ABSTRACT
<p><b>BACKGROUND</b>Awake fiberoptic intubation (AFOI) is usually performed in the management of the predicted difficult airway. The aim of this study was to evaluate the feasibility of dexmedetomidine with midazolam (DM) and sufentanil with midazolam (SM) for sedation for awake fiberoptic nasotracheal intubation.</p><p><b>METHODS</b>Fifty patients with limited mouth opening scheduled for AFOI were randomly assigned to two groups (n = 25 per group) by a computer-generated randomization schedule. All subjects received midazolam 0.02 mg/kg as premedication and airway topical anesthesia with a modified "spray-as-you-go" technique. Group DM received dexmedetomidine at a loading dose of 0.5 μg/kg over 10 min followed by a continuous infusion of 0.25 μg·kg-1·h-1, whereas Group SM received sufentanil at a loading dose of 0.2 μg/kg over 10 min followed by a continuous infusion of 0.1 μg·kg-1·h-1. As necessary, since the end of the administration of the loading dose of the study drug, an additional dose of midazolam 0.5 mg at 2-min intervals was given to achieve a modified Observers' Assessment of Alertness/Sedation of 2-3. The quality of intubation conditions and adverse events were observed.</p><p><b>RESULTS</b>The scores of ease of the AFOI procedure, patient's reaction during AFOI, coughing severity, tolerance after intubation, recall of the procedure and discomfort during the procedure were comparable in both groups (z = 0.572, 0.664, 1.297, 0.467, 0.895, and 0.188, respectively, P > 0.05). Hypoxic episodes similarly occurred in the two groups, but the first partial pressure of end-tidal CO2after intubation was higher in Group SM than that in Group DM (45.2 ± 4.2 mmHg vs. 42.2 ± 4.3 mmHg, t = 2.495, P < 0.05).</p><p><b>CONCLUSIONS</b>Both dexmedetomidine and sufentanil are effective as an adjuvant for AFOI under airway topical anesthesia combined with midazolam sedation, but respiratory depression is still a potential risk in the sufentanil regimen.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Conscious Sedation , Methods , Dexmedetomidine , Therapeutic Uses , Double-Blind Method , Fiber Optic Technology , Methods , Hypnotics and Sedatives , Therapeutic Uses , Intubation, Intratracheal , Methods , Midazolam , Therapeutic Uses , Sufentanil , Therapeutic Uses , WakefulnessABSTRACT
Objective: To observe the L-Arg (L-arginine) transport, the nitric oxide (NO) production, and NO synthase (NOS) activity in platelets, investigate the significance of the L-Arg-NO system in the pathogenesis of microvascular angina (MVA), and to study the reversing effects of intravenous L-Arg infusion on L-Arg transport. Methods: The 3H-L-Arg transport, NO production, and NOS activity in platelets were examined in 15 patients with MVA and 15 healthy controls. The 15 patients were given intravenous L-Arg infusion (20 g/d) after basic physical examination and were examined again 10 days later. Results: The L-Arg transport in platelets of MVA patients was obviously lower than that in the normal group; the maximum transport velocity (Vmax) decreased by 34. 4% compared with the normal group (P<0.01); and the Michaelis constant (Km) increased by 21.4% (P<0.05). The production of NO2- and the activity of NOS in platelets were decreased by 47.1% (P< 0.05) and 25.4% (P<0.05) compared with the normal group, respectively. Intravenous L-Arg infusion reversed the above changes in MVA patients; it increased the Vmax by 11.9% (P<0.01) and decreased Km by 18% (P<0.05); it also increased production of NO2- by 1.33 folds (P<0.05) and NOS activity by 1.2 folds (P<0.05). Especially, the attack of angina and patient ECG were greatly improved after intravenous L-Arg infusion. Conclusion: L-Arg-NO pathway is impaired in MVA patients, which might be responsible for the endothelium-dependent vascular relaxation in MVA patients. Intravenous L-Arg infusion may benefit the impaired function of L-Arg-NO transport in patients with MVA.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the chronic effects of intracoronary autologous bone marrow mononuclear cell (BM-MNCs) transplantation in patients with refractory heart failure (RIHF) after myocardial infarction.</p><p><b>METHODS</b>Thirty patients with RIHF (LVEF < 40%) were enrolled in this nonrandomized study, autologous BM-MNCs (5.0 +/- 0.7) x 10(7) were transplanted with via infarct-related coronary artery in 16 patients and 14 patients received standard medical therapy served as control. Baseline and follow up evaluations included complete clinical evaluations, plasma BNP, ANP, ET-1 measurements, echocardiography, PET, and Holter monitoring.</p><p><b>RESULTS</b>Baseline characteristics were similar between the 2 groups. There were no major periprocedural complications. One patient developed ventricular premature contractions during cell infusion for several seconds and recovered spontaneously. Compared to pre-transplantation, plasma BNP and ET-1 significantly decreased and plasma ANP significantly increased at 7 days post transplantation; 6 minutes walking distance increased from (72.1 +/- 31.5) to (201.6 +/- 23.3) m (P < 0.01), LVEF increased 9.9% (P < 0.001) and FDG-PET revealed vital myocardium area increased (10.3 +/- 3.4)% (P < 0.01) at 3 months after BM-MNCs transplantation. At 6 months follow up, the NYHA class improved from (3.4 +/- 0.1 to 2.4 +/- 0.2, P < 0.001) and no patient died and 1 patient rehospitalized due to lower extremities edema. In control group, LVEF decreased 7.2% compared to baseline (P < 0.001) and was significantly lower than transplantation group at 3 months (P < 0.001). At 6 months follow up, the NYHA class increased from (3.5 +/- 0.1 to 3.9 +/- 0.1, P < 0.05), 2 patients died and 10 patients rehospitalized due to aggravated heart failure.</p><p><b>CONCLUSION</b>Present study demonstrates that intracoronary transplantation of autologous BM-MNCs is safe and effective for treating patients with RIHF after myocardial infarction.</p>