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Target controlled infusion

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https://www.readbyqxmd.com/read/28212183/cxcl12-cxcr4-signaling-contributes-to-the-pathogenesis-of-opioid-tolerance-a-translational-study
#1
Chih-Peng Lin, Kai-Hsiang Kang, Huang-Ju Tu, Ming-Yueh Wu, Tzu-Hung Lin, Houng-Chi Liou, Wei-Zen Sun, Wen-Mei Fu
BACKGROUND: Long-term opioid therapy for chronic pain may lead to analgesic tolerance, especially when administered intrathecally, thus preventing adequate pain relief. Discovering drug targets to treat opioid tolerance using a mechanism-based approach targeting opioid-induced neuroinflammation provides new therapeutic opportunities. In this study, we provide translational evidence that CXCL12/CXCR4 signaling contributes to the pathogenesis of opioid tolerance. METHODS: The CXCL12 levels in the cerebrospinal fluid of opioid-tolerant patients were compared with those of opioid-naive subjects...
March 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28208043/the-australasian-diabetes-data-network-first-national-audit-of-children-and-adolescents-with-type-1-diabetes
#2
Helen Phelan, Helen Clapin, Loren Bruns, Fergus J Cameron, Andrew M Cotterill, Jennifer J Couper, Elizabeth A Davis, Kim C Donaghue, Craig A Jefferies, Bruce R King, Richard O Sinnott, Elaine B Tham, Jerry K Wales, Timothy W Jones, Maria E Craig
OBJECTIVES: To assess glycaemic control, anthropometry and insulin regimens in a national sample of Australian children and adolescents with type 1 diabetes. DESIGN: Cross-sectional analysis of de-identified, prospectively collected data from the Australasian Diabetes Data Network (ADDN) registry. SETTING: Five paediatric diabetes centres in New South Wales, Queensland, South Australia, Victoria and Western Australia. PARTICIPANTS: Children and adolescents (aged 18 years or under) with type 1 diabetes of at least 12 months' duration for whom data were added to the ADDN registry during 2015...
February 20, 2017: Medical Journal of Australia
https://www.readbyqxmd.com/read/28207547/planning-for-operating-room-efficiency-and-faster-anesthesia-wake-up-time-in-open-major-upper-abdominal-surgery
#3
Hou-Chuan Lai, Shun-Ming Chan, Chueng-He Lu, Chih-Shung Wong, Chen-Hwan Cherng, Zhi-Fu Wu
Reducing anesthesia-controlled time (ACT) may improve operation room (OR) efficiency result from different anesthetic techniques. However, the information about the difference in ACT between desflurane (DES) anesthesia and propofol-based total intravenous anesthesia (TIVA) techniques for open major upper abdominal surgery under general anesthesia (GA) is not available in the literature.This retrospective study uses our hospital database to analyze the ACT of open major upper abdominal surgery without liver resection after either desflurane/fentanyl-based anesthesia or TIVA via target-controlled infusion with fentanyl/propofol from January 2010 to December 2011...
February 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28196745/development-of-cell-based-assay-for-predictively-evaluating-the-fc%C3%AE-r-mediated-human-immune-cell-activation-by-therapeutic-monoclonal-antibodies
#4
Michiko Takakura, Minoru Tada, Akiko Ishii-Watabe
Therapeutic monoclonal antibodies (mAbs) have important roles in treatments for various cancers and inflammatory diseases. Their highly target specificities provide controlled safety profiles. However, therapeutic mAbs commonly pose a risk of the induction of the release of cytokines, which may result in adverse events including infusion reaction and cytokine release syndrome. Several mechanisms are involved in the cytokine releases induced by therapeutic mAbs, and the activation of immune effector cells via Fcγ receptors (FcγRs) is one of the putative mechanisms for most IgG-subclass mAbs...
February 11, 2017: Biochemical and Biophysical Research Communications
https://www.readbyqxmd.com/read/28177205/monitoring-depth-of-sedation-evaluating-the-agreement-between-the-bispectral-index-qcon-and-the-entropy-module-s-state-entropy-during-flexible-bronchoscopy
#5
Johannes N Müller, Matthias Kreuzer, Paul S García, Gerhard Schneider, Hubert Hautmann
BACKGROUND: We investigated the correlation and agreement of three depth of anesthesia indices, bispectral index (BIS), qCON and state entropy (SE), during propofol sedation, because there is extensive literature that deals with the comparability of these indices during general anesthesia, but not during sedation. METHODS: We recorded electroencephalogram (EEG) and SE trend data, using the Entropy Module from 21 patients who underwent elective bronchoscopy with target-controlled infusion of propofol...
February 8, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28169848/efficacy-of-flow-monitoring-during-ecmo
#6
Aditya Badheka, Sara E Stucker, Joseph W Turek, Madhavan L Raghavan
The hypothesis that blood flow monitoring could serve as an effective early indicator of distal obstruction during ECMO was tested under controlled experimental conditions. The ECMO circuit typically includes (or could be easily modified to include) a shunt that bifurcates from the main line returning a small amount of blood back to the pump with access points for drug infusions. Distal circuit obstructions in the oxygenator and beyond will result in an increased diversion of flow from the distal line to the shunt...
February 6, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28160190/changes-in-cardiac-function-after-a-single-intravenous-administration-of-ckd-712-in-healthy-male-volunteers
#7
Sang-In Park, JaeWoo Kim, Kyung-Sang Yu, In-Jin Jang, SeungHwan Lee
BACKGROUND AND OBJECTIVES: CKD-712, a candidate treatment for septic shock, acts by increasing cardiac output. This study investigated changes in the pharmacodynamics, pharmacokinetics, and tolerability of CKD-712 after a single intravenous administration. METHODS: A dose-block-randomized, double-blind, placebo-controlled, single-dose escalation study was conducted in 44 healthy subjects receiving 20, 40, 80, 160, 240, or 320 μg/kg CKD-712 or placebo. Pharmacodynamics were evaluated using computerized impedance cardiography, vital signs, platelet aggregation, and bleeding time...
February 3, 2017: Clinical Drug Investigation
https://www.readbyqxmd.com/read/28139517/role-of-jagged1-hey1-signal-in-angiotensin-ii-induced-impairment-of-myocardial-angiogenesis
#8
Ai-Li Guan, Tao He, Yi-Bing Shao, Yi-Fan Chi, Hong-Yan Dai, Yan Wang, Li Xu, Xuan Yang, Hua-Min Ding, Shang-Lang Cai
BACKGROUND: Angiotensin II (Ang II) is a major contributor to the development of heart failure. However, the molecular and cellular mechanisms that underlie this process remain elusive. Inadequate angiogenesis in the myocardium leads to a transition from cardiac hypertrophy to dysfunction, and our previous study showed that Ang II significantly impaired the angiogenesis response. The current study was designed to examine the role of Jagged1-Notch signaling in the effect of Ang II during impaired angiogenesis and cardiac hypertrophy...
2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/28139349/safety-and-efficacy-of-ozanezumab-in-patients-with-amyotrophic-lateral-sclerosis-a-randomised-double-blind-placebo-controlled-phase-2-trial
#9
Vincent Meininger, Angela Genge, Leonard H van den Berg, Wim Robberecht, Albert Ludolph, Adriano Chio, Seung H Kim, P Nigel Leigh, Matthew C Kiernan, Jeremy M Shefner, Claude Desnuelle, Karen E Morrison, Susanne Petri, Diane Boswell, Jane Temple, Rajat Mohindra, Matt Davies, Jonathan Bullman, Paul Rees, Arseniy Lavrov
BACKGROUND: Neurite outgrowth inhibitor A (Nogo-A) is thought to have a role in the pathophysiology of amyotrophic lateral sclerosis (ALS). A monoclonal antibody against Nogo-A showed a positive effect in the SOD1(G93A) mouse model of ALS, and a humanised form of this antibody (ozanezumab) was well tolerated in a first-in-human trial. Therefore, we aimed to assess the safety and efficacy of ozanezumab in patients with ALS. METHODS: This randomised, double-blind, placebo-controlled, phase 2 trial was done in 34 centres in 11 countries...
January 27, 2017: Lancet Neurology
https://www.readbyqxmd.com/read/28128418/p2x7-receptor-in-the-hippocampus-is-involved-in-gp120-induced-cognitive-dysfunction
#10
Y Liu, G Q Chen, B Y Liu, Q Chen, Y M Qian, S S Qin, C L Liu, C S Xu
To investigate the role of the P2X7 receptor in learning and memory dysfunction induced by HIV-1 envelope glycoprotein gp120 (gp120), we established HIV-1-associated dementia (HAD) animal models by intracerebroventricular (ICV) infusion of gp120 in rats. We observed gp120-induced cognitive dysfunction in the radial arm water maze test. Results showed that rats in the gp120 groups had longer escape latencies and more errors compared to those in the control group. For example, the average trial time in the 50-ng/day-gp120 group on day eight (16...
January 23, 2017: Genetics and Molecular Research: GMR
https://www.readbyqxmd.com/read/28124225/feasibility-of-automated-titration-of-vasopressor-infusions-using-a-novel-closed-loop-controller
#11
Joseph Rinehart, Michael Ma, Michael-David Calderon, Maxime Cannesson
Blood pressure management is a central concern in critical care patients. For a variety of reasons, titration of vasopressor infusions may be an ideal use-case for computer assistance. Using our previous experience gained in the bench-to-bedside development of a computer-assisted fluid management system, we have developed a novel controller for this purpose. The aim of this preliminary study was to assess the feasibility of using this controller in simulated patients to maintain a target blood pressure in both stable and variable blood-pressure scenarios...
January 25, 2017: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/28112062/the-doyle-saleh-blink-reflex
#12
P W Doyle, I Beegun, H A Saleh
OBJECTIVES: When performing septoplasty or septorhinoplasty, we have observed that patients blink on injection of local anaesthetic (lidocaine 1 per cent with adrenaline 1:80 000) into the nasal mucosa of the anterior septum or vestibular skin, despite appropriate general anaesthesia. This study sought to quantify this phenomenon by conducting a prospective audit of all patients undergoing septoplasty or septorhinoplasty. METHODS: Patients were observed for a blink reflex at the time of local anaesthetic infiltration into the nasal vestibule...
January 23, 2017: Journal of Laryngology and Otology
https://www.readbyqxmd.com/read/28107308/acute-right-heart-failure-after-hemorrhagic-shock-and-trauma-pneumonectomy-a-management-approach-a-blinded-randomized-controlled-animal-trial-using-inhaled-nitric-oxide
#13
Andrea L Lubitz, Lars O Sjoholm, Amy Goldberg, Abhijit Pathak, Thomas Santora, Thomas E Sharp, Markus Wallner, Remus M Berretta, Lauren A Poole, Jichuan Wu, Marla R Wolfson
BACKGROUND: Hemorrhagic shock and pneumonectomy causes an acute increase in pulmonary vascular resistance (PVR). The increase in PVR and right ventricular (RV) afterload leads to acute RV failure, thus reducing left ventricular (LV) preload and output. Inhaled nitric oxide (iNO) lowers PVR by relaxing pulmonary arterial smooth muscle without remarkable systemic vascular effects. We hypothesized that with hemorrhagic shock and pneumonectomy, iNO can be used to decrease PVR and mitigate right heart failure...
2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28107273/influence-of-depth-of-hypnosis-on-pupillary-reactivity-to-a-standardized-tetanic-stimulus-in-patients-under-propofol-remifentanil-target-controlled-infusion-a-crossover-randomized-pilot-study
#14
Nada Sabourdin, Jean-Baptiste Peretout, Eliane Khalil, Marie-Laurence Guye, Nicolas Louvet, Isabelle Constant
BACKGROUND: Pupillometry allows the measurement of pupillary diameter variations in response to nociceptive stimuli. This technique has been used to monitor the balance between analgesia and nociception. Under general anesthesia, the amplitude of pupillary dilation is related to the amount of administered opioids. The objective of this study was to determine whether at a constant infusion rate of opioids, the pupillary response was influenced by depth of hypnosis assessed by the bispectral index (BIS)...
January 19, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28105111/effect-of-rocuronium-on-the-bispectral-index-under-anesthesia-and-tracheal-intubation
#15
Hui Yue, Jinyu Han, Ling Liu, Kaiyuan Wang, Jincheng Li
The aim of the present study was to investigate the effect of various doses of rocuronium on bispectral index (BIS) responses to propofol induction and tracheal intubation, as well as the role of the non-depolarization muscle relaxant rocuronium on the depth of sedation. A total of 72 patients (American Society of Anesthesiologists physical status I-II) were anaesthetized with propofol using a target-controlled infusion, and randomly divided into two sedation level groups (n=36). The patients were divided into 2 groups according to the BIS value: A normal sedation group (group 1), with a stable BIS value at 40-60, and a deep sedation group (group 2), with a BIS value <20 or with burst suppression...
December 2016: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28101342/pharmacodynamic-analysis-of-target-controlled-infusion-of-propofol-in-patients-with-hepatic-insufficiency
#16
Jing-Ru Pan, Jun Cai, Shao-Li Zhou, Qian-Qian Zhu, Fei Huang, Yi-Han Zhang, Xin-Jin Chi, Zi-Qing Hei
The effect of liver dysfunction on target-controlled infusion (TCI) of propofol remains poorly documented. The pharmacodynamic performance of propofol TCI was evaluated in a cohort of Chinese patients with hepatic insufficiency. Fifty-three patients with hepatic insufficiency were enrolled in the current prospective, observational study. Anesthesia was induced with propofol via TCI to a plasma concentration of 3 µg/ml. Following loss of consciousness (LOC), fentanyl and cisatracurium were administered. Pharmacodynamic parameters were recorded during TCI, including time to LOC, bispectral index (BIS), heart rate (HR) and blood pressure...
December 2016: Biomedical Reports
https://www.readbyqxmd.com/read/28100033/relaxin-3-inputs-target-hippocampal-interneurons-and-deletion-of-hilar-relaxin-3-receptors-in-floxed-rxfp3-mice-impairs-spatial-memory
#17
M Haidar, G Guèvremont, C Zhang, Rad Bathgate, E Timofeeva, C M Smith, A L Gundlach
Hippocampus is innervated by γ-aminobutyric acid (GABA) 'projection' neurons of the nucleus incertus (NI), including a population expressing the neuropeptide, relaxin-3 (RLN3). In studies aimed at gaining an understanding of the role of RLN3 signaling in hippocampus via its Gi/o -protein-coupled receptor, RXFP3, we examined the distribution of RLN3-immunoreactive nerve fibres and RXFP3 mRNA-positive neurons in relation to hippocampal GABA neuron populations. RLN3-positive elements were detected in close-apposition with a substantial population of somatostatin (SST)- and GABA-immunoreactive neurons, and a smaller population of parvalbumin- and calretinin-immunoreactive neurons in different hippocampal areas, consistent with the relative distribution patterns of RXFP3 mRNA and these marker transcripts...
January 18, 2017: Hippocampus
https://www.readbyqxmd.com/read/28098809/the-clinical-benefits-and-accuracy-of-continuous-glucose-monitoring-systems-in-critically-ill-patients-a-systematic-scoping-review
#18
REVIEW
Sigrid C J van Steen, Saskia Rijkenberg, Jacqueline Limpens, Peter H J van der Voort, Jeroen Hermanides, J Hans DeVries
Continuous Glucose Monitoring (CGM) systems could improve glycemic control in critically ill patients. We aimed to identify the evidence on the clinical benefits and accuracy of CGM systems in these patients. For this, we performed a systematic search in Ovid MEDLINE, from inception to 26 July 2016. Outcomes were efficacy, accuracy, safety, workload and costs. Our search retrieved 356 articles, of which 37 were included. Randomized controlled trials on efficacy were scarce (n = 5) and show methodological limitations...
January 14, 2017: Sensors
https://www.readbyqxmd.com/read/28098590/analgesia-and-sedation-requirements-in-mechanically-ventilated-trauma-patients-with-acute-preinjury-use-of-cocaine-and-or-amphetamines
#19
Bridgette Kram, Shawn J Kram, Michelle L Sharpe, Michael L James, Maragatha Kuchibhatla, Mark L Shapiro
BACKGROUND: The purpose of this study was to determine whether mechanically ventilated trauma patients with a positive urine drug screen (UDS) for cocaine and/or amphetamines have different opioid analgesic and sedative requirements compared with similar patients with a negative drug screen for these stimulants. METHODS: This retrospective, single-center cohort study at a tertiary care, academic medical and level 1 trauma center in the United States included patients ≥16 years of age who were admitted to an adult intensive care unit with a diagnosis of trauma between 2009 and 2013 with a UDS documented within 24 hours of admission, and were mechanically ventilated for >24 hours...
March 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28094434/the-effect-of-remifentanil-on-propofol-requirements-to-achieve-loss-of-response-to-command-vs-loss-of-response-to-pain
#20
H B Scott, S W Choi, G T C Wong, M G Irwin
When providing total intravenous anaesthesia, careful selection of end-points is required in titrating dose to effect during induction. Although propofol and remifentanil have predominantly different pharmacodynamic effects, they are seen to interact in achieving loss of consciousness and analgesia. To highlight these differences, we performed a double-blind, randomised controlled trial, comparing one group of patients receiving propofol alone (n = 42) with another group receiving remifentanil plus propofol (n = 46) as a target-controlled infusion of remifentanil (Minto; 3 ng...
January 17, 2017: Anaesthesia
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