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https://www.readbyqxmd.com/read/28625302/pharmacogenetics-in-obstetric-anesthesia
#1
REVIEW
Ruth Landau, Richard Smiley
The 21st century has been billed as the era of "precision/personalized medicine." Genetic investigation of clinical syndromes may guide therapy as well as reveal previously unknown biological or pharmacological pathways that may result in novel drug therapies. Several clinical issues in obstetrics and obstetric anesthesiology have been targets for genetic investigations. These include evaluation of the genetic effects on preterm labor and the progression of labor, spinal anesthesia-induced hypotension and the response to medications used to treat hypotension, and the effect of gene variants on pain and analgesic responses...
March 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/28602247/different-clinical-features-of-anaphylaxis-according-to-cause-and-risk-factors-for-severe-reactions
#2
Sang-Yoon Kim, Min-Hye Kim, Young-Joo Cho
BACKGROUND: Anaphylaxis is a life-threatening allergic reaction. Several studies reported different anaphylactic reactions according to the causative substances. However, a comparison of anaphylaxis for each cause has not been done. This study was conducted to identify common causes of anaphylaxis, characteristics of anaphylactic reaction for each cause and to analyze the factors related to the severity of the reaction. METHODS: Medical records of patients who visited the emergency room of Ewha Womans University Mokdong Hospital from March 2003 to April 2016 and diagnosed with anaphylactic shock were retrospectively reviewed...
June 8, 2017: Allergology International: Official Journal of the Japanese Society of Allergology
https://www.readbyqxmd.com/read/28590439/reclassifying-anaphylaxis-to-neuromuscular-blocking-agents-based-on-the-presumed-patho-mechanism-ige-mediated-pharmacological-adverse-reaction-or-innate-hypersensitivity
#3
REVIEW
David Spoerl, Haig Nigolian, Christoph Czarnetzki, Thomas Harr
Approximately 60% of perioperative anaphylactic reactions are thought to be immunoglobulin IgE mediated, whereas 40% are thought to be non-IgE mediated hypersensitivity reactions (both considered non-dose-related type B adverse drug reactions). In both cases, symptoms are elicited by mast cell degranulation. Also, pharmacological reactions to drugs (type A, dose-related) may sometimes mimic symptoms triggered by mast cell degranulation. In case of hypotension, bronchospasm, or urticarial rash due to mast cell degranulation, identification of the responsible mechanism is complicated...
June 7, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/28588484/akrinor-tm-a-cafedrine-theodrenaline-mixture-20-1-increases-force-of-contraction-of-human-atrial-myocardium-but-does-not-constrict-internal-mammary-artery-in-vitro
#4
Benjamin Kloth, Simon Pecha, Eileen Moritz, Yvonne Schneeberger, Klaus-Dieter Söhren, Edzard Schwedhelm, Hermann Reichenspurner, Thomas Eschenhagen, Rainer H Böger, Torsten Christ, Sebastian N Stehr
Background: Intraoperative hypotension is a common problem and direct or indirect sympathomimetic drugs are frequently needed to stabilize blood pressure. Akrinor(TM) consists of the direct and the indirect sympathomimetic noradrenaline and norephedrine. Both substances are covalently bound to the phosphodiesterase (PDE) inhibitor theophylline, yielding theodrenaline and cafedrine, respectively. We investigated pharmacodynamic effects of Akrinor(TM) and its constituents on contractile force and tension in human atrial trabeculae and internal A...
2017: Frontiers in Pharmacology
https://www.readbyqxmd.com/read/28572638/mitochondrial-targeting-by-dichloroacetate-improves-outcome-following-hemorrhagic-shock
#5
Kumar Subramani, Sumin Lu, Marie Warren, Xiaogang Chu, Haroldo A Toque, R William Caldwell, Michael P Diamond, Raghavan Raju
Hemorrhagic shock is a leading cause of death in people under the age of 45 and accounts for almost half of trauma-related deaths. In order to develop a treatment strategy based on potentiating mitochondrial function, we investigated the effect of the orphan drug dichloroacetate (DCA) on survival in an animal model of hemorrhagic shock in the absence of fluid resuscitation. Hemorrhagic shock was induced in rats by withdrawing 60% of the blood volume and maintaining a hypotensive state. The studies demonstrated prolonged survival of rats subjected to hemorrhagic injury (HI) when treated with DCA...
June 1, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28564654/high-dose-cannabidiol-induced-hypotension-after-global-hypoxia-ischemia-in-piglets
#6
Håvard T Garberg, Rønnaug Solberg, Jon Barlinn, Jose Martinez-Orgado, Else-Marit Løberg, Ola Didrik Saugstad
BACKGROUND: Cannabidiol (CBD) is considered a promising neuroprotectant after perinatal hypoxia-ischemia (HI). We have previously studied the effects of CBD 1 mg/kg in the early phase after global HI in piglets. In contrast to prior studies, we found no evidence of neuroprotection and hypothesized that higher doses might be required to demonstrate efficacy in this animal model. OBJECTIVE: To assess the safety and potential neuroprotective effects of high-dose CBD...
June 1, 2017: Neonatology
https://www.readbyqxmd.com/read/28541755/epinephrine-but-not-vasopressin-attenuates-the-airway-response-to-anaphylactic-shock-in-rats
#7
Feng Zheng, Ruxandra Copotoiu, Charles Tacquard, Bruno Demoulin, Jean Marc Malinovsky, Bruno Levy, Dan Longrois, Grégoire Barthel, Paul Michel Mertes, François Marchal, Silvia Demoulin-Alexikova, Olivier Collange
PURPOSE: The two life-threatening signs of anaphylactic shock (AS) are severe arterial hypotension and bronchospasm. Guidelines recommend epinephrine as first-line treatment. Arginine vasopressin (AVP) has been proposed as an alternative if epinephrine does not correct arterial hypotension. These two drugs may have beneficial, neutral or deleterious effects on airflow either directly or by modifying factors that regulate vasodilatation and/or edema in the bronchial wall. AIM OF THE STUDY: To compare the effects of epinephrine and AVP on airflow and airway leakage in a rat model of AS...
April 2017: Experimental Lung Research
https://www.readbyqxmd.com/read/28539561/predictors-of-mortality-rehospitalization-for-syncope-and-cardiovascular-events-in-patients-with-cardiovascular-syncope
#8
Tatsuya Onuki, Makoto Shoji, Yuya Nakamura, Ko Ogawa, Akinori Ochi, Koichiro Inokuchi, Shiro Kawasaki, Yoshimi Onishi, Yoshimasa Onuma, Yumi Munetsugu, Miwa Kikuchi, Hiroyuki Ito, Yoshino Minoura, Norikazu Watanabe, Taro Adachi, Mitsuharu Kawamura, Taku Asano, Kaoru Tanno, Youichi Kobayashi
BACKGROUND: Predictors of poor outcomes remain unknown for cardiovascular syncope patients after discharge.Methods and Results:We reviewed the medical records of consecutive patients admitted to hospital with cardiovascular syncope. We then performed Cox stepwise logistic regression analysis to identify significant independent factors for death, rehospitalization for syncope, and cardiovascular events. The study group was 206 patients with cardiovascular syncope. Of them, bradycardia was diagnosed in 50%, tachycardia in 27%, and structural disease in 23%...
May 25, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28501080/intravenous-contrast-induced-nephropathy-the-rise-and-fall-of-a-threatening-idea
#9
REVIEW
Lyndon Luk, Jonathan Steinman, Jeffrey H Newhouse
Contrast-induced nephropathy (CIN) has been considered to be a cause of renal failure for over 50 years, but careful review of past and recent studies reveals the risks of CIN to be overestimated. Older studies frequently cited the use of high-osmolality contrast media, which have since been replaced by low-osmolality contrast media, which have lower risks for nephropathy. In addition, literature regarding CIN typically describes the incidence following cardiac angiography, whereas the risk of CIN from intravenous injection is much lower...
May 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/28489728/novel-adjunct-drugs-reverse-endothelial-glycocalyx-damage-after-hemorrhagic-shock-in-rats
#10
Ivo P Torres Filho, Luciana N Torres, Christi Salgado, Michael A Dubick
INTRODUCTION: There is interest in the small-volume therapeutic use of adjunct drugs for treating hemorrhagic shock (HS). However, critical information is only partially available on mechanisms of action of promising compounds such as adenosine-lidocaine-Magnesium (ALM), beta-hydroxybutyrate plus melatonin (BHB/M), and poloxamer 188 (P-188). Therefore, we tested the hypothesis that these adjuncts would reverse HS-induced damage to microvascular endothelial glycocalyx and hemodynamics...
May 9, 2017: Shock
https://www.readbyqxmd.com/read/28449192/anti-inflammatory-effects-of-pegylated-human-adrenomedullin-in-a-mouse-dss-induced-colitis-model
#11
Sayaka Nagata, Motoo Yamasaki, Kazuo Kitamura
Preclinical Research Human adrenomedullin (hAM), a hypotensive peptide, also has anti-inflammatory effects. hAM can reduce the severity of the dextran sulphate sodium (DSS)- and 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced colitis in animal models. Furthermore, in a clinical study, hAM treatment reduced the Disease Activity Index in ulcerative colitis. However, these therapeutic effects required continuous administration of hAM as the half-life of native hAM is quite short in blood. To resolve this problem, hAM N-terminal was conjugated with two kinds of polyethylene glycol (PEG); 5 kDa PEG or 60 kDa PEG (5 kDa PEG-hAM and 60 kDa PEG-hAM respectively)...
April 27, 2017: Drug Development Research
https://www.readbyqxmd.com/read/28447886/drug-induced-hyperlactatemia
#12
Eike Blohm, Jeffrey Lai, Mark Neavyn
BACKGROUND: Hyperlactatemia is common in critically ill patients and has a variety of etiologies. Medication toxicity remains an uncommon cause that providers often fail to recognize. In this article, we review several medications that cause hyperlactatemia in either therapeutic or supratherapeutic dosing. When known, the incidence, mortality, pathophysiology, and treatment options are discussed. METHODS: We performed a literature search using PUBMED and Google Scholar for English language articles published after 1980 regarding medication induced hyperlactatemia and its management...
April 27, 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28439951/incidence-and-risk-factors-of-hypotension-after-intravenous-fosphenytoin-administration
#13
H K Kim, I G Hwang, I-S Koh, D W Kim
WHAT IS KNOWN AND OBJECTIVE: Fosphenytoin (FOS) administered intravenously offers several benefits over intravenously administered phenytoin, including a faster infusion rate, decreased pain and irritation at the infusion site, and fewer cardiovascular complications. However, some studies suggest that the intravenous administration of FOS in some patients may also induce adverse cardiovascular events. Here, we investigated the clinical characteristics of patients who experienced hypotension following an intravenous infusion of a FOS loading dose...
April 24, 2017: Journal of Clinical Pharmacy and Therapeutics
https://www.readbyqxmd.com/read/28413279/comparing-slow-and-rapid-bolus-of-ephedrine-in-pregnant-patients-undergoing-planned-cesarean-section-under-spinal-anesthesia
#14
Prabu Gunasekaran, Lenin Babu Elakkumanan, Hemavathi Balachander, M V S Satyaprakash
BACKGROUND AND AIMS: While ephedrine was the preferred drug for treating spinal-induced hypotension in pregnancy, its use has declined because of resultant fetal acidosis. The objective of this randomized control trial was to compare the effects of a slow and rapid bolus of ephedrine on fetal acidosis, maternal blood pressure, and heart rate (HR) during cesarean section performed under spinal anesthesia. MATERIAL AND METHODS: Eighty full-term parturients scheduled for cesarean section under spinal anesthesia were randomly allocated into two groups...
January 2017: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/28407743/new-drugs-new-toxicities-severe-side-effects-of-modern-targeted-and-immunotherapy-of-cancer-and-their-management
#15
REVIEW
Frank Kroschinsky, Friedrich Stölzel, Simone von Bonin, Gernot Beutel, Matthias Kochanek, Michael Kiehl, Peter Schellongowski
Pharmacological and cellular treatment of cancer is changing dramatically with benefits for patient outcome and comfort, but also with new toxicity profiles. The majority of adverse events can be classified as mild or moderate, but severe and life-threatening complications requiring ICU admission also occur. This review will focus on pathophysiology, symptoms, and management of these events based on the available literature.While standard antineoplastic therapy is associated with immunosuppression and infections, some of the recent approaches induce overwhelming inflammation and autoimmunity...
April 14, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28358593/a-case-of-amoxicillin-induced-acute-generalized-exanthematous-pustulosis-presenting-as-septic-shock
#16
Katherine A McDonald, Tadeusz A Pierscianowski
This case report demonstrates the challenges of diagnosing and managing acute generalized exanthematous pustulosis (AGEP) presenting as septic shock. The disseminated, erythematous, pustular rash is a common feature. However, extensive organ involvement and life-threatening hypotension are unusual. The constellation of signs has not previously been documented following amoxicillin therapy. Toxic epidermal necrolysis (TEN) and toxic shock syndrome (TSS) were considered in addition to AGEP because of the systemic presentation...
March 1, 2017: Journal of Cutaneous Medicine and Surgery
https://www.readbyqxmd.com/read/28243591/transcranial-motor-evoked-potentials-during-spinal-deformity-corrections-safety-efficacy-limitations-and-the-role-of-a-checklist
#17
Shankar Acharya, Nagendra Palukuri, Pravin Gupta, Manish Kohli
INTRODUCTION: Intraoperative neuromonitoring (IONM) has become a standard of care in spinal deformity surgeries to minimize the incidence of new onset neurological deficit. Stagnara wake up test and ankle clonus test are the oldest techniques described for spinal cord monitoring, but they cannot be solely relied upon as a neuromonitoring modality. Somatosensory evoked potentials monitor only dorsal tracts and give high false positive and negative alerts. Transcranial motor evoked potentials (TcMEPs) monitor the more useful motor pathways...
2017: Frontiers in Surgery
https://www.readbyqxmd.com/read/28155226/propofol-versus-thiopental-sodium-for-the-treatment-of-refractory-status-epilepticus
#18
REVIEW
Hemanshu Prabhakar, Mani Kalaivani
BACKGROUND: This review is an update of a previously published review in the Cochrane Database of Systematic Reviews (Issue 6, 2015).Failure to respond to antiepileptic drugs in patients with uncontrolled seizure activity such as refractory status epilepticus (RSE) has led to the use of anaesthetic drugs. Coma is induced with anaesthetic drugs to achieve complete control of seizure activity. Thiopental sodium and propofol are popularly used for this purpose. Both agents have been found to be effective...
February 3, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28138563/ganglionic-gfap-glial-gq-gpcr-signaling-enhances-heart-functions-in-vivo
#19
Alison Xiaoqiao Xie, Jakovin J Lee, Ken D McCarthy
The sympathetic nervous system (SNS) accelerates heart rate, increases cardiac contractility, and constricts resistance vessels. The activity of SNS efferent nerves is generated by a complex neural network containing neurons and glia. Gq G protein-coupled receptor (Gq-GPCR) signaling in glial fibrillary acidic protein-expressing (GFAP(+)) glia in the central nervous system supports neuronal function and regulates neuronal activity. It is unclear how Gq-GPCR signaling in GFAP(+) glia affects the activity of sympathetic neurons or contributes to SNS-regulated cardiovascular functions...
January 26, 2017: JCI Insight
https://www.readbyqxmd.com/read/28091926/effect-of-hypotensive-drugs-on-dynamics-of-nitroxide-producing-renal-function-in-rats-with-nephrogenic-hypertension
#20
E V Eliseeva, E F Romanchenko, I V Dyuizen, A V Tyrtyshnikova, Yu I Pigolkin
An original model of nephrogenic hypertension in rats was used for histochemical mapping of NADPH diaphorase (NO synthase) in various renal segments to examine the effect of hypotensive drugs furosemide, bendazol, and clonidine on the time course of nitroxide production in the kidneys. In various nephron segments, these drugs modulated NO synthesis in different ways. Clonidine induced a stable up-regulation of NO synthesis, which can maintain active vasodilation and gradually diminish the rennin production...
January 2017: Bulletin of Experimental Biology and Medicine
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