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ABC., imagem cardiovasc ; 33(4): eabc110, 20200000.
Article in Portuguese | LILACS | ID: biblio-1146299


Fundamento: Durante o ecocardiograma sob estresse com dobutamina, podem ocorrer efeitos adversos e exames inconclusivos. Objetivo: Avaliar em uma grande população geral a segurança e a exequibilidade do ecocardiograma sob estresse com dobutamina. Métodos: Estudo de 10.006 ecocardiogramas sob estresse com dobutamina realizados no período de julho de 1996 a setembro de 2007. A dobutamina foi administrada em quatro estágios (10, 20, 30 e 40 µ para pesquisa de isquemia miocárdica e iniciada com 5 µ ¹.min-1 apenas na análise de viabilidade miocárdica. A atropina foi iniciada conforme os protocolos vigentes. Foram verificados dados clínicos, hemodinâmicos e efeitos adversos associados ao ecocardiograma sob estresse com dobutamina. Resultados: Durante os ecocardiogramas sob estresse com dobutamina, ocorreu angina típica (8,9%), pico hipertensivo (1,7%), ectopias ventriculares isoladas (31%), taquiarritmia supraventricular (1,89%), fibrilação atrial (0,76%) e taquicardia ventricular não sustentada (0,6%). Os efeitos adversos citados foram mais frequentes nos pacientes com ecocardiogramas sob estresse com dobutamina positivos para isquemia. A desaceleração sinusal paradoxal (0,16%) não ocorreu em ecocardiogramas sob estresse com dobutamina positivo. As três complicações graves ocorreram em ecocardiogramas sob estresse com dobutamina positivos para isquemia. Foram dois casos (0,02%) com fibrilação ventricular e um caso de síndrome coronariana aguda (0,01%). Não houve caso de taquicardia ventricular sustentada, ruptura cardíaca, assistolia ou óbito. Comparados aos exames concluídos, nos inconclusivos, os pacientes usaram menos atropina (81,5% versus 49,9%; p< 0,001) e mais betabloqueador (4,7% versus 19%; p< 0,001), apresentando mais pico hipertensivo (1,1% versus 14,2%; p = 0,0001) e taquicardia ventricular não sustentada (0,5% versus 2,2%; p< 0,001). Conclusão: O ecocardiograma sob estresse com dobutamina realizado de forma apropriada é seguro e apresenta elevada exequibilidade.

Background: Adverse effects and inconclusive results may occur on dobutamine stress echocardiography. Objective: To assess the safety and feasibility of dobutamine stress echocardiography in a large general population. Methods: A total of 10,006 dobutamine stress echocardiographies were performed between July 1996 and September 2007. Dobutamine was administered in four stages (10, 20, 30, and 40 µcg·kg-1·min-1) to research myocardial ischemia starting with 5 µcg·kg- ¹·min-1 to analyze myocardial viability. Atropine administration was initiated according to current protocols. Clinical, hemodynamic, and adverse effect data associated with dobutamine stress echocardiography findings were verified. Results: Typical angina (8.9%), hypertensive peak (1.7%), isolated ventricular ectopias (31%), supraventricular tachyarrhythmia (1.89%), atrial

Humans , Male , Female , Aged , Coronary Disease/diagnosis , Drug-Related Side Effects and Adverse Reactions , Atropine/administration & dosage , Retrospective Studies , Risk Factors , Echocardiography, Stress/adverse effects , Echocardiography, Stress/drug effects , Dobutamine/administration & dosage , Dobutamine/adverse effects , Electrocardiography/methods , Hypertension/complications , Metoprolol/administration & dosage
Article in Korean | WPRIM | ID: wpr-811318


PURPOSE: We report a case of Urrets-Zavalia syndrome with a fixed dilated pupil after an uneventful trabeculectomy.CASE SUMMARY: Trabeculectomy was performed on a 51-year-old male who had a history of recurrent uveitis in the left eye, with uncontrolled intraocular pressure despite maximally-tolerated medial therapy. There was no unexpected event during surgery. Topical 1% atropine was used for only 2 days after surgery. In the early postoperative period, 1% prednisolone and 0.3% ofloxacin were given four times a day, then gradually reduced. One month later, only 1% prednisolone was given once a day. Intraocular pressure in his left eye was well controlled from 8–14 mmHg after surgery. One month after surgery, the pupils remained dilated. There was no reaction to topical 2% pilocarpine and no relative afferent pupillary defect or posterior synechia.CONCLUSIONS: Our case, although rare, suggests that Urrets-Zavalia syndrome should be considered in patients with well-controlled intraocular pressure after uneventful trabeculectomy.

Atropine , Humans , Intraocular Pressure , Male , Middle Aged , Ofloxacin , Pilocarpine , Postoperative Period , Prednisolone , Pupil , Pupil Disorders , Trabeculectomy , Uveitis
Arq. bras. oftalmol ; 82(5): 425-428, Sept.-Oct. 2019. graf
Article in English | LILACS | ID: biblio-1019439


ABSTRACT A rare case of bilateral congenital microcoria associated with antimetropia in a 47-year-old man is here described. The patient presented with a chief complaint of progressive vision loss in his right eye over the past five years. A slit-lamp examination and ultrasound biomicroscopy confirmed congenital microcoria and cataracts. Phacoemulsification was performed using an iris expansion device and the anterior capsule was stained using the "trypan down under" technique. Preoperative considerations, the surgical approach, and postoperative management are discussed.

RESUMO Um caso raro de microcoria congênita bilateral associada à antimetropia em um homem de 47 anos de idade é descrito aqui. O paciente queixava-se de perda visual progressiva em seu olho direito nos últimos 5 anos. Um exame com lâmpada de fenda e biomicroscopia ultrassônica confirmaram microcoria congênita e catarata. A facoemulsificação foi realizada usando dispositivo de expansão iriana, e a cápsula anterior foi corada através da técnica "trypan down under". Considerações pré-operatórias, abordagem cirúrgica e manejo pós-operatório são discutidos.

Humans , Male , Adult , Middle Aged , Ophthalmic Solutions/administration & dosage , Atropine/administration & dosage , Cataract/complications , Cataract Extraction , Pupil Disorders/congenital , Phacoemulsification/methods , Pupil Disorders/surgery , Pupil Disorders/complications , Microscopy, Acoustic
Article in English | WPRIM | ID: wpr-719635


Most diabetic patients experience diabetic mellitus (DM) urinary bladder dysfunction. A number of studies evaluate bladder smooth muscle contraction in DM. In this study, we evaluated the change of bladder smooth muscle contraction between normal rats and DM rats. Furthermore, we used pharmacological inhibitors to determine the differences in the signaling pathways between normal and DM rats. Rats in the DM group received an intraperitoneal injection of 65 mg/kg streptozotocin and measured blood glucose level after 14 days to confirm DM. Bladder smooth muscle contraction was induced using acetylcholine (ACh, 10⁻⁴ M). The materials such as, atropine (a muscarinic receptor antagonist), U73122 (a phospholipase C inhibitor), DPCPX (an adenosine A1 receptor antagonist), udenafil (a PDE5 inhibitor), prazosin (an α₁-receptor antagonist), papaverine (a smooth muscle relaxant), verapamil (a calcium channel blocker), and chelerythrine (a protein kinase C inhibitor) were pre-treated in bladder smooth muscle. We found that the DM rats had lower bladder smooth muscle contractility than normal rats. When prazosin, udenafil, verapamil, and U73122 were pre-treated, there were significant differences between normal and DM rats. Taken together, it was concluded that the change of intracellular Ca²⁺ release mediated by PLC/IP3 and PDE5 activity were responsible for decreased bladder smooth muscle contractility in DM rats.

Acetylcholine , Animals , Atropine , Blood Glucose , Calcium Channels , Humans , Injections, Intraperitoneal , Muscle, Smooth , Papaverine , Prazosin , Protein Kinase C , Rats , Receptor, Adenosine A1 , Receptors, Muscarinic , Streptozocin , Type C Phospholipases , Urinary Bladder , Verapamil
Article in English | WPRIM | ID: wpr-719408


BACKGROUND: Dexmedetomidine has been widely used during spinal anesthesia to provide sedation. However, dexmedetomidine frequently causes significant bradycardia. This study was designed to evaluate whether fluid loading could reduce the incidence of bradycardia after intravenous dexmedetomidine infusion in patients under spinal anesthesia. METHODS: A total of 99 patients, 18 to 65 years of age, with American Society of Anesthesiologists physical status 1 or 2, who were scheduled for elective total knee replacement or internal fixation of lower leg fracture under spinal anesthesia were enrolled. The patients were randomly assigned into one of the three groups, and fluid was loaded as follows: group LOW - 4 ml/kg, group MID - 8 ml/kg, and group HI - 12 ml/kg. After fluid loading and spinal anesthesia, dexmedetomidine was infused as follows: 1 μg/kg of loading dose for 10 minutes, thereafter continuous infusion at 0.4 μg/kg/h. RESULTS: The heart rate of group HI was significantly higher than that of group LOW (P = 0.049). The dosage of atropine administration was significantly lower in group HI than in group LOW (P = 0.003). The change in thoracic fluid contents was significantly higher in group HI than in group LOW (P = 0.018). CONCLUSIONS: Fluid loading during spinal anesthesia can reduce the incidence and extent of bradycardia after intravenous dexmedetomidine infusion.

Anesthesia, Spinal , Arthroplasty, Replacement, Knee , Atropine , Bradycardia , Dexmedetomidine , Fluid Therapy , Heart Rate , Humans , Incidence , Leg
Neonatal Medicine ; : 67-71, 2019.
Article in Korean | WPRIM | ID: wpr-741661


Pylorospasm is a cause of delayed gastric emptying in young infants. As in patients with hypertrophic pyloric stenosis, most pylorospasm patients present with projectile vomiting. However, unlike that in case of hypertrophic pyloric stenosis, no persistent pyloric stenotic lesions are present. As such, follow-up using serial gastrointestinal fluoroscopy or ultrasonography can be helpful in diagnosing patients with clinical signs of gastroparesis. Most cases can be treated conservatively, but some patients require pharmacologic treatment. Antispasmodics have been proposed as a treatment for pylorospasm, but their use in neonates and infants has rarely been reported. Herein, we present a case of pylorospasm diagnosed in the neonatal period and successfully treated with intravenous atropine.

Atropine , Fluoroscopy , Follow-Up Studies , Gastric Emptying , Gastroparesis , Humans , Infant , Infant, Newborn , Parasympatholytics , Pyloric Stenosis, Hypertrophic , Pylorus , Spasm , Ultrasonography , Vomiting
Article in English | WPRIM | ID: wpr-762279


BACKGROUND: The trigeminocardiac reflex (TCR), which occurs after stimulation of the territory of the trigeminal nerve, is very rarely reported to be caused by stimulation of the mandibular branch. We report a case of TCR in open reduction for temporomandibular joint (TMJ) dislocation. CASE: A 74-year-old female presented for TMJ dislocation. During open reduction of TMJ under general anesthesia, severe bradycardia (15 beats/min) occurred. Immediately 0.5 mg atropine was administered intravenously, and the surgical manipulation was stopped. After 30 seconds, heart rate normalized. During surgery, severe bradycardia occurred one more time. It disappeared spontaneously as soon as surgical manipulation was stopped. The surgery was completed uneventfully. CONCLUSIONS: Because of the possibility of profound bradycardia, asystole, or even death when evoked, it is important to be aware of the trigeminocardiac reflex during manipulation of the mandibular divisions, especially during surgical stimulation of the TMJ.

Aged , Anesthesia, General , Atropine , Bradycardia , Joint Dislocations , Female , Heart Arrest , Heart Rate , Humans , Reflex, Trigeminocardiac , Temporomandibular Joint , Trigeminal Nerve
Article in English | WPRIM | ID: wpr-762272


BACKGROUND: New complications associated with sugammadex have been increased since its widespread use. We report a case of an 80-year-old male who experienced profound bradycardia and sustained hypotension after administration of sugammadex. CASE: Following administration of 200 mg sugammadex after laparoscopic cholecystectomy, sudden bradycardia (29 beats/min) developed for 10 seconds and his train-of-four (TOF) ratio remained at 0.2 for 5 min. An additional 200 mg sugammadex was administered and profound bradycardia (21–30 beats/min) and hypotension (60/40 mmHg) developed. Atropine at 0.5 mg was administered, but the effect lasted only 30 s. Profound bradycardia occurred four more times at 30 s intervals, and ephedrine and phenylephrine were injected intermittently to increase the patient's heart rate and blood pressure. The TOF ratio became 0.9 about 10 min after administration of additional sugammadex. CONCLUSIONS: Awareness must be heightened regarding the possibility of sugammadexinduced bradycardia and hypotension, and more attention should be paid to patients with slow recovery times following muscle relaxation, despite the use of sugammadex.

Aged, 80 and over , Atropine , Blood Pressure , Bradycardia , Cholecystectomy, Laparoscopic , Ephedrine , Heart Rate , Humans , Hypotension , Male , Muscle Relaxation , Neuromuscular Blockade , Phenylephrine , Postoperative Complications
Braz. J. Pharm. Sci. (Online) ; 55: e17231, 2019. tab, graf
Article in English | LILACS | ID: biblio-1039057


Anesthetics are an indispensable prerequisite for surgical intervention and pharmacological animal studies. The objective of present study was to optimize the dose of ketamine (K) and xylazine (X) along with atropine sulfate (A) in order to achieve surgical tolerance in BALB/c mice. Several doses of ketamine (100, 150, 200 mg/kg) and xylazine (10, 15, 20 mg/kg) were mixed and combination of nine doses (K/X: 100/10, 100/15, 100/20, 150/10, 150/15, 150/20, 200/10,200/15,200/20) were evaluated (n=9 per combination). A constant dose of atropine (0.05 mg/kg) was also used to counter side effect. Time-related parameters were evaluated on the basis of reflexes. KX at dose 200/20 mg/kg produced surgical tolerance in all nine mice with duration 55.00±6.87 minutes. The induction time 0.97±0.09 minutes, sleeping time 90.67±5.81 minutes and immobilization time (102.23±6.83 minutes) were significantly higher than all combination. However, this combination was considered unsafe due to 11 % mortality. While, KX at dose 200/15 mg/kg results in none of the mortality, so was considered as safe. Moreover, this combination produces surgical tolerance in 89 % mice with duration (30.00±7.45 minutes). It was concluded that KX at dose 200/15 mg/kg along with atropine 0.05 mg/kg is safe for performing surgical interventions in BALB/c mice.

Animals , Male , Mice , Xylazine/agonists , Ketamine/agonists , Atropine/antagonists & inhibitors , Anesthesia/classification
Psychiatry Investigation ; : 464-468, 2019.
Article in English | WPRIM | ID: wpr-760945


To examine the feasibility of low-charge electrotherapy (LCE) in treating geriatric major depressive disorder (MDD) patients. Bi-temporal LCEs (approximately 25 mC) were performed with an electroconvulsive therapy (ECT) instrument three times per week. We used the Hamilton Depression Scale 17 (HAMD-17) and the Hamilton Anxiety Scale (HAMA) to assess the effects of LCE and the Mini-Mental State Examination (MMSE) to evaluate the cognitive function change before and after LCE. Six visits occurred at the baseline, after LCE sessions 3, 6, and 9, after the last session, and at the end of the one-month follow-up period. Four patients were enrolled in the study. Two patients completed all LCE sessions. Two patients withdrew during the trial, one due to the adverse event of uroschesis potentially caused by atropine and the other due to her own will. All four patients completed the follow-up sessions. The HAMD-17 and HAMA scores were reduced significantly at the last LCE session and the end of the follow-up period compared with the scores at the baseline. As measured by the MMSE, cognitive impairment showed no significant changes at the last LCE session and the end of the follow-up period compared with that at the baseline. In this case series, LCE showed potential as an alternative current-based treatment for treating geriatric MDD patients. Further research is needed to assess the efficiency and safety of LCE.

Anxiety , Atropine , Cognition , Cognition Disorders , Depression , Depressive Disorder, Major , Electric Stimulation Therapy , Electroconvulsive Therapy , Follow-Up Studies , Humans
Rev. medica electron ; 40(6): 2071-2082, nov.-dic. 2018. graf
Article in Spanish | LILACS, CUMED | ID: biblio-978718


RESUMEN Se presenta un caso clínico de un varón de 27 años de edad, con una ectasia corneal y presencia de queratoglobo en ambos ojos. La manifestación clínica fue disminución lenta y progresiva de la agudeza visual en ambos ojos y dolor en el ojo izquierdo. Al examen oftalmológico se constató hidrops corneal agudo en ojo izquierdo y otras complicaciones corneales, propias de esta anomalía. Se realizó un estudio oftalmológico que permitió un diagnóstico certero. Se aplicó la terapéutica correspondiente y se sugirieron otras opciones terapéuticas (AU).

ABSTRACT We present the clinical case of a male patient, aged 27 years, with corneal ectasia and keratoglobus in both eyes. The clinical manifestation was progressive and slow decrease of the visual acuity in both eyes and pain in the left eye. At the ophthalmologic examination, acute corneal hydrops was found in the left eye, and also other complications that are proper of this anomaly. An ophthalmologic study was carried out that lead to an accurate diagnosis. The correspondent therapy was applied and several therapeutic options were suggested (AU).

Humans , Male , Adult , Atropine/therapeutic use , Vision Disorders , Corneal Diseases/diagnosis , Visually Impaired Persons , Low Pressure , Corneal Perforation/prevention & control , Keratoconus/diagnosis , Visual Acuity , Corneal Topography , Eyeglasses , Keratoconus/congenital , Keratoconus/etiology , Keratoconus/drug therapy , Keratoconus/epidemiology
ABC., imagem cardiovasc ; 31(4)Out.- Dez. 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-964027


Fundamento: Ocorre modificação no fluxo da artéria torácica interna, após sua anastomose na artéria coronária descendente anterior. Objetivo: Avaliar o efeito da ligadura dos ramos proximais da artéria torácica interna anastomosada na artéria coronária descendente anterior, quanto às velocidades e à reserva de velocidade de fluxo coronariano, em pacientes com fração de ejeção do ventrículo esquerdo preservada (> 50%). Métodos: Estudo prospectivo de pacientes com fração de ejeção do ventrículo esquerdo > 50% revascularizados. O Grupo I foi formado por 25 pacientes com ligadura dos grandes ramos da artéria torácica interna antes de sua anastomose na artéria coronária descendente anterior, e o Grupo II por 28 pacientes sem ligadura. Registrou-se o Doppler em nível proximal da artéria torácica interna no pré-operatório, pós-operatório precoce e no pós-operatório tardio de 6 meses. Foram mensurados os picos de velocidade sistólica e diastólica, e as velocidades médias sistólica e diastólica. A reserva de velocidade de fluxo coronariano foi obtida durante o ecocardiograma sob estresse com dobutamina no pós-operatório tardio de 6 meses. Resultados: No pós-operatório precoce, o pico de velocidade sistólica e a velocidade média sistólica diminuíram, enquanto aumentaram o pico de velocidade diastólica e a velocidade média diastólica nos dois grupos (p < 0,05). Do pós-operatório precoce para o tardio em 6 meses, apenas o pico de velocidade diastólica se modificou, diminuindo nos dois grupos (p < 0,05). Durante o ecocardiograma sob estresse com dobutamina, o pico de velocidade diastólica e a velocidade média diastólica aumentaram (p < 0,05), e os grupos não diferiram, mas o pico de velocidade sistólica e a velocidade média sistólica aumentaram apenas no Grupo II (p < 0,05). A reserva de velocidade de fluxo coronariano dos grupos calculada pelo pico de velocidade diastólica (Grupo I = 2,17 ± 0,64 e Grupo II = 2,28 ± 0,63) e pela velocidade média diastólica (Grupo I = 2,27 ± 0,54 e Grupo II = 2,5 ± 0,79) não diferiu. Conclusão: Em pacientes com fração de ejeção do ventrículo esquerdo preservada, a ligadura dos grandes ramos da artéria torácica interna anastomosada na artéria coronária descendente anterior não compromete a reserva de velocidade de fluxo coronariano, mas determina limitação no aumento das velocidades sistólicas

Introduction: Modification of internal thoracic artery flow occurs after its anastomosis in the left anterior descending coronary artery. Objective: To evaluate the effect of ligation of the proximal branches of anastomosed internal thoracic artery flow on the left anterior descending in relation to velocities and coronary flow velocity reserve in patients with left ventricular ejection fraction preserved (> 50%). Methods: Prospective study of patients with left ventricular ejection fraction > 50% and revascularized. Group I was composed of 25 patients with ligation of the major branches of the internal thoracic artery flow before its anastomosis in the left anterior descending coronary artery, and Group II was composed of 28 patients without ligation. Doppler was recorded at the proximal level of internal thoracic artery flow in the preoperative, early postoperative and 6 months later. The systolic peak velocity and diastolic, and systolic mean velocity and diastolic were measured. Coronary flow velocity reserve was obtained during dobutamine stress echocardiography in postoperative period 6 months later. Results: In the postoperative, the systolic peak velocity and the systolic mean velocity decreased while increasing the diastolic peak velocity and the diastolic mean velocity in the groups (p < 0.05). From the postoperative to the postoperative period 6 months later, only the diastolic peak velocity modified, occurring its decrease in the groups (p < 0.05). During the dobutamine stress echocardiography, diastolic peak velocity and the diastolic mean velocity increased (p < 0.05) and groups did not differ, however, the systolic peak velocity and the systolic mean velocity increased only in Group II (p < 0.05). The coronary flow velocity reserve of the groups calculated by diastolic peak velocity (Group I = 2.17 ± 0.64 and Group II =2.28 ± 0.63) and diastolic mean velocity (Group I = 2.27 ± 0.54 and Group II = 2.5 ± 0.79) did not differ. Conclusion: In patients with preserved left ventricular ejection fraction, the ligation of the large branches of the anastomosed internal thoracic artery flow into the left anterior descending coronary artery does not compromise the coronary flow velocity reserve, but determines limitation in the increase of the systolic velocities

Humans , Male , Female , Middle Aged , Fractional Flow Reserve, Myocardial , Internal Mammary-Coronary Artery Anastomosis , Mammary Arteries/surgery , Myocardial Revascularization/methods , Atropine/administration & dosage , Stroke Volume , Transplantation , Echocardiography/methods , Echocardiography, Doppler/methods , Statistical Analysis , Prospective Studies , Analysis of Variance , Echocardiography, Stress/methods , Dobutamine/administration & dosage , Heart Ventricles
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(3): 296-301, jul.-ago. 2018. ilus, tab, graf
Article in English, Portuguese | LILACS, SES-SP | ID: biblio-916542


O sistema cardiovascular é responsável pelo fluxo circulatório adequado, o qual depende do volume sistólico e frequência cardíaca (FC). Quando insuficientes, causa hipofluxo cerebral e incapacidade de realizar atividades. A bradicardia é causada por: a) disfunção sinusal, manifestada por FC inapropriadas, pausas ou síndrome de taqui-bradicardia, síncopes, tonturas e intolerância aos esforços, sem risco à vida; b) distúrbio da condução atrioventricular (bloqueios atrioventriculares - BAV): de primeiro, segundo (Mobitz I, Mobitz II e avançado) e terceiro grau (Total) . O BAV de primeiro grau e do tipo Mobitz I tem bom prognóstico. O BAV Mobitz II, avançado e total, mesmo oligossintomático ou transitório, sem causas removíveis, tem maior morbimortalidade; c) distúrbios neuromediados e a síncope reflexa são desencadeados por posição ortostática ou exposição à estresse emocional e a síndrome do seio carotídeo associada à estimulação da carótida. A FC baixa pode estar associada a um maior risco, sendo que os sinais e sintomas indicam gravidade. Na urgência, deve-se tratar as causas subjacentes assegurar o bom funcionamento das vias aéreas administrar O2 monitorar ritmo, FC, pressão arterial, e, também, o acesso venoso. É importante analisar o ritmo, exame físico e histórico, além de pesquisar e tratar os fatores contribuintes. Caso haja sinais de baixa perfusão, deve-se administrar atropina. A estimulação por marcapasso transcutâneo é indicada, caso a atropina seja ineficaz. Além disso, deve-se considerar a adrenalina ou dopamina e estimulação transvenosa

The cardiovascular system is responsible for adequate circulatory flow, which depends on systolic volume and heart rate (HR). When insufficient, it causes cerebral hypoflow and inability to perform activities. Bradycardia is caused by: a) sinus dysfunction, manifested by inappropriate HR, pauses or tachycardia-bradycardia syndrome, syncope, dizziness and intolerance to exertion, without risk to life; b) atrioventricular conduction disorder (atrioventricular (AV) blocks): first, second (Mobitz type I, Mobitz type II and advanced) and third degree (complete). First-degree and Mobitz type I AV block both have good prognosis. Mobitz type II, advanced and complete AV block, even oligosymptomatic or transient, without removable causes, have higher morbidity and mortality; c) neuromediated disorders and reflex syncope are triggered by orthostatic position or exposure to emotional stress and carotid sinus syndrome, associated with carotid stimulation. Low HR may be associated with increased risk, and signs and symptoms indicate severity. In emergency conditions the underlying causes should be treated to ensure good functioning of the airways; administer O2; monitor cardiac rhythm, HR, blood pressure, and venous access. It is important to analyze rhythm, and conduct a physical examination and clinical history, and to check for and treat contributing factors. If there are signs of low perfusion, atropine should be administered. Simulation by transcutaneous pacemaker is indicated if atropine is ineffective. Epinephrine or dopamine and transvenous stimulation should also be considered

Humans , Male , Female , Perfusion/methods , Arrhythmias, Cardiac/therapy , Bradycardia/therapy , Emergencies , Intensive Care Units , Pacemaker, Artificial , Atrial Fibrillation/complications , Atrial Fibrillation/therapy , Atropine/administration & dosage , Tachycardia, Sinus , Dopamine/therapeutic use , Risk Factors , Age Factors , Syncope, Vasovagal/complications , Electrocardiography/methods , Atrioventricular Block/complications , Atrioventricular Block/therapy , Heart Rate , Hypertension/complications
ABC., imagem cardiovasc ; 31(3)jul.-set. 2018. tab
Article in Portuguese | LILACS | ID: biblio-909412


Fundamento: O ecocardiograma sob estresse com dobutamina-atropina (EEDA) é um exame acessível e importante, principalmente em pacientes sob investigação de doença coronariana. Contudo, faz-se necessário a avaliação de sua segurança, devido ao seu emprego em pacientes com patologias cada vez mais complexas, graves e idosos.Objetivo: Confirmar segurança do EEDA e avaliar os preditores de arritmias em ambiente não hospitalar.Métodos: EEDA foi realizado com o objetivo de avaliar isquemia utilizando o protocolo padrão de infusão de dobutamina de 5 a 40 mcg/kg/min associado a atropina.Resultados: Foram avaliados de forma prospectiva 2227 pacientes no período de setembro a novembro de 2010. Idade média foi de 60,7 +/- 12,5 anos e 60,8% eram mulheres. A fração de ejeção média foi de 67,9% +/- 9. Dentre dos eventos adversos, 12 pacientes apresentaram resposta hipertensiva, 466 arritmias, 58 cefaleias e 57 dores precordial. Nenhum paciente apresentou infarto agudo do miocárdio, fibrilação ventricular, ruptura cardíaca, assistolia ou morte. Quanto ao surgimento das arritmias significativas, 3 pacientes apresentaram fibrilação atrial,16 taquicardias supraventricular sustentada, 19 taquicardias ventricular não sustentada e 2 taquicardias ventricular sustentada. Nestes pacientes, idade (OR = 1,0559, p = 0,0002) e o índice de escore de contração segmentar (IECS) em repouso > 1 (OR 2,5039, p = 0,0354) foram preditores independentes para o surgimento de arritmias significativas durante o exame.Conclusão: O EEDA mostrou-se seguro nesse grupo de pacientes em ambiente não hospitalar. Idade e IECS em repouso > 1 foram preditores independentes para o surgimento de arritmias significativas durante o exame

Background: Dobutamine-atropine stress echocardiography (DASE) is an accessible and important test, especially in patients under investigation for coronary artery disease. However, it is necessary to evaluate its safety, as it is used in patients with increasingly complex and serious conditions and in seniors.Objective: To confirm the safety of DASE and evaluate the predictors of arrhythmias in a non-hospital setting. Methods: DASE was performed to evaluate ischemia using the standard protocol of dobutamine infusion of 5 to 40 mcg/kg/min associated with atropine. Results: From September to November 2010, 227 patients were evaluated prospectively. The mean age was 60.7 +/- 12.5 years old and 60.8% were females. Mean ejection fraction was 67.9 +/- 9. Among the adverse events, 12 patients presented hypertensive response, 466 had arrhythmia, 58 had headaches and 57 had precordial pain. No patient had acute myocardial infarction, ventricular fibrillation, cardiac rupture, asystole or death. As for the onset of significant arrhythmia, three patients had atrial fibrillation, 16 had sustained supraventricular tachycardia, 19 had non-sustained ventricular tachycardia and 2 had sustained ventricular tachycardia. In these patients, age (OR = 1.0559, p = 0.0002) and segmental contractility index at rest (SCIr) > 1 (OR 2.5039, p = 0.0354) were independent predictors for the onset significant arrhythmia during the test. Conclusion: DASE was proven safe in this group of patients in a non-hospital setting. Age and SCIr > 1 were independent predictors for the onset of significant arrhythmia during the test

Humans , Male , Female , Middle Aged , Arrhythmias, Cardiac , Dobutamine/administration & dosage , Echocardiography, Stress/adverse effects , Predictive Value of Tests , Safety , Atrial Fibrillation/diagnosis , Atropine/administration & dosage , Diagnostic Imaging/methods , Heart Failure , Heart Rate , Heart Ventricles , Hypertension , Prospective Studies , Risk Factors , Statistical Analysis , Stroke Volume , Ventricular Fibrillation
Rev. bras. ter. intensiva ; 30(1): 121-126, jan.-mar. 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-899567


RESUMO A nicotina é uma substância perigosa, extraída das folhas de fumo. Quando absorvida em quantidade excessiva, ela pode levar à insuficiência respiratória e à parada cardíaca. A comercialização de cigarros eletrônicos (e-cigarros) permite que os usuários manuseiem diretamente o líquido, com consequente aumento do risco de exposição à nicotina líquida. Descrevemos nossa experiência no tratamento do caso de um paciente que ingeriu elevada concentração de nicotina líquida contida em líquido para e-cigarros. O paciente apresentava bradicardia e hipotensão, que são sintomas de estimulação parassimpática, além de comprometimento da consciência. O paciente teve recuperação após tratamento com atropina e vasopressor.

ABSTRACT Nicotine is a dangerous substance extracted from tobacco leaves. When nicotine is absorbed in excessive amounts, it can lead to respiratory failure and cardiac arrest. The commercialization of electronic cigarettes (e-cigarettes) has allowed users to directly handle e-cigarette liquid. Consequently, the risk of liquid nicotine exposure has increased. We describe our experience of managing the case of a patient who orally ingested a high concentration of liquid nicotine from e-cigarette liquid. The patient presented with bradycardia and hypotension, which are symptoms of parasympathetic stimulation, together with impaired consciousness. He recovered following treatment with atropine and a vasopressor.

Humans , Male , Bradycardia/etiology , Electronic Nicotine Delivery Systems , Nicotine/poisoning , Atropine/therapeutic use , Vasoconstrictor Agents/therapeutic use , Bradycardia/drug therapy , Hypotension/etiology , Hypotension/drug therapy , Middle Aged
Article in Korean | WPRIM | ID: wpr-719004


Allergic contact dermatitis is an inflammatory condition associated with periorbital erythema, edema, and pruritus. The periorbital skin is relatively thin compared with the skin over other facial areas; therefore, it is vulnerable to allergen penetration and may show a variety of cutaneous manifestations. Recently, vision enhancement surgery is a widely performed procedure, and the prevalence of senile cataract and glaucoma is increasing. The prevalence of periocular allergic contact dermatitis is increasing secondary to the growing use of topical ophthalmic medications. Several studies in Korea have reported periocular allergic contact dermatitis secondary to the use of topical ophthalmic medications including latanoprost (Latano®), fluorometholone (Tolon®), polymyxin B (Terramycin®), atropine sulfate (Atropine®), neomycin sulfate (Cambison®), and befunolol hydrochloride (Bentos®), among others. However, ofloxacin (Effexin®)-induced allergic contact dermatitis has not been reported in the domestic and/or foreign literature. We report a case of periocular allergic contact dermatitis secondary to the use of ofloxacin ophthalmic ointment.

Atropine , Cataract , Dermatitis, Allergic Contact , Edema , Erythema , Fluorometholone , Glaucoma , Korea , Neomycin , Ofloxacin , Polymyxin B , Prevalence , Pruritus , Skin
Article in English | WPRIM | ID: wpr-718571


PURPOSE: To determine whether responses to serotonin are altered in bladder strips from cats diagnosed with a naturally occurring form of bladder pain syndrome/interstitial cystitis termed feline interstitial cystitis (FIC). METHODS: Full thickness bladder strips were isolated from aged matched healthy control cats and cats with clinically verified FIC. Bladder strips were mounted in an organ bath and connected to a tension transducer to record contractile activity. A serotonin dose response (0.01–10μM) was determined for each strip with the mucosa intact or denuded. RESULTS: Bladder strips from control and FIC cats contracted in response to serotonin in a dose-dependent manner. The normalized force of serotonin-evoked contractions was significantly greater in bladder strips from cats with FIC (n=7) than from control cats (n=4). Removal of the mucosa significantly decreased serotonin-mediated responses in both control and FIC bladder preparations. Furthermore, the contractions in response to serotonin were abolished by 1μM atropine in both control and FIC bladder strips. CONCLUSIONS: The effect of serotonin on contractile force, but not sensitivity, was potentiated in bladder strips from cats with FIC, and was dependent upon the presence of the mucosa in control and FIC groups. As atropine inhibited these effects of serotonin, we hypothesize that, serotonin enhances acetylcholine release from the mucosa of FIC cat bladder strips, which could account for the increased force generated. In summary, FIC augments the responsiveness of bladder to serotonin, which may contribute to the symptoms associated with this chronic condition.

Acetylcholine , Animals , Atropine , Baths , Cats , Cystitis , Cystitis, Interstitial , Mucous Membrane , Serotonin , Transducers , Urinary Bladder , Urothelium
Article in English | WPRIM | ID: wpr-717096


OBJECTIVE: In severe organophosphate (OP) poisoning, administration of atropine via continuous intravenous infusion is typically considered. To date, there have been no studies on predicting successful atropine discontinuation through plasma cholinesterase (PChE) and serum lactate levels, which are monitored during critical care in severe acute OP poisoning. Therefore, we retrospectively evaluated the usefulness of serum lactate and PChE as predictors of successful discontinuation of atropine infusion. METHODS: This retrospective observational study was performed on consecutive adult patients treated for severe acute OP poisoning between March 2011 and December 2016. We sequentially evaluated serum lactate and PChE levels on emergency department arrival and before a discontinuation trial of atropine infusion. Discontinuation of atropine intravenous infusion was attempted in patients after clearance of respiratory secretions and cessation of bronchoconstriction. Discontinuation of atropine infusion attempts were divided into successful and failed trials. RESULTS: A total of 95 trials were conducted in 62 patients. Serum lactate levels before trials were significantly different between patients with successful and failed trials. The area under the curve for prediction of successful atropine discontinuation using serum lactate levels before trial discontinuation were 0.742 (95% confidence interval, 0.638 to 0.846). PChE level was not significantly different between two groups. CONCLUSION: Serum lactate levels before the discontinuation trial of atropine infusion served to predict successful discontinuation in severe acute OP poisoning.

Adult , Atropine , Bronchoconstriction , Cholinesterases , Critical Care , Emergency Service, Hospital , Humans , Infusions, Intravenous , Lactic Acid , Observational Study , Organophosphate Poisoning , Plasma , Poisoning , Prognosis , Retrospective Studies
Article in English | WPRIM | ID: wpr-765897


BACKGROUND: The bispectral index (BIS) is a valuable indicator for measuring sedation levels and patient consciousness. Recent reports have highlighted its clinical value as an indicator for anesthesia-related cerebral hypoperfusion and ischemic brain damage. CASE REPORT: A 55-year-old female patient underwent right breast conservation surgery during general anesthesia. During surgery, the patient experienced abrupt bradycardia (heart rate of 36 bpm) without hypotension. During bradycardia, her BIS was severely reduced from 45 to 20 along with elvated suppression ratio (50). After injection of 0.5mg of atropine, her BIS level was recovered, her heart rate was increased, and her suppression ratio was decreased. CONCLUSION: The patient recovered from anesthesia without showing any signs of neurological sequelae based on BIS level monitoring.

Anesthesia , Anesthesia, General , Atropine , Bradycardia , Brain , Breast , Consciousness , Consciousness Monitors , Female , Heart Rate , Humans , Hypotension , Mastectomy, Segmental , Middle Aged
Article in English | WPRIM | ID: wpr-740734


BACKGROUND/AIMS: Although bisacodyl is a widely administered laxative, its underlying mechanism of action remains generally unknown. This study focuses on investigating the effects of bisacodyl on the human colon muscle contraction, and elucidating its mechanism of action. METHODS: Sigmoid colon muscle strips (20 longitudinal and 18 circular muscles) were obtained from 20 subjects who underwent colectomy for colon cancer. Isometric force measurements were calculated in response to electrical field stimulation (EFS, 0.3 milliseconds in trains of 10 Hz for 20 seconds, 150 V). Peak and nadir (tone) during and after EFS, were measured in a controlled state, and after sequential addition of bisacodyl (1 μM), atropine (1 μM), N-nitro-L-arginine (L-NNA, 100 μM), MRS2500 (1 μM), and tetrodotoxin (TTX, 1 μM) to the organ bath. RESULTS: Transient phasic contractions were observed during EFS, and after cessation of EFS. In the longitudinal muscles, nadir during EFS, and tone after EFS, significantly increased after addition of bisacodyl, and persisted after sequential addition of atropine, L-NNA, MRS2500, and TTX, indicating a direct action of bisacodyl on the smooth muscle. In the second experiment, pretreatment of TTX abolished EFS-induced phasic contractions. Although no phasic contraction was produced after perfusion of bisacodyl, tone was increased, thereby supporting evidence of a direct mechanism of action of bisacodyl on the colon smooth muscle. CONCLUSIONS: Bisacodyl increases the tone of longitudinal muscle in the human sigmoid colon through a direct action on the smooth muscle. Further study is warranted to investigate the neural mechanism of action of bisacodyl.

Atropine , Baths , Bisacodyl , Colectomy , Colon , Colon, Sigmoid , Colonic Neoplasms , Humans , In Vitro Techniques , Muscle Contraction , Muscle, Smooth , Muscles , Perfusion , Physiology , Tetrodotoxin