The effect of epinephrine for the treatment of spinal-hypotension: comparison with norepinephrine and phenylephrine, clinical trial / O efeito de epinefrina, norepinefrina e fenilefrina no tratamento da hipotensão pós-raquianestesia: estudo clínico comparativo

Abstract Background and objectives: Limited data are present on safety and efficiency of epinephrine for the prophylaxis and treatment of spinal-hypotension. This study was conducted to compare the effect of epinephrine with norepinephrine and phenylephrine on the treatment of spinal-hypotension and ephedrine requirement during cesarean delivery. Methods: One hundred and sixty parturients with uncomplicated pregnancies undergoing elective cesarean delivery under spinal anesthesia were recruited. They were allocated randomly to receive norepinephrine 5 µg.mL−1 (n = 40), epinephrine 5 µg.mL−1 (n = 40), phenylephrine 100 µg.mL−1 (n = 40) or 0.9% saline infusions (n = 40) immediately after induction of spinal anesthesia. Whenever systolic blood pressure drops to less than 80% of baseline, 5 mg of intravenous ephedrine was administered as rescue vasopressor. The incidence of hypotension, total number of hypotension episodes, the number of patients requiring ephedrine, the mean amount of ephedrine consumption and side effects were recorded. Results: There was no statistically significant difference in incidence of maternal hypotension between groups. The number of patients requiring ephedrine was significantly greater in group saline than in group phenylephrine (p< 0.001). However, it was similar between phenylephrine, norepinephrine, and epinephrine groups. The mean ephedrine consumption was significantly higher in group saline than in norepinephrine, epinephrine, phenylephrine groups (p= 0.001). Conclusion: There is no statistically significant difference in incidence of hypotension and ephedrine consumption during spinal anesthesia for cesarean delivery with the use of epinephrine when compared to norepinephrine or phenylephrine. Epinephrine can be considered an alternative agent for management of spinal hypotension.

Resumo Justificativa e objetivos: Existem dados limitados sobre segurança e eficiência da epinefrina na profilaxia e tratamento da hipotensão arterial associada à raquianestesia. O presente estudo foi realizado para comparar o efeito da epinefrina com norepinefrina e fenilefrina no tratamento da hipotensão após raquianestesia e necessidade de efedrina durante o parto cesáreo. Método: Foram recrutadas 160 parturientes com gestações não complicadas, submetidas a cesariana eletiva sob raquianestesia. Elas foram alocadas aleatoriamente para receber norepinefrina 5 µg.mL-1 (n = 40), epinefrina 5 µg.mL-1 (n = 40), fenilefrina 100 µg.mL-1 (n = 40) ou infusão de solução fisiológica NaCl a 0,9% (n = 40) imediatamente após a indução da raquianestesia. Sempre que houvesse redução da pressão arterial sistólica para valor inferior a 80% da linha de base, 5 mg de efedrina iv eram administrados como vasopressor de resgate. A incidência de hipotensão, o número total de episódios de hipotensão, o número de pacientes que necessitaram de efedrina, o consumo médio de efedrina e os efeitos colaterais foram registrados. Resultados: Não houve diferença estatisticamente significante na incidência de hipotensão materna entre os grupos. O número de pacientes que necessitaram de efedrina foi significantemente maior no grupo solução fisiológica do que no grupo fenilefrina (p< 0,001). No entanto, foi semelhante entre os grupos fenilefrina, norepinefrina e epinefrina. O consumo médio de efedrina foi significantemente maior no grupo solução fisiológica do que nos grupos norepinefrina, epinefrina e fenilefrina (p = 0,001). Conclusão: Não houve diferença estatisticamente significante na incidência de hipotensão e consumo de efedrina durante raquianestesia para parto cesáreo com uso de epinefrina quando comparada à norepinefrina ou fenilefrina. A epinefrina pode ser considerada como agente alternativo para o tratamento da hipotensão após raquianestesia.

The antimicrobial activity of ephedrine and admixture of ephedrine and propofol: an in vitro study / A atividade antimicrobiana de efedrina e da combinação de efedrina e propofol: um estudo in vitro

Abstract Introduction Propofol and Ephedrine are commonly used during anesthesia maintenance, the former as a hypnotic agent and the later as a vasopressor. The addition of propofol to ephedrine or administration of ephedrine before propofol injection is useful for decreasing or preventing propofol related hemodynamic changes and vascular pain. This in vitro study evaluated the antibacterial effect on common hospital-acquired infection pathogens of ephedrine alone or combined with propofol. Material and method The study was performed in two stages. In the first, the Minimum Inhibitory Concentration of propofol and ephedrine alone and combined was calculated for Escherichia coli, Enterococcus faecium, Staphylococcus aureus, Pseudomonas aeruginosa, and a clinical isolate of Acinetobacter spp. at 0, 6, 12 and 24 h, using the microdilution method. In the second stage, the same drugs and combination were used to determine their effect on bacterial growth. Bacterial solutions were prepared at 0.5 MacFarland in sterile 0.9% physiological saline and diluted at 1/100 concentration. Colony numbers were measured as colony forming units.mL-1 at 0, 2, 4, 6, 8, 10 and 12th hours. Results Ephedrine either alone or combined with propofol did not have an antimicrobial effect on Escherichia coli, Enterococcus faecium, or Pseudomonas aeruginosa and this was similar to propofol. However, ephedrine alone and combined with propofol was found to have an antimicrobial effect on Staphylococcus aureus and Acinetobacter species at 512 mcg.mL-1 concentration and significantly decreased bacterial growth rate. Conclusion Ephedrine has an antimicrobial activity on Staphylococcus aureus and Acinetobacter species which were frequently encountered pathogens as a cause of nosocomial infections.

Resumo Introdução Propofol e efedrina são fármacos comumente usados durante a manutenção da anestesia, o primeiro como agente hipnótico e o segundo como vasopressor. A adição de propofol à efedrina ou a administração de efedrina antes da injeção de propofol é útil para diminuir ou prevenir alterações hemodinâmicas e dor vascular relacionadas ao propofol. Este estudo in vitro avaliou o efeito antibacteriano de efedrina, isolada ou em combinação com propofol, em patógenos comuns implicados em infecção hospitalar. Material e método O estudo foi feito em duas etapas. Na primeira, a concentração inibitória mínima (CIM) de propofol e de efedrina isolada e em combinação foi calculada para Escherichia coli, Enterococcus faecium, Staphylococcus aureus, Pseudomonas aeruginosa e um isolado clínico de Acinetobacter spp às 0, 6, 12 e 24 horas, com o método de microdiluição. Na segunda etapa, o mesmo fármaco e sua combinação foram usados para determinar seus efeitos no crescimento bacteriano. As soluções bacterianas foram preparadas em soro fisiológico a 0,9% em 0,5 McFarland e diluídas a uma concentração de 1/100. Os números das colônias foram medidos como ufc.mL-1 às 0, 2, 4, 6, 8, 10 e 12 horas. Resultados Efedrina isolada ou em combinação com propofol não apresentou efeito antimicrobiano sobre E. coli, E. faecium ou P. aeruginosa, um resultado semelhante ao de propofol. Porém, efedrina isolada e em combinação com propofol apresentou efeito antimicrobiano sobre Staphylococcus aureus e Acinetobacter spp, em concentração de 512 mcg.mL-1, e redução significativa da taxa de crescimento bacteriano. Conclusão Efedrina tem atividade antimicrobiana em S. aureus e Acinetobacter spp, patógenos frequentemente identificados como causa de infecções nosocomiais.

Spinal anaesthesia for cesarean delivery; study of different doses of IV ephedrine as prophylaxis to prevent hypotension during

To determine the effective dose of intravenous ephedrine for the prevention of hypotension during spinal anesthesia for cesarean delivery. A randomized, double-blinded dose finding study. The study was carried out in Combined Military Hospital Gujranwala from March 2009 to March 2010. Total patients were 80 full term women who were randomly allocated into four groups and were given Ringer lactate 10 ml per kg body weight intravenously. One minute after the spinal injection, patients were given saline control or ephedrine 0.1 mg per kg body weight, 0.25mg per kg body weight, or 0.4mg per kg body weight for 30 seconds. The study period started at the time of spinal injection and continued for 15 minutes. Systolic arterial pressure and heart rate were recorded at 1 -min intervals. Side effects like hypotension, hypertension, tachycardia, bradycardia, nausea and vomiting were also recorded. Total rescue ephedrine and total dose of used ephedrine in all groups were measured. Neonates were assessed by APGAR score. There was less incidence of hypotension in the ephedrine 0.4mg per kg body weight and 0.25 mg per kg body weight group as compared with ephedrine 0.1 mg per kg body weight and the control group, 5[25%], 13[65%] vs. 16[80%], 18 [90%] respectively. Systolic arterial pressure [SAP] in the first 15 min after the spinal injection was statistically significant greater in the 0.4mg per kg body weight group compared with other groups [P <0.001]. Reactive hypertension occurred in 9[45%] in the 0.4mg per kg group, compared with control group, 0[0%], ephedrine 0.1 mg, 1[5%] and ephedrine 0.25 mg 3[15%] patients. The Heart rate in the first 15 minutes in the ephedrine 0.4mg per kg body weight and 0.25 mg per kg body weight group was statistically significant higher than those of ephedrine 0.1 mg per kg body weight and control group [P<0.001]. The incidence of tachycardia was more in ephedrine 0.4 mg per kg body weight and 0.25 mg per kg body weight groups as compared to ephedrine 0.1 mg per kg body weight and the control group, 9 [45%], 6 [30%] vs. 3 [15%], 2 [10%] respectively. There were significant decrease in total doses of rescue ephedrine required in the ephedrine 0.4mg per kg body weight group as compared to other three groups. Total doses of used ephedrine in all groups were similar. We conclude that although ephedrine 0.25 mg per kg body weight reduces the hypotension but the smallest effective dose of ephedrine to reduce the incidence of hypotension significantly was 0.4mg per kg body weight

The Effects of Intravenous Ephedrine During Spinal Anesthesia for Cesarean Delivery: A Randomized Controlled Trial

We designed a randomized, double-blinded study to determine the efficacy and safety of 0.5 mg/kg intravenous ephedrine for the prevention of hypotension during spinal anesthesia for cesarean delivery. Patients were randomly allocated into two groups: ephedrine group (n=21) and control group (n=21). Intravenous preload of 15 mL/kg lactated Ringer's solution was given. Shortly after the spinal injection, ephedrine 0.5 mg/kg or saline was injected intravenous for 60 sec. The mean of highest and lowest heart rate in the ephedrine group was higher than those of control group (P<0.05). There were significant lower incidences of hypotension and nausea and vomiting in the ephedrine group compared with the control group (8 [38.1%] vs. 18 [85.7%]); (4 [19%] vs. 12 [57.1%], respectively) (P<0.05). The first rescue ephedrine time in the ephedrine group was significantly longer (14.9+/-7.1 min vs. 7.9+/-5.4 min) than that of the control group (P<0.05). Neonatal outcome were similar between the study groups. These findings suggest, the prophylactic bolus dose of 0.5 mg/kg intravenous ephedrine given at the time of intrathecal block after a crystalloid fluid preload, plus rescue boluses reduce the incidence of hypotension.

Control hemodinámico con fenilefrina en anestesia espinal para cirugía de rodilla / Hemodynamic control with phenylephrine in spinal anesthesia during knee surgery

Antecedentes: La anestesia espinal es utilizada en cirugías ortopédicas, pero produce hipotensión arterial en 10-40 por ciento de los pacientes. El uso de fenilefrina en infusión profiláctica ha permitido mantener la presión arterial durante el parto, pero no hay estudios en cirugías de reemplazo de rodilla. Objetivos: Evaluar el efecto de la infusión continua profiláctica de fenilefrina sobre la presión arterial sistólica (PaS), media (PaM) y diastólica (PaD), y la frecuencia cardíaca (FC) en cirugía de implante protésico de rodilla, comparado con placebo. También se evaluaron: la reposición de fluidos, los episodios de hipotensión y bradicardia, y los requerimientos de efedrina. Lugar de realización: Servicio de Anestesiología del Hospital Italiano de Buenos Aires. Diseño: Ensayo clínico, aleatorizado, controlado con placebo, doble ciego. Población: Se incluyeron 30 pacientes sometidos a reemplazo protésico de rodilla. Métodos: Se aleatorizaron al grupo F (bomba con infusión profiláctica con fenilefrina, n = 15) o al grupo P (solución fisiológica, n = 15). Se realizo bloqueo femoral y anestesia espinal. Las variables hemodinámicas se evaluaron en hora basal, inicio de infusión y a los 3, 6, 15, 30, 45 y 60 minutos posbloqueo. Resultados: No se encontró diferencia significativa entre los grupos en cuanto a PaS, PaM, PaD y FC. Tampoco en relación con el número de episodios de hipotensión, bradicardia, administración de efedrina, ni en los requerimientos de fluidos administrados. Conclusiones: En pacientes con anestesia espinal, la infusión profiláctica de fenilefrina no disminuyó la magnitud de la hipotensión posbloqueo, en comparación con placebo, durante la cirugía de implante protésico de rodilla.

Background: Spinal anesthesia is used in orthopedic surgery but it produces arterial hypotension in 10-40 per cent of patients. The use of prophylactic infusion of phenylephrine could maintain arterial pressure during cesarean delivery, but no tests were carried out during knee replacement surgery. Objective: Evaluation of the effect of prophylactic infusion of phenylephrine on systolic (SaP), diastolic (DaP), median (MaP) and cardiac rate (CR) during knee replacement surgery with spinal anesthesia, compared to with placebo. We also evaluated amount of fluids, hypotension and bradycardic episodes, and ephedrine requirements. Setting: Anesthesiology Service of Hospital Italiano de Buenos Aires. Design: clinical trial, randomized, placebo controlled, double blinded. Population: We included 30 patients scheduled for knee replacement surgery. Methods: Patients were randomized to group F (prophylactic infusion of phenylephrine, N = 15) or group P (placebo, n = 15). Hemodynamic variables were evaluated at basal, start of infusion and at 3, 6, 15, 30, 45 and 60 minutes from the blockade. Results: The differences in SaP, DaP, MaP and CR were not statistically different. Neither were the numbers of cases with hypotension, bradycardia, ephedrine requirements or fluids administered. Conclusions: In patients receiving spinal anesthesia for knee replacement surgery, a prophylactic infusion of phenylephrine did not decrease the magnitude of hypotension in comparison with placebo.

Antecedentes: A anestesia espinhal é utilizada em cirurgias ortopédicas, mas causa hipotensao arterial em 10-40 por cento dos pacientes. O uso da fenilefrina em infusao profilática permitiu manter a pressao arterial durante o parto; porém, nao se conhecem estudos sobre seu uso em cirurgias de substitução de joelho. Objetivos: Avaliar o efeito da infusao continua profilática de fenilefrina sobre a pressao arterial sistólica (PaS), média (PaM) e diastólica (PaD) e a freqüencia cardiaca (FC) em cirurgia de implante de prótese de joelho, comparado com placebo. Foram também avaliados: a reposição de fluídos, os episódios de hipotensao e bradicardia, e a necessidade de efedrina. Lugar de realização: Serviço de Anestesiologia do Hospital Italiano de Buenos Aires. Desenho: Estudo clínico, aleatorizado, controlado com placebo, duplo-cego. População: Trinta pacientes submetidos a substituiçao protésica de joelho. Métodos: Os pacientes foram aleatorizados ao grupo F (bomba de infusao profilática, fenilefrina, n = 15) ou ao grupo P (solução fisiológica, n = 15). Foi feito bloqueio 3 em 1 e anestesia espinhal. Avaliaram-se as variáveis hemodinamicas no momento basal, no inicio da infusao e aos 3, 6, 15, 30, 45 e 60 minutos pós-bloqueio. Resultados: Entre os grupos nao se encontrou diferença significativa no que diz respeito a PaS, PaM, PaO e FC, número de casos de hipotensao, de bradicardia, de administração de efedrina nem nas necessidades de fluidos administrados. Conclusoes: Em pacientes com anestesia espinhal, a infusao profilática de fenilefrina nao diminuiu a magnitude da hipotensao pós-bloqueio, em comparação com placebo, durante cirurgia de implante de prótese de joelho.

Prevention of hypotension during propofol induction: a comparison of preloading with 3.5% polymers of degraded gelatin (Haemaccel) and intravenous ephedrine.

The present study compared the efficacy of preloading with colloid "Haemaccel" with vasoconstrictor (intravenous ephedrine sulphate) in preventing hypotension during propofol induction. This prospective, randomized study included 120 patients of Amercan Society of Anaesthesiologists (ASA) physical status I and II ageing 21 to 50 years of both gender coming for routine surgery. Patients were randomly allocated into three groups with 40 patients in each. Group A (control) did not receive any study medication, group B received Haemaccel (10 ml/kg intravenously over 10-15 minutes) and group C received injection ephedrine (0.2 mg/kg iv) prior to induction of anaesthesia. Propofol (2.5 mg/kg iv) was used for induction of anaesthesia. Heart rate and blood pressure were recorded before induction (baseline) and then every minute for 5 minutes after administering propofol. Anaesthesia was continued with standard technique thereafter. Hypotension was defined as fall in systolic blood pressure more than 20% from the basal value. The incidence of hypotension in Haemaccel (23.1%) or ephedrine group (22.5%) was significantly less than the control group (67.5%, P<0.01). We conclude that though preloading with colloid (Haemaccel) or prior injection of sympathomimetic (ephedrine) are not fully efficacious in preventing hypotension caused by propofol induction, both decrease the incidence in significant number of patients with heart rate less than baseline value in the colloid group.

Cardiomiopatia de Takotsubo como causa de infarto agudo do miocárdio em paciente em uso de anti-histamínico associado a pseudo-efedrina / Acute myocardial infarction resulting from takotsubo cardiomyopathy in patient on antihistaminics

Relatamos o caso de uma senhora de 77 anos, que vinha em uso de anti-histamínico associado a pseudo-efedrina por processo alérgico de vias aéreas superiores, admitida no Pronto Socorro com quadro de infarto agudo do miocárdio com elevação do segmento ST em parede ântero-lateral. O cateterismo cardíaco revelou artérias coronárias tortuosas e sem lesões obstrutivas, com hipercontratilidade esquerda. Devido a derrames pericárdicos de repetição, foi submetida à drenagem pleuro-pericárdica. Causas reumatológicas foram excluídas. Após 30 dias, recebeu alta em boas condições clínicas...

This is the report on a 77-year-old female patient on antihistaminic associated to pseudoephedrin to treat an allergy conditionin upper airways. The patient was admitted to the Emergency Unit with acute myocardial infarction and ST segment elevation in the antero-lateral wall. Cardiac catheterism showed tortuous coronaries, no obstructive lesions, and baselinehypercontractility associated to antero-apical akinesia on left ventriculography. As a result of repeated pericardial strokes, the patient was submitted to pleuro-pericardial drainage. Rheumatological causes were ruled out. The patient was discharged after 30 days in good clinical conditions.

Ephedrine for prevention hypotension; comparison between intravenous, intramuscular and oral administration during spinal anesthesia for elective cesarean section

To ameliorate post spinal anesthesia hypotension in patients undergoing cesarean section. To compare the incidence of maternal hypotension associated with spinal anesthesia for cesarean section when intravenous [IV], intramuscular [IM] or oral prophylactic boluses of ephedrine were used. Prospective randomized double blind Department of anesthesiology, Zainibiae Hospital, Shiraz University, Iran. June 2004 to November 2005. 60 ASA grade I-II pregnant mothers were enrolled. Spinal anesthesia was performed using 60-70 mg of 5% solution of lidocaine. The patients were divided into three equal groups [n=20]. Oral and IM ephedrine [25 mg] was administered to the first two groups 30 to 60 minutes before induction of anesthesia [Group A and B, respectively]. In the last 20 patients, IV Ephedrine [25 mg] was administered immediately after induction of spinal anesthesia [Group C]. Maternal blood pressure and pulse rate was checked every 2 minutes. Hypotension was promptly treated with 10-mg ephedrine boluses. Both IM and IV prophylactic doses of ephedrine significantly decreased the incidence of hypotension, compared to oral prophylactic dose of ephedrine [4/20 and 0/20 in the IM and IV ephedrine groups, respectively vs. 9/20 in the oral ephedrine group [p < 0.05]]. Oral prophylactic dose of ephedrine is not effective in preventing hypotension in pregnant women undergoing cesarean section with spinal anesthesia. Therefore, we only recommend a single bolus of IV ephedrine with a dose of 25mg

efficacy of prophylactic ephedrine in prevention of hypotension during spinal anaesthesia for caesarean delivery: IM versus IV routes

Spinal anaesthesia [SA] for caesarean section [CS] is commonly associated with hypotension [HT]. This HT is treated commonly by vasopressor agents especially ephedrine. We aimed to study the effect of prophylactic ephedrine, injected intramuscularly or intravenously, on the incidence of maternal HT during SA. According to the route of ephedrine injection, forty ASAI singleton parturients who presented at term for elective CS under SA were randomly assigned into two groups, each consist of 20 patients: group [IM] received intramuscular ephedrine 30mg at 15 minutes before SA, and group [IV] received intravenous ephedrine 15 mg at the second minute after the SA. Patient's monitoring included continuous ECG, heart rate, non-invasive blood pressure, and peripheral arterial oxygen saturation. SA was performed at the level of L3/L4 using a G25 spinal needle. All patients were injected intrathecally with 2.5 ml of hyperbaric 0.5% bupivacaine using the midline approach. Three patients [15%] in group IM and five patients [25%] in group IV developed HT and treated with IV bolus doses of ephedrine for 5 and 10 occasions respectively. Total extradoses of ephedrine therapy required for treatment of hypotension were lower in IM group [14 mg +/- 9.16] than IV group [18 mg +/- 8.49], but the difference was statistically insignificant [P = 0.55]. IM is as similar as IV ephedrine for decreasing the incidence, maternal hypotension during SA. Regardless to the injection route, HT can not be completely eliminated by the prophylactic doses of ephedrine used in our study

A randomized controlled trial of cetirizine plus pseudoephedrine versus loratadine plus pseudoephedrine for perennial allergic rhinitis.

The purpose of this study was to compare the safety and efficacy of cetirizine plus pseudoephedrine (C+P) with loratadine plus pseudoephedrine (L+P) in the treatment of perennial allergic rhinitis. This was a double blind, randomized, parallel trial with an active control. Subjects aged 12 to 70 years with perennial allergic rhinitis for at least 2 years were enrolled and randomized to receive either of the active study medications plus a placebo resembling the other, twice daily for 4 weeks. Nasal total symptom scale (NTSS) including sneezing, rhinorrhea, nasal itching and nasal stuffiness is evaluated by subjects daily and at baseline, 2 weeks, and 4 weeks by the investigator as efficacy measurement. A total of 51 eligible patients were enrolled and 45 patients completed the treatment course. Both groups had significant reductions in NTSS after 4 weeks of treatment as assessed by the subjects, but there was no significant difference between the two groups (mean +/- SD) reduction of 4.25 +/- 2.45 with C+P vs. 3.52 +/- 2.41 with L+P, p = 0.215. As assessed by the investigator, sneezing was significantly better at 2 weeks (-1.13 vs. -0.52, p = 0.028) and nasal congestion at 4 weeks (-1.71 vs. -1.19, p = 0.031) in subjects treated with C+P compared to those treated with L+P. There were 37 treatment-related adverse events (5 in 4 subjects in the C+P group and 32 in 16 subjects in the L+P group). It was concluded that both cetirizine plus pseudoephedrine and loratadine plus pseudoephedrine are efficacious for perennial allergic rhinitis in Taiwanese subjects. Relief of sneezing and nasal congestion may be marginally better with the cetirizine preparation, which also seemed to be slightly better tolerated, although the incidence of side effects did not differ significantly.

A comparative study of the side effects between pseudoephedrine in Loratadine plus Pseudoephedrine Sulfate Repetabs Tables and loratadine + pseudoephedrine tablet in treatment of allergic rhinitis in Thai patients.

The objective of the study was to evaluate the adverse reactions of Loratadine plus Pseudoephedrine Sulfate Repetabs Tables (LTD+PSE Repetabs) (Loratadine 5 mg + Pseudoephedrine 120 mg) twice daily with that of loratadine (5 mg) twice daily and pseudoephedrine (60 mg) quarter daily in the treatment of patients with allergic rhinitis. The study was designed as an investigator-blind, parallel group study. In this study, 56 patients were equally separated into 2 groups and treated for 14 days with either LTD+PSE Repetabs or loratadine + pseudoephedrine tablet. Both groups were comparable in age, gender, weight; baseline systolic blood pressure, diastolic blood pressure and pulse rate. The change of systolic blood pressure, diastolic blood pressure, and pulse rate did not reach clinical significance throughout the study period. There was no significant difference in occurrences of insomnia, palpitation, mouth dryness and anxiety. However, the incidence of patients with tremor at day 14 in the loratadine + pseudoephedrine tablet group was significantly higher than the LTD+PSE Repetabs group (39% vs 10.7%, p-value = 0.03). Furthermore, one patient in the loratadine + pseudoephedrine tablet group had to discontinue medication at day 7 due to insomnia. In conclusion, LTD+PSE Repetabs is well tolerated and has fewer adverse effects when compared to the loratadine + pseudoephedrine tablet.

Comparison of infusions of phenylephrine and ephedrine in spinal anaesthesia

Objectives to assess the maternal cardiovascular changes [i.e. hypotension] and neonatal status in healthy women who underwent elective C.S under epidural anaesthesia and to compare the effect of optimal doses of 3 different vasopressors on hypotension and acid-base status in mothers and neonates during spinal anaesthesia [SA] for caesarian section [CS]. the total number of pregnant women who underwent, spinal anaesthesia during c.s were 150 between Jan 1st till 31st Dec 1999 at Q.A.M.H., a total of 15 pregnant women were randomly selected into: group 1 received an infusion of ephedrine 1mg/min [at 60ml/hr]. Group 2 received an infusion of ephedrine 2mg/min [at 120ml/hr] and group 3 was given an infusion of phenylephrine 10 mcg/min [at 60ml/hr] there was no significant difference in maternal age, weight or systolic arterial pressure between the 3 groups. Similarly, there was no significant difference between the 3 groups in the volume of bupivacaine used, time taken for anaesthesia to reach T4, time from insertion of the spinal to delivery of fetus and uterine incision delivery time

Efedrina profilática durante raquianestesia para cesariana: bolus seguido de infusäo contínua em dose fixa e infusäo contínua de doses decrescentes / Prophylactic ephedrine during spinal anesthesia for cesarean section: bolus followed by continuous infusion in fixed doses or continuous infusion in decreasing doses

Justificativa e objetivos: o uso profilático de efedrina tem sido preconizado para o controle da pressäo arterial materna durante raquianestesia para cesariana. A dose e o regime de administraçäo efetivos näo estäo claramente estabelecidos.O objetivo deste estudo foi avaliar a eficácia e a segurança da administraçäo profilática de efedrina em bolus seguido de infusäo contínua em dose fixa e de infusäo contínua em doses decrescentes, partindo-se de altas doses iniciais. Método: foram estudadas 120 gestantes de termo, hígidas submetidas a cesarianas eletivas sob raquianestesia, alocadas aleatoriamente em 3 grupos de 40, conforme o regime de administraçäo de efedrina. Grupo C (controle): administrou-se efedrina em bolus de 5mg apenas na vigência de hipotensäo arterial; grupo A (10mg + 2mg.min(elevado a menos 1)): 10mg em bolus seguidos de infusäo contínua de 2mg.min(elevado a menos 1) até o nascimento; grupo B (8+4+2mg.min(elevado a menos 1)): 8mg.min(elevado a menos 1) por 3 minutos, seguidos de 4mg.min(elevado a menos 1) por 2 minutos, seguidos de 2mg.min(elevado a menos 1) até o nascimento. Nos grupos onde se utilizou efedrina profilática, seu uso foi instituído imediatamente após a realizaçäo da raquianestesia. Bolus adicionais de 5mg de efedrina foram administrados em todos os grupos, no caso de episódios de hipotensäo (PAS<80 por cento do controle da paciente). Foram avaliadas as repercussöes maternas, fetais e neonatais. Resultados: a incidência de hipotensäo arterial (10 por cento) foi significativamente menor no grupo B. A incidência de hipertensäo foi semelhante nos grupos estudados. A incidência de náuseas e vômitos diminuiu no grupo da infusäo contínua em doses decrescentes, em relaçäo aos demais grupos, sem significância estatística. A dose de efedrina utilizada e o pH da artéria umbical nos grupos de uso profilático foram significativamente maiores que no grupo C. A incidência de fetos acidóticos e a vitalidade dos recém-nascidos avaliada pelo índice de Apgar foram semelhantes nos grupos estudados. Conclusäo: altas doses de efedrina säo necessárias para controlar a pressäo arterial materna durante raquianestesia para cesariana. O melhor regime é o de infusäo contínua de doses decrescentes, partindo-se de altas doses iniciais, que reduz significativamente a incidência de hipotensäo arterial e determina tendência à reducäo de náusea e vômitos. O uso profilático de efedrina oferece vantagens para o feto

Seudoefedrina. Valoración de su uso en cardiópatas con sinusitis / Pseudoephedrine. Evaluation of its use in patients with heart disease and sinusitis

La seudoefedrina es una amina simpaticomimética de mucho uso como descongestionante nasal, con efectos sistémicos secundarios entre ellos cardiovasculares; por ello, se realizó un estudio prospectivo en 25 pacientes con hipertensión arterial esencial sistémica controlada y/o cardiopatía isquémica que presentaban sinusitis aguda, con seudoefredina 60 mg c/12 hrs por 2 semanas contra placebo y grupo control, monitoreo por electrocardiografía ambulatoria, presión arterial ambulatoria, y revisión clínica. Los resultados demuestran que en pacientes controlados, el uso de seudoefedrina en las dosis recomendadas es útil y seguro. Se recomienda siempre la valoración por cardiólogo previa administración

Prevention of spinal anaesthesia-induced hypotension in elderly: methoxamine or ephedrine

Two vasopressors were compared to reduce incidence of hypotension during spinal anaesthesia in elderly patients, methoxamine 10mg i.m. or ephedrine 10mg i.v. plus 20mg I.m, in terms of haemodynamic stability and requirement for additional vasopressors. Forty patients [aged 60-75yr] undergoing surgery of the lower body were allocated randomly into group M [n=20] and group E [n=20] the vasopressors were injected 10 min before induction of spinal anaesthesia. Rescue ephedrine 3-6 mg was given if systolic blood pressure [SAP] or mean arterial blood pressure [MAP] reduced more than 25% of the base line value. Patient and spinal characteristics were similar in the two groups. SAP and MAP increased initially form baseline until induction of spinal anaesthesia and then decreased for 25 min in both groups [not significant between groups]. Heart rate [HR] decreased from the baseline in group M [p<0.05] and was lower than in group E at all time form 4-70 min [p<0.01]. The incidence of hypotension of SAP and MAP was not significant between groups [SAP 25% vs 30% and MAP 20% vs 25%]. Requirements for rescue ephedrine [20% vs 25%] dose of rescue ephedrine given [4.8 vs 5.1mg] and time to onset of hypotension [9.8 vs 11.6 min] were similar in groups M and E. respectively. We conclude that methoxamine 10mg i.m. given 10 min before induction of spinal anaesthesia in normovolaemic elderly insignificantly reduce Incidence of subsequent SAP and MAP hypotension. requirements for rescue vasopressor therapy but has significant reduction of HR compared with ephedrine 10 mg i.v. plus 20mg i.m

Administración profilactica de efedrina intramuscular para cesárea / Administraction profilactic of the intramuscular ephedrine to cesarean

El objetivo de este estudio es investigar la efectividad de la efedrina intramuscular en el control de la hipotensión arterial, desarrollada en pacientes embarazadas sometidas a cesárea segmentaria, bajo anestesia peridural, para lo cual fueron estudiadas prospectivamente 32 pacientes con 38 semanas o más de gestación, estado físico ASA I-II e indicación de cesárea, sin patología hipertensiva ni indicios de sufrimiento fetal agudo. Se dividieron en dos grupos: uno control de 15 pacientes y otro estudio constituido por 17 pacientes, el cual recibió 25 mg. de efecdrina intramuscular 10 a 20 minutos antes de la anestesia. La incidencia de hipotensión arterial significativamente menor (23,52 por ciento) en el grupo efedrina intramuscular que en el grupo control (66,66 por ciento). La cantidad de Ringer Lactato utilizada fue mayor en el grupo control (1169 ñ 169 ml) que en el grupo efedrina intramuscular 752,32 ñ 223 ml). El índice de Apgar al minuto fue proporcionalmente mayor en el grupo efedrina intramuscular. Este estudio demuestra que existe una relación clínica y estadísticamente significativa entre la administración profiláctica de 25 mg. de efedrina intramuscular y la disminución de la incidencia de hipotensión arterial en pacientes embarazadas sometidas a cesárea segmentaria bajo anestesia peridural

Complicaciones durante la anestesia espinal con aguja atraucan en operación cesárea / Complications through the spinal anesthesia peformed with atraucan needle for caesarean operation

A 33 pacientes gestantes se les practicó operación cesárea bajo bloqueo subaracnoide utilizando agujas espinales con doble bisel (atraucan núm. 26). El nivel anestésico fue satisfactorio en 70 por ciento de los casos, únicamente 10 pacientes presentaron hipotensión arterial tras la inhibición simpática, ninguna desarrolló cefalea u otra complicación tardía. En cinco pacientes se dificultó la introducción de la aguja al percibirse contacto óseo, de las cuales en tres se requirió cambiarla en virtud de la fragilidad del material, fundamentalmente a nivel del bisel cortante, lo cual limita su empleo en la anestesia subaracnoidea

Anafilaxia causada por lidocaína / Severe lidocaine anaphylaxia

Se presenta el caso de anafilaxia a lidocaína en una paciente sometida a analgesia epidural para trabajo de parto, la cual desarrolló inmediatamente después de la aplicación de una dosis de prueba de lidocaína (PISA). La anafilaxia al anestésico local se comprobó mediante la determinación del factor inhibidor de leucocitos y del porcentaje de degranulación de basófilos

Dosificación de drogas hipertensinógenas en orina de pacientes hipertensos / Dosification of hipertensionogen drugs from the urine of hipertensive patients

Se presentan los resultados del estudio realizado en una gran Unidad de las FAR a 84 combatientes en los que se dosificó la presencia de drogas hipertensinógenas en la orina. Los pacientes se clasificaron en 4 grupos de acuerdo con las cifras tensionales y la presencia o no de alteraciones del pulso. Para la dosificación de las drogas se utilizó el método de cromatografía de capa fina. Se analizan las posibles causas de los hallazgos detectados y se hacen recomendaciones para la solución del problema. Se propone incluir la categoría de hipertensión ficticia (autoprovocada) a la actual clasificación de la entidad