Effect of different induction techniques on the inflammatory response in pediatric cardiac surgery

Many drugs administered for the purposes of anesthesia and sedation, possess potentially important immunomodulatory effects. Most data in this area is experimental. However, developments in this emerging field are worthy of consideration in the light of their future therapeutic potential. This study was designed to determine the effect of using different induction drugs on adhesive molecules plus the anti-inflammatory cytokine 5nterleukin-10 [IL-10] in pediatrics undergoing cardiac surgeries. 45 pediatric 0.1]. Starting after induction [T2] till 4 hours after operation [T6], Ketamine and sevoflurane groups showed significant lower serum soluble intercellular adhesion molecule-1 [sICAM] level compared with Etomidate groups [P <0.0001]. There were statistically increased IL-10 level in ketamine group at T4, T5, T6, compared to the other two groups. Conclusion: In contrast to etomidate anesthesia, ketamine and sevoflurane reduce the up-regulation of slCAM-1 level; therefore the inflammatory response can be attenuated. Only ketamine can potentiate the anti-inflammatory defense through increasing the IL-10 in pediatric patients undergoing cardiac surgeries

Comparative study between the effects of clevidipine and nitroglycerine in patients with pulmonary hypertension undergoing mitral valve replacement

Pulmonary hypertension [PHT] is commonly found in patients undergoing mitral valve replacement [MVR]. Various pharmacologic agents have been used to decrease the pulmonary artery pressure in pulmonary hypertensive patients. Clevidipine is a third-generation IV dihydropyridine calcium channel blocker, specific arterial dilator, with rapid onset and offset. The aim of the present study was to compare between the effects of clevidipine and nitroglycerine on pulmonary and systemic hemodynamics as well as pulmonary oxygenation. Thirty patients with PHT scheduled for elective MVR were enrolled in this study and randomly allocated into 2 groups. Patients received either nitroglycerin infusion at 0.25-10 microg/kg/min [NTG group] or clevidipine infusion at 0.4-8 microg/kg/min [CLV group]. Pulmonary and systemic hemodynamic parameters as well as oxygenation data were measured after induction of anesthesia, after weaning from CPB before the start of the study medication, and after 30 minutes, 2 hours, and 4 hours from the start of the study medication. The incidence of postoperative atrial fibrillation and total ICU and hospital length of stays were also recorded. The mean pulmonary artery pressure [MPAP], pulmonary vascular resistance [PVR], pulmonary capillary wedge pressure [PCWP], mean arterial blood pressure [MAP], and systemic vascular resistance [SVR] were significantly lower in the CLV group compared to the NTG group. In both groups, these parameters were significantly lower at 30 min, 2 hours, and 4 hours after drug administration compared to pre-drug administration values. There was no statistical significant change in the heart rate [HR] in the CLV group, however, it was significantly increased at 30 min, 2 hours, and 4 hours after drug administration compared to pre-drug administration values in the NTG group. The cardiac index [Cl] was significantly increased at 30 min, 2 hours, and 4 hours after drug administration compared to pre-drug administration values in CLV group and was statistically higher than NTG group. There was a non significant decrease in the PaO[2]/Fi0[2] and no significant change in PaCO[2] and SvO[2] at 30 min, 2 hours, and 4 hours after drug administration compared to pre-drug administration values in both groups with no statistical difference between the two groups. Clevidipine is a valuable alternative to nitroglycerine in the treatment of PHT in patients undergoing MVR as it showed better pulmonary and systemic hemodynamic profiles and did not worsen pulmonar] oxygenation

prognostic value of alveolar recruitment strategy during the intra and postoperative periods in off pump coronary artery bypass surgery

In Off Pump Coronary Artery Bypass [OPCAB] surgery, there is a high incidence of deterioration in lung mechanics and arterial oxygenation. This study aimed at assessing the effect of alveolar recruitment on lung mechanics and oxygenation in patients undergoing OPCAB surgery. In this study, we performed a randomized controlled trial between 2 groups of patients undergoing OPCAB surgery. Group A: patients received a PEEP of 5 cm H20 only. Group 3: Alveolar Recruitment Strategy [ARS] was applied after finishing the proximal anastomotic procedure and repeated in the postoperative period in the ICU. The ARS consisted of raising the peak inspiratory Pressure [PIP] to 30 cm H20 and setting PEEP at 10 cm H20 and maintaining them for 1 minute. Then, both PIP and PEEP were increased to 40 and 15 cm H20 respectively and maintained for another minute. After arrival to the ICU, all patients received 5 cm H20 PEEP, then after 1 hour, the patients received either PEEP only or with the same previous strategy as in O.R. to their groups. In the OR, lung compliance as well as arterial oxygenation were measured after induction of anesthesia, before, and after setting both PEEP and ARS. In the ICU, arterial oxygenation was measured before both PEEP and ARS, as well as one and four hours later. Postoperative pulmonary complications including hypoxemia, hypercapnia, atelectasis, prolonged intubation, pulmonary congestion, pulmonary infection, total ICU stay and mortality werq recorded. There was a significant rise in lung compliance and arterial oxygenation in the ARS [Group B] than in the PEEP group [Group A]. As regards the Arterial Oxygen Tension, there was a continuous statistically significant rise in group B than in group A, 30 minutes after starting the ARS in the OR, before starting the ARS in the ICU, 30 minutes, 1 and 4 hours later [206.5 +/- 23.9,192.2 +/- 23.5, 250.7 +/- 31.9, 211.9 +/- 21.3 mmHg and 195.3 +/- 24.5 mm/Hg respectively in group B versus 126.9 +/- 10.1, 128.7111.6, 129.1 +/- 10.4, 129.8 +/- 9.4 mmHg and 130.1 +/- 9.7 mm/Hg respectively in group A] [P< 0.0001]. Additionally, there was a marked reduction in the postoperative hypoxemia, hypercarnia, atelectasis, prolonged intubation, infection and prolonged ICU stay in the ARS group. OPCAB patients in whom there is a reduction in lung compliance owing to the large volumes of intravenous fluids and compression of the right chest by the rotated heart during revascularization of the postero-lateral coronary vessels, applying an ARS in those patients greatly improves lung mechanics and arterial oxygen tension

Effects of dexmedetomidine in morbidly obese patients undergoing laparoscopic gastric bypass

Obese patients may be sensitive to the respiratory depressant effect of opioid analgesics. Alternative methods for analgesia may be beneficial for management of bariatric surgery. We evaluated the effect of dexmedetomidine on anesthetic requirements during surgery, hemodynamic, recovery profile and morphine use in the postoperative period. Eighty adult patients scheduled for elective laparoscopic Roux-en-Y gastric bypass surgery were randomly assigned to one of two study groups; Group D [40 patients] received dexmedetomidine [0.8-micro g/kg bolus, 0.4 micro g.kg[-1]. h[-1] and Group P [40 patients] received normal saline [placebo] in the same volume and rate. Intraoperative and postoperative mean blood pressure and heart rate were recorded. The total amount of intraoperative fentanyl and propofol required to maintain anesthesia were measured. Recovery profile, pain score and total amount of morphine used via patient controlled analgesia [PCA] were assessed. During surgery, dexmedetomidine decreased the total amount of intraoperative fentanyl and propofol required for maintenance of anesthesia compared to placebo. Patients who received dexmedetomidine showed significant decrease of intraoperative and postoperative mean blood pressure, heart rate. In the postoperative period, dexmedetomidine decreased pain scores and PCA morphine use significantly and showed better recovery profile as compared to the placebo group. There was no difference in the incidence of postoperative nausea and vomiting [PONV] between both groups. The intraoperative infusion of dexmedetomidine decreased the total amount of propofol and fentanyl required to maintain anesthesia, offered better control of intraoperative and postoperative hemodynamics, decreased postoperative pain level, decreased the total amount of morphine used and showed better recovery profile compared with placebo

Fused pyrimidines synthesis and anti-inflammatory testing of certainnovel imidazo [1,2-c] quinazoline, pyrimido [2,1-a] phthalazine derivatives

A number of heterocyclic compounds containing pyrimidine nucleus, namely, imidazo[l,2-c]quinazolines, pyrazolo[3,4-d]triazoIo[3.4-b]pyrimidines and pyrimido[2,1-a] phthalazines has been synthesized. Acidic moieties that characterize most of nonsteroidal antiinflammatory drugs [NSAIDs] or ester groups, as potential pro-drug functionaIities, have been incorporated. The potency of eight compounds to inhibit carrageenin-induced paw edema in rats has been evaluated

Synthesis of novel thiazolopyrimidine and thiazolothiatriazine derivatives

The synthesis and characterization of several substituted thiazolopyrimidines and thiazolothiatriazines are described. 2-Amino-4-arylthiazoles were cyclized with ethyl cyanoacetate and chlorosulphonyl isocyanate to provide the target compounds. Two of the synthesized compounds were evaluated for their antiinflammatory activity. Thiazole derivatives are associated with diverse pharmacological and biological activities such as antibacterial[1-3] antifungal[4] anthilmintic[5-8], antiinflammatory[9-14], antiallegric [15] antianginal[16] and diuretic activities[17]. This work describes the synthesis and the structure elucidation of novel fused thiazolopyrimidine and thiazolothiatriazine derivatives

Conductometric determination of some pharmaceutically important thiol compounds

A simple and sensitive electro-analytical method was developed for the determination of five pharmaceutical compounds containing thiol group; namely, N-acetylcysteine, captopril, D-penicillamine, 6-mercaptopurine and thioguanine. By utilizing the reaction of the thiol group with silver ions, small amounts of the studied compounds were determined conductometrically in aqueous medium using silver nitrate as titrant. The mean percentage recoveries ranged from [100.3 +/- 0.9] to [100.84 +/- 0.74]. The proposed method was successfully applied to the determination of the studied compounds in dosage forms, and the results were in good agreement with those obtained using the official methods

Synthesis of certain 1,5-diazepine derivatives of expected CNS depressant activity

A series of compounds of fused 1,5-diazepine structure, 3-substituted by an arylhydrazono group: 7-methyl-3-arylhydrazono-1,5-benzodiazepin 2-ones [7-12] and 3-arylhydrazono-pyrido [2,3-b] 1,5-diazepin-2-ones [13-18] have been synthesized, with special incorporation of fluoro, trifluoromethyl and methylmercapto functions at the arylhydrazono moiety. The pharmacological screening of these new compounds is under investigation

Synthesis of certain 2-aminoadamantane derivatives as potential antimicrobial agents

Several 2-aminoadamantane derivatives that incorporate pyrimidine or s-triazine moiety were synthesized. 2-[2-adamantylguanidino]-5- arylhydrazono-6-methyl-4-pyrimidinone [2a,b], 2-[a-adamantylamino]- 4-amino-s-triazine and its 6-chloromethyl derivative [3a,b] were prepared by cyclization of 1-[2-adamantyl] biguanide HCl [1] with ethyl 2-arylhydrazono-3-oxobutyrates [A], ethyl formate and ethyl chloroacetate, respectively; where 1-[2-adamantyl]-3-[4,5-dioxo-2-imidazoli-dinylidene] guanidine [4] was used as intermediate for the preparation of amides [5a,b], hydrazide [7] and azomethine derivatives [8a,b] of alkyl 2-[2-adamantylamino]-4-amino-s-triazine-6-carboxylates [5a,b]. The antimicrobial testing of the prepared compounds proved that compound [8b] was the most active. It showed a marked bacteriostatic effect against Staphylococcus aureus and Bacillus subtilis

Synthesis of certain 1,3,4oxadiazoles, 1,2,4-triazoles and 1,3,4-thiadiazoles as potential chemotherapeutic agents

A series of five membered heterocycles namely 5-substituted-4-acetyl-2-[2-chloro-4 nitrophenyl]- 1,3,4-oxadiazolines 6-10, 4-substituted aminomethyl-2-[2-chloro-4-nitrophenyl]-1,3,4-oxadiazoline-5-thiones 12-15, 2-substituted-5-[2-chloro-4-nitrophenyl]-1,3,4-oxadiazoles 22-27, 4-substituted-3-[2-chloro-4-nitrophenyl]-5-phenyl-1,2,4-triazoles 28-30 and 2-substituted amino-5-[2-chloro-4-nitro-phenyl]-1,3,4-thiadiazoles 36-40, were synthesized. Eight representative compounds were tested for their invitro antimicrobial activity against some pathogenic microorganisms, some of them were proved to be active

Studies on the synthesis of certain sulphur compounds as antimicrobials, antishistosoma and Molluscidies

Interaction of 3, 3-dimercapto-1-[2-thienyl]-2-propen-1-one [I] with alkylhalides, acid chloride gave the S, S-disubstituted derivatives [II, IV], condensation of [I] with aldehydes afforded different products according to the reagent used. In concentrated hydrochloric acid it gives the dithioacetals [V]; while in glacial acetic acid, the chalcone [VI] was the unexpected product. Sulphurization of [I] with P4S10 afforded 5 [2-thienyl]-1,2-dithiacyclopenten-3, thione [VII] in a satisfactory yield; while bromination of [VII], followed by boiling in water gave 5 [2-thienyl]-1, 2-dithiacyclopenten-3-one [IV]. Bromination of [IX] yielded the 4-bromoderivative [X] which on treating with methanolic potassium hydroxide hydrolyses and through interreaction, 2, 5-di [2-thienyl]-1, 4-dithiacyclohexadiene-3, 6-dicarboxylic methylester [IX] was collected. Desulphurization of [XV] followed by alkaline hydrolysis gave 2, 4-di [2-thienyl] thiophene 3, 5-dicarboxylic acid [XVIII]. Oxidative cyclization of furfurylidene thiosemicarbazone gave 2-amino-5 [2-furyl]-1, 3, 4- thiadiazole [XIX] which on treating with isocyanates; namely, naphthyl, and/or cyclohexyl gave the disubstituted ureas [XX]. Condensation of disubstituted urea derivative with bromoethylacetate or/and chloroacetyl chloride obtained the imidazolidinone derivative [XXI], while with dibromoethane yielded the hedantoin derivative [XXII], screening of most derivatives showed activities

2,4-bis [substituted] -5nitropyrimidines of expected diuretic action

Interest in pyrimidine diuretics have been intensified, since the discovery of the diuretic action of xanthines. A large series of pyrimidine derivatives was prepared, and its diuretic activity has been established. Also, several sulphonamides and disulphonamides are potent carbonic anhydrase inhibitors and effective diuretic agents. Therefore, this work describes the synthesis of new 2,4-bis [substituted]-5-nitro-pyrimidine derivatives, some of them include the sulphonamide moiety, which are expected to possess biological activity as diuretic agents

Synthesis and spectroscopic studies of Novel type of unsaturated sugars

Reaction of carboethoxy acetonylidene triphenyl phosphorane [A] with aldehydo and keto sugars [la-d] led to the formation of the corresponding carboethoxy acetonylidene derivatives [2a-d], which constitute useful synthetic intermediates. Their spectroscopic data indicated the unique E configuration between the two olefinic protons and the presence of a keto enol equilibrium, in which the enolic structure stabilized by celation. Conversion of [2a] into a new type of 3 substituted coumarin [3] was established

Alkyl malonamido ester derivatives and their analogues

The chemical reactivity of methylene group of I was examined through diazocoupling. IR spectra of the obtained products 1 a-e exclude the possibility of the presence of the diazo tautomer [from a] in equilibrium with the hydrazo tautomer [from b], which is the more stable thermodynamically. The B aminobutyrate 2 was found to exist in equilibrium 2 reversible reaction 2a. Aliphatic aldehydes adds to the NH of the B aminocrotonate tautomer 2a resulting in the corresponding 1,3 oxazine derivatives 3a and b. The alkyl malonamido sugars 4 and 5 was obtained by the direct cylation of II and III, respectively. 4 was easily converted to 3 substituted coumarin 6, while methyl malonamidoaziridine derivative 5 did not. The reactivity of the methylene groups was discussed. The IR and H-NMR data were examined in details