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1.
Niger J Physiol Sci ; 37(1): 69-76, 2022 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-35947834

RESUMO

The present study was designed to investigate the effects of caffeine and adrenaline administration on memory and anxiety in male rats. Rats weighing about 140-200g were used for the study. They were divided into three groups (4 animals per group). Study groups 1; a,b,c,d were healthy rats administered normal saline, 5,10 and 15mg/kg bw caffeine intraperitoneally (i.p.), respectively for 6 weeks. Study groups 2; a,b,c,d administered normal saline, 0.1, 0.2 and 0.31mg/kg bw adrenaline (i.p.), respectively for 6 weeks. Study groups 3; a,b,c,d administered normal saline, 5mg/kg caffeine (i.p.) + 0.1mg/kg adrenaline (i.p.), 10mg/kg Caffeine (i.p.) + 0.2mg/kg Adrenaline (i.p.) and 15mg/kg Caffeine (i.p.) + 0.3mg/kg Adrenaline (i.p.) respectively for 6 weeks. The result showed no significant difference in spatial memory across all animals in study groups 1: b,c,d when compared to control (a). Study groups 2: (b, c) showed increase in spatial memory when compared to control (a). 2(d) showed a significant (p<0.05) decrease. Study groups 3: b, c, d showed no significant difference in spatial memory when compared to control (a). Study groups 1: b, c showed significant (p<0.05) reduction in duration for the short and long term memory test when compared to control. Study groups 2 showed reduction in duration for both the long and short term memory test when compared to control Study groups 3 no significant (p<0.05) difference in short and long term memory test across all animals in the group. It was also observed that adrenaline enhanced short and long term memory and only high dose of adrenaline distorted spatial memory. Study groups 1; (b,c) showed significant (p<0.05) increase in the number of entries to the open arm of the elevated plus maze when compared to control (a). Study groups 2; (b), showed significant (p<0.05) increase in the frequencies of entries to the closed arm of the elevated plus maze when compared to control (a). Study groups 2; (d), showed a significant (p<0.05) decrease in the frequency of entries to the open and closed arm when compared to control (a). The study revealed that co- administration of caffeine and adrenaline led to elevation of mood, increased activity and reduction of anxiety in Wistar rats. In addition, it was observed that only high dose of adrenaline increased anxiety. It was also observed that caffeine and adrenaline enhanced short and long term memory and only high dose of adrenaline distorted spatial memory.


Assuntos
Cafeína , Epinefrina , Animais , Ansiedade/induzido quimicamente , Ansiedade/tratamento farmacológico , Cafeína/farmacologia , Epinefrina/farmacologia , Masculino , Aprendizagem em Labirinto , Ratos , Ratos Wistar , Solução Salina/farmacologia
2.
J Med Case Rep ; 16(1): 303, 2022 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-35941712

RESUMO

BACKGROUND: We describe a patient presenting with central retinal artery occlusion (CRAO) of the right eye after retrobulbar anesthesia with adrenaline for macular pucker surgery. CASE PRESENTATION: The patient, a 67-year-old Caucasian man, developed a CRAO postoperatively by the next-day control likely due to the retrobulbar injection of a combination of Xylocaine and Bupivacaine with adrenaline as anesthetic. CONCLUSIONS: The addition of adrenaline to the standard anesthetic solution could be a risk factor for serious complications, such as CRAO.


Assuntos
Oclusão da Artéria Retiniana , Cirurgia Vitreorretiniana , Idoso , Anestesia Local/efeitos adversos , Epinefrina/efeitos adversos , Humanos , Doença Iatrogênica , Masculino , Oclusão da Artéria Retiniana/induzido quimicamente
3.
Curr Biol ; 32(15): R817-R824, 2022 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-35944478

RESUMO

Dopamine was first described by George Barger, James Ewens, and Henry Dale in 1910 as an epinephrine-like monoamine compound. Initially believed to be a mere precursor of norepinephrine, it was mostly ignored for the next four decades (Figure 1A). However, in the 1950s Kathleen Montagu showed that dopamine occurred in the brain by itself, and a series of studies by Arvid Carlsson and collaborators demonstrated that dopamine is a bona fide neurotransmitter, a finding that would earn Carlsson the 2000 Nobel Prize in Physiology and Medicine. In a landmark experiment, he pharmacologically blocked all dopamine neurotransmission in rabbits, which rendered them completely paralyzed, and then fully recovered their behavior with an injection of the dopamine precursor L-DOPA, demonstrating that dopamine was essential for self-initiated movement (Figure 1B). A similar effect was quickly reproduced by Oleg Hornykiewicz and collaborators in human Parkinsonian patients. Within a few years, dopamine jumped from relative obscurity to being critical for life as we know it.


Assuntos
Dopamina , Prêmio Nobel , Animais , Encéfalo/fisiologia , Dopamina/fisiologia , Epinefrina , Humanos , Levodopa , Masculino , Coelhos , Transmissão Sináptica
4.
Scanning ; 2022: 3689344, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35950089

RESUMO

In order to solve the nursing problems of local anesthesia patients under arthroscopy, a nursing method and experience based on local anesthesia patients under arthroscopy was proposed. From June 2019 to May 2021, 478 patients who underwent knee arthroscopy under spinal anesthesia or local anesthesia were retrospectively investigated, including 186 cases (38.9%) under local anesthesia and 292 cases (61.1%) under spinal anesthesia. 2% lidocaine plus epinephrine was injected locally and intra-articular in patients with local anesthesia, and 0.75% bupivacaine in patients with spinal anesthesia. It was found that in the local anesthesia group and spinal anesthesia group, 94.1% (175/186) and 98.3% (287/292) patients did not feel pain during operation. 93.0% (173/186 cases) and 96.2% (281/292 cases) of patients in the two groups were satisfied or very satisfied with the effect of anesthesia, respectively. The experimental results showed that local anesthesia was a simple and effective anesthesia method for knee arthroscopy, which was more reliable and safer than spinal anesthesia. Local anesthesia could be used for knee arthroscopy or cleaning and rinsing, free body removal, or even common meniscinoplasty.


Assuntos
Anestesia Local , Artroscópios , Artroscopia/métodos , Epinefrina , Humanos , Lidocaína , Estudos Prospectivos , Estudos Retrospectivos
5.
JAMA Netw Open ; 5(8): e2226191, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35951327

RESUMO

Importance: Epinephrine improves return of spontaneous circulation after out-of-hospital cardiac arrest (OHCA). These beneficial cardiac effects do not directly translate to better neurologic outcomes, possibly because of epinephrine-induced microvascular effects that produce critical brain ischemia. Objective: To examine whether targeted temperature management (TTM) modifies the adverse association between increasing prehospital epinephrine dose and neurologically favorable survival. Design, Setting, and Participants: This retrospective cohort study assessed 14 612 adults from Seattle and King County, Washington, with nontraumatic OHCA between January 1, 2008, and December 31, 2018, and included those who achieved return of spontaneous circulation and were unconscious at hospital admission. Data analysis was performed from April 2021 to May 2022. Exposures: Epinephrine dose and TTM during prehospital resuscitation. Main Outcomes and Measures: Favorable neurologic survival (Cerebral Performance Category [CPC] 1 or 2) and survival to hospital discharge. Results: Of the 14 612 assessed adults, 5253 (median age, 63 years; IQR, 51-74 years; 3460 [65.8%] male) were eligible for the study. The median epinephrine dose was 2.0 mg (IQR, 1.0-3.0 mg); 3052 patients (58.1%) received TTM. In all, 1889 patients (36.0%) survived with CPC 1 to 2, and 2177 (41.4%) survived to discharge. Increasing doses of epinephrine were associated with a decreasing likelihood of CPC 1 to 2 (odds ratio [OR], 0.46; 95% CI 0.42-0.50 for each additional milligram of epinephrine) and survival (OR, 0.47; 95% CI, 0.43-0.51). The dose-dependent epinephrine association was modified by TTM. After adjusting for Utstein covariates, TTM was associated with a relative stepwise improvement in odds of CPC 1 to 2 (interaction OR, 1.36; 95% CI, 1.22-1.51) and survival (interaction OR, 1.37; 95% CI, 1.24-1.51). A significant interaction was also observed when the analysis was stratified according to initial rhythm among shockable OHCA and nonshockable OHCA (shockable interaction OR, 1.20; 95% CI, 1.04-1.39; and nonshockable interaction OR, 1.24, 95% CI, 1.07-1.45). Conclusions and Relevance: This cohort study found an interaction between TTM and epinephrine dose such that the beneficial association of TTM increased with increasing epinephrine dose, suggesting that TTM may attenuate the adverse effects of higher-dose epinephrine.


Assuntos
Serviços Médicos de Emergência , Hipotermia Induzida , Parada Cardíaca Extra-Hospitalar , Adulto , Estudos de Coortes , Epinefrina/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos
7.
PLoS One ; 17(8): e0272279, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35925990

RESUMO

BACKGROUND: Vasoactive treatment is a cornerstone in treating hypoperfusion in cardiogenic shock following acute myocardial infarction (AMICS). The purpose was to compare the achievement of treatment targets and outcome in relation to vasoactive strategy in AMICS patients stratified according to the Society of Cardiovascular Angiography and Interventions (SCAI) shock classification. METHODS: Retrospective analysis of patients with AMICS admitted to cardiac intensive care unit at two tertiary cardiac centers during 2010-2017 with retrieval of real-time hemodynamic data and dosages of vasoactive drugs from intensive care unit databases. RESULTS: Out of 1,249 AMICS patients classified into SCAI class C, D, and E, mortality increased for each shock stage from 34% to 60%, and 82% (p<0.001). Treatment targets of mean arterial blood pressure > 65mmHg and venous oxygen saturation > 55% were reached in the majority of patients; however, more patients in SCAI class D and E had values below treatment targets within 24 hours (p<0.001) despite higher vasoactive load and increased use of epinephrine for each severity stage (p<0.001). In univariate analysis no significant difference in mortality within SCAI class D and E regarding vasoactive strategy was observed, however in SCAI class C, epinephrine was associated with higher mortality and a significantly higher vasoactive load to reach treatment targets. In multivariate analysis there was no statistically association between individually vasoactive choice within each SCAI class and 30-day mortality. CONCLUSION: Hemodynamic treatment targets were achieved in most patients at the expense of increased vasoactive load and more frequent use of epinephrine for each shock severity stage. Mortality was high regardless of vasoactive strategy; only in SCAI class C, epinephrine was associated with a significantly higher mortality, but the signal was not significant in adjusted analysis.


Assuntos
Infarto do Miocárdio , Choque Cardiogênico , Angiografia , Epinefrina/uso terapêutico , Humanos , Infarto do Miocárdio/complicações , Infarto do Miocárdio/tratamento farmacológico , Estudos Retrospectivos
8.
Clin Med (Lond) ; 22(4): 332-339, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35882481

RESUMO

Anaphylaxis is a serious systemic hypersensitivity reaction that is usually rapid in onset and may cause death. It is characterised by the rapid development of airway and/or breathing and/or circulation problems. Intramuscular adrenaline is the most important treatment, although, even in healthcare settings, many patients do not receive this intervention contrary to guidelines. The Resuscitation Council UK published an updated guideline in 2021 with some significant changes in recognition, management, observation and follow-up of patients with anaphylaxis. This is a concise version of the updated guideline.


Assuntos
Anafilaxia , Anafilaxia/diagnóstico , Anafilaxia/tratamento farmacológico , Tratamento de Emergência/efeitos adversos , Epinefrina/uso terapêutico , Humanos , Ressuscitação/efeitos adversos
9.
BMC Gastroenterol ; 22(1): 368, 2022 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-35909111

RESUMO

BACKGROUND: Although the current guidelines recommend endoscopic combination therapy, endoscopic epinephrine injection (EI) monotherapy is still a simple, common and effective modality for treating peptic ulcer bleeding (PUB). However, the rebleeding risk after EI monotherapy is still high, and identifying rebleeding patients after EI monotherapy is unclear, which is highly important in clinical practice. This study aimed to identify risk factors and constructed a predictive nomogram related to rebleeding after EI monotherapy. METHODS: We consecutively and retrospectively analyzed 360 PUB patients who underwent EI monotherapy between March 2014 and July 2021 in our center. Then we identified independent risk factors associated with rebleeding after initial endoscopic EI monotherapy by multivariate logistic regression. A predictive nomogram was developed and validated based on the above predictors. RESULTS: Among all PUB patients enrolled, 51 (14.2%) had recurrent hemorrhage within 30 days after endoscopic EI monotherapy. After multivariate logistic regression, shock [odds ratio (OR) = 12.691, 95% confidence interval (CI) 5.129-31.399, p < 0.001], Rockall score (OR = 1.877, 95% CI 1.250-2.820, p = 0.002), tachycardia (heart rate > 100 beats/min) (OR = 2.610, 95% CI 1.098-6.203, p = 0.030), prolonged prothrombin time (PT > 13 s) (OR = 2.387, 95% CI 1.019-5.588, p = 0.045) and gastric ulcer (OR = 2.258, 95% CI 1.003-5.084, p = 0.049) were associated with an increased risk of rebleeding after an initial EI monotherapy treatment. A nomogram incorporating these independent high-risk factors showed good discrimination, with an area under the receiver operating characteristic curve (AUROC) of 0.876 (95% CI 0.817-0.934) (p < 0.001). CONCLUSIONS: We developed a predictive nomogram of rebleeding after EI monotherapy, which had excellent prediction accuracy. This predictive nomogram can be conveniently used to identify low-risk rebleeding patients after EI monotherapy, allowing for decision-making in a clinical setting.


Assuntos
Hemostase Endoscópica , Úlcera Gástrica , Epinefrina/uso terapêutico , Hemostasia , Hemostase Endoscópica/efeitos adversos , Humanos , Nomogramas , Úlcera Péptica Hemorrágica/tratamento farmacológico , Recidiva , Estudos Retrospectivos , Fatores de Risco , Úlcera Gástrica/complicações
10.
Crit Care ; 26(1): 231, 2022 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-35909163

RESUMO

BACKGROUND: Targeted temperature management at 33 °C (TTM33) has been employed in effort to mitigate brain injury in unconscious survivors of out-of-hospital cardiac arrest (OHCA). Current guidelines recommend prevention of fever, not excluding TTM33. The main objective of this study was to investigate if TTM33 is associated with mortality in patients with vasopressor support on admission after OHCA. METHODS: We performed a post hoc analysis of patients included in the TTM-2 trial, an international, multicenter trial, investigating outcomes in unconscious adult OHCA patients randomized to TTM33 versus normothermia. Patients were grouped according to level of circulatory support on admission: (1) no-vasopressor support, mean arterial blood pressure (MAP) ≥ 70 mmHg; (2) moderate-vasopressor support MAP < 70 mmHg or any dose of dopamine/dobutamine or noradrenaline/adrenaline dose ≤ 0.25 µg/kg/min; and (3) high-vasopressor support, noradrenaline/adrenaline dose > 0.25 µg/kg/min. Hazard ratios with TTM33 were calculated for all-cause 180-day mortality in these groups. RESULTS: The TTM-2 trial enrolled 1900 patients. Data on primary outcome were available for 1850 patients, with 662, 896, and 292 patients in the, no-, moderate-, or high-vasopressor support groups, respectively. Hazard ratio for 180-day mortality was 1.04 [98.3% CI 0.78-1.39] in the no-, 1.22 [98.3% CI 0.97-1.53] in the moderate-, and 0.97 [98.3% CI 0.68-1.38] in the high-vasopressor support groups with regard to TTM33. Results were consistent in an imputed, adjusted sensitivity analysis. CONCLUSIONS: In this exploratory analysis, temperature control at 33 °C after OHCA, compared to normothermia, was not associated with higher incidence of death in patients stratified according to vasopressor support on admission. Trial registration Clinical trials identifier NCT02908308 , registered September 20, 2016.


Assuntos
Reanimação Cardiopulmonar , Hipotermia Induzida , Parada Cardíaca Extra-Hospitalar , Adulto , Reanimação Cardiopulmonar/métodos , Epinefrina/uso terapêutico , Humanos , Hipotermia Induzida/métodos , Norepinefrina/uso terapêutico , Parada Cardíaca Extra-Hospitalar/tratamento farmacológico , Temperatura , Vasoconstritores/uso terapêutico
11.
Anesth Prog ; 69(2): 38-40, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35849809

RESUMO

We report a case of wide QRS tachycardia or ventricular tachycardia with a pulse after the administration of epinephrine under general anesthesia. After induction and achieving a sufficiently deep plane of general anesthesia, gauze soaked in a 1:100,000 epinephrine solution was applied to the patient's nasal mucosa and 1% lidocaine with 1:100,000 epinephrine was administered via intraoral infiltration. Several minutes after the start of surgery, the patient's blood pressure and heart rate suddenly increased and a wide QRS tachycardia was observed on the electrocardiogram, which then reverted to a normal sinus rhythm. According to the past reports, similar arrhythmias have occurred after administration of epinephrine in the head and neck. These findings suggest that anesthesia providers must be aware of the risks associated with epinephrine and local anesthetic use, particularly in the head and neck region.


Assuntos
Epinefrina , Lidocaína , Anestesia Geral/efeitos adversos , Anestesia Local , Anestésicos Locais/efeitos adversos , Arritmias Cardíacas , Epinefrina/efeitos adversos , Humanos , Lidocaína/efeitos adversos , Taquicardia/induzido quimicamente
12.
Curr Opin Allergy Clin Immunol ; 22(4): 215-220, 2022 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-35852895

RESUMO

PURPOSE OF REVIEW: To identify patterns and key issues though a systematic review in order to support prevention strategies and reduce avoidable deaths related to drug-induced anaphylaxis (DAF). RECENT FINDINGS: DAF rate has been estimated by 0.13-0.53/106 population/year. General global trends of DAF are increasing over time, mostly occurring at healthcare settings (62%) with a similar gender distribution and an average age of 53 years. Antibiotics, anaesthetics, radio-contrast media and NSAIDs were the most frequently implicated agents. Main comorbidities were personal history of drug allergy, cardiovascular diseases and asthma. Main manifestations were cardiovascular and respiratory commitments. Use of adrenaline is mentioned in only 29% of the articles. SUMMARY: DAF is increasing worldwide and most cases are iatrogenic. This first systematic review of DAF identified key gaps and served as a wake-up call to prevent avoidable deaths. Phenotype at risk for DAF was represented by patients aged more than 54 years, with personal history of drug allergy/hypersensitivity with no or incomplete allergological work-up, cardiovascular disease and/or asthma with need of hospitalization and/or frequent healthcare assistance. Additional risk for those who need frequent use of intravenous antibiotics and/or undergoing surgery or image investigation with radiocontrast media.


Assuntos
Anafilaxia , Asma , Hipersensibilidade a Drogas , Anafilaxia/induzido quimicamente , Anafilaxia/epidemiologia , Anafilaxia/prevenção & controle , Antibacterianos/efeitos adversos , Meios de Contraste/efeitos adversos , Epinefrina , Humanos
13.
Am J Physiol Lung Cell Mol Physiol ; 323(2): L142-L151, 2022 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-35787178

RESUMO

Epinephrine (EPI), an endogenous catecholamine involved in the body's fight-or-flight responses to stress, activates α1-adrenergic receptors (α1ARs) expressed on various organs to evoke a wide range of physiological functions, including vasoconstriction. In the smooth muscle of human bronchi, however, the functional role of EPI on α1ARs remains controversial. Classically, evidence suggests that EPI promotes bronchodilation by stimulating ß2-adrenergic receptors (ß2ARs). Conventionally, the selective ß2AR agonism of EPI was thought to be, in part, due to a predominance of ß2ARs and/or a sparse, or lack of α1AR activity in human airway smooth muscle (HASM) cells. Surprisingly, we find that HASM cells express a high abundance of ADRA1B (the α1AR subtype B) and identify a spontaneous "switch-like" activation of α1ARs that evokes intracellular calcium, myosin light chain phosphorylation, and HASM cell shortening. The switch-like responses, and related EPI-induced biochemical and mechanical signals, emerged upon pharmacological inhibition of ß2ARs and/or under experimental conditions that induce ß2AR tachyphylaxis. EPI-induced procontractile effects were abrogated by an α1AR antagonist, doxazosin mesylate (DM). These data collectively uncover a previously unrecognized feed-forward mechanism driving bronchospasm via two distinct classes of G protein-coupled receptors (GPCRs) and provide a basis for reexamining α1AR inhibition for the management of stress/exercise-induced asthma and/or ß2-agonist insensitivity in patients with difficult-to-control, disease subtypes.


Assuntos
Miócitos de Músculo Liso , Receptores Adrenérgicos beta 2 , Agonistas Adrenérgicos beta , Brônquios , Broncodilatadores/farmacologia , Epinefrina/farmacologia , Humanos , Músculo Liso , Receptores Adrenérgicos alfa 1
14.
Artigo em Inglês | MEDLINE | ID: mdl-35793735

RESUMO

Chelonoidis carbonaria aortic rings present endothelium-derived release of dopamine, noradrenaline, adrenaline and 6-nitrodopamine (6-ND). Here it was investigated whether 6-ND release is coupled to nitric oxide (NO) synthesis and its action on the vascular smooth muscle reactivity. Basal release of 6-ND from aortic rings in the absence and presence of the NO synthesis inhibitor L-NAME was quantified by LC-MS-MS. Aortic rings were suspended vertically between two metal hooks in 10-mL organ baths containing Krebs-Henseleit's solution and attached to isometric transducers. The tissues were allowed to equilibrate for 1 h before starting the experiments. The release of 6-ND was significantly reduced by previous incubation with L-NAME. 6-ND (up to 300 µM) had no contractile activity in the aortic rings. 6-ND (1, 3 and 10 µM) produced significant rightward shifts of the concentration-response curves to dopamine in endothelium-intact (pA2 6.09) and L-NAME pre-treated endothelium-intact (pA2 7.06) aortic rings. Contractions induced by noradrenaline and adrenaline were not affected by pre-incubation with 6-ND. The EFS (16 Hz)-induced aortic contractions were significantly inhibited by incubation with 6-ND (10 µM). In the thromboxane A2 mimetic U-46619 (30 nM) pre-contracted endothelium intact aortic rings, 6-ND (1 nM-1 µM) and the dopamine D2-receptor antagonist haloperidol (1 nM-1 µM) induced concentration-dependent relaxations. The relaxations were not present in endothelium-removed aortic rings but they were not affected by incubation with L-NAME in endothelium-intact aortic rings. The results indicate that the synthesis of this novel catecholamine in Chelonoidis carbonaria aortic rings is coupled to NO release and that 6-ND acts as a highly selective dopamine D2-like receptor antagonist.


Assuntos
Dopamina , Tartarugas , Animais , Aorta , Aorta Torácica , Dopamina/análogos & derivados , Dopamina/farmacologia , Antagonistas de Dopamina/farmacologia , Epinefrina/farmacologia , NG-Nitroarginina Metil Éster/farmacologia , Óxido Nítrico , Norepinefrina/farmacologia
15.
Medicine (Baltimore) ; 101(30): e29311, 2022 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-35905267

RESUMO

During endoscopic orthopedic surgery, epinephrine mixed with irrigation saline is frequently used to improve visualization. By monitoring hemodynamic parameters throughout the procedure, we intended to discover the hemodynamic effect of epinephrine between the normal saline irrigation fluid without epinephrine group (NS) and normal saline irrigation fluid with epinephrine group (EPI). Patients who underwent 1-level lumbar decompression or discectomy surgery without fusion between August 2019 and July 2020 were reviewed retrospectively. The hemodynamic parameters were compared between the NS group and EPI group. As a second endpoint, the incidence of hypotension and hypertension events, expected blood loss, postoperative nausea and vomiting and postoperative epidural hematoma were compared between the 2 groups. The 2 groups were homogeneous in terms of age, sex, weight, height, body mass index (BMI), ASA physical status (ASA PS), and diagnosis. The incidence of hypotension events (67.2 % in the NS group, 45.7 % in the EPI group, P =.015) and severe hypotension events (51.7 % in the NS group, 28.6 % in the EPI group, P = .015) were less frequent in the EPI group. Only epinephrine had a significant protective effect through a multivariable analysis (P = .027, OR = 2.361) and in severe hypotension events, only epinephrine had a significant protective effect through a multivariable analysis (P = .011, OR = 2.818), and EBL was the risk factor through a multivariable analysis (P = .016, OR = 1.002) We believe that the addition of epinephrine to irrigation saline has hemodynamic protective effects in patients who underwent endoscopic lumbar surgery.


Assuntos
Hipotensão , Solução Salina , Epinefrina/uso terapêutico , Hemodinâmica , Humanos , Hipotensão/etiologia , Estudos Retrospectivos
16.
Nutrients ; 14(13)2022 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-35807887

RESUMO

Lipid transfer proteins (LTPs) are widely widespread plant food allergens which represents the main cause of food allergy in adults living in the Mediterranean basin. The purpose of this study was to investigate in LTP patients the actual use of prescribed epinephrine auto-injector and appropriateness of its prescription. In addition, we investigated in these patients: (1) occurrence of new food reaction in the following three years after to diagnosis; (2) need and number of access to emergency services; (3) presence of possible predictive factors to further food reactions. One-hundred sixty-five adult patients sensitized to LTPs have been included. During follow-up, we recorded 68 further reactions, most of them (77.9%) characterized by local symptoms; rarely the patients required an emergency-department visits (16.1%) and only one patient (1.7%) used the epinephrine auto-injector. The patients with a previous history of anaphylaxis at baseline turned back to access to emergency services also during the follow-up (p = 0.006). The majority of patients with recorded systemic reactions (p = 0.004) and treated in an emergency room (p = 0.028) did not have any co-factor-enhanced at diagnosis. We noted an association between platanus pollen sensitization and severity of further reactions during the follow-up (p = 0.026). Epinephrine auto-injector were prescribed to 108/165 patients (65.5%) with an over-prescription rate of 25%. The unforeseeable clinical presentation of LTP allergic reactions and the eventual role played by the cofactor make necessary schedule a follow-up to monitor the patients over time and to assess the actual use of epinephrine auto injectors prescribed.


Assuntos
Anafilaxia , Hipersensibilidade Alimentar , Adulto , Alérgenos , Anafilaxia/tratamento farmacológico , Proteínas de Transporte , Epinefrina , Hipersensibilidade Alimentar/tratamento farmacológico , Hipersensibilidade Alimentar/epidemiologia , Humanos , Prescrições , Estudos Retrospectivos , Medição de Risco
17.
Comput Intell Neurosci ; 2022: 2056969, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35875745

RESUMO

Objective: The aim of the study was to study the effects of the ultrasound-guided stellate ganglion block on hemodynamics, stressful response, and postoperative gastrointestinal functions in patients with colorectal cancer. Methods: A total of 100 patients with colorectal cancer hospitalized from January 2021 to December 2021 were selected. After anesthesia induction, the right stellate ganglion block was performed under ultrasound guidance in the research group and the general anesthesia was performed in the control group. The heart rate (HR), mean arterial pressure (MAP), epinephrine, cortisol, self-rating anxiety scale (SAS), Ramsay sedation score (RSS), postoperative bowel sound recovery time, anal exhaust time, and the incidence of gastrointestinal adverse reactions 24 hours after operation were studied pre-and post-24-hour anesthesia induction. Results: Following 24-hour operation, the HR and MAP values were largely reduced (p < 0.05). Following 24-hour operation, epinephrine and cortisol became obviously higher (p < 0.05). After 24-hour operation, the levels of epinephrine and cortisol in the research group were greatly lower. The score of the SAS in the study cohort was less than that of the controls (p < 0.05). The RSS of the research group was obviously increased (p < 0.05). The recovery time of intestinal sound and the anal exhaust time of the study cohort became remarkably shorter (p < 0.05). The incidence of gastrointestinal adverse reactions 24 hours after operation of the study cohort was much less common (p < 0.05). Conclusion: The ultrasound-guided stellate ganglion block can reduce the fluctuation of blood circulation during radical resection of colorectal cancer, reduce postoperative gastrointestinal dysfunction and stress reaction, relieve patients' anxiety, and contribute to the recovery of gastrointestinal function.


Assuntos
Neoplasias Colorretais , Gânglio Estrelado , Neoplasias Colorretais/cirurgia , Epinefrina , Hemodinâmica , Humanos , Hidrocortisona , Ultrassonografia de Intervenção
18.
Front Endocrinol (Lausanne) ; 13: 875865, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35795145

RESUMO

The adrenal medulla plays a critical role in mammalian homeostasis and the stress response. It is populated by clustered chromaffin cells that secrete epinephrine or norepinephrine along with peptides into the bloodstream affecting distant target organs. Despite been heavily studied, the central control of adrenal medulla and in-situ spatiotemporal responsiveness remains poorly understood. For this work, we continuously monitored the electrical activity of individual adrenomedullary chromaffin cells in the living anesthetized rat using multielectrode arrays. We measured the chromaffin cell activity under basal and physiological stress conditions and characterized the functional micro-architecture of the adrenal medulla. Under basal conditions, chromaffin cells fired action potentials with frequencies between ~0.2 and 4 Hz. Activity was almost completely driven by sympathetic inputs coming through the splanchnic nerve. Chromaffin cells were organized into independent local networks in which cells fired in a specific order, with latencies from hundreds of microseconds to a few milliseconds. Electrical stimulation of the splanchnic nerve evoked almost exactly the same spatiotemporal firing patterns that occurred spontaneously. Hypoglycemic stress, induced by insulin administration resulted in increased activity of a subset of the chromaffin cells. In contrast, respiratory arrest induced by lethal anesthesia resulted in an increase in the activity of virtually all chromaffin cells before cessation of all activity. These results suggest a stressor-specific activation of adrenomedullary chromaffin cell networks and revealed a surprisingly complex electrical organization that likely reflects the dynamic nature of the adrenal medulla's neuroendocrine output during basal conditions and during different types of physiological stress.


Assuntos
Medula Suprarrenal , Células Cromafins , Medula Suprarrenal/inervação , Medula Suprarrenal/metabolismo , Animais , Células Cromafins/metabolismo , Epinefrina , Mamíferos/metabolismo , Norepinefrina , Ratos , Nervos Esplâncnicos/metabolismo
19.
Bull Exp Biol Med ; 173(3): 330-334, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35852683

RESUMO

We studied the role of adrenoceptors in the regulation of activity of mitochondrial and cytoplasmic enzymes in cardiomyocytes by catecholamines and their metabolites. Different types of adrenergic receptors (AR) agonists acting either on both α- and ß-AR or selectively on α- or ß-AR, as well as quinoid metabolites of catecholamines were used. It was found that the activating effect of ß-AR agonist isadrin (isoproterenol) on succinate dehydrogenase of the mitochondria in the heart is prevented by ß-adrenergic blockade. The activating effect of dopamine, epinephrine, and isoproterenol on cytochrome C-oxidase and the inhibitory effect of dopamine, norepinephrine, epinephrine, and isoproterenol on Mg-activated ATPase was not mediated by adrenoreceptors. Hormones of the sympathoadrenal system epinephrine, dopamine, norepinephrine, isoproterenol, and catecholamine metabolites (adrenochrome and adrenoxyl) modulating activity of the respiratory chain enzymes of mitochondria in the heart regulate the processes of tissue respiration by transferring mitochondria into a state of "loose" phosphorylation and respiration coupling. Epinephrine as a ß-AR agonist increased activity of cytosolic enzymes catalyzing metabolism of purine nucleotides (adenosine deaminase and AMP deaminase), enzymes of antioxidant defense (glutathione peroxidase and catalase), and the level of malondialdehyde and diene conjugates. ß-AR blockade with metoprolol abolished the activating effect of epinephrine on glutathione reductase, glutathione peroxidase, and catalase and reduced the level of malondialdehyde and diene conjugates.


Assuntos
Catecolaminas , Dopamina , Agonistas Adrenérgicos beta/farmacologia , Antagonistas Adrenérgicos beta/farmacologia , Catalase/metabolismo , Catecolaminas/metabolismo , Dopamina/metabolismo , Epinefrina/metabolismo , Epinefrina/farmacologia , Glutationa Peroxidase/metabolismo , Isoproterenol/farmacologia , Malondialdeído/metabolismo , Mitocôndrias/metabolismo , Miócitos Cardíacos/metabolismo , Norepinefrina/metabolismo , Norepinefrina/farmacologia , Receptores Adrenérgicos/metabolismo , Receptores Adrenérgicos beta/metabolismo
20.
Scand J Clin Lab Invest ; 82(4): 329-333, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35791842

RESUMO

Twenty-four-hour urine measurements play a crucial role in the diagnosis, follow-up and treatment of various diseases. There are different approaches to the collection of urine in patients who need to collect multiple urine samples at a time, especially in hospitals with heavy workloads. In this study, we compared the sodium, potassium, chloride, amylase, calcium, creatinine, phosphorus, microalbumin, protein, magnesium, urea, uric acid, adrenaline, noradrenaline, dopamine, metanephrine, normetanephrine, vanillylmandelic acid, 5-hydroxyindoleacetic acid and homovanillic acid results of 24-h urine samples analyzed immediately without acid addition, which we accepted as the reference and baseline measurement, with the results of the samples analyzed after waiting for 24 h without acid addition, analyzed immediately with acid addition and analyzed after waiting for 24 h with acid addition. Chloride, microalbumin, amylase and protein tests, which are recommended to be measured in the sample without preservatives, are affected by acid addition. Adrenaline, noradrenaline and dopamine, which are the tests recommended to be measured in acid-added urine are degraded in the samples without acid, and the levels of metanephrine and normetanephrine were not significantly degraded in the absence of preservatives.


Assuntos
Metanefrina , Normetanefrina , Amilases , Cloretos , Dopamina/urina , Epinefrina/urina , Humanos , Norepinefrina/urina , Normetanefrina/urina
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