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1.
Medicine (Baltimore) ; 99(3): e18825, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011494

RESUMO

BACKGROUND: Patient-controlled intravenous analgesia (PCIA) has been suggested as an effective method of pain relief. There are several randomized controlled trials (RCTs) of dexmedetomidine (DEX) combined with tramadol for PCIA in Chinese surgical patients. The purpose of this study was to perform a systematic review and meta-analysis to evaluate the efficacy and safety of DEX combined with tramadol for PCIA in Chinese surgical patients from current data. METHODS: The RCTs of DEX combined with tramadol for PCIA were gathered from the PubMed, Excerpta Medica Database, Cochrane Library, Cochrane Library, China National Knowledge Infrastructure database, and VIP databases. After data extraction and quality assessment of the included RCTs, RevMan 5.3 software was employed for the meta-analysis of visual analog scale (VAS) scores, Ramsay sedation scores, effective pressure times for PCIA, tramadol consumption, and safety. RESULTS: Fourteen RCTs were included. Compared with tramadol alone, postoperative intravenous tramadol-DEX combination PCA led to lower VAS scores (weighted mean differences [WMD]12h = 0.14, 95% confidence interval [CI] v1.50 to 1.79; WMD24h = 0.78, 95% CI -0.92 to -0.62; WMD48h = 0.51, 95% CI -0.66 to -0.38; all P < .05), lower Ramsay sedation scores (WMD24h = 0.08, 95% CI -0.14 to -0.02; WMD48h = 0.09, 95% CI -0.11 to -0.07; all P < .05), and less postoperative tramadol consumption (WMD0-24h = -102.59 mg, 95% CI -149.68 to -55.49; WMD0-48h = -152.91 mg, 95% CI -259.93 to -45.89; all P < .05). With regard to safety, there was a significant difference between DEX-tramadol and tramadol for PCIA in terms of the incidence of postoperative nausea and vomiting, dizziness, chills, and restlessness (all P < .05). CONCLUSION: According to the domestic evidence, this systematic review and meta-analysis suggests that DEX-tramadol PCIA is superior to tramadol in terms of analgesic efficacy and safety for Chinese surgical patients. However, because of some clear limitations (sample size and heterogeneity), these results should be interpreted with caution. Further large-scale and well-designed studies are needed to summarize and analyze the data to draw a more convincing conclusion.


Assuntos
Analgesia Controlada pelo Paciente , Analgésicos não Entorpecentes/administração & dosagem , Analgésicos Opioides/administração & dosagem , Dexmedetomidina/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Tramadol/administração & dosagem , Administração Intravenosa , China , Combinação de Medicamentos , Humanos
3.
Sci Total Environ ; 710: 135396, 2020 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-31923654

RESUMO

Tramadol (TRA) is a widely used human pharmaceutical and a well-established emerging pollutant and its potential genotoxic and cytotoxic effects on humans as well as its fate in aqueous systems demand full investigation. The present study is a multidisciplinary approach and provides important insights on the potential risks of Tramadol on humans accompanied by its photolytic transformation under simulated solar irradiation. The present study revealed that Tramadol can induce genotoxic and cytotoxic effects under the specific experimental conditions, significantly depended on the tested concentration. In addition, the photolytic transformation of Tramadol was investigated in detail under simulated solar irradiation in two different water matrices: ultrapure water (UW) and treated wastewater (WW). Differences in the degradation rates were observed between UW and WW, being slower in WW. The results showed that more than 70% of Tramadol was removed after 240 min in UW ([TRA] = 10 mg L-1, I = 500 W m-2). After this period, TOC removal was found to be about 40%. Transformation of N atoms into NO3- and NH4+ followed a similar trend reaching up to 38% release. Τramadol degraded mainly by HO radicals and 1O2 through a self-sensitizing process while direct photolysis was also significant. Hydroxylation, demethylation and N-oxidation of the parent compound were found to be the main degradation pathways confirming the important role of HO and 1O2 in the photolytic process. Toxicity measurements showed a noticeable increase of the inhibition for Vibrio fischeri at the first stages which coincide with the formation of the major TPs.


Assuntos
Tramadol/química , Aliivibrio fischeri , Humanos , Cinética , Preparações Farmacêuticas , Fotólise , Poluentes Químicos da Água
4.
Int Endod J ; 53(2): 176-185, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31702056

RESUMO

AIM: To establish the effects of submucosal single doses of two medicines on postoperative pain after root canal treatment in mandibular molar teeth with symptomatic irreversible pulpitis. METHODOLOGY: In this randomized controlled, double-blind clinical trial, 90 patients with the diagnosis of symptomatic irreversible pulpitis in their mandibular first or second molars were included and randomly divided into three groups (n = 30): a control group that received normal saline and two experimental groups that received a single dose of either tramadol (100 mg 2 mL-1 ) or dexamethasone (8 mg 2 mL-1 ). After local anaesthesia and before treatment, submucosal injections were administered into the mucobuccal fold adjacent to the mandibular molars, and a routine single-visit root canal treatment procedure was performed in all groups. After the root canal treatments, the patients were asked to score their pain level using the Heft-Parker visual analogue scale (0-170 mm) at 6, 12, 24, 48 and 72 h. The experimental groups were compared using one-way anova or Kruskal-Wallis H-test. The groups that were significantly different were compared pairwise using Student's t-test or the Mann-Whitney U-test. The findings were expressed as the mean ± standard deviation or median (min-max). The categorical variables were tested using the chi-square test or Fisher's exact chi-square test, and the results were expressed as counts and percentages. RESULTS: At the 6-h and 48-h time intervals, the intensity of pain was significantly less in both the dexamethasone and tramadol groups than in the control group (P < 0.0167). At the end of 12 h, the pain level in the dexamethasone group was significantly less compared to the other groups (P < 0.0167). CONCLUSIONS: Pretreatment submucosal dexamethasone and tramadol injections significantly diminished post-treatment endodontic pain of patients with symptomatic irreversible pulpitis following single-visit root canal treatment. However, dexamethasone was more effective than tramadol in pain reduction in the first 12 h.


Assuntos
Pulpite , Tramadol , Anestésicos Locais , Dexametasona , Método Duplo-Cego , Humanos , Nervo Mandibular , Dente Molar
6.
Biochem Med (Zagreb) ; 30(1): 010802, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31839727

RESUMO

Introduction: Hypoglycaemia has been reported as an unusual complication of tramadol use and in a few cases of tramadol poisoning, but the exact mechanism is not known. Case description: An ambulance crew was dispatched to an unconscious 46-year old man. A glucometer point-of-care measurement revealed a profound hypoglycaemia (1.9 mmol/L). Treatment with intravenous glucose was started and the patient was transported to the hospital. The patient had several episodes of pulseless electrical activity requiring cardiopulmonary resuscitation in the ambulance and upon arrival in the hospital. Despite continuous glucose infusion the hypoglycaemia was difficult to correct during the next few hours and the patient developed hypokalaemia. Further investigation to identify the cause of hypoglycaemia revealed that insulin and C-peptide were inappropriately raised. A toxicological investigation revealed the presence of tramadol and its metabolites in lethal concentrations. Also acetaminophen, ibuprofen and lormetazepam were present. Ethanol screening was negative (< 0.1 g/L) and no sulfonylurea were detected. The patient developed multiple organ failure, but eventually recovered. What happened: The hypoglycaemia was caused by inappropriate stimulation of insulin secretion in a patient intoxicated with tramadol. The sudden hypokalaemia was caused by a massive intracellular shift of potassium in response to the hyperinsulinemia, triggered by the intravenous administration of glucose. Main lesson: To our knowledge, we are the first to document a significant rise in endogenous insulin production in a hypoglycaemic patient presenting with tramadol intoxication. Our observation suggests that hyperinsulinemia could be the cause of the hypoglycaemia associated with tramadol use.


Assuntos
Analgésicos Opioides/efeitos adversos , Hipoglicemia/diagnóstico , Tramadol/efeitos adversos , Analgésicos Opioides/uso terapêutico , Glicemia/análise , Peptídeo C/sangue , Glucose/administração & dosagem , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/etiologia , Insulina/sangue , Masculino , Pessoa de Meia-Idade , Dor/tratamento farmacológico , Tramadol/uso terapêutico
7.
Chemosphere ; 238: 124587, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31425864

RESUMO

Pharmaceuticals are emerging as environmentally problematic compounds. As they are often not appropriately removed by sewage treatment plants, pharmaceutical compounds end up in surface water environments worldwide at concentrations in the ng to µg L-1 range. There is a need to further explore single compound and mixture effects using e.g. in vivo test model systems. We have investigated, for the first time, behavioral effects in larval zebrafish (Danio rerio) exposed to a binary mixture of an antidepressant drug (citalopram) and a synthetic opioid (tramadol). Citalopram and tramadol have a similar mode of action (serotonin reuptake inhibition) and are known to produce drug-drug interactional effects resulting in serotonin syndrome (SS) in humans. Zebrafish embryo-larvae were exposed to citalopram, tramadol and 1:1 binary mixture from fertilization until 144 h post-fertilization. No effects on heart rate, spontaneous tail coiling, or death/malformations were observed in any treatment at tested concentrations. Behavior (hypoactivity in dark periods) was on the other hand affected, with lowest observed effect concentrations (LOECs) of 373 µg L-1 for citalopram, 320 µg L-1 for tramadol, and 473 µg L-1 for the 1:1 mixture. Behavioral EC50 was calculated to be 471 µg L-1 for citalopram, 411 µg L-1 for tramadol, and 713 µg L-1 for the 1:1 mixture. The results of this study conclude that tramadol and citalopram produce hypoactivity in 144 hpf zebrafish larvae. Further, a 1:1 binary mixture of the two caused the same response, albeit at a higher concentration, possibly due to SS.


Assuntos
Analgésicos Opioides/farmacologia , Citalopram/farmacologia , Inibidores de Captação de Serotonina/farmacologia , Tramadol/farmacologia , Poluentes Químicos da Água/farmacologia , Peixe-Zebra/embriologia , Animais , Embrião não Mamífero/efeitos dos fármacos , Larva/efeitos dos fármacos
8.
Einstein (Sao Paulo) ; 18: eAO4409, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31618286

RESUMO

OBJECTIVE: To compare the chest tube drainage by the same thoracotomy intercostal space with the traditional approach in patients undergoing muscle-sparing thoracotomy. METHODS: We evaluated 40 patients aged ≥18 years who underwent elective muscle sparing thoracotomies. Patients were divided into two groups of 20 patients. One group underwent thoracic drainage by the same intercostal space of thoracotomy and the other by traditional chest drainage approach. RESULTS: The mean length of hospital stay for the intercostal drainage group in the intensive care unit was 1.5 day (1.0 to 2.0 days) and 2.0 days (25.1 to 3.0 days) for the traditional chest drainage group (p=0.060). The intercostal drainage group had mean length of hospital stay (p=0.527) and drainage (p=0.547) of 4 days, and the traditional chest drainage group and 2 and 5.5 days, respectively. Dipirona and tramadol doses did not differ between groups (p=0.201 and p=0.341). The mean pain scale values on first postoperative was 4.24 in the drainage by the same intercostal group and 3.95 in the traditional chest drainage (p=0.733). In third postoperative day, mean was 3.18 for the first group and 3.11 for the traditional group (p=0.937). In the 15th day after surgery, drainage by the incision was 1.53 and the traditional chest drainage was 2.11 (p=0.440), 30th days after drainage by incision was 0.71 and traditional chest drainage was 0.84 (p=0.787). Complications, for both groups were similar with 30% in proposed drainage and 25% in traditional approach (p=0.723). CONCLUSION: Drainage by the same thoracotomy intercostal space was feasible and results 30 days after surgery were not inferior to those of the traditional chest drainage approach.


Assuntos
Tubos Torácicos , Drenagem/métodos , Toracotomia/métodos , Analgesia Epidural , Analgésicos/uso terapêutico , Fibrilação Atrial/etiologia , Dipirona/uso terapêutico , Drenagem/estatística & dados numéricos , Dispneia/etiologia , Humanos , Tempo de Internação , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Período Pós-Operatório , Estudos Prospectivos , Toracotomia/efeitos adversos , Tramadol/uso terapêutico
10.
Huan Jing Ke Xue ; 40(7): 3242-3248, 2019 Jul 08.
Artigo em Chinês | MEDLINE | ID: mdl-31854724

RESUMO

Tramadol (TRA) and fentanyl (FEN) are used as common painkillers in clinical practice, but they have been increasingly abused in recent years due to their addictive nature. Two substances and their metabolites enter wastewater through urine and are collected and treated by wastewater treatment plants (WWTPs) before being discharged into the aquatic environment. In this study, wastewater analysis was performed to examine the patterns of TRA and FEN use in the urban area of Beijing for the first time. Influent and effluent samples were collected from 23 WWTPs during two sampling campaigns. Concentrations TRA in influents were found to range from(10.2±8.7)to(175.3±59.7) ng·L-1, while FEN was not detected in most of the samples, or occurred at very low concentrations. Relatively low TRA removal was observed at plants with activated sludge processes. Moreover, TRA loads in the central area of Beijing were significantly higher than those in the suburban areas. Annual TRA use was estimated through wastewater-based epidemiology. The greatest TRA use, approximately 202.5 kg, was found in Haidian district. Seasonal variation in TRA loads was significant, with greater use in the summer than in winter. The method presented in this study can be used as an important reference for monitoring TRA and FEN use via wastewater-based epidemiology and for assessing the risk of the abuse of these compounds in China.


Assuntos
Fentanila/análise , Tramadol/análise , Águas Residuárias/análise , Poluentes Químicos da Água/análise , Pequim , Monitoramento Ambiental
11.
J Opioid Manag ; 15(6): 499-506, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31850512

RESUMO

BACKGROUND: As determinants of the opioid epidemic are several, describing patterns of opioid prescription over time is of importance. OBJECTIVE: To characterize the prescribing patterns of opioids per US region and physician specialty from 2012 to 2015. METHODS: Truven Health Analytics MarketScan® Databases were used to obtain data on opioid prescription rates per US region and physician specialty for the years 2012-2015. Opioids included in the study are tramadol, hydrocodone, codeine, oxycodone, oxymorphone, methadone, and fentanyl. RESULTS: Starting sample consisted of 5,860,096 individuals. An increase in prescriptions was seen for codeine (22.3 percent), oxycodone (22.4 percent), and tramadol (22.4 percent), while other opioids had decreases between 6.5 and 20.2 percent during this period. Family medicine physicians were the most frequent prescriber for all opioids except for oxycodone; nonphysician prescribers' share of prescriptions nearly doubled for all opioids. The share of oxycodone and of tramadol among all opioids increased in all regions, while the opposite was seen for hydrocodone. Codeine prescription share increased substantially in the South but not in other regions. When comparing the period of 2012-2015, differences were significant for all regions (p < 0.0001 for all regions). In 2015, the rate of prescription of oxycodone was nearly twofold higher in the Northeast vs North Central (38 percent vs 18.5 percent, p < 0.0001), while tramadol was substantially more frequently prescribed in the South, where it responded to nearly 20 percent of all opioid prescriptions (p < 0.0001). CONCLUSION: Patterns of prescription per opioid vary considerably per physician specialty and per US region. Although an overall decrease in prescriptions was seen, certain opioids were more frequently prescribed in 2015 than in 2012.


Assuntos
Analgésicos Opioides , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Humanos , Hidrocodona , Oxicodona , Padrões de Prática Médica/estatística & dados numéricos , Tramadol , Estados Unidos
12.
J Opioid Manag ; 15(4): 342-344, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637686

RESUMO

A 49-year-old male with major depressive disorder well-managed with venlafaxine [serotonin and norepinephrine reuptake inhibitor (SNRI)] and no history of manic episodes developed his first manic episode following use of tramadol. Tramadol-induced mania has been described with selective serotonin reuptake inhibitors but not SNRIs. In addition, mania is not listed as a potential clinical side effect-further illustrating this relative rarity. Due to tramadol's SNRI activity, there is definitive risk for mood lability in individuals managed with tramadol and other serotonergic medications as seen in this patient. The authors findings suggest the need for greater risk consideration when prescribing tramadol with other related agents such as venlafaxine.


Assuntos
Transtorno Bipolar , Transtorno Depressivo Maior , Tramadol , Cloridrato de Venlafaxina , Analgésicos Opioides , Transtorno Bipolar/induzido quimicamente , Transtorno Depressivo Maior/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores de Captação de Serotonina/efeitos adversos , Tramadol/efeitos adversos , Tramadol/uso terapêutico , Cloridrato de Venlafaxina/efeitos adversos , Cloridrato de Venlafaxina/uso terapêutico
13.
Br J Anaesth ; 123(6): 865-876, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31591020

RESUMO

BACKGROUND: There is growing interest in the effect of postoperative analgesics on oncological outcomes after cancer surgery. We investigated the impact of tramadol after breast cancer surgery on recurrence and mortality and explored the mechanism by which tramadol affects cultured breast cancer cells in vitro. METHODS: Electronic medical records of patients who underwent breast cancer surgery between November 2005 and December 2010 at Severance Hospital in Korea were reviewed. Cox regression analyses were used to identify factors related to postoperative recurrence and mortality. We performed the sensitivity test with propensity score matching to adjust for selection bias. In addition, we investigated the effects of tramadol on human breast adenocarcinoma (Michigan Cancer Foundation-7 [MCF-7]) cells via assessment of cell viability, clonogenic assay, and cell cycle analysis in vitro. RESULTS: Of 2588 breast cancer patients, 36.4% had received tramadol. Those who received tramadol had a 0.71-fold decreased risk of recurrence and a 0.56-fold decrease in mortality. The MCF-7 cell viability assays showed that tramadol had an anti-proliferative effect by cell cycle arrest, suppressing colony formation, and regulation of oestrogen and progesterone receptors. Tramadol induced apoptosis of MCF-7 cells via extracellular signal-regulated kinases by decreasing of 5-hydroxytryptamine (HT)2B receptor and transient receptor potential vanilloid-1 expression. CONCLUSIONS: After breast cancer surgery, patients who received tramadol had a decreased risk of postoperative recurrence and mortality. The anti-tumour effect of tramadol appears to involve inhibition of proliferation, induction of apoptosis, and effects on 5-HT2B receptor and TRPV-1.


Assuntos
Adenocarcinoma/cirurgia , Analgésicos Opioides/farmacologia , Neoplasias da Mama/cirurgia , Recidiva Local de Neoplasia/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Tramadol/farmacologia , Adulto , Idoso , Apoptose/efeitos dos fármacos , Mama/efeitos dos fármacos , Mama/cirurgia , Proliferação de Células/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Feminino , Humanos , Técnicas In Vitro , Células MCF-7 , Mastectomia , Pessoa de Meia-Idade , República da Coreia , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Resultado do Tratamento , Células Tumorais Cultivadas
14.
Pediatrics ; 144(5)2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31575622

RESUMO

OBJECTIVES: Little is known about the risk for overdose after opioid prescription. We assessed associations between the type of opioid, quantity dispensed, daily dose, and risk for overdose among adolescents who were previously opioid naive. METHODS: Retrospective analysis of 1 146 412 privately insured adolescents ages 11 to 17 years in the United States captured in the Truven MarketScan commercial claims data set from January 2007 to September 2015. Opioid overdose was defined as any emergency department visit, inpatient hospitalization, or outpatient health care visit during which opioid overdose was diagnosed. RESULTS: Among our cohort, 725 participants (0.06%) experienced an opioid overdose, and the overall rate of overdose events was 28 events per 100 000 observed patient-years. Receiving ≥30 opioid tablets was associated with a 35% increased risk for overdose compared to receiving ≤18 tablets (hazard ratio [HR] = 1.35; 95% confidence interval: 1.05-1.73; P = .02). Daily prescribed opioid dose was not independently associated with an increased risk for overdose. Tramadol exposure was associated with a 2.67-fold increased risk for opioid overdose compared to receiving oxycodone (adjusted HR = 2.67; 95% confidence interval: 1.90-3.75; P < .0001). Adolescents with preexisting mental health conditions demonstrated increased risk for overdose, with HRs ranging from 1.65 (anxiety) to 3.09 (substance use disorders). CONCLUSIONS: One of 1600 (0.06%) previously opioid-naive adolescents who received a prescription for opioids experienced an opioid overdose a median of 1.75 years later that resulted in medical care. Preexisting mental health conditions, use of tramadol, and higher number of dispensed tablets (>30 vs <18) were associated with an increased risk of opioid overdose.


Assuntos
Analgésicos Opioides/uso terapêutico , Overdose de Drogas/epidemiologia , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Analgésicos Opioides/envenenamento , Criança , Conjuntos de Dados como Assunto , Feminino , Humanos , Masculino , Transtornos Mentais/complicações , Oxicodona/envenenamento , Medicamentos sob Prescrição/envenenamento , Medicamentos sob Prescrição/uso terapêutico , Estudos Retrospectivos , Tramadol/envenenamento , Estados Unidos/epidemiologia
16.
Arq. bras. med. vet. zootec. (Online) ; 71(5): 1558-1564, set.-out. 2019. tab
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1038680

RESUMO

The aim of this study was to assess the effects of chemical restraint, general anesthesia and opioid treatment on hematological components in Cuniculus paca. Eight healthy, adult, captivity female animals , underwent three laparoscopic procedures with a 15-day interval were evaluated. After physical restraint, an association of ketamine (25mg/kg) and midazolam (0.5mg/kg) was administered intramuscularly for chemical restraint. Posteriorly, anesthesia was induced and maintained with isoflurane; and randomly administered methadone (0.5mg/kg), tramadol (5mg/kg) or saline-placebo (0,1mL/kg) intramuscularly. After pharmacological restraint and in the final laparoscopy stage, venous blood samples were obtained for complete blood count, total plasma protein (TP), creatinine, alanine aminotransferase (ALT), sodium, potassium, chloride and ionized calcium analysis. During general anesthesia, hemoglobin, TP concentration and lymphocytes decreased (P=0.029; <0.001; 0.022 respectively), whereas the potassium levels increased (P=0.034). In conclusion, chemical restraint with ketamine/midazolam association causes a slight decrease in blood cellular components. Isoflurane anesthesia for laparoscopic procedure lead to decrease in hemoglobin, lymphocytes and protein concentrations, while potassium increased, without any influence from the tramadol or methadone treatment. However, these alterations were transient, and its hematologic values can collaborate in carrying out epidemiological, pathophysiological or case studies in the Cuniculus paca.(AU)


O objetivo do presente estudo foi avaliar os efeitos de contenção química, anestesia geral e tratamento com opiáceos nos parâmetros hematológicos em Cuniculus paca. Foram avaliados oito animais saudáveis, fêmeas, adultas, de cativeiro, que foram submetidas a três procedimentos laparoscópicos, com intervalo de 15 dias. Após a contenção física, uma associação de cetamina (25mg/kg) e midazolam (0,5mg/kg) foi administrada por via intramuscular para contenção química. Posteriormente, a anestesia foi induzida e mantida com isoflurano, e administrou-se aleatoriamente metadona (0,5mg/kg), tramadol (5mg/kg) ou placebo salina por via intramuscular. Após a contenção farmacológica e em estágio final da laparoscopia, foram obtidas amostras de sangue venoso para contagem sanguínea completa, proteína de plasma total (TP), creatinina, alanina aminotransferase (ALT), cálcio, sódio, potássio e cloreto ionizado. Durante a anestesia geral, a concentração de hemoglobina, TP e linfócitos diminuiu (P= 0,029;< 0,001; 0,022, respectivamente), enquanto os níveis de potássio aumentaram (P= 0,034). Em conclusão, a contenção química com associação de cetamina/midazolam promove uma ligeira diminuição dos componentes celulares do sangue. A anestesia com isoflavano para o procedimento laparoscópico levou a uma diminuição das concentrações de hemoglobina, linfócitos e proteínas, enquanto o potássio aumentou, sem qualquer influência do tratamento com tramadol ou metadona. No entanto, essas alterações foram transitórias, e os seus valores hematológicos obtidos podem colaborar na realização de estudos epidemiológicos, fisiopatológicos ou casuísticas para Cuniculus paca.(AU)


Assuntos
Animais , Feminino , Cuniculidae/cirurgia , Cuniculidae/sangue , Anestesia/veterinária , Anestésicos/sangue , Tramadol/administração & dosagem , Midazolam/administração & dosagem , Isoflurano/administração & dosagem , Ketamina/administração & dosagem , Metadona/administração & dosagem
17.
Life Sci ; 236: 116860, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31518605

RESUMO

AIMS: Intrathecal injection of morphine presents analgesic and antiedematogenic effects in rats. However, it is unknown whether tramadol, which possess a mixed mechanism of action, can also produce analgesic and antiedematogenic effects similarly. MAIN METHODS: Male Wistar rats received carrageenan and LPS in the right knee joint. Tramadol (10 µg) was injected intrathecally 20 min before articular LPS injection. Incapacitation and articular edema were measured 5 h after LPS stimulation. Synovial fluid was collected for leukocyte counting and western blot analysis. Whole joint and lumbar spinal cord were also collected for histology and immunohistochemistry, respectively. Intrathecal pretreatments groups were with the NKCC1 blocker bumetanide, TRPV1 agonist resiniferatoxin, µ-opioid receptor antagonist CTOP and serotonergic neurotoxin 5,7-DHT, all previously to tramadol. KEY FINDINGS: Tramadol treatment caused the reduction of incapacitation and edema. It also reduced c-Fos protein expression in the spinal cord dorsal horn and slightly reduced TNF-α levels in synovial fluid, but neither reduced cell migration nor tissue damage. Bumetanide and resiniferatoxin prevented the analgesic and antiedematogenic effects of tramadol. CTOP prevented the analgesic and the antiedematogenic effects, but 5,7-DHT prevented only tramadol-induced analgesia. SIGNIFICANCE: Spinal NKCC1 cotransporter and peptidergic peripheral afferents seem to be important for the analgesic and antiedematogenic effects of tramadol, as well as µ-opioid receptor. However, the monoamine uptake inhibition effect of tramadol seems to be important only to the analgesic effect.


Assuntos
Analgésicos Opioides/administração & dosagem , Artralgia/prevenção & controle , Artrite Experimental/complicações , Artrite Reativa/complicações , Edema/prevenção & controle , Lipopolissacarídeos/toxicidade , Tramadol/administração & dosagem , Animais , Artralgia/etiologia , Artralgia/patologia , Artrite Experimental/induzido quimicamente , Artrite Experimental/fisiopatologia , Artrite Reativa/induzido quimicamente , Artrite Reativa/fisiopatologia , Modelos Animais de Doenças , Edema/etiologia , Edema/patologia , Injeções Espinhais , Masculino , Ratos , Ratos Wistar
18.
Gene ; 718: 144030, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31390540

RESUMO

Opioids are widely used in the treatment of cancer related pain. They mainly exert their effects on opioid receptors. The most common opioid in the treatment of pain is morphine. Previous studies show that they may have effects on cancer cell behavior. These may include apoptosis, angiogenesis, invasion, inflammation and immune reactions. Tramadol, also an opioid is widely used in the treatment of cancer pain and is not well studied in cancer behavior. We aimed to investigate the effects of tramadol on cancer stem cells and metabolic changes in colon carcinoma cells. We used Colo320 (ATCC, CCL-220), Colo741 (ECACC, 93052621) and HCT116 (ATCC, CCL-247) colon cancer cell lines. CD133 was considered colon cancer stem cell marker and used to sort CD133+ and CD133- cells by magnetic cell sorting. MTT (mitochondria-targeted therapeutics) technique was used to detect tramadol's cytotoxic effect on cells in the study groups. Cells were treated with 1 mg/kg, 1.5 mg/kg and 2 mg/kg tramadol for 24 h at 37 °C and 5% CO2.Caspase-3, Ki-67, Bcl-2 and VGEF distributions were performed using indirect immunoperoxidase staining for immunohistochemical analysis. The study showed that tramadol has triggering effect on apoptosis in Colo320 colon cancer stem cells.


Assuntos
Apoptose/efeitos dos fármacos , Neoplasias do Colo , Citotoxinas/farmacologia , Células-Tronco Neoplásicas , Tramadol/farmacologia , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/metabolismo , Neoplasias do Colo/patologia , Células HCT116 , Humanos , Invasividade Neoplásica , Células-Tronco Neoplásicas/metabolismo , Células-Tronco Neoplásicas/patologia
19.
Curr Pain Headache Rep ; 23(10): 76, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31388761

RESUMO

PURPOSE OF REVIEW: Deaths associated to tramadol, a synthetic opioid, are rising globally. Herein, we characterize prescription patterns of tramadol relative to other opioids in the USA from 2012 to 2015, by geographic region and physician specialty. RECENT FINDINGS: Data on opioid was obtained using Truven Health Analytics MarketScan for the years 2012-2015. Inclusion criteria included subjects living in the USA with ages from 12 to 64 years. Patterns of prescription of tramadol were contrasted with other prescription opioids including hydrocodone, codeine, oxycodone, oxymorphone, methadone, and fentanyl. Between 2012 and 2015, prescriptions for tramadol increased by 22.8%. The absolute rate of prescription varies considerably per region, with tramadol representing nearly 20% of opioid prescriptions in the South, which, in turn, represents nearly 50% of all prescriptions in the USA. Significant differences were seen when comparing prescribers of tramadol with other opioids (p < 0.0001). Tramadol was more frequently prescribed by family practice (40% vs. 32%) and internal medicine physicians (19% vs. 16%). Family medicine, internal medicine, and non-physician prescribers responded by 67.2% of all tramadol prescriptions in 2015. The proportion of patients receiving tramadol from non-physician prescribers increased by 56% between 2012 and 2015 (p < 0.001) IOM. Tramadol prescriptions rates have continuously increased both nationally and throughout all US regions. Important differences exist among regions and physician specialties. These results may be helpful in the creation of regional policies to monitor reasons for this increase and to avoid excessive use of tramadol.


Assuntos
Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Papel do Médico , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Tramadol/uso terapêutico , Humanos , Padrões de Prática Médica , Estados Unidos
20.
Sci Total Environ ; 687: 858-866, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31412489

RESUMO

The biodegradation of biorecalcitrant opioid drug tramadol (TRAM) was studied in a model biodegradation experiment performed with an enriched activated sludge culture pre-adapted to high concentration of TRAM (20 mg/L). TRAM and its transformation products (TPs) were determined by applying ultrahigh-performance liquid chromatography/quadrupole-time-of-flight mass spectrometry (UHPLC-QTOF-MS), the sludge culture was characterized using a 16S rRNA gene amplicon sequencing, whereas ecotoxicological evaluation was performed based on determination of toxicity to freshwater algae. Tramadol removal was much faster (t1/2 = 1.3 days) and more efficient in glucose-containing mineral medium (cometabolic conditions) than in a medium without glucose. The elimination of the parent compound resulted in the formation of five TPs, two of which (TP 249 and TP 235) were identified as N-desmethyltramadol (N-DM TRAM) and N,N-didesmethyltramadol (N,N-diDM TRAM). The remaining 3 TPs (TP 277a-c) were isomeric compounds with an elemental composition of protonated molecules C16H24NO3 and a putative structure which involved oxidative modification of the dimethylamino group. Pronounced changes in the taxonomic composition of the activated sludge were observed during the enrichment, especially regarding an enhanced percentage of 8 genera (Bacillus, Mycobacterium, Enterobacter, Methylobacillus, Pedobacter, Xanthobacter, Leadbetterella and Kaistia), which might be related to the observed transformations. The removal of TRAM resulted in proportional reduction of algal toxicity, implying a positive result of the accomplished transformation processes.


Assuntos
Biodegradação Ambiental , Tramadol/metabolismo , Eliminação de Resíduos Líquidos/métodos , Poluentes Químicos da Água/metabolismo , Bactérias , Esgotos , Microbiologia da Água
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