Clinico-Epidemiological Profile of Scorpion Sting in a Tertiary Care Centre in South Tamil Nadu

Introduction: Venomous scorpion sting is a medicalemergency. The clinical manifestations vary widely betweenthe children and adult group. Current research aimed to studythe epidemiological profile of Scorpion Stings and to study theclinical profile and prevalence of complications of Scorpionstings.Material and methods: 82 cases of Scorpion sting admittedin Toxicology unit of Tirunelveli Medical College werestudied. Detailed history was taken, and a thorough clinicalexamination was done in all patients. All patients were givenPrazosin except in cases with hypotension.Results:Scorpion sting was more common in monsoonfollowed by Summer season. The sting was more prevalent inthe lower limb. Commonest symptom was pain followed bynumbness and tingling. Dyspnea and perspiration were lesscommon. 60.9% had grade1 envenomation followed by 25.7%patients with grade 2 envenomation. Severe envenomationwas less common. Tachycardia was frequently noted (62.2%)whereas only 3 patients developed pulmonary edema. Allpatients recovered well, and there was nil mortality.Conclusion:Prazosin had good outcome in all patients withscorpion sting. The study throws light on the common clinicalfeatures and complications of scorpion sting.

Effect of α1-adrenergic signaling pathway on doxorubicin-induced apoptosis in cardiomyocytes / 上海交通大学学报（医学版）

Objective • To investigate the effects of α1-adrenergic receptor agonist phenylephrine (Phe) and antagonist prazosin (Pra) on cardiomyocyte apoptosis induced by doxorubicin (DOX). Methods • H9C2 cardiomyocytes were divided into 4 groups. Except for the control group incubated with medium alone, all other groups were treated with 1.8 μmol/L DOX. For agonist group and antagonist group, 0.1 mmol/L Phe and 10 μmol/L Pra were added respectively in DOX-treated cells. After culture for 24 h, flow cytometry and TUNEL assay were performed to detect the apoptosis rate. Western blotting was used to detect the expression of cleaved caspase 3. Real-time PCR was used to detect the expression of anti- and pro-apoptotic Bcl-2 family genes. CCK-8 assay was used to detect the cell viability. Results • The DOX-induced apoptosis was inhibited by Phe with decreased apoptosis rate of H9C2 and decreased expression of cleaved caspase 3, but promoted by Pra. Increased expression of Bcl-2 and Bcl-w and decreasedexpression of Bax and Bad at mRNA levels were found in agonist group in comparison with the cells treated with DOX alone; while decreased expression of Bcl-2 and Bcl-w and increased expression of Bax and Bad were found in antagonist group. The cell viability after 24 h of treatment with agonist was higher than cells treated with DOX alone, but no signifiant difference was found in cell viability between antagonist group and DOX group. Conclusion • α1-Adrenergic signaling pathway may be involved in endogenous myocardial protection in the process of cardiomyocyte apoptosis induced by DOX.

Preparation and physicochemical characterization of prazosin conjugated PLGA nanoparticles for drug delivery of flutamide

In the current work, a sustained drug delivery system of flutamide (FLT) was developed using Poly(D,L-lactide-co-glycolide) (PLGA) decorated bypoly(ethylene glycol) (PEG) grafted prazosin (PLGA-PEG-Praz) as a targeting moiety. In a multi-step reaction, PLGA was linked to PEG and prazosin. The structure of the synthesized polymers was confirmed by FTIR and 1H-NMR. Flutamide-loaded nanoparticles were prepared by quasi-emulsion solvent diffusion technique. The nanoparticles were evaluated for size, zeta potential, polydispersity index, drug crystallinity, loading efficiency, and release properties. Also, the physicochemical properties of the nanoparticles were analyzed using Scanning Electron Microscopy (SEM), Differential Scanning Calorimetry, and Powder X-Ray Diffractometry (XRD). The particle size of nanoparticles was ranged between 191 and 249 nm. Loading efficiency of nanoparticles was about 43%-69%. Results showed a steady release rate for nanoparticles compared to that of a pure drug powder. SEM characterization confirmed that particles were in nanosize range. DSC and XRPD results verified a decrease in drug crystallinity in the prepared formulations. In conclusion, the results of this study showed that PLGA-PEG-Praz nanoparticles could be a good choice to improve the physicochemical properties of the drug and these formulations can increase Flutamide efficacy.

Effect of prazosin on MMP-1 and TIMP-1 expression in atherosclerosis plaque of ApoE -/- mice model / 重庆医学

Objective To observe the effects of prazosin on matrix metalloproteinase‐1(MMP‐1) and tissue inhibitor of met‐alloproteinase 1 (TIMP‐1) expression in atherosclerosis plaque of ApoE knock‐out(ApoE-/- ) mice model and to explore its anti‐atherosclerotic effect and mechanism .Methods Twenty‐four 8‐week‐old ApoE-/- mice were randomly divided into the normal diet group ,high‐fat diet group and prazosin group ,8 cases in each group .The normal diet group was fed by common fodder ,while the high fat group and prazosin group were fed by high fat diet ;on the basis of the high fat diet ,the prazosin group was started to con‐duct gavage of prazosin hydrochloride 1 mg/kg every day ,while the normal diet group and the high fat diet group were daily ga‐vaged by the same volume of normal saline .The abdominal aortic venous blood after 12 weeks in each group was collected for detec‐ting the blood lipid levels .The aorta arterial blood sample was collected for detecting MMP‐1 and TIMP‐1 expression levels by im‐munohistochemistry .Results Compared with the high fat diet group ,the levels of serum TG ,TC and LDL‐C in the prazosin group were significantly decreased ,and the HDL‐C level was increased ,the differences were statistically significant (P< 0 .01 or P<0 .05);the area of aorta arterial atherosclerotic plaque and intima thickness were significantly increased ,while prazosin could signif‐icantly inhibit the plaque formation and intima hyperplasia ;compared with the normal diet group ,the expression level of MMP‐1 protein in the high fat diet group and prazosin group was significantly increased ,while the TIMP‐1 protein expression level was de‐creased ,moreover the MMP‐1 protein expression level in the prazosin group was lower than that in the high fat diet group ,while the TIMP‐1 protein expression level was higher than that in the high fat diet group ,the differences were statistically significant (P<0 .05) .Conclusion Prazosin can decrease the level of TC and LDL‐C ,increase the HDL‐C level and has certain anti‐atherosclerotic effect ,its mechanism may be related with the decrease of the MMP‐1 level and the increase of the TIMP‐1 level in plaque .

Study of α1 adrenoceptor-mediated vasoconstriction and protein expressions induced by mmLDL in mouse mesenteric artery / 中国药理学通报

Aim To investigate the effects of mmLDL on the up-regulation ofα1 receptors in moues mesenter- ic arteries. Methods Mice tail intravenous injection of mmLDL was used . Vitro sensitive myograph was empl- oyed to examine Noradrenaline ( NA) induced vascular contraction on mice mesenteric artery, and the mRNA and protein expressions ofα1 andα2 receptors were an-alyzed by real-time PCR and Western blot, respective-ly. Results mmLDL significantly increased NA in-duced concentration-contractile curve, and the data of Emax and pEC50 were from ( 122. 61 ± 9. 40 )% and (5. 65 ± 0. 05 ) in normal saline ( NS ) group to (161. 01 ± 6. 90 )% and ( 6. 20 ± 0. 08 ) in mmLDL group (P tion-contractile curve induced by NA towards right. Af-ter using mmLDL, the mRNA and protein levels of α1 adrenoceptor were significantly increased, but the mR-NA and protein levels of α2 adrenoceptor were not changed. Conclusion Tail intravenous injection of mmLDL enhances the vascular expressions of α1 adre-noceptors and the contractile effects mediated byα1 ad-renoceptors.

Determination of hydrochlorothiazide, prazosin hydrochloride, promethazine hydrochloride, reserpine, and nifedipine illegally added into Qingnao Jiangya Tablets by HPLC method / 中草药

Objective: To set up an HPLC method for the determination of hydrochlorothiazide, prazosin hydrochloride, romethazine hydrochloride, reserpine, and nifedipine illegally added into Qingnao Jiangya Tablets (QJT). Methods: HPLC method was used. Octadecyl silane bonded silica as a filler (APOLLO C18 column, 250 mm × 4.6 mm) was used with the mobile phase consisting of water containing 0.02% phosphoric acid and acetonitrile in gradient mode. The flow rate was 1.0 mL/min, column temperature was 25℃, and detection wavelength was set at UV 251 nm. Results: The calibration curve showed the good linearity for hydrochlorothiazide, prazosin hydrochloride, romethazine hydrochloride, reserpine, and nifedipine in the ranges of 21.24-2 124.0 ng (r = 1.000 0), 16.184-1 618.4 ng (r = 1.000 0), 19.72-1 972.0 ng (r = 1.000 0). 18.976-1 897.6 ng (r = 1.000 0), and 22.504-2 250.4 ng (r = 1.000 0), respectively; The average recovery rates (n = 6) were 100.93%, 101.61%, 103.07%, 97.58%, and 96.36%, respectively; RSD values were 1.52%, 1.21%, 1.08%, 0.73%, and 0.48%, respectively. Conclusion: The accurate and reproducible method can be used for the determination of hydrochlorothiazide, prazosin hydrochloride, romethazine hydrochloride, reserpine, and nifedipine illegally added into QJT.

Impact of Metabolic Syndrome on Response to Medical Treatment of Benign Prostatic Hyperplasia

PURPOSE: To investigate the effect of metabolic syndrome (MetS) on the response to medical therapy of benign prostatic hyperplasia (BPH) after a 3-month period of treatment. MATERIALS AND METHODS: This was a cohort study of 100 patients, 47 with MetS and 53 without MetS, referred to either the primary care unit or referral hospital with BPH who had moderate lower urinary tract symptoms of prostate involvement and were candidates for medical treatment. Our main outcome was response to medical treatment with prazosin 1 mg twice a day and finasteride 5 mg daily in patients with BPH on the basis of International Prostate Symptom Score (IPSS). Multivariate analysis of covariance was used to compare BPH treatment response in patients with and without MetS before and after receiving treatment. RESULTS: The mean volume of the prostate was significantly higher in MetS patients than in patients without MetS (57+/-32.65 mL compared with 46.00+/-20.19 mL, p=0.036). The control group demonstrated an 11-unit reduction in IPSS, whereas those with MetS showed a reduction in the symptom score of only 6 units (p<0.001). Regarding the components of MetS separately, triglyceride (p<0.001), fasting blood sugar (p=0.001), and waist circumference (p=0.028) significantly affected the clinical progression of BPH. The observational nature of this study may be a limitation in comparison with an interventional study. CONCLUSIONS: The results of the present study showed that MetS can negatively affect the response to medical treatment of BPH. Therefore, it is necessary to consider MetS in selecting patients with BPH for drug therapy.

Subtherapeutic Dose of Prazosincan Ameliorate Metformin Induced Lactic Acidosis in Renal Compromised Rats.

Incidence of lactic acidosis caused by metformin is rare but this can occur in renal compromised individuals because of metformin accumulation. The drug enters the liver through organic cationic transporter 1(OCT1) and reduces oxygen consumption in mitochondria resulting in reduced lactate clearance and lactic acidosis. In the present study, we investigated that inhibition of the transport of metformin in the liver could reduce the blood lactate levels. Eighteen healthy male albino rats were selected for the study. Group 1- control group included 6 rats, they were given normal saline for 10 days by i.p injection. Group 2- Twelve rats were induced nephrotoxicity by gentamicin at the doses of 40mg/kg given by i.p. route . Group 3- six rats from group 2 were given metformin according to human doses of 1000mg/day and group 4- included six rats from group 2 received metformin and prazosin at subtherapeutic dose i.e. according to 1mg/day human dose. Blood urea, serum creatinine and total urinary albumin were found to be significantly.

Prazosina de liberação lenta para pacientes com transtorno do estresse pós-traumático resistentes aos ISRS / Slow-release prazosin for SSRI-resistant posttraumatic stress disorder patients

CONTEXTO: Prazosina, um antagonista de receptores alfa-1 adrenérgicos, é utilizada no tratamento de pesadelos e insônia relacionados com TEPT. Apesar das evidências sugerindo sua eficácia também no tratamento de sintomas gerais de TEPT, sua curta meia-vida (2-3 horas) pode limitar seus efeitos terapêuticos.OBJETIVO: Descrever quatro casos de pacientes com TEPT resistentes aos inibidores de recaptação de serotonina ou de serotonina e adrenalina (terapia convencional) tratados com uma apresentação de prazosina de liberação lenta.MÉTODOS: Quatro pacientes com TEPT grave, resistentes à terapia convencional, tiveram a prazosina de liberação lenta (meia-vida de 10,8 horas) adicionada as suas prescrições por pelo menos três meses. Os sintomas de TEPT foram avaliados pela PCL-C e pelos itens referentes a pesadelos e insônia da CAPS, na linha de base e no final do período de observação de cada paciente.RESULTADOS: Dois pacientes mostraram melhora dos sintomas gerais de TEPT (redução de 35,7% e 11,9% nos escores da PCL-C), e três mostraram melhora de pesadelos e insônia (nos escores da CAPS). O único paciente que recebeu doses da prazosina pela manhã e ao deitar-se foi o que mostrou a maior melhora dos sintomas gerais de TEPT.CONCLUSÃO: Possivelmente, a sustentação do bloqueio da atividade noradrenérgica no sistema nervoso central promovida pela prazosina de liberação lenta durante o dia se faz necessária para a melhora de sintomas residuais de TEPT em pacientes em tratamento convencional com antidepressivos.

BACKGROUND: Prazosin is an antagonist of alpha-1 adrenergic receptor used to treat PTSD-related nightmares and insomnia. Although evidence suggests that it is also effective in the treatment of general symptoms of PTSD, its short half-life (2-3 hours) may limit its therapeutic effects.OBJECTIVE: To describe four cases of patients with PTSD resistant to selective serotonin reuptake inhibitors (SSRIs) or selective serotonin/noradrenaline reuptake inhibitor (SNRIs) therapy (conventional therapy) treated with slow-release prazosin presentation.METHODS: Four patients with severe PTSD resistant to conventional therapy received slow-release prazosin (half-life of 10.8 hours) added to their prescription for at least three months. PTSD symptoms were evaluated by the PCL-C, together with nightmares and insomnia items of CAPS, at baseline and at the last observation of each patient.RESULTS: Two patients showed improvement in general symptoms of PTSD (reduction of 35.7% and 11.9% in PCL-C scores), and three showed relief from nightmares and insomnia (CAPS scores). The only patient who received morning and bedtime doses of prazosin showed the greatest improvement in general symptoms of PTSD.DISCUSSION: It is possible that the sustained blockade of noradrenergic activity in the central nervous system provided by slow-release prazosin during the day is necessary to further ameliorate residual PTSD symptoms in patients receiving conventional antidepressant therapy.

Pheochromocytoma in children and adolescents.

Eleven subjects aged <20 yr with histologically proven pheochromocytoma between 1987 and 2006 were analyzed. Family history was present in 18%. In 2 patients, pheochromocytoma was part of VHL and in one it was associated with MEN 2. Twenty four hour urine VMA level was elevated in 100% and metanephrine level in 73%. CT/ MRI were showing the tumor in all. Prazosin extended release tablets (maximum 30 mg/day) were used in 73% and doxazosin (maximum 12 mg/ day) in 27%. Intraoperative BP fluctuations were seen in 27%. All were biochemically cured after surgery. Preoperative á blockade with extended release prazosin and doxazosin were effective in controlling perioperative BP fluctuations. Hence these drugs can be used in children and adolescents without fear of postoperative hypotension.

Inhibitory Effect of Fentanyl on Phenylephrine-Induced Contraction of the Rat Aorta

PURPOSE: Fentanyl was reported to inhibit the alpha1-adrenoceptor agonist-induced contraction. The goal of this in vitro study was to identify the alpha1-adrenoceptor subtype primarily involved in the fentanyl-induced attenuation of phenylephrine-induced contraction in isolated endothelium-denuded rat aorta. MATERIALS AND METHODS: Aortic rings were suspended in order to record isometric tension. Concentration-response curves for phenylephrine (10-9 to 10-5 M) were generated in the presence or absence of one of the following drugs: fentanyl (3x10-7, 10-6, 3x10-6 M), 5-methylurapidil (3x10-8, 10-7, 3x10-7 M), chloroethylclonidine (10-5 M) and BMY 7378 (3x10-9, 10-8, 3x10-8 M). Phenylephrine concentration-response curves were generated in the presence or absence of fentanyl in rings pretreated with either 3x10-9 M prazosin, 10-9 M 5-methylurapidil or 3x10-9 M BMY 7378. RESULTS: Fentanyl (10-6, 3x10-6 M) attenuated phenylephrine-induced contraction in the rat aorta. 5-Methylurapidil and BMY 7378 produced a parallel rightward shift in the phenylephrine concentration-response curve. The pA2 values for 5-methylurapidil and BMY 7378 were estimated to be 7.71 +/- 0.15 and 8.99 +/- 0.24, respectively. Fentanyl (10-6 M) attenuated phenylephrine-induced contraction in rings pretreated with 10-9 M 5-methylurapidil, but did not alter the rings when pretreated with 3x10-9 M BMY 7378. Pretreatment of the rings with chloroethylclonidine showed a 72.9 +/- 2.3% reduction in phenylephrine-induced maximal contraction. CONCLUSION: The results suggest that fentanyl attenuates phenylephrine-induced contraction by inhibiting the pathway involved in the alpha1D-adrenoceptor-mediated contraction of the rat aorta.

Acute Pulmonary Edema for Surgical Removal of Pheochromocytoma: A case report / 대한마취과학회지

This report describes the perioperative management of an adrenergic crisis and intraoperative pulmonary edema occurring during planned surgery for pheochromocytoma. We experienced the anesthetic management of a 45-year-old male patient with pheochromocytoma on the extra-adrenal retroperitoneum. The patient had been treated with prazosin for only 1 week before surgery. After inducing anesthesia with intravenous remifentanil, thiopental sodium, and rocuronium, anesthesia was maintained with nitrous oxide, oxygen, and isoflurane administration. The blood pressure was poorly controlled with sodium nitroprusside, esmolol, and remifentanil after manipulating the tumor. Pulmonary edema occurred intraoperatively but subsided with positive end expiratory pressure and the use of diuretics and morphine. After removing the tumor, the blood pressure was well controlled using a colloid solution, Hartman's solution, and dopamine administration. This complication occurred because of inadequate preoperative preparation. We reported this case of surgery for the removal of a pheochromocytoma with a review of the relevant literature.

Effecet of intrathecal injection of 6-OHDA or ?_1-adrenoceptor antagonist on the spinal analgesia of ketamine / 中国药理学通报

Aim To investigate the relationship between spinal cord noradrenergic neurons ? 1 adrenoceptors and the spinal analgesia of ketamine. Methods Kunming mice were used. Analgesia tests were investigated with warm water tail flick test. The effects of intrathecal injection (ith) of ketamine (50,100,200 ?g)on tail flick latency of animals were observed. And the effect of pretreatment with intrathecal 6 hydrodoapa(6 OHDA, 6?g ) and ? 1 adrenoceptor antagonist prazosin (5, 15 ?g) or terazosin (5, 15 ?g) , respectively on the spinal analgesia of ketamine (100 ?g,ith) was studied. Results Dose dependent analgesia was observed following ith ketamine (100,200 ?g, P

Morphological study of uveoscleral pathway following topical Prazosin in free-sympathetic rabbit eyes / 中华实验眼科杂志

ObjectiveTo observe the morphology of the uveoscleral pathway following topical Prazosin（PZ） in rabbit free-sympathetic eyes．MethodsThe one lateral superior cervical ganglionectomy（SCG） were preformed on each rabbit．PZ drops were installed only on the SCG eyes on 14 days Postoperationly．Microamounts of fluorescein isothiocyanate-bovine serum albumin（FITC-BSA） was infused into anterior chamber of rabbit eyes as the teacer，two rabbits in each group were killed at 2，4，6，8，10，and 12h after PZ instillation．Degress of fluorescent intensity of ciliary body，suprachoroidal space，anterior and posterior sclera，and choroid were observed under fluorescence microscopy．ResultsThe IOP of the SCG eyes was lower after installation of PZ．But the reduced extent is below that of normal rabbit eyes；After installation of PZ，the fluorescent intensity of the ciliary body，suprachoroidal space，anterior and posterior sclera，and choroid was less stronger than the control eyes，but fader than at the same area of the normal eyes obviously．ConclusionThe outflow effects of PZ drops on increasing uveoscleral pathway were obviously decreased in the SCG eyes．It depends on the activity of sympathetic nerve system partially．Besides，there are other mechanisms．

The effect of prazosin as a first-line therapy for the symptomatic benign prostatichypertrophy / 대한비뇨기과학회지

We evaluated 41 patients with symptomatic benign prostatic hypertrophy who were treated with prazosin alone more than 3 months. Among them, 21 patients( 51.2%) showed improvement of both symptom score and maximal flow rate. There was the similar effectiveness on the patients with acute urinary retention as on the patients without retention. The pretreated prostate volume and prostate specific antigen were not statistically different between the responders and nonresponders.After with drawl of the medication, almost all patients immediately complained of the symptoms worsened again. So, we concluded that the d-blocker can be used as a first-line therapy in selected patients with symptomatic benign prostatic hypertrophy with temporal effect.

Preventive effects of prazosin for urinary retention after epidural anesthesia / 대한비뇨기과학회지

Prazosin blocks the alpha-1 adrenergic receptor of sympathetic nerve. The effects of prazosin in patient with epidural lumbar anesthesia were analyzed with blind test. In a prospective randomized study, we compared a group of 25 patients who received prazosin with a control group of 58 patients. Forty-one( 70.7 %) of 58 patients developed acute urinary retention. In 11 of 25 patients(44 %), who were medicated with prazosin(3mg. per 18 hours) urinary retention was noted ( p >0.05). Mean catheterization rate in urinary retented patients was 1.61 in control group(41 cases), and was 1.27 in prazosin medicated group( 11 case) (p <0.05). Prazosin is an effective drug not only to prevent acute urinary retention but also to reduce the need for catherization.

The Studies on the Epinephrine - Induced Arrhythmias During Halothane Anesthesia in Dogs / 대한마취과학회지

It is known that the concurrent administration of epinephrine, whether applied subcutaneously or parenterally during halothane anesthesia, can result in the initiation of ventrieular arrhythmias, which may be life threatening. However the mechanism by which halothane sensitizes the heart to catecholamines are not known yet. The purpose of this study was to investigate the mechanism of epinephrine induced cardiac arrhythmias during 1.2 MAC halothane anesthesia in dogs. Thirty-eight dogs were randomly assigned to five groups, halothane anesthesia were measured the arrythmogenic doses of epinephrine(ADE) before and after each treatment with sodium nitroprusside (SNP) (n=9), lidocaine(n=7), propranolol(n=7), prazosin(n=7) and verapamil(n=8), and compared each other. The results were follows. 1) The control ADE to induce ventricular arrhythmias was 2.160.15 ug/kg/min. 2) Treatment with SNP resulted in a decrease(28%) in mean blood pressure, but did not increase the ADE compared to the control. 3) Lidocaine and propranolol significantly increased the control ADE by 1.5 times, respectively, but there was no different between the ADE of lidocaine and that of propranolol. 4) Prazosin and verapamil also significantly increased the control ADE by 3.3 times and 2.6 times respectively, and the increased amplitudes were significant greater than the effect noted after lidocaine or propranolol treatment. There results suggest that the mechanism of epinephrine-induced cardiac arrhythmias during halothane anesthesia is mainly mediated via alpha-1 receptor and calcium channel, and alpha-1 blocker and calcium channel blocker may be useful to prevent the epinephrine-induced cardiac arrhythmias during halothane anesthesia.

Clinical Evaluation of Anesthetic Management for Pheochromocytoma Following Prazosin Pre-treament / 대한마취과학회지

Perioperative management of patients with pheochromocytoma is challenging. Accordingly, proper preoperative preparation is important. Prazosin, a selective alpha I blocker, may offer a potential advantage. This 54-year-old woman was treated with prazosin 2 mg, b.i.d. for 15 days and also with propranolol 20 mg, b.i.d. for a few days intermittently before the proposed surgery. Both symptoms and blood pressure were well controlled effectively. Induction of anesthesia was accomplished with nitrolingual spray, fentanyl 100 ug, 1% idocaine 50 mg, 2.5% thiopental sodium 200 mg, vecuronium 6 mg and 100% O2-enflurane. During the surgical and anesthetic procedure, the patient showed a reduced incidence of excessive blood-pressure variations and no arrhythmia was present except for supraventricular ectopic beats. Conclusively, we believe that careful preoperative preparation is recommended to minimize intraoperative hemodynamic dieturbances and their sequelae.

Anesthetic Experience of a Patient with Pheochromocytoma - A case report / 대한마취과학회지

We have experienced an anesthetic management of a 39-year-old male patient with pheo-chromocytoma on left adrenal gland. The patient had been treated with prazosin for 2 weeks preoperatively and premedicated with lorazepam, diazepam and glycopyrrolate. Following induction of anesthesia with intravenous diazepam, fentanyl, thiopental sodium and vecuronium, endotracheal intubation was performed. After intubation, anethesia was maintained with O2-N2O-isoflurane and vecuronium. Blood pressure until tumor removal had been controlled with sodium nitroprusside and phentolamine. After tumor resection, blood pressure was controlled by Hartmanns solution, whole blood and dopamine administration. A tolerable blood pressure and pulse rate were maintained throughout the procedure.

Eficácia anti-hipertensiva e tolerabilidade do cloridrato de prazosina de liberaçäo lenta. Estudo multicêntrico brasileiro / Anti-hypertensive efficacy and tolerability of sustained-release prazosin hydrochloride. A Brazilian multicenter study

Objetivo: Avaliar o efeito anti-hipertensivo e a tolerabilidade de dose única diária de cloridrato de prazosina de liberaçäo lenta (SR). Casuística e Métodos: 1393 portadores de hipertensäo arterial sistêmica primária (HAS) leve (644 pacientes e moderada (749 pacientes), com média etária de 47,63 anos, sendo 745 (53,52%) do sexo masculino, 1011 (72,84%) brancos e 279 (20,1%) negros. De acordo com protocolo multicêntrico aberto näo comparativo, os pacientes receberam cloridrato de prozosina SR em dose inicial de 1 mg, ajustada até máximo de 6 mg, de acordo com a resposta (objetivo = pressäo arterial diastólica (PAD) < ou = 90 mmHg), por prazo de 4 semanas. Resultados: A dose média diária foi de 2,08 mg, em tomada única. Ao final do estudo, 1274 (91,46%) pacientes atingiram PAD < ou = 90 mmHg, sendo 624 do grupo HAS leve e 650 do HAS moderada. O número de pacientes sob controle nas 3 primeiras semanas foi de 426 (1ª semana), 844 (2ª semana) e 1147 (3ª semana). APAD reduziu-se da média de 104 ñ 5 mmHg para a de 88 ñ 8 mmHg (p < 0,05). A freqüência cardíaca variou da média de 82 ñ 9 bpm pré-tratametno para 80 ñ 8 bpm na 4ª semana. Reaçöes adversas foram reconhecidas em 377 (27,06%) pacientes, total de 444 eventos, sendo mais freqüente a associaçäo de vertigem, tontura e lipotímia. Apenas 8 (2,12%) pacientes necessitaram reduzir as doses de cloridrato de prazosina SR e 5 (1,32%) tiveram de abandonar o estudo pelos efeitos indesejáveis da droga. Conclusäo: Cloridrato de prazosina SR em tomada única diária parece ser real avanço no tratamento da HAS leve e moderada, facilitando-o sem perda da eficácia e com boa tolerabilidade

Purpose: To evaluate the efficacy and tolerability of a single daily dose of sustained-release (SR) formulation of prazosin hydrocloride. Patients and Methods: 1393 outpatients in a multicenter open comparative trial. 644 patients had mild hypertension and 749 patients had moderate hypertension. The mean age was 47.63 years, 745 (53.52%) were male, 1011 (72.84%) white and 279 (20.1%) black. The patients received prazosin hydrocloride SR during 4 weeks in an initial dose of 1 mg, adjusted to a maximum of 6 mg in order to decrease the diastolic blood pressure (DBP) to 90 mmHg or less. Results: The mean daily dose was 2.08 mg. At the end of the study, 1274 (91.46%) patients had DBP £ 90 mmHg or less. 624 patients were in the mild hypertension group and 650 patients were in the moderate hypertension group. The number of patients under DBP control in the first three weeks was 426 (first week), 844 (second week) and 1147 (third week). The DBP decreased from the mean value of 104 ± 5 mmHg to 88 ± 8 mmHg (p < 0.05)’. The mean heart rate ranged from 82 ± 9 beats/min (pre-treatment) to 80 8 beats/min (fourth week). Adverse effects were identified in 377 (27.06%) patients, total of 444 episodes, the more frequent being dizziness. Only 8 (2.12%) patients had to reduce the doses of prazosin hydrocloride SR and 5 (1.32% ) had to discontinue the treatment on account of the adverse effects of the drug. Conclusion: Prazosin hydrocloride SR in a single daily dose seems to be an advance in the treatment of patients with mild and moderate hypertension.