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1.
Medicine (Baltimore) ; 100(3): e24353, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546069

RESUMO

BACKGROUND: The perioperative administration of dexmedetomidine may improve the quality of recovery (QoR) after major abdominal and spinal surgeries. We evaluated the effect of an intraoperative bolus of dexmedetomidine on postoperative pain, emergence agitation, and the QoR after laparoscopic cholecystectomy. METHODS: Patients undergoing elective laparoscopic cholecystectomy were randomized to receive dexmedetomidine 0.5 µg/kg 5 minutes after anesthesia induction (dexmedetomidine group, n = 45) or normal saline (control group, n = 45). The primary outcome was the QoR at the first postoperative day using a 40-item scoring system (QoR-40). Secondary outcomes included intraoperative hemodynamic parameters, postoperative agitation, pain, and nausea and vomiting. RESULTS: The heart rate and the mean blood pressure were significantly lower in the dexmedetomidine group than in the control group (P < .001 and .007, respectively). During extubation, emergence agitation was significantly lower in the dexmedetomidine group than in the control group (23% vs 64%, P < .001). The median pain scores in the post-anesthetic care unit were significantly lower in the dexmedetomidine group than in the control group (4 [2-7] vs 5 [4-7], P = .034). The incidence of postoperative agitation, pain, and nausea and vomiting was not different between the groups. On the first postoperative day, recovery profile was similar between the groups. However, the scores on the emotional state and physical comfort dimensions were significantly higher in the dexmedetomidine group than in the control group (P = .038 and .040, respectively). CONCLUSIONS: A bolus dose of dexmedetomidine after anesthesia induction may improve intraoperative hemodynamics, emergence agitation, and immediate postoperative analgesia. However, it does not affect overall QoR-40 score after laparoscopic cholecystectomy.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Dexmedetomidina/normas , Dor Pós-Operatória/tratamento farmacológico , Agitação Psicomotora/tratamento farmacológico , Agonistas de Receptores Adrenérgicos alfa 2/farmacologia , Agonistas de Receptores Adrenérgicos alfa 2/normas , Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Adulto , Análise de Variância , Colecistectomia Laparoscópica/métodos , Dexmedetomidina/farmacologia , Dexmedetomidina/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
2.
Medicine (Baltimore) ; 100(1): e23998, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429762

RESUMO

BACKGROUND: This study aimed to investigate the effects of dexmedetomidine (Dex) on hemodynamics and organ protection in congenital heart disease (CHD) children who underwent open-heart surgery under cryogenic cardiopulmonary bypass. METHODS: Ninety children were randomly allocated to group C (0.9% saline 0.2 µg/kg/hour), group D1 (Dex 0.2 µg/kg/hour), and group D2 (Dex 0.4 µg/kg/hour) (n = 30 per group). All participants received fentanyl, propofol and 1% sevoflurane for anesthesia induction. Hemodynamic data were measured from T0 (before the induction) to T7 (30 minutes after extubation). The difference of arterial internal jugular vein bulbar oxygen difference and cerebral oxygen extraction ratio were calculated according to Fick formula. Enzyme-linked immunosorbent assay was performed to detect the serum myocardial, brain and kidney injury markers. The incidence of acute kidney injury (AKI) was calculated by serum creatinine level. Tracheal extubation time, postoperative pain score and emergence agitation score were also recorded. RESULTS: Compared with group C, group D1, and D2 exhibited reduction in hemodynamic parameters, myocardial and brain injury indicators, and tracheal extubation time. There were no significant differences in blood urea nitrogen and neutrophil gelatinase-associated lipocalin or incidence of AKI among the 3 groups. Besides, the incidence of tachycardia, nausea, vomiting and moderate agitation, and the FLACC scale in group D1 and D2 were lower than those in group C. Moreover, Dex 0.4 g/kg/hour could further reduce the dosage of fentanyl and dopamine compared with Dex 0.2 g/kg/hour. CONCLUSIONS: Dex anesthesia can effectively maintain hemodynamic stability and diminish organ injuries in CHD children.


Assuntos
Dexmedetomidina/normas , Defeitos dos Septos Cardíacos/tratamento farmacológico , Administração Intravenosa , Agonistas de Receptores Adrenérgicos alfa 2/normas , Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Criança , Pré-Escolar , China , Dexmedetomidina/uso terapêutico , Feminino , Defeitos dos Septos Cardíacos/fisiopatologia , Hemodinâmica/efeitos dos fármacos , Hemodinâmica/fisiologia , Humanos , Hipnóticos e Sedativos/normas , Hipnóticos e Sedativos/uso terapêutico , Masculino , Midazolam/uso terapêutico , Assistência Perioperatória , Resultado do Tratamento
3.
Psychosomatics ; 61(6): 585-596, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32828569

RESUMO

BACKGROUND: The pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as one of the biggest health threats of our generation. A significant portion of patients are presenting with delirium and neuropsychiatric sequelae of the disease. Unique examination findings and responses to treatment have been identified. OBJECTIVE: In this article, we seek to provide pharmacologic and treatment recommendations specific to delirium in patients with COVID-19. METHODS: We performed a literature search reviewing the neuropsychiatric complications and treatments in prior coronavirus epidemics including Middle Eastern respiratory syndrome and severe acute respiratory syndrome coronaviruses, as well as the emerging literature regarding COVID-19. We also convened a work group of consultation-liaison psychiatrists actively managing patients with COVID-19 in our hospital. Finally, we synthesized these findings to provide preliminary pharmacologic recommendations for treating delirium in these patients. RESULTS: Delirium is frequently found in patients who test positive for COVID-19, even in the absence of respiratory symptoms. There appears to be a higher rate of agitation, myoclonus, abulia, and alogia. No data are currently available on the treatment of delirium in patients with COVID-19. Extrapolating from general delirium treatment, Middle Eastern respiratory syndrome/severe acute respiratory syndrome case reports, and our experience, preliminary recommendations for pharmacologic management have been assembled. CONCLUSIONS: COVID-19 is associated with neuropsychiatric symptoms. Low-potency neuroleptics and alpha-2 adrenergic agents may be especially useful in this setting. Further research into the pathophysiology of COVID-19 will be key in developing more targeted treatment guidelines.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Antipsicóticos/uso terapêutico , Encefalopatias/fisiopatologia , Infecções por Coronavirus/fisiopatologia , Delírio/tratamento farmacológico , Agonistas de Dopamina/uso terapêutico , Pneumonia Viral/fisiopatologia , Betacoronavirus , Encefalopatias/psicologia , Depressores do Sistema Nervoso Central/uso terapêutico , Infecções por Coronavirus/psicologia , Delírio/fisiopatologia , Delírio/psicologia , Moduladores GABAérgicos/uso terapêutico , Humanos , Lorazepam/uso terapêutico , Melatonina/uso terapêutico , Pandemias , Pneumonia Viral/psicologia , Guias de Prática Clínica como Assunto
4.
Psychosomatics ; 61(5): 544-550, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32591212

Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Antipsicóticos/uso terapêutico , Infecções por Coronavirus/terapia , Delírio/tratamento farmacológico , Hipnóticos e Sedativos/efeitos adversos , Pneumonia Viral/terapia , Agitação Psicomotora/tratamento farmacológico , Medicamentos Indutores do Sono/uso terapêutico , Idoso , Analgésicos Opioides/efeitos adversos , Azepinas/uso terapêutico , Betacoronavirus , Depressores do Sistema Nervoso Central/uso terapêutico , Clordiazepóxido/efeitos adversos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/psicologia , Delírio/etiologia , Delírio/fisiopatologia , Delírio/psicologia , Dexmedetomidina/efeitos adversos , Feminino , Guanfacina/uso terapêutico , Haloperidol/uso terapêutico , Humanos , Hidromorfona/efeitos adversos , Unidades de Terapia Intensiva , Ketamina/efeitos adversos , Melatonina/uso terapêutico , Midazolam/efeitos adversos , Oxicodona/efeitos adversos , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Pneumonia Viral/psicologia , Propofol/efeitos adversos , Agitação Psicomotora/etiologia , Agitação Psicomotora/fisiopatologia , Agitação Psicomotora/psicologia , Respiração Artificial , Transtornos do Sono do Ritmo Circadiano/tratamento farmacológico , Transtornos do Sono do Ritmo Circadiano/etiologia , Transtornos do Sono do Ritmo Circadiano/fisiopatologia , Traqueostomia , Triazóis/uso terapêutico , Ácido Valproico/uso terapêutico
5.
J Clin Psychiatry ; 81(3)2020 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-32297719

RESUMO

OBJECTIVE: To assess guanfacine extended-release (GXR) efficacy and safety in adults with attention-deficit/hyperactivity disorder (ADHD). METHODS: This phase 3, double-blind, placebo-controlled study (conducted between October 2016 and July 2017) included Japanese patients aged ≥ 18 years with ADHD (DSM-5). Patients received GXR (n = 101) or placebo (n = 100) titrated from 2 mg/d to 4-6 mg/d (dose-optimization; 5 weeks), followed by 4-6 mg/d (dose-maintenance; 5 weeks), then tapered doses to 2 mg/d (2 weeks). Primary endpoint was change from baseline in total score on the Japanese version of the ADHD-Rating Scale IV with adult prompts (ADHD-RS-IV) at week 10. Other measures were ADHD-RS-IV subscales, Clinical Global Impression-Improvement scale (CGI-I) and Patient Global Impression-Improvement scale (PGI-I) (percentage of patients very much improved/much improved), treatment-emergent adverse event (TEAE) incidences, and TEAEs leading to discontinuation. RESULTS: Compared with placebo, there was statistically significantly greater improvement in ADHD-RS-IV total score reduction with GXR (least squares mean ± SE: GXR vs placebo, -11.55 ± 1.10 vs -7.27 ± 1.07; P = .0005; effect size 0.52). There were significantly greater improvements in GXR for ADHD-RS-IV inattention (-7.39 ± 0.79 vs -4.89 ± 0.76; P = .0032) and hyperactivity-impulsivity (-3.84 ± 0.54 vs -2.10 ± 0.52; P = .0021) subscale scores, CGI-I scores (48.1% vs 22.6%; P = .0007), and PGI-I scores (25.3% vs 11.8%; P = .0283). More patients in the GXR versus the placebo group reported TEAEs (81.2% vs 62.0%) and discontinued due to TEAEs (19.8% vs 3.0%). The main TEAEs in the GXR group were somnolence, thirst, blood pressure decrease, nasopharyngitis, postural dizziness, and constipation; most TEAEs were mild to moderate in severity. CONCLUSIONS: In Japanese adults with ADHD, GXR improved ADHD symptoms without any major safety concerns. Trial Registration: Japan Primary Registries Network (https://rctportal.niph.go.jp/en): JapicCTI-163231


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Guanfacina/administração & dosagem , Administração Oral , Adolescente , Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Preparações de Ação Retardada , Relação Dose-Resposta a Droga , Método Duplo-Cego , Esquema de Medicação , Feminino , Seguimentos , Guanfacina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Resultado do Tratamento , Adulto Jovem
6.
PLoS One ; 15(4): e0224720, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32348301

RESUMO

Small intestinal strangulation associated with ischaemia-reperfusion injury (IRI) is common in horses. In laboratory animals IRI can be ameliorated by ischaemic preconditioning (IPC) and pharmacological preconditioning (PPC) with dexmedetomidine. The aim of this study was to determine the effect of PPC with dexmedetomidine or IPC in an equine model of small intestinal ischaemia-reperfusion (IR). In a randomized controlled experimental trial, 15 horses were assigned to three groups: control (C), IPC, and PPC with dexmedetomidine (DEX). All horses were placed under general anaesthesia and 90% jejunal ischaemia was induced for 90 minutes, followed 30 minutes of reperfusion. In group IPC, three short bouts of ischaemia and reperfusion were implemented, and group DEX received a continuous rate infusion of dexmedetomidine prior to the main ischaemia. Jejunal biopsies were collected before ischaemia (P), and at the end of ischaemia (I) and reperfusion (R). Mucosal injury was assessed by the Chiu-Score, inflammatory cells were stained by cytosolic calprotectin. The degree of apoptosis and cell necrosis was assessed by cleaved-caspase-3 and TUNEL. Parametric data were analyzed by two-way ANOVA for repeated measurements followed by Dunnetts t-test. Non parametric data were compared between groups at the different time points by a Kruskal-Wallis-Test and a Wilcoxon-2-Sample-test. The mucosal injury score increased during I in all groups. After reperfusion, IRI further progressed in group C, but not in IPC and DEX. In all groups the number of cleaved caspase-3 and TUNEL positive cells increased from P to I. The number of TUNEL positive cells were lower in group DEX compared to group C after I and R. Infiltration with calprotectin positive cells was less pronounced in group DEX compared to group C, whereas in group IPC more calprotectin positive cells were seen. In conclusion, IPC and DEX exert protective effects in experimental small intestinal ischaemia in horses.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Dexmedetomidina/uso terapêutico , Isquemia/terapia , Precondicionamento Isquêmico/métodos , Jejuno/irrigação sanguínea , Traumatismo por Reperfusão/terapia , Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Agonistas de Receptores Adrenérgicos alfa 2/farmacologia , Animais , Dexmedetomidina/administração & dosagem , Dexmedetomidina/farmacologia , Cavalos , Isquemia/tratamento farmacológico , Jejuno/efeitos dos fármacos , Jejuno/patologia , Distribuição Aleatória , Traumatismo por Reperfusão/tratamento farmacológico
7.
Int Heart J ; 61(2): 263-272, 2020 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-32132317

RESUMO

This study aims to evaluate the effect of dexmedetomidine (DEX) sedation for relieving anxiety and the incidence of atrial fibrillation (AF) after off-pump coronary artery bypass graft (OPCABG).This randomized, double-blind, controlled trial was conducted on 196 patients who underwent OPCABG in Shandong Provincial Hospital from July 2017 to June 2018. The patients were randomly assigned to two groups, intervention of DEX group and Propofol (PROP) group. Episodes of postoperative AF (POAF) were identified within 5 days after OPCABG. Perioperative anxiety status was assessed using Zung's Self-Rating Anxiety Scale (SAS). The baseline demographic and surgical characteristics of the population and other outcome variables were evaluated.We analyzed 62 patients in the DEX group and 61 patients in the PROP group. There was no significant difference in SAS anxiety scores between two groups before surgery (P = 0.104), while SAS had significantly after surgery (P = 0.018). The incidence of POAF in the DEX group was lower than that of the PROP group (16.1% versus 32.8%, P = 0.037), and a total of 30 patients (30/123, 24.4%) manifested POAF after OPCABG. Some univariable predictors of POAF were detected. The conceptual model of mediator analyses showed DEX was not only directly related to POAF but was also indirectly related through the independent effect of anxiety level.The findings indicated that patients receiving DEX were more likely to have less incidence of POAF, also uniquely showed DEX administration and POAF processes as a function of anxiety status.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Ansiedade/prevenção & controle , Fibrilação Atrial/prevenção & controle , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Dexmedetomidina/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Idoso , Ansiedade/etiologia , Fibrilação Atrial/etiologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos
8.
Am J Nurs ; 120(4): 60, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32218053

RESUMO

Editor's note: The mission of Cochrane Nursing is to provide an international evidence base for nurses involved in delivering, leading, or researching nursing care. Cochrane Corner provides summaries of recent systematic reviews from the Cochrane Library. For more information, see https://nursing.cochrane.org.


Assuntos
Antipsicóticos/uso terapêutico , Estado Terminal , Delírio/tratamento farmacológico , Unidades de Terapia Intensiva , Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Adulto , Dexmedetomidina/uso terapêutico , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração Artificial
9.
J Glaucoma ; 29(4): 280-286, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32053556

RESUMO

PRéCIS:: Adjuvant diclofenac and apraclonidine eye drop given in conjunction with selective laser trabeculoplasty (SLT) do not significantly impact medium-term intraocular pressure (IOP) reduction compared with placebo, but apraclonidine can be used to blunt immediate postlaser pressure spikes. PURPOSE: There is limited high-grade evidence guiding the choice of eye drops given before and after SLT. The authors chose to measure IOP during the first 24 hours, at 1 week, 6 weeks, and 6 months after SLT, and compare the effect of apraclonidine before SLT and diclofenac after SLT, with placebo. MATERIALS AND METHODS: In this double-blind, randomized, placebo-controlled trial, patients with open-angle glaucoma or ocular hypertension referred for SLT were recruited between 2016 and 2018. Patients were randomized to receive either apraclonidine pre-SLT with placebo post-SLT, placebo pre-SLT with diclofenac post-SLT, or placebo before and after SLT. RESULTS: Sixty eyes from 35 patients were treated with 360-degree SLT. Twenty-four-hour IOP measurements with patient self-monitoring after SLT demonstrated a moderate IOP spike at 1 hour and 2 hours post-SLT in the placebo and diclofenac study arms (mean=+4.05±0.58 mm Hg and +4.47±0.73, respectively, P<0.001 vs. pre-SLT IOP), which was prevented by apraclonidine (mean=-2.41±0.88 mm Hg, P<0.0001 vs. other study arms post-SLT). There were no significant differences between the 3 arms of the study on the long-term IOP reduction achieved by SLT (6 wk: P=0.51, 6 mo: P=0.42). CONCLUSIONS: Neither the use of apraclonidine before SLT nor diclofenac after SLT significantly influenced the IOP reduction induced by SLT. Except for a slight and transient reduction in intraocular inflammation, there was no beneficial effect of diclofenac on early IOP changes or the degree of patient discomfort relative to placebo.


Assuntos
Clonidina/análogos & derivados , Diclofenaco/uso terapêutico , Glaucoma de Ângulo Aberto/cirurgia , Pressão Intraocular/efeitos dos fármacos , Hipertensão Ocular/cirurgia , Trabeculectomia , Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Idoso , Anti-Inflamatórios não Esteroides/uso terapêutico , Clonidina/uso terapêutico , Método Duplo-Cego , Feminino , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Terapia a Laser/efeitos adversos , Lasers Semicondutores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/fisiopatologia , Soluções Oftálmicas/uso terapêutico , Tonometria Ocular
10.
Expert Opin Pharmacother ; 21(4): 417-426, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31971448

RESUMO

Introduction: Attention-deficit/hyperactivity disorder (ADHD) commonly occurs in children, adolescents, and adults. Although symptoms of ADHD often respond robustly to treatment with stimulants (amphetamine or methylphenidate), not all patients are appropriate candidates for treatment with these drugs. Guanfacine extended-release (GXR) is a non-stimulant alternative drug approved for the treatment of ADHD in the United States (U.S.), Canada, and Europe.Areas covered: The chemistry, pharmacokinetics, mechanism of action and dosage of GXR are presented. Efficacy and safety data obtained in clinical trials with subjects aged 6-17 years for both GXR monotherapy and use in combination with stimulants are described. Meta-analyses comparing GXR to other drugs are presented. MedWatch surveillance data collected for GXR since approval in the U.S. are also discussed.Expert opinion: Although GXR is effective for the treatment of ADHD and has a different side effect profile than stimulants, it is not as impressive in reducing symptoms. Despite the availability of multiple pharmacological treatments for ADHD, there remains an unmet need for formulations as potent as stimulants but with fewer adverse effects. Several pharmacological agents for ADHD treatment are in development. It is not clear that any of these compounds will replace currently available formulations as first-line alternatives.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Guanfacina/uso terapêutico , Adolescente , Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Agonistas de Receptores Adrenérgicos alfa 2/efeitos adversos , Estimulantes do Sistema Nervoso Central/administração & dosagem , Estimulantes do Sistema Nervoso Central/efeitos adversos , Criança , Preparações de Ação Retardada , Composição de Medicamentos , Quimioterapia Combinada , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Guanfacina/administração & dosagem , Guanfacina/efeitos adversos , Humanos , Metilfenidato/uso terapêutico , Estados Unidos
12.
Cutan Ocul Toxicol ; 39(1): 21-24, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31615279

RESUMO

Purpose: To compare the efficacy, safety, and potential advantages of the preservative-free versus preserved brimonidine %0.15 preparations in patients with primer open-angle glaucoma (POAG) or ocular hypertension (OHT).Methods: Forty-two eyes of the 21 treatment-naive patients with POAG or OHT were enrolled in this study. Eyes were randomly assigned to receive brimonidine-purite 0.15% or preservative-free brimonidine 0.15% two times daily. Efficacy of the two eye drops was assessed by measuring the intraocular pressure (IOP) at 9-10 am at baseline and week 4. Safety and potential advantages of the drops were evaluated at weeks 4 in terms of ocular symptoms and tear parameters. Ocular symptom values of the patients were evaluated with a scale of 0-4 (0 = no discomfort and 4 = severe discomfort).Results: Both of the brimonidine tartrate formulations resulted in statistically similar IOP reduction (preserved formulation; -5.2 mmHg [22.9% reduction] preservative-free formulation; -5.7 mmHg [24.1% reduction], p = 0.37). It was found that brimonidine tartrate formulations with and without topical preservatives did not produce a statistically significant difference in pain, stinging, and blurred vision at the upon instillation (p > 0.05). However, the burning sensation was significantly higher in the preservative-free formulation at the first instillation compared to the preserved formulation (p = 0.01). Also, there was no statistically significant difference between the two formulations in terms of symptoms (itching, burning, tearing, stinging, and photophobia) and tear parameters during the day (p > 0.05).Conclusions: Although topical preservative-free brimonidine tartrate treated eyes had a more burning sensation at the first drop, the two formulations were similar in terms of ocular tolerability in the short term period. Also, both formulations were found to reduce IOP at a similar rate.


Assuntos
Tartarato de Brimonidina/uso terapêutico , Glaucoma de Ângulo Aberto/tratamento farmacológico , Hipertensão Ocular/tratamento farmacológico , Conservantes Farmacêuticos/administração & dosagem , Agonistas de Receptores Adrenérgicos alfa 2/química , Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Adulto , Tartarato de Brimonidina/administração & dosagem , Tartarato de Brimonidina/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas/administração & dosagem , Soluções Oftálmicas/química , Soluções Oftálmicas/uso terapêutico , Conservantes Farmacêuticos/química
13.
Eur J Ophthalmol ; 30(2): 293-298, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30526051

RESUMO

AIM: To evaluate the effectiveness of brinzolamide-brimonidine fixed combination to control the intraocular pressure elevation throughout the first 24 h following uncomplicated phacoemulsification cataract surgery. PATIENTS AND METHODS: A total of 62 patients who underwent phacoemulsification cataract surgery were included in this prospective randomized comparative case series. The brinzolamide-brimonidine fixed combination group (34 eyes) was administered a single dose of brinzolamide-brimonidine fixed combination immediately after phacoemulsification. No treatment was administered in the control group (28 eyes). Intraocular pressure was measured 1 day before surgery (baseline) and at 6, 12 and 24 h postoperatively. RESULTS: The brinzolamide-brimonidine fixed combination group had significantly lower intraocular pressure at 6, 12 and 24 h after phacoemulsification compared to baseline (p < 0.0001 for all comparisons), while in control group, intraocular pressure was significantly higher at 6 and 12 h after surgery compared to baseline (p < 0.001 and p < 0.0001, respectively). In control group, an intraocular pressure elevation ⩾ 5 mm Hg was noted in 32.4% of the eyes at 6 and 12 h and in 5.9% of eyes at 24 h after surgery, while in brinzolamide-brimonidine fixed combination group, only 8.8% of the eyes at 6 h postoperatively had such an intraocular pressure elevation. CONCLUSION: The administration of a single drop of brinzolamide-brimonidine fixed combination effectively prevented intraocular pressure elevations and intraocular pressure spikes during the first 24 h after uneventful phacoemulsification.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Tartarato de Brimonidina/uso terapêutico , Inibidores da Anidrase Carbônica/uso terapêutico , Pressão Intraocular/efeitos dos fármacos , Hipertensão Ocular/prevenção & controle , Facoemulsificação , Sulfonamidas/uso terapêutico , Tiazinas/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Tonometria Ocular
14.
Anesth Analg ; 130(4): 1054-1062, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-30346356

RESUMO

BACKGROUND: Organ ischemia-reperfusion injury often induces local and systemic inflammatory responses, which in turn worsen organ injury. These inflammatory responses can be regulated by the central nervous system, particularly by the vagal nerve and nicotinic acetylcholine receptors, which are the key components of cholinergic anti-inflammatory pathway. Activation of the cholinergic anti-inflammatory pathway can suppress excessive inflammatory responses and be a potential strategy for prevention of ischemia-reperfusion injury of organs including the kidney. METHODS: Vagal nerve activity, plasma acetylcholine, catecholamine and inflammatory mediators, renal tissue injury, and cell death were measured in mice with bilateral renal ischemia/reperfusion with or without treatment with dexmedetomidine (Dex), an α2-adrenergic receptor agonist. RESULTS: Dex significantly increased the discharge frequency of the cervical vagal nerve by up to 142 Hz (mean) (P < .001), and preserved kidney gross morphology and structure and attenuated cell apoptosis after ischemia-reperfusion. Furthermore, Dex also significantly increased acetylcholine release to 135.8 pmol/L (median) when compared to that (84.7 pmol/L) in the sham group (P < .001) and reduced the levels of several inflammatory mediators induced by renal ischemia/reperfusion. All the effects were abolished by vagotomy, splenectomy, or combinative administration of atipamezole, an α2-adrenergic receptor antagonist. CONCLUSIONS: Our findings suggest that Dex provides renoprotection, at least in part, through anti-inflammatory effects of the parasympathetic nervous system activation in addition to its direct actions on α2-adrenergic receptors.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/farmacologia , Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Anti-Inflamatórios/farmacologia , Dexmedetomidina/farmacologia , Dexmedetomidina/uso terapêutico , Nefropatias/prevenção & controle , Sistema Nervoso Parassimpático/efeitos dos fármacos , Traumatismo por Reperfusão/prevenção & controle , Acetilcolina/sangue , Antagonistas de Receptores Adrenérgicos alfa 2/farmacologia , Animais , Apoptose/efeitos dos fármacos , Catecolaminas/sangue , Imidazóis/farmacologia , Mediadores da Inflamação/metabolismo , Rim/patologia , Nefropatias/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Nervo Vago/fisiopatologia
15.
Am J Obstet Gynecol ; 222(6): 532-541, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31715148

RESUMO

Chronic hypertension and associated cardiovascular disease are among the leading causes of maternal and perinatal morbidity and death in the United States. Chronic hypertension in pregnancy is associated with a host of adverse outcomes that include preeclampsia, cesarean delivery, cerebrovascular accidents, fetal growth restriction, preterm birth, and maternal and perinatal death. There are several key issues related to the diagnosis and management of chronic hypertension in pregnancy where data are limited and further research is needed. These challenges and recent guidelines for the management of chronic hypertension are reviewed. Well-timed pregnancies are of utmost importance to reduce the risks of chronic hypertension; long-acting reversible contraceptive options are preferred. Research to determine optimal blood pressure thresholds for diagnosis and treatment to optimize short- and long-term maternal and perinatal outcomes should be prioritized along with interventions to reduce extant racial and ethnic disparities.


Assuntos
Anti-Hipertensivos/uso terapêutico , Parto Obstétrico/métodos , Hipertensão/terapia , Complicações Cardiovasculares na Gravidez/terapia , Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Antagonistas Adrenérgicos beta/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Cesárea , Doença Crônica , Gerenciamento Clínico , Feminino , Retardo do Crescimento Fetal/epidemiologia , Idade Gestacional , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Contracepção Reversível de Longo Prazo , Metildopa/uso terapêutico , Cuidado Pós-Natal/métodos , Pré-Eclâmpsia/epidemiologia , Cuidado Pré-Concepcional/métodos , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Cuidado Pré-Natal/métodos , Índice de Gravidade de Doença , Inibidores de Simportadores de Cloreto de Sódio e Potássio/uso terapêutico , Fatores de Tempo , Vasodilatadores/uso terapêutico
16.
Crit Care ; 23(1): 402, 2019 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-31829277

RESUMO

BACKGROUND: The α2 agonists, dexmedetomidine and clonidine, are used as sedative drugs during critical illness. These drugs may have anti-inflammatory effects, which might be relevant to critical illness, but a systematic review of published literature has not been published. We reviewed animal and human studies relevant to critical illness to summarise the evidence for an anti-inflammatory effect from α2 agonists. METHODS: We searched PubMed, the Cochrane library, and Medline. Animal and human studies published in English were included. Broad search terms were used: dexmedetomidine or clonidine, sepsis, and inflammation. Reference lists were screened for additional publications. Titles and abstracts were screened independently by two reviewers and full-text articles obtained for potentially eligible studies. Data extraction used a bespoke template given study diversity, and quality assessment was qualitative. RESULTS: Study diversity meant meta-analysis was not feasible so descriptive synthesis was undertaken. We identified 30 animal studies (caecal ligation/puncture (9), lipopolysaccharide (14), acute lung injury (5), and ischaemia-reperfusion syndrome (5)), and 9 human studies. Most animal (26 dexmedetomidine, 4 clonidine) and all human studies used dexmedetomidine. In animal studies, α2 agonists reduced serum and/or tissue TNFα (20 studies), IL-6 (17 studies), IL-1ß (7 studies), NFκB (6 studies), TLR4 (6 studies), and a range of other mediators. Timing and doses varied widely, but in many cases were not directly relevant to human sedation use. In human studies, dexmedetomidine reduced CRP (4 studies), TNFα (5 studies), IL-6 (6 studies), IL-1ß (3 studies), and altered several other mediators. Most studies were small and low quality. No studies related effects to clinical outcomes. CONCLUSION: Evidence supports potential anti-inflammatory effects from α2 agonists, but the relevance to clinically important outcomes is uncertain. Further work should explore whether dose relationships with inflammation and clinical outcomes are present which might be separate from sedation-mediated effects.


Assuntos
Clonidina/normas , Dexmedetomidina/normas , Inflamação/tratamento farmacológico , Agonistas de Receptores Adrenérgicos alfa 2/normas , Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Animais , Clonidina/uso terapêutico , Estado Terminal/terapia , Dexmedetomidina/uso terapêutico , Modelos Animais de Doenças , Humanos , Inflamação/fisiopatologia
17.
Asian J Anesthesiol ; 57(3): 66-84, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31842530

RESUMO

Shivering is a common postoperative complication that occurs after both general and regional anesthesia even in the cases when hypothermia during surgery has been averted. Patients describe it as a highly unpleasant experience, while clinicians are concerned due to its adverse effects such as increased oxygen consumption. In this article, we present a summary of the pathophysiological mechanisms involved in postoperative shivering (POS), risk factors, and inadvertent effects. The major objective of this article was to review the existing literature on the effi ciency of various drug interventions as a prophylactic measure against POS. Since α2-adrenergic, opioid, anticholinergic, and serotonergic pathways are thought to play a role in the pathogenesis of POS, a wide variety of drugs has been investigated in this regard. Although the methodological diversity of the study designs and regimens does not support drawing defi nite conclusions, there is evidence indicating a benefi cial effect of dexmedetomidine, ketamine, tramadol, meperidine, dexamethasone, nefopam, granisetron, and ondansetron in the prevention of POS. The purpose of this review is to provide a thorough insight on various drug options and to serve as an aid for clinicians for careful analysis of the advantages and disadvantages of each regimen to decide which regimen will be ideally suited for the medical profi le of each patient.


Assuntos
Complicações Pós-Operatórias/prevenção & controle , Tremor por Sensação de Frio/efeitos dos fármacos , Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Humanos , Nefopam/uso terapêutico , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Receptores de N-Metil-D-Aspartato/antagonistas & inibidores , Tramadol/uso terapêutico
18.
Aging (Albany NY) ; 11(21): 9556-9568, 2019 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-31682592

RESUMO

Dexmedetomidine is known to alleviate cerebral ischemia-reperfusion injury (CIRI). We established a rat model of CIRI, which exhibited higher neurological deficit scores and a greater number of apoptotic cells in the cerebral ischemic penumbra than controls. Dexmedetomidine reversed the neuronal apoptosis and improved neurological function in this model. We then examined Sigma-1 receptor (Sig-1R) expression on the endoplasmic reticulum (ER) in brain tissues at different reperfusion time points. Sig-1R expression increased with CIRI and decreased with increasing reperfusion times. After 24 hours of reperfusion, dexmedetomidine upregulated Sig-1R expression, and ER stress proteins (GRP78, CHOP, JNK and Caspase-3) were detected in brain tissues with Western blotting. Moreover, GRP78 expression followed a pattern similar to Sig-1R. Dexmedetomidine induced GRP78 expression but inhibited CHOP, Caspase-3 and phosphorylated-JNK expression in brain tissues. A Sig-1R-specific inhibitor reduced GRP78 expression and partially inhibited the upregulation of GRP78 by dexmedetomidine. The inhibitor also increased CHOP and Caspase-3 expression and partially reversed the inhibitory effects of dexmedetomidine on these pro-apoptotic ER stress proteins. These results suggest that dexmedetomidine at least partially inhibits ER stress-induced apoptosis by activating Sig-1R, thereby attenuating brain damage after 24 hours of ischemia-reperfusion.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Lesões Encefálicas/prevenção & controle , Dexmedetomidina/uso terapêutico , Receptores sigma/metabolismo , Traumatismo por Reperfusão/prevenção & controle , Agonistas de Receptores Adrenérgicos alfa 2/farmacologia , Animais , Apoptose/efeitos dos fármacos , Dexmedetomidina/farmacologia , Avaliação Pré-Clínica de Medicamentos , Estresse do Retículo Endoplasmático/efeitos dos fármacos , Masculino , Distribuição Aleatória , Ratos Sprague-Dawley
19.
Plast Reconstr Surg ; 144(6): 1080e-1094e, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31764672

RESUMO

LEARNING OBJECTIVES: After reading this article, the participant should be able to: 1. Describe the fundamental concepts of multimodal analgesia techniques and how they target pain pathophysiology. 2. Effectively educate patients on postoperative pain and safe opioid use. 3. Develop and implement a multimodal postoperative analgesia regimen. SUMMARY: For many years, opioids were the cornerstone of postoperative pain control, contributing to what has become a significant public health concern. This article discusses contemporary approaches to multimodal, opioid-sparing postoperative pain management in the plastic surgical patient.


Assuntos
Recuperação Pós-Cirúrgica Melhorada , Dor Pós-Operatória/prevenção & controle , Acetaminofen/uso terapêutico , Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Analgésicos Opioides/uso terapêutico , Anestesia por Condução/métodos , Anestesia Local/métodos , Anestésicos Combinados , Anestésicos Locais/farmacocinética , Anti-Inflamatórios não Esteroides/uso terapêutico , Antidepressivos/uso terapêutico , Bloqueio do Plexo Braquial/métodos , Aconselhamento , Gabapentina/uso terapêutico , Humanos , Educação de Pacientes como Assunto , Modalidades de Fisioterapia , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios , Receptores de N-Metil-D-Aspartato/antagonistas & inibidores
20.
Anesth Analg ; 129(6): 1529-1535, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31743172

RESUMO

BACKGROUND: Dexmedetomidine (Dex) is an attractive agent for procedural sedation due to its unique pharmacodynamic profile, specifically affording predictable sedation without concurrent respiratory depression. However, Dex has previously been reported to prevent or terminate arrhythmias. The purpose of this study was to investigate paroxysmal supraventricular tachycardia (PSVT) inducibility and homeostatic stability during electrophysiology studies (EPSs) and ablation when a standardized Dex protocol was used as the primary sedation agent. METHODS: We performed a retrospective review of 163 consecutive procedures for PSVT ablation that received Dex as the primary sedative with adjunct fentanyl and midazolam boluses (DEX-FENT-MIDAZ). This cohort was compared to 163 consecutive control procedures wherein strictly fentanyl and midazolam were used for sedation. The primary outcome reviewed was PSVT inducibility assessed before ablation. Reviewed secondary outcomes included level of sedation and intraprocedure hemodynamics and oxygenation. RESULTS: The arrhythmia profiles of the DEX-FENT-MIDAZ and control cohorts were very similar. The overall incidence of a "negative" EPSs in which arrhythmia was not induced was 24% in the DEX-FENT-MIDAZ group and 26% in the control group (P = .7). Unintended deep sedation was significantly less with DEX-FENT-MIDAZ (4.3% vs 27%; P ≤ .0001). However, DEX-FENT-MIDAZ use was associated with a higher incidence of intraprocedure hypotension. CONCLUSIONS: Dex sedation during EPSs is not associated with a reduction in PSVT inducibility. The therapeutic utility of Dex during EPS arises from the predictable sedation Dex affords but is associated with an increased incidence of intraprocedure hypotension.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Ablação por Cateter , Dexmedetomidina/uso terapêutico , Técnicas Eletrofisiológicas Cardíacas , Frequência Cardíaca , Hipnóticos e Sedativos/uso terapêutico , Taquicardia Supraventricular/cirurgia , Agonistas de Receptores Adrenérgicos alfa 2/efeitos adversos , Adulto , Idoso , Pressão Sanguínea/efeitos dos fármacos , Estimulação Cardíaca Artificial , Dexmedetomidina/efeitos adversos , Feminino , Humanos , Hipnóticos e Sedativos/efeitos adversos , Hipotensão/induzido quimicamente , Hipotensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/fisiopatologia , Resultado do Tratamento
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