly be considered under such circumstances.

10.
J Crit Care ; 38: 253-258, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27997877

RESUMO

PURPOSE: To evaluate the effects of atrial natriuretic peptide (ANP) on renal function and medical costs in patients with acute kidney injury (AKI) associated with cardiac surgery. MATERIALS AND METHODS: The Japanese trial for AKI in Post-cardiovascular surgery patients by ANP (JAPAN) was a prospective, multicenter, randomized, double-blind, placebo-controlled study conducted in 11 hospitals in Japan. Acute kidney injury was defined as an increase in serum creatinine of at least 0.3 mg/dL within 48 hours. The patients were randomly assigned to receive ANP (0.02 µg kg-1 min-1) or placebo. The primary end point was a change in renal function. The secondary end points were a need for renal replacement therapy, the lengths of intensive care unit and hospital stays, and medical costs incurred over the 90-day follow-up. RESULTS: Of the 77 randomized patients, 37 were in the ANP group and 40 were in the placebo group. Although ANP significantly (P = .018) increased urine output, it did not significantly improve renal function compared with placebo. There were no significant differences between the groups in the renal replacement therapy rate, the lengths of the intensive care unit and hospital stays, or medical costs. CONCLUSION: Atrial natriuretic peptide infusion did not show a renoprotective effect or cost-saving effect in the treatment of cardiac surgery-associated AKI.


Assuntos
Injúria Renal Aguda/tratamento farmacológico , Fator Natriurético Atrial/administração & dosagem , Procedimentos Cirúrgicos Cardíacos , Complicações Pós-Operatórias/tratamento farmacológico , Idoso , Método Duplo-Cego , Feminino , Custos de Cuidados de Saúde , Humanos , Infusões Intravenosas , Unidades de Terapia Intensiva , Japão , Testes de Função Renal , Tempo de Internação , Masculino , Estudos Prospectivos , Terapia de Substituição Renal/estatística & dados numéricos
12.
Ann Vasc Dis ; 7(2): 178-82, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24995067

RESUMO

We report the case of a 37-year-old man with isolated unilateral absence of the pulmonary artery (UAPA), which was diagnosed upon the occurrence of hemoptysis. Plain chest radiography demonstrated decreased left pulmonary volume. Computed tomography of the chest revealed the complete absence of the left pulmonary artery. Angiography revealed marked dilation of the left bronchial artery, inferior phrenic artery, internal thoracic artery, and the arterial branches of the thyrocervical trunk. These arteries were considered as collateral circulation to the left lung. In cases with UAPA, collateral circulation should be evaluated by angiography to obtain useful information for treatment.

13.
Brain Nerve ; 66(2): 161-70, 2014 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-24523314

RESUMO

Critically ill patients in the intensive care unit (ICU) often develop ICU-acquired weakness, which is characterized by acute or subacute onset diffuse limb weakness, during the early course of their severe illness and is related to prolonged mechanical ventilation, ICU stay, hospital stay, and even increased mortality. The development of generalized weakness or paralysis may be because of critical illness polyneuropathy (CIP), critical illness myopathy (CIM), and a combination of both. The basic mechanisms underlying these disorders are complex and poorly understood. Several risk factors, including severe sepsis and multiple organ failure, are implicated, whereas the effects of the use of steroids and neuromuscular blocking agents and hyperglycemia on the development of this condition remain to be clarified. Furthermore, whether each risk factor is associated with the development of CIP, CIM, or both has not been clarified thus far. Typically, the condition of patients is diagnosed on the basis of the assessment of risk factors, neurological findings, and electrophysiological examinations, including nerve conduction study and needle electromyography. In addition, muscle biopsy and direct muscle stimulation test can be used to distinguish CIP from CIM. To date, no therapeutic approach has been established for ICU-acquired weakness, and potential preventive measures should be implemented in the daily management of the critically ill patients. Further studies are required to clarify the pathogenesis of these disorders and to identify appropriate therapeutic options.


Assuntos
Unidades de Terapia Intensiva , Debilidade Muscular/terapia , Doenças Musculares/terapia , Polineuropatias/terapia , Estado Terminal/epidemiologia , Estado Terminal/terapia , Humanos , Debilidade Muscular/epidemiologia , Debilidade Muscular/etiologia , Debilidade Muscular/prevenção & controle , Doenças Musculares/epidemiologia , Doenças Musculares/etiologia , Doenças Musculares/prevenção & controle , Polineuropatias/diagnóstico , Polineuropatias/epidemiologia , Polineuropatias/etiologia , Fatores de Risco
14.
Chudoku Kenkyu ; 27(3): 208-12, 2014 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-27526514

RESUMO

A 26-year-old man was found unable to move after oral consumption of 120 mL of RiUP X5® (containing 5 g/100 mL minoxidil) as a suicidal attempt. The patient complaining of frequent vomiting and weakness was transferred to our hospital. Findings on arrival: GCS E4V5M6; respiratory rate 24/ min; blood pressure 83/43 mmHg; pulse 152/min, regular; SpO297% (oxygen by mask: 6 L/min); thus, the patient was in shock. The systolic blood pressure and the pulse rate improved to about 90 mmHg and to about 130/min, respectively, in response to rapid intravenous infusion of 2,000 mL of lactated Ringer's solution. His circulatory condition tended to improve with parenteral fluid infusion alone. Forty hours after admission, however, heart failure developed due to excessive I.V. fluid infusion and abnormal body fluid distribution associated with delayed vascular smooth muscle relaxation; therefore, mechanical ventilation was initiated. Simultaneously, intravenous noradrenaline infusion was started because of a fall of the blood pressure. Subsequently, as the patient's respiratory and circulatory conditions gradually improved, he was weaned from mechanical ventilation, and the noradrenaline infusion was discontinued at 108 hours after admission. The patient made favorable progress and was discharged home on the 9th hospital day. Minoxidil exerts adverse effects mainly on the cardiovascular system. Since minoxidil is an over-the-counter drug readily available to the public, and emergency physicians should be aware of its severe toxicity.


Assuntos
Minoxidil/envenenamento , Adulto , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Humanos , Soluções Isotônicas/administração & dosagem , Masculino , Norepinefrina/administração & dosagem , Respiração Artificial , Lactato de Ringer , Tentativa de Suicídio , Resultado do Tratamento
16.
J Anesth ; 24(3): 447-51, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20300780

RESUMO

Cardiopulmonary resuscitation (CPR) in the lateral position during noncardiac surgery has been described in only a few reports in the past. Here, we report a case of cardiac arrest in a 61-year-old man undergoing microvascular decompression surgery for trigeminal neuralgia in the left lateral decubitus position. During the initial 5 min of CPR, chest compression was performed in this position by two rescuers; one from the chest and the other from the back, pushing simultaneously. Because ventricular arrhythmia was refractory to conventional CPR even after placing the patient back to the supine position, extracorporeal life support was introduced in the operating room by using the femoro-femoral approach (right atrio-femoral veno-arterial bypass). This alternative CPR markedly decreased the frequency of ventricular arrhythmia. Subsequent coronary angiogram detected 99% stenosis of the right coronary artery. Ventricular arrhythmia ceased after coronary revascularization, and the patient was successfully weaned from the extracorporeal bypass circuit. The patient was discharged alive with minimal neurological impairment. We suggest that chest compression in the lateral position by two rescuers is an efficient resuscitation maneuver, and if an electrical storm is refractory to conventional CPR, extracorporeal life support should be considered in the operating-room setting.


Assuntos
Reanimação Cardiopulmonar , Circulação Extracorpórea , Parada Cardíaca/etiologia , Procedimentos Neurocirúrgicos , Anestesia Geral , Pressão Sanguínea/fisiologia , Angiografia Coronária , Estenose Coronária/complicações , Estenose Coronária/cirurgia , Descompressão Cirúrgica , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Postura , Neuralgia do Trigêmeo/cirurgia
17.
J Anesth ; 22(1): 77-80, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18306021

RESUMO

A 75-year-old previously healthy man presented for elective resection of rectal cancer under general anesthesia. Six days before the operation, he had a high-grade fever, and elevated leukocyte count and C-reactive protein concentration, but this was resolved by an intravenous antibiotic. His condition was well controlled before the operation. Soon after the operation started, severe hypoxemia emerged, with low arterial pressure. Fiberoptic bronchoscopy demonstrated a massive amount of plasma-like edema fluid; the total amount of suctioned fluid was approximately 800 ml at the end of the surgery. This acute pulmonary edema appeared to be due to increased permeability rather than pulmonary congestion as indicated by chest radiography, pulmonary artery occlusion pressure, echocardiogram, and the protein-rich edema fluid. Elevated concentrations of the proinflammatory cytokines, interleukin (IL)-6 and IL-8, in both plasma and the pulmonary edema fluid, suggested a possible role of systemic and pulmonary inflammation in the development of this acute pulmonary capillary leak. According to the "two-hit" hypothesis, the bacterial infection preceding the operation may have primed the immune cells, and the following surgical stress may have then triggered rapid progression of acute respiratory distress syndrome. We should keep in mind that, especially following sepsis, sudden massive pulmonary capillary leak can occur during elective surgery, even though the patient's condition is well controlled.


Assuntos
Anestesia Geral , Síndrome de Vazamento Capilar/etiologia , Hipóxia/etiologia , Pneumopatias/etiologia , Síndrome do Desconforto Respiratório/complicações , Idoso , Síndrome de Vazamento Capilar/diagnóstico por imagem , Síndrome de Vazamento Capilar/fisiopatologia , Procedimentos Cirúrgicos Eletivos , Humanos , Interleucina-6/análise , Interleucina-8/análise , Pneumopatias/diagnóstico por imagem , Pneumopatias/fisiopatologia , Masculino , Radiografia , Síndrome do Desconforto Respiratório/diagnóstico por imagem , Síndrome do Desconforto Respiratório/fisiopatologia , Resultado do Tratamento
18.
Neurosci Lett ; 350(1): 41-5, 2003 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-12962913

RESUMO

Volatile anesthetics are known to depress excitatory synaptic transmission. Inhibition of voltage-dependent Ca2+ channels is speculated to underlie this mechanism, which remains to be clarified in vivo. We examined the sensitivity to halothane in mice lacking the N-type Ca2+ channel, a major contributor of presynaptic neurotransmitter release. Sensitivity to halothane was significantly increased in the knockout mice compared with the wild-type littermates. Halothane also depressed field excitatory postsynaptic potentials recorded from the Schaffer collateral-CA1 hippocampal synapses more greatly in the knockout mice. We further examined sleep time induced by injection of propofol, an intravenous anesthetic that mainly affects inhibitory synaptic transmission. In contrast, sensitivity to propofol was significantly decreased in the knockout mice. We suggest that inhibition of the N-type Ca2+ channel underlies mechanisms of halothane anesthesia but counteracts propofol anesthesia.


Assuntos
Anestésicos Inalatórios/farmacologia , Anestésicos Intravenosos/farmacologia , Canais de Cálcio Tipo N/fisiologia , Halotano/farmacologia , Propofol/farmacologia , Animais , Pressão Sanguínea/efeitos dos fármacos , Canais de Cálcio Tipo N/genética , Relação Dose-Resposta a Droga , Potenciais Pós-Sinápticos Excitadores/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Heterozigoto , Hipocampo/citologia , Hipocampo/efeitos dos fármacos , Homozigoto , Técnicas In Vitro , Camundongos , Camundongos Knockout , Medição da Dor/efeitos dos fármacos , Reflexo/efeitos dos fármacos , Reflexo/genética , Sono/efeitos dos fármacos
19.
Anesth Analg ; 97(1): 96-103, table of contents, 2003 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12818950

RESUMO

UNLABELLED: Because inhibition of voltage-dependent Ca(2+) channels can be a mechanism underlying general anesthesia, we examined sensitivities to propofol and halothane in mice lacking the R-type (Ca(v)2.3) channel widely expressed in neurons. Sleep time after propofol injection (26 mg/kg IV) and halothane MAC(RR) and MAC (50% effective concentrations for the loss of the righting reflex and for the tail pinch/withdrawal response, respectively) were determined. Significantly shorter propofol-induced sleep time (291.6 +/- 16.8 s versus 344.4 +/- 12.1 s) and larger halothane MAC(RR) (1.11% +/- 0.04% versus 0.98% +/- 0.03%) were observed in Ca(v)2.3 channel knockouts (Ca(v)2.3(-/-)) than in wild-type (Ca(v)2.3(+/+)) litter mates. To investigate the basis of the decreased anesthetic sensitivities in vivo, field excitatory postsynaptic potentials and population spikes (PSs) were recorded from Schaffer collateral CA1 synapses in hippocampal slices. Propofol (10-30 micro M) inhibited PSs by potentiating gamma-aminobutyric acid-ergic inhibition, and this potentiation was markedly smaller at 30 micro M in Ca(v)2.3(-/-) mice, possibly accounting for the decreased propofol sensitivity in vivo. Halothane (1.4%-2.2%) inhibited field excitatory postsynaptic potentials similarly in both genotypes, whereas 1%-2% halothane depressed PSs more in Ca(v)2.3(-/-) mice, suggesting the postsynaptic role of the R-type channel in the propagation of excitation and other mechanisms underlying the increased halothane MAC(RR) in Ca(v)2.3(-/-) mice. IMPLICATIONS: Because inhibition of neuronal Ca(2+) currents can be a mechanism underlying general anesthesia, we examined anesthetic sensitivities in mice lacking the R-type (Ca(v)2.3) Ca(2+) channels both in vivo and in hippocampal slices. Decreased sensitivities in mutant mice imply a possibility that agents blocking this channel may increase the requirements of anesthetics/hypnotics.


Assuntos
Anestésicos Inalatórios/farmacologia , Anestésicos Intravenosos/farmacologia , Canais de Cálcio Tipo R/genética , Canais de Cálcio Tipo R/fisiologia , Halotano/farmacologia , Propofol/farmacologia , Animais , Gasometria , Pressão Sanguínea/efeitos dos fármacos , Temperatura Corporal/efeitos dos fármacos , Relação Dose-Resposta a Droga , Potenciais Pós-Sinápticos Excitadores/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Hipocampo/efeitos dos fármacos , Técnicas In Vitro , Injeções Intravenosas , Camundongos , Camundongos Knockout , Células Piramidais/efeitos dos fármacos , Sono/efeitos dos fármacos , Fatores de Tempo
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