Assessment of Complications and Hemodynaamic Stability with the Use of Dexmedetomidine with Bupivacaine

Background: Spinal block is the most commonly performedmethod for surgical treatments. Sensory block till the level ofT10 is considered promising to remove the unease formed bybladder distension. The aim of the present study was toevaluate the complications and hemodynamic stability with theusage of dexmedetomidine with bupivacaine.Materials and Methods: Patients with surgeries of spine, backinfections, neurological problems or hepatic disorders were notincluded in the study. On reaching the Operating Theatre themonitors were integrated for observing non-invasive bloodpressure, oxygen saturation and electrocardiography. Thebaseline recordings of BP, heart rate and partial pressure ofoxygen were noted. Spinal puncture was achieved at level ofL3 –L4 or L4 –L5 with 25-gauge needle at the sitting posture.All the data thus obtained was arranged in a tabulated formand analyzed using SPSS software.Results: The mean age of the subjects was 38.25+/-4.77years. Table 1 illustrates the hemodynamic parametersamongst both the groups. The preoperative pulse in Group Iwas 82.34+/- 3.54 and in group II was 83.90+/-2.65. There was1 subject each in Group I and II with nausea. There was 1subject in group II with hypotension.

Assessment of Complications and Haemodynamic Stability with the Use of Dexmedetomidine with Bupivacaine: An Institutional Based Study

Background: Lesser doses of local anesthetic in addition withadditives provides the necessary sensory level with enoughanalgesia. Dexmedetomidine is the S enantiomer ofmedetomidine that carries a high degree of specificity foradrenoreceptor. The present study was conducted with the aimto assess the complications and haemodynamic stability withthe use of dexmedetomidine with bupivacaine.Materials and Methods: The present study was conducted ina prospective manner for a period of 1 year at Department ofAnaesthesiology, Lady Hardinge Medical College & Smt. S. K.Hospital, New Delhi, India. No anesthesiologist enrolled in thepresent study was conscious of the group assigned till theentire 30 subjects were enrolled and the study was completed.After verifying a clear and free flow of the CSF, the drugadministration was completed and the subjects were placed atthe supine position. For every patient, heart rate and meanarterial pressure monitoring was done every 2 min for the initial10 minutes after spinal anesthesia, then after every 5 minutestill 30 minutes and then every 30 minutes till complete motorand sensory recovery. All the data thus obtained was arrangedin a tabulated form and analyzed using SPSS software.Probability value of less than 0.05 was regarded as significant.Results: The present study enrolled 30 subjects with15 patients in each group. The mean age of the subjects was39.22+/-4.67 years. The preoperative BP in Group I was94.67+/-8.22 and in group II was 91.52+/-5.38. There was nosignificant difference between them. There was 1 subject eachin Group I and II with nausea and shivering respectively.Conclusion: The study showed no significant alterations in thehaemodynamic stability the side effects between subjects whoreceived bupivacaine alone or bupivacaine plusdexmedetomidine.

Effect of Selective beta-1 Adrenoreceptor Blocker on Exercise Tolerance in Patients with Hypertention / 中国康复理论与实践

Objective To explore the effect of selective beta-1 adrenoreceptor blocker on exercise tolerance in patients with hyperten-sion. Methods From May, 2015 to May, 2016, 72 patients with hypertension were divided into two groups, according to whether taking the selective beta-1 receptor blocker. Group A (n=35) took the selective beta-1 receptor blocker two weeks before cardiopulmonary exercise, while group B (n=37) did not take anything at the same time. The exercise tolerance was compared between two groups. Results The maxi-mal systolic blood pressure, peak heart rate, one-minute heart rate after exercise (HR1) and rate-pressure product were lower in group A than in group B (t>2.012, P0.05). Conclusion The selective beta-1 adrenore-ceptor blocker could reduce myocardial oxygen consumption, and improve vagus nerve activity, but did not reduce exercise tolerance in pa-tients with hypertension.

β3-adrenoceptor impacts apoptosis in cultured cardiomyocytes via activation of PI3K/Akt and p38MAPK / 华中科技大学学报（医学）（英德文版）

β3-adrenoceptor (β3-AR) has been shown to promote myocardial apoptosis. However, the exact physiological role and importance of this receptor in the human myocardium, and its underlying mode of action, have not been fully elucidated. The present study aimed to determine the effects of β3-AR on the promotion of myocardial apoptosis and on norepinephrine (NE) injury. We analyzed NE-induced cardiomyocyte (CM) apoptosis by using a TUNEL and an annexin V/propidium iodide apoptosis assay. Furthermore, we investigated the NE-induced expression of the apoptosis marker genes Akt and p38MAPK, their phosphorylated counterparts p-Akt and p-p38MAPK, caspase-3, Bcl-2, and Bax. In addition, we determined the effect of a 48-h treatment with a β3-AR agonist and antagonist on expression of these marker genes. β3-AR overexpression was found to increase CM apoptosis, accompanied by an increased expression of caspase-3, bax/bcl-2, and p-p38MAPK. In contrast, the β3-blocker reduced apoptosis of CMs and the associated elevated Akt expression. We identified a novel and potent anti-apoptosis mechanism via the PI3K/Akt pathway and a pro-apoptosis pathway mediated by p38MAPK.

Neuroprotection and mechanisms of dexmedetomidine / 中国药理学通报

Dexmedetomidine( DEX) is a pure potent, highly se-lective and highly specific agonist ofα2-adrenergic receptors with sedative, analgesic and sympatholytic properties. The sedative effect mimics natural sleep of“arousable” and“cooperative” se-dation without respiratory depression. Due to the above properties and advantages, DEX has received adequate attention in clinical practice and its spectrum of application is also expanding. In re-cent years, it is proved that DEX is neuroprotective not only in animal researches but also in clinical studies. The neuroprotec-tion of DEX and its related mechanism will be briefly reviewed in this paper.

R347C Polymorphisms in ADRA1A Genes and Mirtazapine Treatment Response in Koreans with Major Depression

OBJECTIVES: Adrenergic alpha 1 and 2 receptors work as pathways to control the serotonergic neuron moderation and mirtazapine acts as antagonist of these receptors. The adrenoreceptor alpha 1a (ADRA1A) gene, which encodes adrenergic alpha 1 receptor, has Arg347Cys genetic polymorphism and the polymorphism has strong relationship with many neuro-psychiatric diseases. In this study, we explored the relationship between ADRA1A R347C polymorphism and mirtazapine treatment response in Koreans with major depression. METHODS: 352 patients enrolled in this study, and the symptoms were evaluated by 17-item Hamilton Depression Rating (HAMD-17) scale. After 1, 2, 4, 8, and 12 weeks of mirtazapine treatment, the association between ADRA1A R347C polymorphism and remission/response outcomes was evaluated. RESULTS: Treatment response to mirtazapine was significantly better in T allele carriers than C allele homozygotes after 12 weeks of mirtazapine monotherapy. The percentile decline of HAMD-17 score in T allele carriers was larger than that of C allele homozygotes. ADRA1A R347C genotypes were not significantly associated with remission. CONCLUSIONS: The result showed that treatment response to mirtazapine was significantly associated with ADRA1A R347C genetic polymorphism. T allele carriers showed better treatment response than C allele homozygotes. It can be supposed that T allele carriers have a trend of better treatment response to mirtazapine monotherapy.

Dexmedetomidine in neurosurgical anesthesia

Dexmedetomidine is a new selective alpha2-adrenoreceptor agonist that can be described as a useful, safe adjunct in neuroanesthesia and neurocritical care practice. This alpha2-adrenoreceptor agonist offers a unique "cooperative sedation" +/- anxiolysis and analgesia without respiratory depression. Cerebral effects are generally consistent with a desirable neurophysiological profile, including neuroprotective characteristics. In addition, sympatholytic and antinociceptive properties allow for hemodynamic stability at critical moments of neurosurgical stimulation. This paper reviews the pharmacokinetic profiles and current clinical uses of dexmedetomidine in the area of neurosurgery patient care.

Effects of Shen-fu on the activity of β-adrenoreceptors in cardiopulmonary resuscitation rats / 中华急诊医学杂志

Objective To study the effects of Shen-fuinjection onthe activity of β-adrenoreceptor in SD rats with cardiopulmonary resuscitation. Method The exprimerit was done at emergency medical lab of Shanghai Changzheng hospital.Cardiac arrest was induced thngh asphyxiation(succinylcholine)and ice-cold 0.5 mol/L KCI in rats,and resuscitation began at five minutes after cardiac orrest.In this experiment,seventy-two male SD rats were randomizly divided into 9 groups:control group(sham group),routine treatment(O.5 h,2 h,4 h,6 h) groups.and Shen-fu treatment(O.5 h,2 h,4 h,6 h),and each group had 8 rats.Rats of Shen-fh treatment groups were injected with shen-fu(20 mL/kg,20 mL/h)during CPR.3H-prazosln Wag used to determine the activity of β-adrenoreceptor in myocyte. The data of the statistic analysiswere presentedin the for mofmeaj14-standard(4-5)deviation.One-way ANOVA was used for muhig Toup comparison,and t-test for comprarison between two groups.Results[3-adrenoreeeptor reached peak at0.5 h after CPR(247.81±8.91)fmol/mg,reached the lowest level at 4 h(104.17 4-13.87)fmol/mg,and returned to the normal level at 6 h(178.53±10.42)fmol/mg.In the eady period.-adrenorecepter activity in control group[O.5 h:(259.91-4-18.09)finol/mJ was similar to that in Shenfu treatment groups(P>O.05).In the late phase,adrenoreeeptor activity in the Shen-fu treatment groups[2 h:(173.04±18.77)fmol/mg,4 h:(148.72±13.88)finoL/mg]was significantly hi#er than that in the control groups(P<0.05).Conclusiom After CPR, ceplor activity firstly rises and then declines,and Shenfu injection Call significantly increase adrenoreceptor activity of mrs in the later period after CPR.

Effect of Metoprolol Tartrate on Central and Peripheral Arterial Pressure in Patients with Hypertension / 中华高血压杂志

Backgroud Various antihypertensive drugs decreased peripheral arterial pressure similarly,while their effects on central arterial pressure may be at variance.The studies of the effect on central arterial pressure of antihypertensive drugs,especially the effect ? adrenoreceptor blockers was paucity.Objective To investigate the effect of ? adrenoreceptor blocker metoprolol tartrate on central and peripheral arterial pressure in patients with hypertension.Methods Fifty patients with primary hypertension who underwent percutaneous coronary angiography were recruited.Radial arterial and ascending aortal pressure as peripheral and central blood pressure were determined.Patients were chewing 25-50 mg metoprolol tartrate or 10 mg nifedipine during the catheterization.Results After administering metoprolol tartrate,the magnitude of decreases in peripheral arterial pressure were significantly(P0.025).Both peripheral and central arterial pressure decreased significantly after administering nifedipine(P0.025).Conclusion Despite similar decrease of peripheral arterial pressure,the decrease magnitude of central arterial pressure by metoprolol tartrate was significantly smaller than that by nifedipine.

Effects of CL 316243 on isolated term-pregnant rat myometrial strips in vitro / 重庆医科大学学报

Objective:To investigate the effects of the selective ?3-adrenoreceptor (AR) agonist,CL 316243,on the contractions and levels of cAMP and cGMP of myometrial strips isolated from term-pregnant rats.Methods:Salbutamol,an agonist of ?2-AR,was chosen as positive control.We evaluated the effect of increasing concentrations of CL 316243 and salbutamol on oxytocin-induced myometrialcontractions with or without metoprolol,ICI 118.551 and SR 59230A.Effects of CL 316243 and salbutamol on cAMP and cGMP levels in isolated myometrial strips were also evaluated by radioimmunoassay.Results:CL 316243 concentration-dependently decreased the amplitude of oxytocin-induced contractions with Emax value(48.13%?5.61%)ofCL316243,whichwas significantlylargerthanEmaxvalue(35.52%?5.15%)ofsalbutamol(P

Effects of norepinephrine on hepatic stellate cells apoptosis in vitro / 基础医学与临床

Objective To investigate the effects of NE on hepatic stellate cells(HSCs)apoptosis.Methods After NE and the antagonists of adrenoceptor subtypes were administered to HSCs,MTT method was used to evaluate cell proliferation.TUNEL assay and flow cytometry(FCM)were used to identify cell apoptosis.Results(1)Compared with control group,NE at concentrations of 1、10 and 100 ?mol/L induced HSCs proliferation in a time-dependent manner;The action of NE at concentrations of 10 ?mol/L reached the peak(0.262?0.085 vs 0.048?0.055,P

Study on Effect of Carvedilol on Children with Endocardial Fibroelastosis / 实用儿科临床杂志

Objective To observe the clinical effect and security of carvedilol on children with endocardial fibroelastosis(EFE).Methods Eighteen children with EFE treatment with carvedilol.The improvement of clinical symptom,heart rate,heart function,side effect and maximal tolerance dose after treatment with carvedilol were observed.Results The clinical symptom was obviously improved;eiection fraction(EF),fractional shortening(FS),mean velocity of circumferential fiber(Mvcf)were significantly increased,left ventricular end-systolic dimension(LVDS),left ventricular mass(LVmass),interventricular septal thickness(IVSs)were notably decreased after treatment with carvedilol.Conclusions The data indicates that carvedilol can significantly reduce left ventricular diastolic dimension(LVDD),IVSs,and LVmass,inhibit the remodeling of ventricle,significantly elevate the heart function of EFE.So carvedilol is benefit and security on children with EFE.

Delayed Cardiac Arrest after Brachial Plexus Block in a Patient Taking a beta-Adrenoreceptor Antagonist and Calcium Channel Blocker: A case report / 대한마취과학회지

A Bezold-Jarisch reflex (BJR) mediated vasovagal syncope is the most common neurally mediated reflex characterized by the sudden failure of the autonomic nervous system and have been reported in patients undergoing a peripheral nerve block. The concomitant administration of a beta-adrenoreceptor antagonist and calcium channel blocker have a synergistic suppressant effect on the autonomic nervous system and interact with the anesthetics significantly. We report a case of a 57-year-old female patient with essential hypertension controlled with lercanidipine and carvedilol. Cardiac arrest developed with spontaneous respiration 50 min after the brachial plexus block to remove a plate in the humerus. Epinephrine was administered and the pulse immediately returned to a normal sinus rhythm. This event might be vasovagal syncope mediated by BJR, and realted to the antihypertensive medication used.

Effets du clenbutérol sur l'expression de l'IGF-1 et des IGFPBs par les cellules musculaires C2C12

Nous avons etudie les effets du clenbuterol; un agoniste du recepteur ?2-adrenergique entrainant l'hypertrophie musculaire; sur l'expression de l'IGF-1 et des IGFBPs par les myotubes de cellules C2C12 en culture. A la concentration de 10-4 M; le clenbuterol a entraine une augmentation du niveau de l'ARN messager de l'IGF-1; IGFBP-4 et de l'IGFBP-5. L'effet sur l'IGFBP-5 est apparu apres 24h alors que les effets sur l'IGF-1 et l'IGFBP-4; plus tardifs; ont ete observes au bout de 48 heures d'incubation. Ces resultats montrent que le clenbuterol agit directement sur les cellules musculaires pour augmenter de l'expression de l'IGF-1 et des IGFBPs; mediateurs possibles de l'hypertrophie musculaire

The regulation and its mechanism of Polydatin on the ?-adrenoreceptor in cardiac myocytes stimulated by lipopolysaccharide / 中国药理学通报

Aim To observe the effect of polydatin(PD) on the activities of ?-AR in cardiomyocytes under the stimulation of LPS. Methods Cardiac myocytes were isolated and cultured from neonatal rats. Radioligand binding assay and flow cytometry were used to detect the function of ?-AR. Results In control group, the density of ?-AR (B max) was 4.14?1.41 fmol?(1?105 cells) -1 and ?-AR affinity (K d) was (4.02?0.59) nmol?L -1. In LPS group, ?-AR density was down-regulated 〔B max=1.78?0.12 fmol?(1?105 cells) -1〕 and the affinity decreased (K d=23.88?2.34 nmol?L -1). In LPS+PD group, ?-AR B max was recovered to 3.37?0.36 fmol?(1?105 cells) -1 and the affinity increased (K d=3.44?0.44 nmol?L -1). In PD group, ?-AR functions had no significant difference with normal group 〔B max=2.76?0.32 fmol?(1?105 cells) -1 and K d=4.63?1.54 nmol?L -1〕. The ?-AR amount measured by flow cytometry showed the same change tendency as the radioligand binding assay. Conclusion ?-AR activities may be down-regulated during the pathological process of LPS treatment. PD could reverse the effects of LPS by up-regulating ?-adrenoreceptors.

Genotype distributions of the 5 sites SNPs in the 3 subtypes of beta adrenoreceptor / 重庆医科大学学报

Objective:To study the genotype-by site distributions of SNP(single nucleotide polymorphisms)at the 5 sites in the 3 subtypes of beta adrenoreceptor(Beta-AR or B-AR).Methods:DNA was extracted from the peripheral venous blood of 338 subjects using Blood DNA Mini Kit.The 5 sites SNP in the 3 subtypes of Beta-AR were genotyped by PCR-RFLP(polymerase chain reaction-restriction fragment length polymorphism) and allele specified PCR techniques.Results:The natural distribution characteristics for SNP at the 5 sites in the 3 subtypes of Beta-AR of 338 subjects were gotten.The predominant phenotypes are as follows:Beta1-AR wild homozygote Ser/Ser49(70%),Beta1-AR wild homozygote Arg/Arg389(63%),Beta2-AR heterozygote Arg/Gly16(80%),Beta2-AR heterozygote Gln/Glu27(50%),Beta3-AR wild homozygote Trp/Trp64(65%).Conclusion:It is heterogeneous in distribution in different styles for the genotype-by site distribution of SNP at the 5 sites in the 3 subtypes of Beta-AR,which is the basis for further investigating the relationship among the distribution,gene function and diseases.

Differences of glucocorticoid and beta2-adrenergic receptor mRNA expression in steroid-dependent asthma / 천식및알레르기

BACKGROUND: Steroid-dependency is one of Phenotypes of severe asthma. Because steroid-dependent asthmatics require long-term systemic steroids to control their symptoms. they have potentially increased risks to experience serious events caused by systemic steroids. But the pathophysiology of steroid-dependent asthma is poorly understood. Differences of glucocorticoid and beta2-aderenergic receptor expression may have some roles in the pathophysiology of steroid-dependent asthma. OBJECTIVE: The aim of this study was to evaluate the differences of mRNA expression of glucocorticoid receptor and beta2-adrenergic receptor between the steroid-dependent severe asthmatics and those with mild-to-moderate severity. METHODS: Thirty-nine asthmatic patients were enrolled, twenty with mild-to-moderate severity and nineteen with steroid-dependent severe asthma. Induced sputum was collected using 4% hypertonic saline nebulization and total RNA was extracted from the cells collected. Using RT-PCR, we asessed the amounts of glucocorticoid receptor and beta2-adrenergic receptor mRNA semiquantitatively from the extracted RNA. RESULTS: There were no significant differences in sex, age, smoking history, duration of asthma, positive rate of atopy, and percent predicted value of FEV1 between the two groups. The amount of glucocorticoid receptor mRNA expression was significantly lower in steroid-dependent asthmatic group than in mild-to-moderate severity group(p<0.05). There was no significant difference in amount of beta2-adrenoreceptor mRNA expression between the two groups. CONCLUSION: Decreased expression of glucocorticoid receptor mRNA may have some role in the pathophysiology of steroid-dependent asthma.

The Influences of Clonidine Premedication on the A-lineTM ARX Index and Hemodynamics during Anesthesia Induction with Propofol / 대한마취과학회지

BACKGROUND:Clonidine, an alpha2-adrenergic receptor agonist, has been shown to have a sedative effect and to suppress hemodynamics when used as a premedicant. We evaluated the change of AEP index and hemodynamics after clonidine premedication and induction with propofol. METHODS:The study design was a prospective, randomized, double-blind study. 90 patients who were scheduled for elective surgery were randomly assigned in 3 groups (Group 1, 2 and 3). In groups 2 and 3, the patients were administered 2 microgram/kg or 4 microgram/kg of i.v. clonidine 30 minutes before the induction of propofol anesthesia, respectively. We measured A-lineTM ARX index (AAI), systolic blood pressure, mean arterial pressure, diastolic blood pressure and heart rate at the ward; before the administration of clonidine premedication, before induction, just before intubation and 1 minute after endotracheal intubation, and compared these parameters among the 3 groups. RESULTS:Each dose of clonidine had a suppressive effect before the induction of anesthesia and suppressed hemodynamics successfully during intubation. In groups 2 and 3, the AAI was lower than in group 1 (P < 0.05), but 7 patients had bradycardia and 3 patients had been hypotensive in group 3. CONCLUSIONS: Intravenous injection of 2 microgram/kg clonidine as a premedicant reduced AAI significantly (P < 0.05) compared to the control group, with good hemodynamic stability. Therefore, we believe that AAI can be used to predict hypnotic state during propofol anesthesia.

The Influences of Clonidine Premedication on the Bispectral Index and Hemodynamics during the Induction of Anesthesia and Endotracheal Intubation with Propofol / 대한마취과학회지

BACKGROUND: The bispectral index (BIS) has been used as an indicator of a sedative state. In this study, we investigated the influence of intravenous clonidine 2 or 3 microgram/kg on the bispectral index and cardiovascular response to anesthetic induction. METHODS: The study design is prospective, randomized and double-blind. Ninety patients scheduled to undergo elective surgery under general anesthesia were divided into 3 groups. Each group received no premedication (group 1, n = 30), clonidine 2 microgram/kg (group 2, n = 30) and clonidine 3 microgram/kg (group 3, n = 30). The sedation and responsiveness scores of the Modified Observer's Assessment of Alertness/Sedation Scale (MOAAS/S) were measured before induction and the BIS, blood pressure, and heart rate were measured at before induction, after propofol injection, and after intubation. RESULTS: The BIS was significantly lower in groups 2 and 3 than in group 1 before anesthetic induction and intubation. Mean blood pressure was significantly lower in groups 2 and 3 than in group 1 before anesthetic induction, after propofol infusion and after intubation. Heart rate was also significantly lower in groups 2 and 3 than in group 1 after intubation. The sedation score and MOAAS/S were significantly lower in groups 2 and 3 than in group 1. CONCLUSIONS: Clonidine-premedicated patients appear to maintain stable hemodynamics during anesthetic induction and intubation. The bispectral index can be objectively used in clonidine-premedicated patients when evaluating the degree of sedation.

The Effect of Doxazosin Premedication on Urinary Retention after Epidural Morphine / 대한마취과학회지

BACKGROUND: Urinary retention is the most common and distressing complication in the postoperative period after an epidural morphine administration. In this prospective placebo-controlled study, the efficacy of doxazosin on preventing urinary retention after epidural morphine was investigated. METHODS: A total of 75 males who underwent elective arthroscopic knee surgery were randomized into three groups. Patients in group I received a placebo orally before surgery. Group II patients received 4 mg of doxazosin, and group III patients received 8 mg of doxazosin. In all patients, 2 mg of epidural morphine in 6 ml normal saline was administrated by the epidural route in the L3-4 interspace. General anesthesia was induced in all patients. The volumes of the first two postoperative urine voidings, the time intervals between the end of surgery and the first micturition and the need for bladder catheterization were recorded. RESULTS: There were statistically no significant differences among the groups in the first two postoperative voidings (Group I 449 ml/445 ml, Group II 343 ml/388 ml, Group III 376 ml/380 ml). No significant differences were noted among the three groups in the mean time between the end of the surgery and the first micturition (Group I 467 minutes, Group II 440 minutes, Group III 366 minutes). Also, with urinary catheterization, there were no differences among the groups (G I6/25, G II 5/25, G III 7/25). CONCLUSIONS: Prophylactic use of doxazosin does not prevent postoperative urinary retention after epidural morphine.