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1.
Isr Med Assoc J ; 22(4): 219-223, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32286023

RESUMO

BACKGROUND: In an effort to alter eye color during World War II, devout Nazi researcher Karin Magnussen had adrenaline eye drops administered to inmates at the concentration camp Auschwitz-Birkenau. A Sinti family, with a high prevalence of heterochromia iridis, was forced to participate in this study. Members of this family, as well as other victims, were later killed and had their eyes enucleated and sent to Magnussen for examination. Magnussen articulated the findings of these events in a manuscript that has never been published. The author is the first ophthalmologist to review this manuscript. The generation who experienced the atrocities of World War II will soon be gone and awareness of what happened during this tragic chapter of world history is fading. OBJECTIVES: To describe these events to raise awareness among future generations. METHODS: A literature review and archival search was conducted. RESULTS: Magnussen's research was based on an animal study published in 1937. For Magnussen's study, adrenaline drops were administered to inmates, including a 12-year-old girl from the Sinti family. As there was a reported case of deaf-mutism within the family, Waardenburg syndrome seems to be the most plausible explanation for this family's heritable heterochromia. CONCLUSIONS: The effort to change eye color was doomed to fail from the beginning because there was a probable diagnosis of Waardenburg syndrome. Extinction of humans for ophthalmological research is an insane act beyond imagination. For the sake of these victims, and for the generations who still feel their pain, it is imperative to tell their stories.


Assuntos
Campos de Concentração/história , Epinefrina/efeitos adversos , Cor de Olho , Experimentação Humana/história , Doenças da Íris/induzido quimicamente , Transtornos da Pigmentação/induzido quimicamente , Epinefrina/administração & dosagem , Feminino , Alemanha , História do Século XX , Experimentação Humana/ética , Humanos , Masculino , Prisioneiros , Violência/história , II Guerra Mundial
3.
Dermatol Surg ; 46(1): 26-30, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30829774

RESUMO

BACKGROUND: Recently, the safety of lidocaine plus epinephrine use in outpatient surgery has come under scrutiny despite its long history of use in outpatient dermatologic procedures and surgeries. OBJECTIVE: To assess the frequency of crash cart and other emergency interventions during Mohs micrographic surgery when lidocaine plus epinephrine is used as a local anesthetic and evaluate patient comorbidities associated with these events. MATERIALS AND METHODS: A retrospective chart review was conducted in an outpatient Mohs micrographic surgery clinic. RESULTS: One thousand one hundred twenty-seven Mohs cases were reviewed from the period of March 2015 to June 2016 with 864 meeting the inclusion criteria of patient weight, medical history, and amount of lidocaine administered recorded. No adverse events requiring emergency intervention with a crash cart or transfer to the emergency department occurred despite a patient population with advanced age and a wide range of comorbidities. CONCLUSION: No serious adverse events requiring emergency intervention were associated with lidocaine with epinephrine doses administered below the Food and Drug Administration recommended maximum. The authors did not find evidence from this study or after a literature search to support the requirement for a crash cart and other emergency equipment to be present during procedures.


Assuntos
Anestésicos Locais/efeitos adversos , Epinefrina/efeitos adversos , Lidocaína/efeitos adversos , Cirurgia de Mohs/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Simpatomiméticos/efeitos adversos , Idoso , Anestésicos Locais/administração & dosagem , Epinefrina/administração & dosagem , Feminino , Humanos , Injeções Intradérmicas , Injeções Subcutâneas , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Simpatomiméticos/administração & dosagem
5.
Medicine (Baltimore) ; 98(45): e17502, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702610

RESUMO

AIM: Our objective is to assess the effects of epinephrine for out of hospital cardiac arrest. BACKGROUND: Cardiac arrest was the most serious medical incidents with an estimated incidence in the United States of 95.7 per 100,000 person years. Though epinephrine improved coronary and cerebral perfusion, improving a return of spontaneous circulation, potentially harmful effects on the heart lead to greater myocardial oxygen demand. Concerns about the effect of epinephrine for out-of-hospital cardiac arrest were controversial and called for a higher argument to determine whether the effects of epinephrine is safe and effective for shor and long terms outcomes. METHOD: Searching databases consist of all kinds of searching tools, such as Medline, the Cochrane Library, Embase, PubMed, etc. All the included studies should meet our demand of this meta-analysis. In the all interest outcomes blow we take the full advantage of STATA to assess, the main measure is Risk Ratio (RR) with 95% confidence, the publication bias are assessed by Egger Test. RESULT: In current systematic review and meta-analysis of randomized trials investigating epinephrine for out of hospital cardiac arrest, we found that epinephrine was associated with a significantly higher likelihood of ROSC (RR = 3.05, I = 23.1%, P = .0001) and survival to hospital discharge (RR = 1.40, I = 36.3%, P = .008) compared with non-adrenaline administration. Conversely, epinephrine did not increase CPC 1 or 2 (RR = 1.15, I = 40.5%, P = .340) and hospital admission (RR = 2.07, I = 88.2%, P = .0001). CONCLUSION: In conclusion, in this systematic review and meta-analysis involving studies, the use of epinephrine resulted in a significantly higher likelihood of survival to hospital discharge and ROSC than the non-epinephrine administration, but, there was no significant between group difference in the rate of a favorable neurologic outcome.


Assuntos
Epinefrina/uso terapêutico , Parada Cardíaca Extra-Hospitalar/tratamento farmacológico , Idoso , Epinefrina/efeitos adversos , Hospitalização , Humanos , Pessoa de Meia-Idade , Razão de Chances , Alta do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
6.
Niger J Clin Pract ; 22(8): 1172-1174, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31417065

RESUMO

Dental anesthesia is one of the most frequently performed medical procedures. Although the frequency of ocular complications is extremely low, these reactions can be highly alarming and may bring up medicolegal issues when they do occur. Dentists and oral surgeons should be well-informed of these adverse reactions and should be aware that both ophthalmologists and emergency physicians might be required to care for these patients.


Assuntos
Anestesia Dentária/efeitos adversos , Anestesia Local/efeitos adversos , Anestésicos Locais/efeitos adversos , Carticaína/efeitos adversos , Diplopia/etiologia , Epinefrina/efeitos adversos , Oftalmoplegia/etiologia , Extração Dentária , Adulto , Anestesia Dentária/métodos , Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Carticaína/administração & dosagem , Epinefrina/administração & dosagem , Humanos
7.
Braz J Cardiovasc Surg ; 34(4): 444-450, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31454198

RESUMO

OBJECTIVES: Postoperative arrhythmia is an important complication of coronary artery bypass grafting (CABG) surgeries among patients. It seems that opioid usage is implicated in the pathogenesis of this condition due to its impacts on different organ systems, such as the autonomic nervous system. The present study was performed to investigate the effect of opium use on postoperative arrhythmia in patients undergoing CABG surgery. METHODS: Study participants were selected via convenience sampling from patients undergoing CABG surgery in a referral hospital. Study variables, including use of inotropic drugs, vital signs monitoring parameters and postoperative arrhythmia were observed and recorded at baseline and at follow-up time after surgery. RESULTS: Sixty-five (14.8%) patients had postoperative arrhythmia, and 104 participants were addicted. Prevalence of postoperative arrhythmia was the same among addict and non-addict patients. According to the regression analysis model, only serum level of epinephrine in operating room, heart rate and central venous pressure at baseline and 48 hours after operation are known as independent predictors of postoperative arrhythmia among study population. CONCLUSION: This study showed that although opium addiction increased postoperative arrhythmia among patients undergoing CABG surgery, this difference was not significant, and this association is probably mediated by other study variables.


Assuntos
Arritmias Cardíacas/etiologia , Ponte Cardiopulmonar/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Transtornos Relacionados ao Uso de Opioides/complicações , Complicações Pós-Operatórias/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/epidemiologia , Pressão Sanguínea , Pressão Venosa Central , Epinefrina/efeitos adversos , Feminino , Frequência Cardíaca , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Adulto Jovem
9.
Plast Reconstr Surg ; 144(1): 149-154, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31246822

RESUMO

BACKGROUND: Conventional dogma suggests that the use of local anesthetic with epinephrine is contraindicated in the digits because of fear of ischemia and necrosis. Although several reports have refuted this notion, the precept is still propagated in many clinical forums. For many years, the authors have used lidocaine with epinephrine to perform removal of postaxial polydactyly in infants and have observed few complications and no cases of digital ischemia or necrosis. This investigation details the authors' outcomes with this anesthetic modality in neonates and supports the growing body of literature documenting the safety of using lidocaine with epinephrine in the digits. METHODS: A retrospective review of all infants younger than 6 months who underwent preaxial and postaxial polydactyly excision and removal of their sequelae of the hand or foot under local anesthesia, from 2011 to 2017, was completed. All demographic characteristics, frequency of complications, and descriptive statistics of the sample clinical group were documented. RESULTS: In the 215 patients who met inclusion criteria, a total of 402 procedures were performed. Mean follow-up was 19.9 months for 140 patients, or 264 procedures (65.7 percent). The total complication rate was 2.6 percent. There were two cases of minor bleeding, one wound dehiscence, and four surgical-site infections. CONCLUSIONS: In 402 procedures of surgical excision of polydactyly in infants, there were few short-term complications, none of which were necrosis or any vascular complication related to the use of epinephrine. The authors believe that, with the use of a low-dose epinephrine injection (1:200,000), the risk for digital infarction is low in this population. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Epinefrina/efeitos adversos , Polidactilia/cirurgia , Vasoconstritores/efeitos adversos , Anestésicos Locais/administração & dosagem , Quimioterapia Combinada , Epinefrina/administração & dosagem , Feminino , Dedos/anormalidades , Dedos/cirurgia , Humanos , Lactente , Recém-Nascido , Masculino , Bloqueio Nervoso/métodos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Dedos do Pé/anormalidades , Dedos do Pé/cirurgia , Vasoconstritores/administração & dosagem
10.
Curr Opin Anaesthesiol ; 32(3): 263-267, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30985339

RESUMO

PURPOSE OF REVIEW: As the application of a test dose after epidural catheter insertion in obstetrics has recurrently been associated with serious adverse events affecting both maternal and foetal outcomes, the question whether to test or not remains a controversial issue. RECENT FINDINGS: Present guidelines do not provide clear recommendations in this regard and several recent surveys indicate a heterogeneity in clinical routine. SUMMARY: Physiological alterations during pregnancy and labour restrict the use and also the validity of traditional test agents. Epinephrine is not appropriate to detect a vascular insertion in labour and the application of a local anaesthetic test dose may lead to dose-dependent fatal consequences should the catheter be intrathecal, due to an increased sensitivity in parturients. Given the current practice of opioid-amended-low-concentration epidurals, the waiving of a test dose results at worst in a failed epidural, a stark contrast to the potentially severe to fatal complications of a 'traditional' test dose. Hence, an originally preventive measure providing potentially more harm than the consequences of the situation aimed to prevent, should not be recommended. A simple fractionated administration of the initial analgesic dose seems reasonable though.


Assuntos
Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Anestésicos Locais/administração & dosagem , Cateterismo/métodos , Epinefrina/administração & dosagem , Analgesia Epidural/efeitos adversos , Analgesia Epidural/instrumentação , Analgesia Epidural/normas , Analgesia Obstétrica/efeitos adversos , Analgesia Obstétrica/instrumentação , Analgesia Obstétrica/normas , Anestésicos Locais/efeitos adversos , Cateterismo/efeitos adversos , Cateterismo/instrumentação , Cateterismo/normas , Cateteres/efeitos adversos , Relação Dose-Resposta a Droga , Espaço Epidural , Epinefrina/efeitos adversos , Feminino , Humanos , Injeções Epidurais/efeitos adversos , Injeções Epidurais/instrumentação , Injeções Epidurais/métodos , Injeções Epidurais/normas , Guias de Prática Clínica como Assunto , Gravidez
11.
Evid. actual. práct. ambul ; 22(1): e001077, abr. 2019. tab.
Artigo em Espanhol | LILACS | ID: biblio-1015125

RESUMO

La bronquiolitis es una infección respiratoria aguda baja de causa viral, de aparición invernal, que es común en bebés de 0a 12 meses de edad. Conduce a que las vías respiratorias pequeñas se inflamen y se llenen de desechos, obstruyéndose.El bebé tiene una tos fuerte, secreción nasal, generalmente fiebre y puede presentar sibilancias dificultad respiratoria ydesaturación de oxígeno. Tras la presentación de un caso en la guardia se generó una controversia científica sobre lautilidad de los broncodilatadores en pacientes con bronquiolitis. Luego de realizar una búsqueda bibliográfica y seleccionarla evidencia más reciente y de mejor calidad, se concluye que la evidencia no apoya el uso de broncodilatadores enpacientes con bronquiolitis.(AU)


Bronchiolitis is a low acute respiratory lower respiratory tract infection of viral origin, winter appearance, which is commonin babies from 0 to 12 months of age. It causes the small airways in the lungs to become inflamed and fill with debris. Theinfant has a harsh cough, runny nose, usually fever and may have wheezing, respiratory distress and oxygen desaturation.After the presentation of a case in the emergency department, a scientific controversy was generated about the usefulnessof bronchodilators in patients with bronchiolitis. After conducting a literature search and selecting the most recent and bestquality evidence, it is concluded that evidence does not support the use of bronchodilators in patients with bronchioliTIS.(AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Broncodilatadores/administração & dosagem , Bronquiolite/tratamento farmacológico , Epinefrina/administração & dosagem , Albuterol/administração & dosagem , Infecções Respiratórias/tratamento farmacológico , Broncodilatadores/efeitos adversos , Broncodilatadores/uso terapêutico , Bronquiolite/diagnóstico , Epinefrina/efeitos adversos , Sons Respiratórios/diagnóstico , Tosse/prevenção & controle , Albuterol/efeitos adversos , Albuterol/uso terapêutico , Febre/prevenção & controle
12.
Plast Reconstr Surg ; 143(3): 800-810, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30817652

RESUMO

Most unstable metacarpal and phalangeal fractures for which operative treatment is indicated can be reduced and stabilized with either open or closed techniques using local anesthetic with epinephrine instead of intravenous sedation or general anesthesia. With the patient wide-awake during surgery, the hand can be taken through active range of motion to assess fracture stability. In this article, the authors review the rationale and technique for wide-awake, local anesthesia, no tourniquet surgery in the treatment of phalangeal and metacarpal fractures and impart pearls to optimize the patient experience and illustrate common fixation techniques using percutaneous Kirschner wires. The intraoperative assessment of fracture stability permits an accelerated, protected-range-of-motion protocol that minimizes postoperative stiffness and facilitates expedient recovery.


Assuntos
Analgesia/métodos , Anestesia Local/métodos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Traumatismos da Mão/cirurgia , Anestesia Geral/efeitos adversos , Anestésicos Locais/administração & dosagem , Fios Ortopédicos , Epinefrina/administração & dosagem , Epinefrina/efeitos adversos , Falanges dos Dedos da Mão/lesões , Fixação Interna de Fraturas/instrumentação , Consolidação da Fratura , Fraturas Ósseas/reabilitação , Traumatismos da Mão/reabilitação , Humanos , Ossos Metacarpais/cirurgia , Necrose/induzido quimicamente , Participação do Paciente , Náusea e Vômito Pós-Operatórios/etiologia , Náusea e Vômito Pós-Operatórios/prevenção & controle , Amplitude de Movimento Articular , Fatores de Tempo , Resultado do Tratamento , Vasoconstritores/administração & dosagem
13.
BMJ ; 364: k4259, 2019 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-30833377

RESUMO

The studyA randomised trial of epinephrine in out-of-hospital cardiac arrestPerkins GD, Ji C, Deakin CD, Quinn T, Nolan JP, Scomparin C, Regan S, Long J, Slowther A, Pocock H, Black JJM, Moore F, Fothergill RT, Rees N, O'Shea L, Docherty M, Gunson I, Han K, Charlton K, Finn J, Petrou S, Stallard N, Gates S, Lall R for the PARAMEDIC2 CollaboratorsPublished on 18 July 2018 N Engl J Med 2018;379:711-21.This project was funded by the National Institute for Health Research HTA Programme (project number 12/127/126).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000639/adrenaline-can-restart-the-heart-but-is-no-good-for-the-brain.


Assuntos
Epinefrina/administração & dosagem , Parada Cardíaca/tratamento farmacológico , Doenças do Sistema Nervoso/induzido quimicamente , Reanimação Cardiopulmonar/métodos , Epinefrina/efeitos adversos , Epinefrina/uso terapêutico , Parada Cardíaca/complicações , Humanos , Estudos Observacionais como Assunto , Taxa de Sobrevida , Simpatomiméticos/efeitos adversos , Simpatomiméticos/uso terapêutico , Reino Unido/epidemiologia
14.
J Emerg Med ; 56(4): 444-447, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30755346

RESUMO

BACKGROUND: Brugada pattern on electrocardiography (ECG) can manifest as type 1 (coved pattern) and type 2 (saddleback pattern). Brugada syndrome represents an ECG with Brugada pattern in a patient with symptoms or clinical factors, including syncope, cardiac arrest, ventricular dysrhythmias, and family history. Brugada syndrome is caused by a genetic channelopathy, but the Brugada pattern may be drug-induced. Epinephrine-induced Brugada pattern has not been reported previously. CASE REPORT: A 63-year-old man developed anaphylaxis secondary to a bee sting, had a transient loss of consciousness, and self-administered intramuscular epinephrine. He subsequently presented to the emergency department and was found to have a type 1 Brugada pattern on ECG that resolved during observation. A historic ECG was reviewed that demonstrated a baseline type 2 Brugada pattern. His anaphylaxis was managed with steroids and antihistamines. He was observed without subsequent dysrhythmic events on telemetry or any further symptoms. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The differential diagnosis for syncope includes dysrhythmia, such as Brugada syndrome. Among other possible drugs, epinephrine may induce a type 1 Brugada pattern. Patients with Brugada pattern on ECG should be referred immediately to electrophysiology for consideration of implantation of a cardioverter-defibrillator device, given the association of Brugada pattern with sudden cardiac arrest and ventricular dysrhythmias.


Assuntos
Anafilaxia/tratamento farmacológico , Síndrome de Brugada/diagnóstico , Epinefrina/efeitos adversos , Venenos de Abelha/efeitos adversos , Síndrome de Brugada/diagnóstico por imagem , Eletrocardiografia/métodos , Epinefrina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade
15.
BMC Musculoskelet Disord ; 20(1): 61, 2019 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-30736773

RESUMO

BACKGROUND: Although intraoperative periarticular multi-drug injection has been used for postoperative pain control after total knee arthroplasty (TKA), the injection has the inherent shortcoming of limited acting time. This randomized controlled trial was performed to assess whether adding percutaneous periarticular multi-drug injection at the day following TKA would improve the postoperative pain relief. METHODS: A total of 43 participants were randomly assigned to receive additional periarticular injection at 08:30, postoperative day 1 or no additional injection. The multi-drug solution including 40 mg of methylprednisolone, 150 mg of ropivacaine, and 0.1 mg of epinephrine was infiltrated into the muscle belly of the vastus medialis. In both groups, patients were treated with intraoperative periarticular multi-drug injection and postoperative intravenous and oral nonsteroidal anti-inflammatory drugs. We did not use any narcotic pain medications postoperatively. The primary outcome was the patients' global assessment of postoperative pain at rest measured using a visual analog scale (VAS) and quantified as the area under the curve (AUC) of serial assessments until 20:00, postoperative day 5. RESULTS: The mean AUC for the postoperative pain VAS at rest was 1616 ± 1191 in patients received the additional periarticular injection versus 2808 ± 1494 in those received no injection (mean difference, - 1192; 95% confidence interval, - 2043 to - 340; p = 0.007). No wound complication or surgical site infection was observed in either groups. CONCLUSIONS: Adding percutaneous periarticular multi-drug injection at the day following TKA may provide better postoperative pain relief. Further studies are needed to confirm the safety of the percutaneous injection. TRIAL REGISTRATION: University Hospital Medical Information Network UMIN000029003 . Registered 5 September 2017.


Assuntos
Agonistas Adrenérgicos/administração & dosagem , Anestésicos Locais/administração & dosagem , Artroplastia do Joelho/efeitos adversos , Epinefrina/administração & dosagem , Glucocorticoides/administração & dosagem , Metilprednisolona/administração & dosagem , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Ropivacaina/administração & dosagem , Agonistas Adrenérgicos/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/efeitos adversos , Anti-Inflamatórios não Esteroides/administração & dosagem , Combinação de Medicamentos , Epinefrina/efeitos adversos , Feminino , Glucocorticoides/efeitos adversos , Humanos , Injeções , Japão , Masculino , Metilprednisolona/efeitos adversos , Pessoa de Meia-Idade , Manejo da Dor/efeitos adversos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Ropivacaina/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
16.
Ugeskr Laeger ; 181(7)2019 Feb 11.
Artigo em Dinamarquês | MEDLINE | ID: mdl-30777590

RESUMO

In this case report, we present a 28-year-old woman who was admitted to a neuro-intensive care unit with sub-arachnoid haemorrhage. She was intubated and haemodynamically unstable. Over five days the need for norepinephrine reached the level of 1.2 µg/kg/min to insure a sufficient cerebral perfusion pressure. Epinephrine and vasopressin were without effect in raising the blood pressure. On suspicion of tachyphylaxis the norepinephrine infusion was stopped, and no decline in blood pressure was observed. After two days without use of any vasopressor agents, the efficacy of norepinephrine returned to normal.


Assuntos
Circulação Cerebrovascular/efeitos dos fármacos , Hemorragia Subaracnóidea/tratamento farmacológico , Taquifilaxia , Vasoconstritores/efeitos adversos , Vasopressinas/efeitos adversos , Adulto , Pressão Sanguínea/efeitos dos fármacos , Epinefrina/efeitos adversos , Epinefrina/uso terapêutico , Feminino , Humanos , Norepinefrina/efeitos adversos , Norepinefrina/uso terapêutico , Hemorragia Subaracnóidea/fisiopatologia , Vasoconstritores/uso terapêutico , Vasopressinas/uso terapêutico
17.
Mol Pharm ; 16(3): 1340-1349, 2019 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-30689395

RESUMO

Caffeine is the most consumed active stimulant. About 80% of pregnant women consume caffeine orally on a daily basis. Many reports indicated consumption of >200 mg caffeine during pregnancy could increase the likelihood of miscarriage. In this article, we developed a pregnancy physiological-based pharmacokinetic/pharmacodynamic (PBPK/PD) model for caffeine to examine association between maternal caffeine consumption during pregnancy and caffeine plasma levels at doses lower and higher than 200 mg to predict changes in caffeine concentrations across the 3 trimesters, and to predict associated changes in caffeine PD parameters. Two models were successfully developed using GastroPlus software, a nonpregnant model for validation purposes and a pregnant model for validation and prediction of maternal caffeine plasma concentrations following single and multiple dosing. Using observed and predicted data, we were able to validate and simulate PK changes of caffeine in nonpregnant women and the PD effect of caffeine on certain enzymes and catecholamines associated with caffeine intake. Furthermore, the pregnancy PBPK model successfully predicted changes in caffeine PK across the three trimesters. Caffeine increased exposure during pregnancy was related to reduced activity of caffeine metabolizing enzyme CYP1A2. The model also predicted increased levels of caffeine in the fetoplacental compartment (FPC) due to increased maternal caffeine plasma concentrations. Increased caffeine levels in maternal blood was accompanied by greater inhibition of the phosphodiesterase enzyme, higher cyclic adenosine monophosphate, and greater increase of epinephrine levels, which could increase the risk of pregnancy loss. The application of the developed PBPK model to predict the PD effect could provide a useful tool to help define potential cut-offs for caffeine intake in various stages of pregnancy.


Assuntos
Cafeína/sangue , Modelos Biológicos , Trimestres da Gravidez/fisiologia , Aborto Espontâneo/etiologia , Cafeína/administração & dosagem , Cafeína/efeitos adversos , Proteínas Quinases Dependentes de AMP Cíclico/sangue , Citocromo P-450 CYP1A2/metabolismo , Relação Dose-Resposta a Droga , Regulação para Baixo , Epinefrina/efeitos adversos , Epinefrina/sangue , Feminino , Humanos , Diester Fosfórico Hidrolases/sangue , Gravidez , Software
18.
Cleve Clin J Med ; 86(1): 66-72, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30624186

RESUMO

Patients who have had anaphylaxis or who are at risk of it (eg, due to food allergy or Hymenoptera hypersensitivity) should carry an epinephrine autoinjector at all times. However, the risks and benefits must be considered on an individual basis, especially in patients with atherosclerotic heart disease, elderly patients on polypharmacy, patients receiving allergen immunotherapy, those with large local reactions to insect stings, and individuals with oral allergy syndrome.


Assuntos
Anafilaxia/tratamento farmacológico , Epinefrina/administração & dosagem , Adolescente , Adulto , Idoso , Anafilaxia/etiologia , Criança , Pré-Escolar , Epinefrina/efeitos adversos , Feminino , Humanos , Injeções/instrumentação , Masculino , Pessoa de Meia-Idade , Medição de Risco , Adulto Jovem
19.
A A Pract ; 12(11): 438-440, 2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-30663992

RESUMO

Local anesthetic toxicity is a rare but serious complication of local anesthetic administration. Although lidocaine has a safety profile superior to other amide local anesthetics, we report a case of cardiac arrest after intranasal injection of lidocaine. The case involves a 22-year-old healthy woman who experienced pulseless electrical activity shortly after a submucosal injection of 2.2 mg/kg of lidocaine with epinephrine. Resuscitative efforts were unsuccessful until a bolus of intralipid was given. This case emphasizes that even a "low" dose of a less lipophilic drug has the potential for severe toxicity.


Assuntos
Anestésicos Locais/administração & dosagem , Epinefrina/administração & dosagem , Parada Cardíaca/induzido quimicamente , Lidocaína/administração & dosagem , Administração Intranasal , Anestésicos Locais/efeitos adversos , Epinefrina/efeitos adversos , Emulsões Gordurosas Intravenosas/administração & dosagem , Emulsões Gordurosas Intravenosas/uso terapêutico , Feminino , Parada Cardíaca/tratamento farmacológico , Humanos , Injeções , Lidocaína/efeitos adversos , Resultado do Tratamento , Adulto Jovem
20.
Early Hum Dev ; 130: 27-32, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30660015

RESUMO

BACKGROUND: Distressed infants in the delivery room and those that have completed postnatal transition are both resuscitated according to established neonatal resuscitation guidelines, often with endotracheal (ET) epinephrine at the same dose. We hypothesized that ET epinephrine would have higher bioavailability in a post-transitional compared to transitioning newborn model due to absence of fetal lung liquid and intra-cardiac shunts. METHODS: 15 term fetal (transitioning newborn) and 6 postnatal lambs were asphyxiated by umbilical cord and ET tube occlusion respectively. Lambs were resuscitated after 5 min of asystole. ET epinephrine (0.1 mg/kg) was administered after 1 min of positive pressure ventilation (PPV) and chest compressions, and repeated 3 min later, followed by intravenous (IV) epinephrine (0.03 mg/kg) every 3 min until return of spontaneous circulation (ROSC). Serial plasma epinephrine concentrations were measured. RESULTS: Peak plasma epinephrine concentrations were lower in transitioning newborns as compared to postnatal lambs: after a single ET dose (145.36 ±â€¯135.5 ng/ml vs 553.54 ±â€¯215 ng/ml, p < 0.01) and after two ET doses (443 ±â€¯192.49 ng/ml vs 1406 ±â€¯420.8 ng/ml, p < 0.01). The rates of ROSC with a single ET dose were similar in both groups (40% vs 50% in newborn and postnatal respectively, p > 0.99). There was a higher incidence of post-ROSC tachycardia and increased carotid blood flow in the postnatal group. CONCLUSIONS: In the postnatal period, ET epinephrine at currently recommended doses resulted in higher peak epinephrine concentrations, post-ROSC tachycardia and cerebral reperfusion without significant differences in incidence of ROSC. Further studies evaluating the optimal dose of ET epinephrine during the postnatal period are warranted.


Assuntos
Broncodilatadores/sangue , Epinefrina/sangue , Ressuscitação/métodos , Administração por Inalação , Animais , Animais Recém-Nascidos , Broncodilatadores/administração & dosagem , Broncodilatadores/efeitos adversos , Broncodilatadores/uso terapêutico , Circulação Cerebrovascular/efeitos dos fármacos , Epinefrina/administração & dosagem , Epinefrina/efeitos adversos , Epinefrina/uso terapêutico , Feminino , Ovinos , Taquicardia/etiologia
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