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Benzodiazepines are among the most commonly used drugs in the field of anesthesia. Remazolam is a newly developed ultra-short-acting benzodiazepine, which has the characteristics of rapid onset, rapid recovery, high safety, and less side effects such as hypotension and respiratory depression. The aim of this review is to summarize the progress of pharmacokinetics, clinical pharmacology mechanism of action and clinical application of remazolam.
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OBJECTIVE To explore the effects of ADRB2 gene regulatory region polymorphism on the efficacy of short-acting beta 2 receptor agonists （SABA） in the treatment of acute asthma attack in children. METHODS A total of 127 children with acute mild to moderate bronchial asthma who received SABA treatment for 7 days in the General Hospital of Northern Theater Command from October 2016 to October 2020 were selected to detect their genotype distribution and compare the improvement of pulmonary functional indicators and curative effect among different genotypes. The effect of the high-order interaction of gene polymorphism on therapeutic effect was investigated. RESULTS Among 127 children， there were 80， 44 and 3 cases of TT， TA and AA types at locus rs2895795， 93， 32 and 2 cases of CC， CG and GG types at locus rs11168070， and 41， 64 and 22 cases of GG， GA and AA types at locus rs12654778， respectively， in accordance with Hardy-Weinberg equilibrium （P＞0.05）. After treatment， the improvement rate of the peak expiratory flow in percent predicted value （PEF%pred） and the improvement rate of the forced expiratory flow at 75% vital capacity in percent predicted value （FEF75%pred） in children with TA type were significantly lower than that of TT type at locus rs2895795 （P＜0.05）； the improvement rates of PEF%pred and FEF75%pred in children with CG type were significantly lower than that of CC type at locus rs11168070 （P＜0.05）； the improvement rates of PEF%pred in children with GA and AA type were significantly lower than that of GG type at locus rs12654778 （P＜0.05）. The differences in fractional exhaled nitric oxide before and after treatment were not statistically significant among different genotypes at each locus （P＞0.05）. The proportion of remarkable improvement of children with TT type at locus rs2895795 was 2.358 times that of children with TA+ AA type （P＜0.05）， and there was no significant effect of higher-order interaction of ADRB2 polymorphism on the efficacy in children with asthma （P＞0.05）. CONCLUSIONS Polymorphisms in the regulatory region of the ADRB2 gene in children with bronchial asthma are associated with the efficacy of SABA in the treatment of acute asthma attack in children. At locus rs2895795， rs11168070 and rs12654778， the improvement of lung function of children with wild-type is more obvious， and the efficacy of SABA treatment on children with TT type is better at locus rs2895795.
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Presentamos el caso de un paciente con una tenosinovitis piógena del 5° dedo de la mano, tratado inicialmente con desbridamiento quirúrgico y antibioterapia empírica. La evolución fue desfavorable, pues el dedo presentaba un defecto de cobertura con signos infecciosos en la herida y las curas resultaban muy dolorosas. Al paciente se le ofertaron varias opciones quirúrgicas y, mientras se decidía por alguna, aceptó por escrito iniciar curas con sevoflurano líquido tópico (según protocolo vigente para uso de fármacos fuera de indicación). El efecto analgésico del sevoflurano apareció rápidamente, y la evolución posterior de la herida fue muy favorable, pues los signos infecciosos desaparecieron y el defecto de cobertura se había cerrado tras tres semanas de empleo de sevoflurano tópico, sin necesidad de nuevas cirugías. Este caso ejemplifica que el uso fuera de indicación de sevoflurano tópico para tratar heridas complejas puede evitar actuaciones quirúrgicas, mucho más agresivas para los pacientes.
The clinical case is presented on a patient suffering from pyogenic tenosynovitis affecting the 5th finger of the hand, which was initially treated with surgical debridement and empirical antibiotic treatment. The clinical outcome was unfavourable, since the finger presented with a coverage defect, and the wound seemed to be infected. Wound cleaning and dressings were very painful. The patient was asked to choose between several surgical therapeutic alternatives, but he gave written informed consent to be treated with topical sevoflurane, following an approved protocol for the off-label use of this drug. Pain was accurately controlled after sevoflurane application, and the wound exhibited a very good outcome with disappearance of the clinical signs of infection and complete closure of the defect coverage after three weeks of sevoflurane, with no new surgical procedures. The present clinical case illustrates how the off-label use of topical sevoflurane for the treatment of complicated wounds could be useful to avoid surgical procedures that are more aggressive for patients.
Subject(s)
Humans , Sevoflurane , Tenosynovitis , Wound Infection , Analgesics, Short-Acting , Pain Management , Anti-Infective Agents, LocalABSTRACT
Objective: The present study was conducted to determine the level of awareness about the difference between short-acting opioid (SAO) and rapid-onset opioid (ROO) formulation. Methods: A questionnaire survey was conducted to evaluate levels of awareness regarding the definition of cancer breakthrough pain, how to use the ROO formulation, and the difference between SAO and ROO formulation among physicians, nurses, and pharmacists. The surveillance period is between December 1, 2017 and December 31, 2017. Results: We received responses from 35 physicians, 102 nurses, and 171 pharmacists. The awareness of the difference between SAO formulation and ROO formulation across all occupation groups was approximately 3.8 in 11 steps from 0 to 10. Regarding the appropriate use of the ROO formulation, there was a tendency for variation among respondents in awareness about items referring to “the starting dose” and “the starting dose does not depend on the daily dose of the opioid analgesic administered on time.” Conclusion: The results of the present study suggest that it is necessary for each healthcare professional to reconfirm their knowledge of ROO formulation in the future and ensure appropriate administration.
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Objective:To investigate the effect of different dosage forms of gonadotropin-releasing hormone agonist(GnRH-a) on in vitro fertilization-embryo transfer(IVF-ET) in patients with mild endometriosis.Methods:Totally 269 cycles(175 cases) of IVF-ET were included,which was divided into three groups:pro-long protocols (long acting 3.75 mg group,102 cycles),long protocols (long acting 1.875 mg group,87 cycles) and short protocols(short-acting 0.1 mg group,80 cycles).The clinical results were compared among groups.Results:The amount of gonadotropin(Gn) were significantly higher in pro-long protocol than the other ones.The implantation rate and clinical pregnancy rate were significantly higher in long acting 1.875mg group than the other two protocols (P ＜ 0.05).Conclusions:Long protocol (long acting GnRH-a down-regulation,1o 875 mg) may be more beneficial to improve the implantation rate and clinical pregnancy rate of in vitro fertilization-embryo transfer(IVF-ET) in patients with endometriosis.
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Los broncodilatadores beta 2 agonistas (B2A), forman parte muy importante en la farmacoterapia del asma bronquial, enfermedad que avanza en el mundo, de manera epidémica. Los B2A, son prescritos a millones de personas en el mundo, por consiguiente; los aspectos de seguridad son de interés público. Los broncodilatadores B2A de acción corta (Short-Acting B2 Agonists o SABA) como salbutamol inhalatorio, según las evidencias actuales, confirman su seguridad, en su uso como fármaco de rescate o a demanda. Los broncodilatadores B2A de acción prolongada (Long-Acting B2 Agonists o LABA), se utilizan asociados a corticoides inhalatorios, como medicamentos controladores de exacerbaciones de accesos asmáticos, por razones de seguridad los LABAs se usan asociados a corticoides inhalatorios...
Beta 2 agonist bronchodilators (B2A) are very important part in the pharmaco therapy of bronchial asthma, a disease that progresses in the world in an epidemic way. The B2A are prescribed to millions of people around the world, there fore the safety aspects is of public interest. Short-Acting B2 Agonists (SABAs), such as albuterol inhaler, according to current evidence, have confirmed their safety when used as a quick-relief or rescue medication. The long-acting B2 agonists (LABAs) are used associated with inhaled corticosteroids as controller drugs for asthma exacerbations, for safety reasons LABAs are used associated with inhaled corticoid...
Subject(s)
Humans , Asthma/therapy , Bronchodilator Agents/therapeutic useABSTRACT
PURPOSE: Correct use of inhaler devices is fundamental to effective asthma management but represents an important challenge for patients. The correct inhalation manoeuvre differs markedly for different inhaler types. The objective of this study was to compare outcomes for patients prescribed the same inhaler device versus mixed device types for asthma controller and reliever therapy. METHODS: This retrospective observational study identified patients with asthma (ages 4-80 years) in a large primary care database who were prescribed an inhaled corticosteroid (ICS) for the first time. We compared outcomes for patients prescribed the same breath-actuated inhaler (BAI) for ICS controller and salbutamol reliever versus mixed devices (BAI for controller and pressurised metered-dose inhaler [pMDI] for reliever). The 2-year study included 1 baseline year before the ICS prescription (to identify and correct for confounding factors) and 1 outcome year. Endpoints were asthma control (defined as no hospital attendance for asthma, oral corticosteroids, or antibiotics for lower respiratory tract infection) and severe exacerbations (hospitalisation or oral corticosteroids for asthma). RESULTS: Patients prescribed the same device (n=3,428) were significantly more likely to achieve asthma control (adjusted odds ratio, 1.15; 95% confidence interval [CI], 1.02-1.28) and recorded significantly lower severe exacerbation rates (adjusted rate ratio, 0.79; 95% CI, 0.68-0.93) than those prescribed mixed devices (n=5,452). CONCLUSIONS: These findings suggest that, when possible, the same device should be prescribed for both ICS and reliever therapy when patients are initiating ICS.