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Int. j. odontostomatol. (Print) ; 14(1): 42-47, mar. 2020. tab
Article in Spanish | LILACS | ID: biblio-1056499


RESUMEN: El objectivo de este estudio fue describir los valores promedio de oximetría, frecuencia cardíaca y eventos de apnea durante la noche y la actividad de los músculos maseteros y temporales en un grupo de adultos jóvenes con BS. Estudio observacional descriptivo de serie de casos que consideró una muestra 20 jóvenes entre 21 y 25 años diagnosticados con BS mediante polisomnografía. Se describieron las condiciones de actividad de los músculos maseteros y temporales mediante electromiografía y los valores e los signos vitales mediante polisomnografía. El análisis estadístico fue de tipo descriptivo, se aplicaron medidas de tendencia central, frecuencias absolutas y relativas. El promedio de la actividad muscular durante la masticación de los maseteros fue (D: 86) (I: 520). El promedio de la actividad muscular durante la masticación de los temporales fue (D: 340) (I: 510). El promedio en los episodios de hipopnea fue de (28,9). El promedio de oximetría fue (NMOR: 93,5) (MOR: 93,8). El promedio de la tasa cardiaca fue (NMOR: 65,4) (MOR: 66,8) latidos/minuto. El promedio de eventos de bruxismo fue (NREM: 135,4) (REM: 120,2).y el índice (eventos BS/hora) (40,60). Las características de las musculares masticatorias y los signos vitales durante el sueño de los sujetos con BS pueden ayudar al entendimiento y a la toma de decisiones en el tratamiento.

ABSTRACT: The objective of the study was to describe the average oximetry, heart rate, and apnea events values during sleep, and the activity of masseter and temporal muscles in a group of young adults with SB (Sleep Bruxism). This serial case and observational descriptive study comprised of a sample of 20 young people between 21 and 25 years of age, who were diagnosed with SB through a polysomnography test. Electromyography recordings served to describe the activity conditions of masseter and temporal muscles, while polysomnography was used to obtain measurement values and vital signs. A descriptive statistical analysis accounting for measures of central tendency, absolute and relative frequencies was performed. During mastication, the average masseter and temporal muscle activity values registered at (D: 86) (I: 520), and (D: 340) (I: 510) respectively. While, the average value for hypopnea episodes was (28.9), and (NREM: 93.5) (REM: 93.8) for oximetry. The average heart rate exhibited a value of (NREM: 65.4) (REM: 66.8) beats / minute, while the values for bruxism events registered at (NREM: 135.4) (REM: 120.2) with an index value of (SB events / hour) (40.60). Muscles of mastication characteristics, and vital signs during sleep for subjects with SB can aid in understanding and decision making in treatment.

Humans , Male , Female , Adult , Bruxism , Sleep Bruxism/complications , Sleep Bruxism/diagnosis , Heart Rate/drug effects , Apnea , Oximetry , Epidemiology, Descriptive , Polysomnography , Dental Occlusion , Electromyography , Observational Study , Mastication , Mexico , Muscle Contraction
Arq. bras. cardiol ; 114(2): 295-303, Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088850


Abstract Background: Cigarette smoking is usually associated with hypertension and may modify vasoconstrictor response. Objective: The present study aimed to analyze and compare the interaction of passive cigarette smoking and hypertension on epinephrine and felypressin blood pressure effects after intravascular injection. Method: 45-day male Wistar rats had the main left renal artery partially constricted and the right kidney removed (1K1C model). Rats were placed in the chamber for exposition to passive cigarette smoking (10 cigarettes) during 10 min (6 days a week). Hypertensive rats received atenolol (90 mg/kg/day) by gavage for two weeks. Hypotensive and hypertensive response, response duration and heart rate were recorded from direct blood pressure values. The significance level was 5%. Results: Passive cigarette smoking increased maximal hypertensive response to epinephrine in normotensive and 1K1C-atenolol treated rats and to felypressin only in 1K1C-atenolol treated rats; it also reduced epinephrine hypotensive response. Epinephrine increased heart rate in normotensive and hypertensive passive smokers or non-smoker rats. Comparing the two vasoconstrictors, epinephrine showed greater hypertensive response in normotensive smokers, 1K1C-atenolol treated smokers and non-smokers. However, in normotensive-nonsmoker rats, felypressin showed a greater and longer hypertensive effect. Conclusions: Our results suggest that passive cigarette smoking may reduce epinephrine vasodilation and increase hypertensive response when compared to felypressin. Therefore, felypressin may be safe for hypertensive patients to avoid tachycardia and atenolol interaction, but for normotensive and non-smoker patients, epinephrine may be safer than felypressin.

Resumo Fundamento: O tabagismo geralmente está associado à hipertensão e pode modificar a resposta vasoconstritora. Objetivo: O presente estudo teve como objetivo analisar e comparar a interação do tabagismo passivo e hipertensão sobre os efeitos da epinefrina e felipressina na pressão arterial após injeção intravascular. Métodos: Ratos Wistar machos de 45 dias tiveram a artéria renal principal esquerda parcialmente obstruída e o rim direito removido (modelo 1K1C). Os ratos foram colocados na câmara para exposição ao tabagismo passivo (10 cigarros) durante 10 minutos (6 dias por semana). Ratos hipertensos receberam atenolol (90 mg/kg/dia) por gavagem durante duas semanas. A resposta hipotensora e hipertensiva, a duração da resposta e a frequência cardíaca foram registradas a partir da medida dos valores diretos da pressão arterial. O nível de significância foi de 5%. Resultados: O tabagismo passivo aumentou a resposta hipertensiva máxima à epinefrina em ratos normotensos e ratos 1K1C tratados com atenolol e à felipressina apenas em ratos 1K1C tratados com atenolol; também reduziu a resposta hipotensiva à epinefrina. A epinefrina aumentou a frequência cardíaca em ratos fumantes passivos ou não-fumantes, normotensos e hipertensos. Comparando os dois vasoconstritores, a epinefrina apresentou maior resposta hipertensiva em fumantes normotensos, ratos 1K1C fumantes e não fumantes tratados com atenolol. No entanto, em ratos normotensos e não fumantes, a felipressina apresentou um efeito hipertensivo maior e mais prolongado. Conclusões: Nossos resultados sugerem que o tabagismo passivo pode reduzir a vasodilatação da epinefrina e aumentar a resposta hipertensiva quando comparado à felipressina. Portanto, a felipressina pode ser segura para pacientes hipertensos, com o objetivo de evitar a interação entre taquicardia e atenolol, mas para pacientes normotensos e não-fumantes, a epinefrina pode ser mais segura que a felipressina.

Animals , Male , Atenolol/pharmacology , Tobacco Smoke Pollution/adverse effects , Blood Pressure/drug effects , Epinephrine/pharmacology , Felypressin/pharmacology , Antihypertensive Agents/pharmacology , Time Factors , Vasoconstrictor Agents/pharmacology , Vasodilation/drug effects , Rats, Wistar , Dose-Response Relationship, Drug , Drug Interactions , Heart Rate/drug effects , Hypertension/drug therapy , Hypotension
Braz. j. med. biol. res ; 53(1): e8645, Jan. 2020. tab, graf
Article in English | LILACS | ID: biblio-1055484


Data about the feasibility and safety of thoracoscopic surgery under non-intubated anesthesia and regional block are limited. In this prospective study, 57 consecutive patients scheduled for thoracoscopic surgery were enrolled. Patients were sedated with dexmedetomidine and anesthetized with propofol and remifentanil. Ropivacaine was used for intercostal nerve and paravertebral block. Lidocaine was used for vagal block. The primary outcomes were mean arterial pressure (MAP), heart rate (HR), oxygen saturation, and end-tidal carbon dioxide partial pressure (ETCO2) at T0 (pre-anesthesia), T1 (immediately after laryngeal mask/nasopharyngeal airway placement), T2 (immediately after skin incision), T3 (10 min after opening the chest), T4 (end of surgery), and T5 (immediately after laryngeal mask/nasopharyngeal airway removal). One patient required conversion to intubation, 15 developed intraoperative hypotension, and two had hypoxemia. MAP at T0 and T5 was higher than at T1-T4; MAP at T3 was lower (P<0.05 vs other time points). HR at T0 and T5 was higher (P<0.05 vs other time points). ETCO2 at T2 and T3 was higher (P<0.05 vs other time points). Arterial pH, PCO2, and lactic acid at T1 differed from values at T0 and T2 (P<0.05). The Quality of Recovery-15 (QoR-15) score at 24 h was lower (P<0.05). One patient experienced dysphoria during recovery. Thoracoscopic surgery with regional block under direct thoracoscopic vision is a feasible and safe alternative to conventional surgery under general anesthesia, intubation, and one-lung ventilation.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Thoracoscopy/methods , Laryngeal Masks , Anesthesia, General/methods , Nerve Block/methods , Blood Pressure/drug effects , Blood Pressure/physiology , Propofol/administration & dosage , Feasibility Studies , Prospective Studies , Dexmedetomidine/administration & dosage , Remifentanil/administration & dosage , Heart Rate/drug effects , Heart Rate/physiology
Article in English | WPRIM | ID: wpr-880313


BACKGROUND@#Decreased heart rate variability (HRV) is a predictor of autonomic system dysfunction, and is considered as a potential mechanism of increased risk of cardiovascular disease (CVD) induced by exposure to particulate matter less than 2.5 μm in diameter (PM@*METHODS@#An updated systematic review and meta-analysis of panel studies till November 1, 2019 was conducted to evaluate the acute effect of exposure to ambient PM@*RESULTS@#A total of 33 panel studies were included in our meta-analysis, with 16 studies conducted in North America, 12 studies in Asia, and 5 studies in Europe. The pooled results showed a 10 μg/m@*CONCLUSION@#Short-term exposure to PM

Adult , Aged , Aged, 80 and over , Air Pollutants/analysis , Air Pollution/analysis , Female , Heart Rate/drug effects , Humans , Male , Middle Aged , Particulate Matter/analysis , Young Adult
Rev. bras. anestesiol ; 69(6): 537-545, nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057471


Abstract Background and objective: Remifentanil is used to attenuate maternal hemodynamic response to intubation and surgical stress during Induction-Delivery period of cesarean section. The goal was to compare the effects of two remifentanil dosing regimens on oxidative stress level, in correlation with its hemodynamic and neonatal effects. Methods: Fifty-one patients, 17 per group, enrolled for elective cesarean section were randomly divided by computer-generated codes into three parallel groups: (A) patients received a 1 µ remifentanil bolus immediately before induction, followed by 0.15 µ infusion, that was stopped after skin incision; (B) patients received a 1 µ remifentanil bolus immediately before induction; (C) (control), patients did not receive remifentanil until delivery. Maternal venous blood samples were taken at basal time, at extraction and 30 minutes after the end of operation for spectrophotometrical determination of malondialdehyde and advanced oxidation protein products concentration. The same was conducted for umbilical venous sample. Results: Systolic blood pressure and heart rate remained significantly lower in group A compared to B and C during entire Induction-Delivery period (p < 0.001, p = 0.02 after intubation; p = 0.006, p = 0.03 after skin incision; p = 0.029, p = 0.04 after extraction; respectively). Malondialdehyde concentration was lower at time of extraction in maternal blood in group A compared to B and C (p = 0.026). All neonatal Apgar scores were ≥ 8 and umbilical acid-base values within normal range. Conclusions: The remifentanil dosing regimen applied in group A significantly attenuated lipid peroxidation and maternal hemodynamic response during entire I-D period, without compromising neonatal outcome.

Resumo Justificativa e objetivo: O remifentanil é usado para atenuar a resposta hemodinâmica materna à intubação e ao estresse cirúrgico durante o intervalo indução-parto cesariana. O objetivo foi comparar os efeitos de dois regimes posológicos de remifentanil sobre o nível de estresse oxidativo, em correlação com seus efeitos na hemodinâmica materna e no neonato. Métodos: Mediante códigos gerados por computador, 51 pacientes (17 por grupo) programadas para cesariana eletiva foram randomicamente divididas em três grupos paralelos (A, B e C). No Grupo A, as pacientes receberam remifentanil em bolus de 1 µ imediatamente antes da indução, seguido por infusão de 0,15 µ que foi interrompida após a incisão da pele; no Grupo B, as pacientes receberam remifentanil em bolus de 1 µ imediatamente antes da indução; no Grupo C (controle), as pacientes não receberam remifentanil até o parto. Amostras de sangue venoso materno foram colhidas no momento basal, na extração do feto e 30 minutos após o término da operação para determinar espectrofotometricamente as concentrações do malondialdeído e dos produtos proteicos de oxidação avançada. O mesmo foi feito para a coleta das amostras de sangue venoso umbilical. Resultados: A pressão arterial sistólica e a frequência cardíaca permaneceram significativamente menores no Grupo A, comparado aos grupos B e C, durante todo o intervalo indução-parto (p < 0,001, p = 0,02 após a intubação; p = 0,006, p = 0,03 após a incisão da pele; p = 0,029, p = 0,04 após a extração do feto, respectivamente). No momento da extração do feto, a concentração do malondialdeído foi menor no sangue materno do Grupo A, comparado aos grupos B e C (p = 0,026). Todos os escores de Apgar neonatais foram ≥ 8 e os valores da avaliação ácido-base do cordão umbilical estavam dentro da faixa normal. Conclusões: O regime posológico de remifentanil aplicado ao Grupo A atenuou de modo significativo a peroxidação lipídica e a resposta hemodinâmica materna durante todo o intervalo indução-parto, sem comprometer o desfecho neonatal.

Humans , Male , Female , Pregnancy , Infant, Newborn , Cesarean Section/methods , Oxidative Stress/drug effects , Remifentanil/administration & dosage , Apgar Score , Blood Pressure/drug effects , Drug Administration Schedule , Pregnancy Outcome , Prospective Studies , Remifentanil/pharmacology , Heart Rate/drug effects , Hemodynamics/drug effects
Arq. bras. cardiol ; 113(5): 925-932, Nov. 2019. graf
Article in English | LILACS | ID: biblio-1055040


Abstract Background: D-limonene (DL) is a monoterpene and is the major component in the essential oil of citrus fruit. It presents antihyperglycemic and vasodilatation activities. Objectives: This study evaluated the cardiovascular effects and potential antiarrhythmic of DL in rats. Methods: Hemodynamic and electrocardiographic (ECG) parameters were measured in male Wistar rats, which under anesthesia had been cannulated in the abdominal aorta and lower vena cava and had electrodes subcutaneously implanted. In the in vitro approach, the heart was removed and perfused using the Langendorff technique. The significance level adopted was 5% (p < 0.05). Results: DL, in doses of 10, 20, and 40 mg/kg (i.v), produced intense and persistent bradycardia associated with hypotension. Bradycardia with prolonged QTc was observed in the ECG in vivo recording. In the in vivo model of arrhythmia induced by Bay K8644, DL (10 mg/kg) decreased the arrhythmia score from 15.33 ± 3.52 to 4.0 ± 2.64 u.a (p < 0.05, n = 4). In isolated perfused hearts, DL (10-3 M) promoted significant reductions in heart rate (from 228.6 ± 8.5 ms to 196.0 ± 9.3 bpm; p < 0.05) and left ventricular development pressure (from 25.2 ± 3.4 to 5.9 ± 1.8 mmHg; n = 5, p < 0.05). Conclusions: DL produces bradycardia and antiarrhythmic activity in rat heart.

Resumo Fundamento: O D-limoneno (DL) é um monoterpeno e o principal componente do óleo essencial de frutas cítricas. Ele apresenta atividades anti-hiperglicêmicas e vasodilatadoras. Objetivos: Este estudo avaliou os efeitos cardiovasculares e antiarrítmicos potenciais do DL em ratos. Métodos: Os parâmetros hemodinâmicos e eletrocardiográficos (ECG) foram mensurados em ratos Wistar machos que, sob anestesia, tiveram a aorta abdominal e a veia cava inferior canuladas e receberam eletrodos implantados subcutaneamente. Na abordagem in vitro, o coração foi removido e perfundido utilizando a técnica de Langendorff. O nível de significância adotado foi de 5% (p < 0,05). Resultados: DL, nas doses de 10, 20 e 40 mg/kg (i.v), produziu bradicardia intensa e persistente associada à hipotensão. A bradicardia com QTc prolongado foi observada no registro in vivo do ECG. No modelo in vivo de arritmia induzida por Bay K8644, DL (10 mg / kg) houve diminuição do escore da arritmia de 15,33 ± 3,52 para 4,0 ± 2,64 u.a (p < 0,05, n = 4). Em corações perfundidos isolados, o DL (10-3 M) promoveu reduções significativas na frequência cardíaca (de 228,6 ± 8,5 ms para 196,0 ± 9,3 bpm; p < 0,05) e na pressão desenvolvida do ventrículo esquerdo (de 25,2 ± 3,4 para 5,9 ± 1,8 mmHg; n = 5, p < 0,05). Conclusões: O DL produz bradicardia e atividade antiarrítmica no coração de ratos.

Animals , Male , Arrhythmias, Cardiac/drug therapy , Bradycardia/drug therapy , Limonene/therapeutic use , Anti-Arrhythmia Agents/therapeutic use , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/chemically induced , Blood Pressure/drug effects , Bradycardia/diagnosis , Rats, Wistar , Ventricular Pressure/drug effects , Models, Animal , Electrocardiography , Isolated Heart Preparation , Limonene/pharmacology , Heart Rate/drug effects , Hemodynamics/drug effects , Hypotension , Anti-Arrhythmia Agents/pharmacology
Mem. Inst. Invest. Cienc. Salud (Impr.) ; 17(2): 86-101, ago. 2019. ilus, tab
Article in Spanish | LILACS, BDNPAR | ID: biblio-1008711


La fibrilación auricular (FA) es la arritmia sostenida más frecuente que puede presentarse en una amplia variedad de condiciones clínicas. A pesar de los progresos en el tratamiento de los pacientes con FA, esta arritmia sigue siendo una de las más importantes causas de accidente cerebrovascular, insuficiencia cardiaca, muerte súbita y morbilidad cardiovascular en todo el mundo. El objetivo del tratamiento con fármacos antiarrítmicos es mejorar los síntomas relacionados con la FA, y buscar un equilibrio entre la carga sintomática, la posibilidad de reacciones farmacológicas adversas y las preferencias del paciente. El control de la frecuencia cardiaca a corto y largo plazo se puede lograr con bloqueadores beta, digoxina, bloqueadores de los canales del calcio o tratamiento combinado. Si bien otros fármacos antiarrítmicos de clase III también tienen un efecto limitador de la frecuencia, solo deben emplearse para el control del ritmo cardiaco. Restaurar y mantener el ritmo sinusal también es una parte integral del tratamiento de la FA. Los fármacos antiarrítmicos de clase III duplican la tasa de pacientes en ritmo sinusal. El tratamiento para el control del ritmo está indicado para mejorar los síntomas de los pacientes con FA que siguen sintomáticos a pesar del tratamiento adecuado para el control de la frecuencia cardiaca. La combinación de antiarrítmicos que prolongan el intervalo QT no se debe emplear para el control del ritmo cardiaco en la FA(AU)

Atrial fibrillation (AF) is the most frequent sustained arrhythmia that can occur in a wide variety of clinical conditions. Despite progress in the treatment of patients with AF, this arrhythmia remains one of the most important causes of stroke, heart failure, sudden death and cardiovascular morbidity worldwide. The aim of treatment with antiarrhythmic drugs is to improve the symptoms related to AF, and to look for a balance between the symptomatic load, the possibility of adverse pharmacological reactions and the patient preferences. The short and long term heart rate control can be achieved with beta blockers, digoxin, calcium channel blockers or combination therapy. Although other class III antiarrhythmic drugs also have a frequency-limiting effect, they should only be used for the control of heart rhythm. Restoring and maintaining sinus rhythm is also an integral part of the treatment of AF. Class III antiarrhythmic drugs double the rate of patients who maintain their sinus rhythm. Treatment for rhythm control is indicated to improve the symptoms of patients with AF who remain symptomatic despite adequate treatment for heart rate control. The combination of antiarrhythmics that prolong the QT interval should not be used to control heart rhythm in AF(AU)

Humans , Atrial Fibrillation/drug therapy , Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/diagnosis , Heart Rate/drug effects
Pesqui. vet. bras ; 39(3): 214-220, Mar. 2019. tab, ilus
Article in English | ID: biblio-1002798


The objective of this study was to evaluate the quality and recovery from anesthesia promoted by the tiletamine-zolazepam (TZ) combination administered intravenously (IV) continuously in bitches pre-medicated with acepromazine. Eight cross-bred, clinically healthy bitches weighing 13.7 ±1.9kg on average were used in this study. After a food fast of 12 h and a water fast of four hours, the animals were treated with acepromazine (0.1mg/kg, intramuscular) and, after 15 minutes, anesthesia was induced with a combination of tiletamine-zolazepam (2mg/kg, IV) immediately followed by continuous IV infusion thereof at a dose of 2mg/kg/h for 60 min. The following parameters were measured in all animals immediately before administration of acepromazine (M15), immediately before anesthetic induction (M0), and at 5, 10, 20, 30, 40, 50, and 60 min after initiation of continuous infusion (M5, M10, M20, M30, M40, M50, and M60): electrocardiography (ECG), heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), body temperature (BT), and arterial hemogasometry, with the last performed only at experimental times M15, M0, M30, and M60. A subcutaneous electrical stimulator was used to evaluate the degree of analgesia. Myorelaxation and quality of anesthetic recovery were also assessed, classifying these parameters as excellent, good, and poor. Anesthetic recovery time was recorded in minutes. HR increased significantly at time M10 in relation to that at M-15, and at times M5, M10, M40, and M50 in relation to that at M0. MAP decreased significantly at M20 and M30 compared with the baseline. BT decreased significantly at M50 compared with that at M0, but no hypothermia was observed. RR showed significant reduction at M5, M10, and M20 in relation to that at M-15, and at M5 and M10 in relation to that at M0, and bradypnoea was observed during the first 20 min after anesthetic induction. Significant decreases in the PR interval at times M10, M40, and M50 were observed in relation to that at M15. Amplitude of the R wave showed significant decrease at M20 compared with that at M-15. In the other ECG parameters, no significant difference was observed between the times evaluated. Hemogasometric parameters and analgesia did not show significant alterations. Myorelaxation and quality of anesthetic recovery were considered excellent. Recovery time was 15.1±7.7 min for positioning of sternal decubitus and 45.5±23.1 minutes for return of ambulation. Continuous IV administration of TZ combination does not produce satisfactory analgesia and does not cause severe cardiorespiratory and hemogasometric effects in bitches pre-medicated with acepromazine.(AU)

Objetivou-se avaliar a qualidade e a recuperação da anestesia promovida pela associação tiletamina-zolazepam, administrada por via intravenosa (IV) contínua, em cadelas pré-medicadas com acepromazina. Foram utilizadas oito cadelas, sem raças definidas, clinicamente sadias, pesando em média 13,7±1,9kg. Após jejum alimentar de 12 horas e hídrico de quatro horas, os animais foram medicados com acepromazina (0,1mg/kg, via intramuscular) e, após 15 minutos, a anestesia foi induzida com a associação tiletamina-zolazepam (2mg/kg, IV) seguida imediatamente pela infusão IV contínua da mesma, na dose de 2mg/kg/h, durante 60 minutos. Os parâmetros que foram mensurados em todos os animais, imediatamente antes da administração da acepromazina (M-15), imediatamente antes da indução anestésica (M0) e, aos 5, 10, 20, 30, 40, 50 e 60 minutos após o início da infusão contínua (M5, M10, M20, M30, M40, M50 e M60) foram os seguintes: eletrocardiografia (ECG), frequência cardíaca (FC), pressão arterial média (PAM), frequência respiratória (f), temperatura corpórea (TC) e hemogasometria arterial, esta sendo realizada apenas nos momentos M-15, M0, M30 e M60. Para avaliação do grau de analgesia foi empregado um estimulador elétrico subcutâneo. Também se avaliou o miorrelaxamento e a qualidade da recuperação anestésica, classificando estes parâmetros em: excelente, bom e ruim. O tempo de recuperação anestésica foi registrado em minutos. A FC aumentou significativamente no momento M10 em relação ao M-15, e nos momentos M5, M10, M40 e M50 em relação ao M0. A PAM diminuiu significativamente em M20 e M30 em comparação ao valor basal. A TC diminuiu significativamente em M50 em comparação ao M0, mas não foi observada hipotermia. A f apresentou uma redução significativa nos momentos M5, M10 e M20 em relação ao M-15, e em M5 e M10 em relação ao M0, sendo observado bradipneia durante os primeiros 20 minutos após a indução anestésica. Foram observadas diminuições significativas do intervalo PR nos momentos M10, M40 e M50, em relação ao M-15. A amplitude da onda R apresentou diminuição significativa em M20 em comparação ao M-15. Nos demais parâmetros da ECG não houve diferença significativa entre os momentos avaliados. Os parâmetros hemogasométricos e a analgesia não apresentaram alterações significativas. O miorrelaxamento e a qualidade da recuperação anestésica foram considerados excelentes. O período de recuperação foi de 15,1±7,7 minutos para posicionamento do decúbito esternal e 45,5±23,1 minutos para retorno da deambulação. A administração intravenosa contínua de tiletamina-zolazepam não produz analgesia satisfatória e não causa efeitos cardiorrespiratórios e hemogasométricos severos, em cadelas pré-tratadas com acepromazina.(AU)

Animals , Female , Dogs , Tiletamine/pharmacology , Zolazepam/pharmacology , Anesthesia Recovery Period , Respiratory Rate/drug effects , Heart Rate/drug effects , Adjuvants, Anesthesia , Anesthesia, Intravenous/veterinary , Acepromazine/pharmacology
Acta cir. bras ; 34(9): e201900905, 2019. tab, graf
Article in English | LILACS | ID: biblio-1054693


Abstract Purpose: To investigate efficacy of combined use of parecoxib and dexmedetomidine on postoperative pain and early cognitive dysfunction after laparoscopic cholecystectomy for elderly patients. Methods: The present prospective randomized controlled study included a total of 80 patients who underwent laparoscopic cholecystectomy surgery during January 2016 to November 2017 in our hospital. All patients were randomly divided into 4 groups, the parecoxib group, the dexmedetomidine group, the parecoxib and dexmedetomidine combined group, and the control group. Demographic data and clinical data were collected. Indexes of heart rate (HR), mean arterial pressure (MAP), levels of jugular venous oxygen saturation (SjvO2) and jugular venous oxygen pressure (PjvO2) were recorded at different time points before and during the surgery. The mini-mental state examination (MMSE) score, Ramsay score and Visual Analogue Score (VAS) were measured. Results: Levels of both SjvO2 and PjvO2 were significantly higher in parecoxib group, dexmedetomidine group and the combined group than the control group. Meanwhile, levels of both SjvO2 and PjvO2 in the combined group were the highest. VAS scores were significantly lower in the combined group than all other groups, and total patient controlled intravenous analgesia (PCIA) pressing times within 48 h after surgery were the lowest in the combined group. Both Ramsay and MMSE scores were the highest in the combined group compared with other groups, while were the lowest in the control group. Conclusion: The combined use of parecoxib and dexmedetomidine could reduce the postoperative pain and improve the postoperative sedation and cognitive conditions of patients after laparoscopic cholecystectomy.

Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Pain, Postoperative/drug therapy , Cholecystectomy, Laparoscopic/adverse effects , Cyclooxygenase 2 Inhibitors/administration & dosage , Adrenergic alpha-2 Receptor Agonists/administration & dosage , Isoxazoles/administration & dosage , Time Factors , Pain Measurement , Prospective Studies , Analysis of Variance , Treatment Outcome , Drug Therapy, Combination , Arterial Pressure/drug effects , Heart Rate/drug effects
Rev. cuba. anestesiol. reanim ; 17(1): 1-6, ene.-abr. 2018. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-991019


Introducción: El bloqueo de rama izquierda del haz de His dependiente de la frecuencia cardíaca no es una entidad común en la práctica clínica del anestesiólogo, sino que se presenta como consecuencia de enfermedades cardiacas o no que ocurren por lentitud de la frecuencia ventricular sobre todo, con enfermedad de las arterias coronarias planteadas solo como diagnóstico después de haberlas descartado. Objetivo: Describir el manejo clínico-anestésico de una paciente que presentó bloqueo de rama izquierda del haz de His para cirugía torácica electiva por tumor de mediastino. Desarrollo: Se presenta un caso clínico de una paciente con bloqueo de rama izquierda dependiente de la frecuencia cardiaca que se anunció para cirugía del tórax, sin historia previa de coronariopatía. La cirugía trascurrió sin complicaciones y con buenos resultados. Conclusiones: el bloque de rama izquierda dependiente de la frecuencia cardiaca es una entidad rara y un diagnóstico excluyente de otras entidades cardiovasculares o no como la isquemia miocárdica. Un adecuado manejo intraoperatorio del paciente proporciona excelentes resultados sin traducción clínica ni complicaciones(AU)

Introduction: Rate-dependent left bundle branch block is not a rare entity for the clinical practice in anesthesiology, but appears as a consequence of heart diseases or not always due to slowness in atrial frequency above all, with coronary artery diseases diagnosed only after their being ruled out. Objective: To describe the clinical-anesthetic management of a patient who presented left bundle branch block for elective thoracic surgery due to mediastinal tumor. Findings: We present a clinical case of a female patient with rate-dependent left bundle branch block who was announced for thoracic surgery, without a previous history of coronary artery disease. The surgery proceeded without complications and with positive outcome. Conclusions: Rate-dependent left-branch block is a rare entity and a diagnosis ruling out other cardiovascular entities or not, such as myocardial ischemia. An adequate intraoperative management of the patient provides excellent outcome without clinical translation or complications(AU)

Humans , Female , Aged , Heart Rate/drug effects , Anesthesia, Conduction/methods , Bundle-Branch Block/surgery
Acta cir. bras ; 33(1): 22-30, Jan. 2018. tab
Article in English | LILACS | ID: biblio-886251


Abstract Purpose: To investigate the influence of dexmedetomidine on myocardial ischemia-reperfusion injury (IRI) in rabbits. Methods: Twenty-four New Zealand white rabbits were randomly divided into two equal-sized groups: IRI group (group IR) and dexmedetomidine group (group D). Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), left ventricular systolic pressure (LVSP), left ventricular end-diastolic pressure (LVEDP), left ventricular diastolic pressure (LVDP), +dp/dtmax, -dp/dtmax, and t-dp/dtmax were recorded and calculated at the following time points: before (T0) and after (T1) dexmedetomidine infusion, after 30-min ischemia (T2), and after 120-min reperfusion (T3). The levels of plasma endothelin 1 (ET-1), thromboxane A2 (TXA2), and platelet activating factor (PAF); area of myocardial infarction (MI); and no-reflow area were evaluated. Results: SBP, DBP, LVSP, LVEDP, LVDP, and +dp/dtmax at T3 were higher in group D than in group IR (P<0.05). The average no-reflow area in group IR was significantly smaller than that in group D (14±3% vs. 38±5%, P=0.0116). The ET-1, TXA2, and PAF levels at T2 and T3 were higher than those at T0 in both groups (P<0.05). Conclusion: Dexmedetomidine could reduce the magnitude of ischemic myocardial no-reflow area and protect the myocardium with ischemia-reperfusion injury.

Animals , Male , Rats , Myocardial Reperfusion Injury/prevention & control , Dexmedetomidine/pharmacology , Adrenergic alpha-2 Receptor Agonists/pharmacology , Reference Values , Thromboxane A2/blood , Platelet Activating Factor/analysis , Myocardial Reperfusion Injury/physiopathology , Random Allocation , Reproducibility of Results , Treatment Outcome , Endothelin-1/blood , Disease Models, Animal , No-Reflow Phenomenon/physiopathology , Heart Rate/drug effects , Hemodynamics
Acta cir. bras ; 32(8): 662-672, Aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-886229


Abstract Purpose: To determine if the combination of lidocaine with epinephrine or gamma globulin would decrease the rate or reduce the amount of local absorption of lidocaine through the airway. Methods: Twenty adult male cats were randomly and evenly distributed into four groups: 1) Group LG: lidocaine administered with gamma globulin; 2) Group LS: lidocaine administered with physiological saline); 3) Group LE: lidocaine administered with epinephrine; 4) Group C: control group. Invasive blood pressure, heart rate, and concentration of lidocaine were recorded before and after administration. Results: The peak of plasma concentrations appeared difference (Group LG: 1.39 ± 0.23 mg/L; Group LS: 1.47 ± 0.29 mg/L and Group LE: 0.99 ± 0.08 mg/L). Compared to Group C, there were significant differences in the average heart rate of Groups LG, LS, and LE (P < 0.05). The average systolic blood pressures were significantly different when each group was compared to Group C (P < 0.05). The biological half-life, AUC0-120, peak time, and half-life of absorption among the three groups have not presented statistically significant differences (P > 0.05). Conclusion: Administering lidocaine in combination with gamma globulin through airway causes significant decrease the rate and reduce the amount of local absorption of lidocaine in cats.

Animals , Male , Cats , gamma-Globulins/pharmacokinetics , Epinephrine/pharmacokinetics , Adrenergic beta-Agonists/pharmacokinetics , Respiratory Tract Absorption/drug effects , Anesthetics, Local/pharmacokinetics , Lidocaine/pharmacokinetics , Reference Values , Time Factors , Trachea/drug effects , Blood Pressure/drug effects , Bronchoscopy/methods , gamma-Globulins/administration & dosage , Epinephrine/administration & dosage , Random Allocation , Reproducibility of Results , Adrenergic beta-Agonists/administration & dosage , Drug Combinations , Heart Rate/drug effects , Anesthetics, Local/administration & dosage , Anesthetics, Local/blood , Lidocaine/administration & dosage , Lidocaine/blood
Rev. bras. cir. cardiovasc ; 32(2): 96-103, Mar.-Apr. 2017. tab
Article in English | LILACS | ID: biblio-843481


Abstract INTRODUCTION: The mortality due to cardiogenic shock complicating acute myocardial infarction (AMI) is high even in patients with early revascularization. Infusion of low dose recombinant human brain natriuretic peptide (rhBNP) at the time of AMI is well tolerated and could improve cardiac function. OBJECTIVE: The objective of this study was to evaluate the hemodynamic effects of rhBNP in AMI patients revascularized by emergency percutaneous coronary intervention (PCI) who developed cardiogenic shock. METHODS: A total of 48 patients with acute ST segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock and whose hemodynamic status was improved following emergency PCI were enrolled. Patients were randomly assigned to rhBNP (n=25) and control (n=23) groups. In addition to standard therapy, study group individuals received rhBNP by continuous infusion at 0.005 µg kg−1 min−1 for 72 hours. RESULTS: Baseline characteristics, medications, and peak of cardiac troponin I (cTnI) were similar between both groups. rhBNP treatment resulted in consistently improved pulmonary capillary wedge pressure (PCWP) compared to the control group. Respectively, 7 and 9 patients died in experimental and control groups. No drug-related serious adverse events occurred in either group. CONCLUSION: When added to standard care in stable patients with cardiogenic shock complicating anterior STEMI, low dose rhBNP improves PCWP and is well tolerated.

Humans , Male , Female , Middle Aged , Aged , Natriuretic Peptide, Brain/administration & dosage , Anterior Wall Myocardial Infarction/drug therapy , Percutaneous Coronary Intervention/mortality , ST Elevation Myocardial Infarction/drug therapy , Shock, Cardiogenic/etiology , Blood Pressure/drug effects , Recombinant Proteins/administration & dosage , Recombinant Proteins/pharmacology , Pulmonary Wedge Pressure/drug effects , Analysis of Variance , Natriuretic Peptide, Brain/therapeutic use , Natriuretic Peptide, Brain/pharmacology , Anterior Wall Myocardial Infarction/complications , Anterior Wall Myocardial Infarction/mortality , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/mortality , Heart Rate/drug effects , Intra-Aortic Balloon Pumping/methods
Arq. bras. cardiol ; 108(2): 154-160, Feb. 2017. tab, graf
Article in English | LILACS | ID: biblio-838693


Abstract Background: Isotonic blood volume expansion (BVE) induced alterations of sympathetic and parasympathetic activity in the heart and blood vessels, which can be modulated by serotonergic pathways. Objective: To evaluate the effect of saline or serotonergic agonist (DOI) administration in the hypothalamic paraventricular nucleus (PVN) on cardiovascular responses after BVE. Methods: We recorded pulsatile blood pressure through the femoral artery to obtain the mean arterial pressure (MAP), systolic (SBP) and diastolic blood pressure (DBP), heart rate (HR) and the sympathetic-vagal ratio (LF/HF) of Wistar rats before and after they received bilateral microinjections of saline or DOI into the PVN, followed by BVE. Results: No significant differences were observed in the values of the studied variables in the different treatments from the control group. However, when animals are treated with DOI followed by BVE there is a significant increase in relation to the BE control group in all the studied variables: MBP (114.42±7.85 vs 101.34±9.17); SBP (147.23±14.31 vs 129.39±10.70); DBP (98.01 ±4.91 vs 87.31±8.61); HR (421.02±43.32 vs 356.35±41.99); and LF/HF ratio (2.32±0.80 vs 0.27±0.32). Discussion: The present study showed that the induction of isotonic BVE did not promote alterations in MAP, HR and LF/HF ratio. On the other hand, the injection of DOI into PVN of the hypothalamus followed by isotonic BVE resulted in a significant increase of all variables. Conclusion: These results suggest that serotonin induced a neuromodulation in the PVN level, which promotes an inhibition of the baroreflex response to BVE. Therefore, the present study suggests the involvement of the serotonergic system in the modulation of vagal reflex response at PVN in the normotensive rats.

Resumo Fundamento: Expansão de volume extracelular (EVEC) promove alterações da atividade simpática e parassimpática no coração e vasos sanguíneos, os quais podem ser moduladas por vias serotoninérgicas. Objetivo: Avaliar o efeito da administração de salina ou agonista serotoninérgico (DOI) nos núcleos paraventriculares hipotalâmico (NPV) sobre respostas cardiovasculares após EVEC. Métodos: Foram obtidos registros da pressão arterial pulsátil, por meio da artéria femoral, para obtenção dos valores da pressão arterial média (PAM), sistólica (PAS), diastólica (PAD), frequência cardíaca (FC) e razão simpático-vagal (LF/HF) de ratos Wistar antes e após receberem microinjeções bilaterais no NPV de salina ou DOI seguida de EVEC. Resultados: Não foram observadas diferenças significativas dos valores das variáveis estudadas nos diferentes tratamentos do grupo controle. Entretanto, quando os animais são tratados com DOI seguida de EVEC ocorre aumento significativo em relação ao grupo controle com EVEC em todas as variáveis estudadas: PAM (114,42±7,85 vs 101,34±9,17), PAS (147,23±14,31 vs 129,39±10,70), PAD (98,01 ±4,91 vs 87,31±8,61), FC (421,02±43,32 vs 356,35±41,99) e LF/HF (2,32±0,80 vs 0,27±0,32). Discussão: O presente estudo mostrou que a indução de EVEC isotônica não promoveu alterações na PAM, PAD, PAS, FC e LF/HF. Por outro lado, os animais que receberam microinjeção de DOI no NPV seguida de EVEC apresentaram aumento significativo de todas as variáveis. Conclusão: Esses resultados sugerem que a serotonina exerce uma neuromodulação em nivel do NPV, e essa promove uma inibição da resposta barorreflexa frente à EVEC. Assim, o presente trabalho sugere o envolvimento serotoninérgico na neuromodulação no nivel do NPV na resposta reflexa vagal em ratos normotensos.

Animals , Male , Paraventricular Hypothalamic Nucleus/drug effects , Paraventricular Hypothalamic Nucleus/physiology , Blood Volume/drug effects , Sodium Chloride/pharmacology , Cardiovascular System/drug effects , Serotonin Receptor Agonists/pharmacology , Reference Values , Time Factors , Blood Pressure/drug effects , Blood Pressure/physiology , Blood Volume/physiology , Cardiovascular Physiological Phenomena , Reproducibility of Results , Rats, Wistar , Baroreflex/drug effects , Baroreflex/physiology , Heart Rate/drug effects , Heart Rate/physiology
Rev. bras. anestesiol ; 67(1): 50-56, Jan.-Feb. 2017. tab, graf
Article in English | LILACS | ID: biblio-843357


Abstract Background and objectives: Hemodynamic response to airway stimuli is a common phenomenon and its management is important to reduce the systemic repercussions. The objective of this study is to compare the efficacy of intravenous magnesium sulfate versus lidocaine on this reflex hemodynamics after laryngoscopy and tracheal intubation. Methods: This single-center, prospective, double-blind, randomized study evaluated 56 patients ASA 1 or 2, aged 18-65 years, scheduled for elective surgeries under general anesthesia with intubation. The patients were allocated into two groups: Group F received 30 mg·kg-1 of magnesium sulphate and Group L, 2 mg·kg-1 of lidocaine, continuous infusion, immediately before the anesthetic induction. Blood pressure (BP), heart rate (HR), and bispectral index (BIS) were measured in both groups at six different times related to administration of the study drugs. Results: In both groups there was an increase in HR and BP after laryngoscopy and intubation, compared to baseline. Group M showed statistically significant increase in the values of systolic and diastolic blood pressure after intubation, which was clinically unimportant. There was no difference in the BIS values between groups. Among patients receiving magnesium sulfate, three (12%) had high blood pressure versus only one among those receiving lidocaine (4%), with no statistical difference. Conclusion: Magnesium sulfate and lidocaine have good efficacy and safety for hemodynamic management in laryngoscopy and intubation.

Resumo Justificativa e objetivos: A resposta hemodinâmica aos estímulos das vias aéreas é um fenômeno comum e seu controle é importante para diminuir as repercussões sistêmicas. O objetivo deste trabalho é comparar os efeitos da administração endovenosa de sulfato de magnésio versus lidocaína na hemodinâmica desse reflexo após a laringoscopia e intubação orotraqueal. Métodos: Este estudo duplamente encoberto, aleatorizado, unicêntrico e prospectivo avaliou 56 pacientes, ASA 1 ou 2, entre 18 e 65 anos, escalados para cirurgias eletivas sob anestesia geral com intubação orotraqueal. Foram alocados em dois grupos, o M recebeu 30 mg·kg-1 de sulfato de magnésio e o L, 2 mg·kg-1 de lidocaína, em infusão contínua, imediatamente antes da indução anestésica. Os valores de pressão arterial (PA), frequência cardíaca (FC) e índice biespectral (BIS) foram aferidos nos dois grupos em seis momentos relacionados com a administração dos fármacos do estudo. Resultados: Em ambos os grupos houve aumento na FC e PA após a laringoscopia e intubação, em relação aos valores basais. No Grupo M observou-se elevação estatisticamente significativa, mas clinicamente pouco importante, nos valores das pressões arteriais sistólica e diastólica após a intubação. Não houve diferença nos valores de BIS entre os grupos. Dos pacientes que receberam o sulfato de magnésio, 3 (12%) apresentaram episódio de hipertensão, ao passo que apenas um dos que receberam lidocaína (4%) apresentou esse sinal, sem diferença estatística. Conclusão: Sulfato de magnésio e a lidocaína apresentam boa eficácia e segurança no controle hemodinâmico à laringoscopia e intubação.

Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Hemodynamics/drug effects , Intubation, Intratracheal/adverse effects , Laryngoscopy/adverse effects , Lidocaine/pharmacology , Magnesium Sulfate/pharmacology , Blood Pressure/drug effects , Infusions, Intravenous , Double-Blind Method , Prospective Studies , Treatment Outcome , Elective Surgical Procedures , Heart Rate/drug effects , Lidocaine/administration & dosage , Magnesium Sulfate/administration & dosage , Middle Aged
Yonsei Medical Journal ; : 105-113, 2017.
Article in English | WPRIM | ID: wpr-65056


PURPOSE: Urapidil is putatively effective for patients with hypertension and acute heart failure, although randomized controlled trials thereon are lacking. We investigated the efficacy and safety of intravenous urapidil relative to that of nitroglycerin in older patients with hypertension and heart failure in a randomized controlled trial. MATERIALS AND METHODS: Patients (>60 y) with hypertension and heart failure were randomly assigned to receive intravenous urapidil (n=89) or nitroglycerin (n=91) for 7 days. Hemodynamic parameters, cardiac function, and safety outcomes were compared. RESULTS: Patients in the urapidil group had significantly lower mean systolic blood pressure (110.1±6.5 mm Hg) than those given nitroglycerin (126.4±8.1 mm Hg, p=0.022), without changes in heart rate. Urapidil was associated with improved cardiac function as reflected by lower N terminal-pro B type natriuretic peptide after 7 days (3311.4±546.1 ng/mL vs. 4879.1±325.7 ng/mL, p=0.027) and improved left ventricular ejection fraction (62.2±3.4% vs. 51.0±2.4%, p=0.032). Patients given urapidil had fewer associated adverse events, specifically headache (p=0.025) and tachycardia (p=0.004). The one-month rehospitalization and all-cause mortality rates were similar. CONCLUSION: Intravenous administration of urapidil, compared with nitroglycerin, was associated with better control of blood pressure and preserved cardiac function, as well as fewer adverse events, for elderly patients with hypertension and acute heart failure.

Acute Disease , Aged , Antihypertensive Agents/administration & dosage , Blood Pressure/drug effects , Cause of Death , Female , Heart Failure/drug therapy , Heart Rate/drug effects , Hemodynamics , Humans , Hypertension/drug therapy , Injections, Intravenous , Male , Middle Aged , Natriuretic Peptide, Brain/blood , Nitroglycerin/administration & dosage , Peptide Fragments/blood , Piperazines/administration & dosage , Ventricular Function, Left/drug effects
Arq. bras. med. vet. zootec ; 68(6): 1613-1620, nov.-dez. 2016. tab, ilus
Article in Portuguese | LILACS, VETINDEX | ID: biblio-827943


O objetivo deste trabalho foi descrever os achados eletrocardiográficos de 11 onças- pardas (Puma concolor). Os animais foram sedados com 0,15mg/kg de detomidina associado a 5mg/kg de cetamina e mantidos anestesiados com sevoflurano (GSEVO, n=6) ou isoflurano (GISO, n=5). A frequência cardíaca foi de 95 ± 13bpm. As alterações observadas nos animais no GSEVO foram: atrial standtill com condução ventricular, episódios isolados de contração ventricular prematura, bloqueio atrioventricular de primeiro grau, diminuição da amplitude do complexo QRS, onda S profunda e aumento da amplitude da onda T. No grupo GISO, observou-se bloqueio de ramo direito do feixe de His, bloqueio atrioventricular de primeiro grau e aumento da amplitude da onda T. Arritmias não puderam ser associadas ao uso dos anestésicos inalatórios devido à não sensibilização do miocárdio às catecolaminas. Achados como o BAV de primeiro grau pode ter ocorrido devido ao uso de agonistas alfa-2 adrenérgicos. Este estudo aumentou o conhecimento sobre as alterações eletrocardiográficas em onças-pardas anestesiadas, entretanto mais estudos são necessários para correlacionar estes achados ao uso de agentes anestésicos.(AU)

The aim of this study was to describe electrocardiographic findings in pumas (Puma concolor). The animals were sedated with 0.15mg/kg of detomidine plus 5mg/kg of ketamine and anesthetized with sevoflurane (GSEVO, n=6), or isoflurane (GISO, n=5). The heart rate was 95 ± 13bpm. The changes observed on GSEVO animals were: atrial standstill with ventricular conduction, isolated episodes of ventricular premature contraction, atrioventricular blockage of first degree, reduction of the amplitude of the QRS complexes, deep S wave, and increase of the amplitude of the T wave. In the GISO group a right bundle branch block of the His bundle, atrioventricular blockage of first degree and of the amplitude of the T wave. Arrhythmias couldn´t be related to the use of inhalant anesthesia due to the lack of myocardial awareness to catecholamines. Findings such as atrioventricular block in first degree may have occurred due to the use of alfa-2 adrenergic agonists. This study improved the knowledge about electrocardiographic alterations in anesthetized pumas, however further studies are required to correlate these findings to the use of anesthetic agents.(AU)

Animals , Anesthesia, Inhalation/veterinary , Electrocardiography , Heart Rate/drug effects , Puma , Anesthesia, General/veterinary , Isoflurane
Rev. bras. anestesiol ; 66(3): 237-241, May.-June 2016. tab, graf
Article in English | LILACS | ID: lil-782887


ABSTRACT BACKGROUND AND OBJECTIVES: Induction of anesthesia is a critical part of anesthesia practice. Sudden hypotension, arrhythmias, and cardiovascular collapse are threatening complications following injection of induction agent in hemodynamically unstable patients. It is desirable to use a safe agent with fewer adverse effects for this purpose. Present prospective randomized study is designed to compare propofol and etomidate for their effect on hemodynamics and various adverse effects on patients in general anesthesia. METHODS: Hundred ASA I and II patients of age group 18-60 years scheduled for elective surgical procedure under general anesthesia were randomly divided into two groups of 50 each receiving propofol (2 mg/kg) and etomidate (0.3 mg/kg) as an induction agent. Vital parameters at induction, laryngoscopy and thereafter recorded for comparison. Adverse effect viz. pain on injection, apnea and myoclonus were carefully watched. RESULTS: Demographic variables were comparable in both the groups. Patients in etomidate group showed little change in mean arterial pressure (MAP) and heart rate (HR) compared to propofol (p > 0.05) from baseline value. Pain on injection was more in propofol group while myoclonus activity was higher in etomidate group. CONCLUSIONS: This study concludes that etomidate is a better agent for induction than propofol in view of hemodynamic stability and less pain on injection.

RESUMO JUSTIFICATIVA E OBJETIVOS: A indução é uma parte crítica da prática de anestesia. Hipotensão súbita, arritmias e colapso cardiovascular são complicações ameaçadoras após a injeção de agente de indução em pacientes hemodinamicamente instáveis. É aconselhável o uso de um agente seguro com menos efeitos adversos para esse propósito. O presente estudo prospectivo, randômico, teve como objetivo comparar propofol e etomidato quanto a seus efeitos sobre a hemodinâmica e aos vários efeitos adversos em pacientes sob anestesia geral. MÉTODOS: Cem pacientes ASA I e II, entre 18-60 anos, programados para procedimento cirúrgico eletivo sob anestesia geral, foram divididos aleatoriamente em dois grupos de 50 cada para receber propofol (2 mg/kg) e etomidato (0,3 mg/kg) como um agente de indução. Os parâmetros vitais na indução, laringoscopia e posteriormente foram registrados para comparação. Efeitos adversos como dor à injeção, apneia e mioclonia foram cuidadosamente monitorados. RESULTADOS: As variáveis demográficas foram comparáveis em ambos os grupos. Os pacientes do grupo etomidato apresentaram pouca alteração da pressão arterial média (PAM) e da frequência cardíaca (FC) em comparação com o grupo propofol (p < 0,05) a partir do valor basal. Houve mais dor à injeção no grupo propofol, enquanto houve mais atividade mioclônica no grupo etomidato. CONCLUSÕES: Este estudo conclui que etomidato é um agente melhor para a indução do que o propofol em relação à estabilidade hemodinâmica e menos dor à injeção.

Humans , Male , Female , Adolescent , Adult , Young Adult , Propofol/pharmacology , Anesthetics, Intravenous/pharmacology , Etomidate/pharmacology , Anesthesia, General , Arrhythmias, Cardiac/chemically induced , Blood Pressure/drug effects , Double-Blind Method , Prospective Studies , Heart Rate/drug effects , Hemodynamics/drug effects , Middle Aged
Brasília; CONITEC; maio 2016. tab, ilus, ilus.
Monography in Portuguese | LILACS, BRISA | ID: biblio-837341


Contexto: A insuficiência cardíaca crônica é uma síndrome sistêmica complexa e progressiva que se caracteriza por comprometimento da perfusão tecidual, com sintomas característicos de dispneia, fadiga, além de piora da qualidade de vida. A síndrome está relacionada a altas taxas de mortalidade e hospitalização. Ivabradina é um protótipo de medicamentos que agem na frequência cardíaca e que recentemente foi aprovada para tratamento de insuficiência cardíaca crônica associada a betabloqueadores em indivíduos em estágios mais avançados da doença e que mantêm a frequência cardíaca alta mesmo em tratamento com as doses mais altas toleradas desses medicamentos. Pergunta: A associação de ivabradina ao tratamento convencional com betabloqueadores é eficaz e segura no tratamento de pacientes com insuficiência cardíaca crônica, quando comparada ao tratamento com betabloqueadores? Evidências científicas: Foram avaliados 15 estudos, dentre os quais um ensaio clínico duplo-cego, randomizado e controlado por placebo no qual se incluíram 6.500 indivíduos com insuficiência cardíaca crônica em estágio funcional NYHA II a IV e frequência cardíaca ≥70 bpm. O tratamento com ivabradina em dose média de 6 mg duas vezes ao dia em associação a betabloqueadores por 23 meses diminuiu o risco de internação por piora no quadro de insuficiência cardíaca em 26%, ao que se associa um NNT de 20 (IC 95% 15 a 31). O medicamento não demonstrou efeito no desfecho primário mortalidade por causas cardiovasculares como também não se observou diminuição de risco de mortalidade por todas as causas. Observou-se uma diminuição no risco de mortalidade por insuficiência cardíaca, desfecho secundário, embora associada à imprecisão importante, em função das baixas taxas de eventos e do amplo intervalo de confiança (NNT 83, IC 95% 52 a 333). Por meio de outros estudos sugere-se que o medicamento tenha efeitos na reversão do remodelamento cardíaco associada à progressividade da doença, diminuição de biomarcadores relacionados à insuficiência cardíaca e na diminuição da pós-carga cardíaca, melhorando o funcionamento ventricular e acoplamento ventrículo arterial, sem, entretanto, interferir na função renal. Identificaram-se efeitos na diminuição da frequência cardíaca e da variação da frequência cardíaca. O uso do medicamento está associado a um NNH de 58 (no período de dois anos) em relação ao desfecho fibrilação atrial em indivíduos com frequência cardíaca maior que 70 bpm. Discussão: O principal benefício do medicamento, cujo efeito foi avaliado por meio de evidência de alta qualidade, é evitar internações por piora no quadro de insuficiência cardíaca. O efeito relativo é de uma diminuição de 26% quando se compara ao uso isolado de betabloqueadores. Entretanto, mesmo para o desfecho de maior benefício, o efeito absoluto ainda é muito baixo, atingindo uma diminuição de 4,9% apenas. Para outros desfechos de hospitalização, o efeito absoluto é ainda mais baixo e mais impreciso. Não houve efeito na mortalidade de forma que o uso do medicamento não obteve efeito nos desfechos mortalidade por todas as causas e por causas cardiovasculares. O efeito estatisticamente significativo observado para diminuição em mortalidade por insuficiência cardíaca partiu de uma medida de baixa qualidade e, portanto, um efeito de baixa confiabilidade e bastante passível de modificação por trabalhos futuros. O medicamento aumenta o risco de fibrilação atrial, como um NNH de 83. Os resultados da análise econômica são frágeis e partem de informações imprecisas, principalmente sobre a estimativa, em termos quantitativos, da população elegível ao tratamento com ivabradina. Decisão: Não incorporar a ivabradina para o tratamento de insuficiência cardíaca crônica moderada a grave em indivíduos com frequência cardíaca ≥ 70 bpm e que toleram menos de 50% da dose alvo recomendada de agentes betabloqueadores, no âmbito do Sistema Único de Saúde - SUS. Foi publicada a Portaria Nº 19, de 24 de maio de 2016.

Humans , Adrenergic beta-Antagonists/administration & dosage , Benzazepines/therapeutic use , Heart Failure/drug therapy , Heart Rate/drug effects , Brazil , Cost-Benefit Analysis/economics , Technology Assessment, Biomedical , Unified Health System
Acta cir. bras ; 31(5): 338-345, May 2016. tab, graf
Article in English | LILACS | ID: lil-783802


ABSTRACT PURPOSE: To investigate the myocardial ischemia-reperfusion with sevoflurane anesthetic preconditioning (APC) would present beneficial effects on autonomic and cardiac function indexes after the acute phase of a myocardial ischemia-reperfusion. METHODS: Twenty Wistar rats were allocated in three groups: control (CON, n=10), myocardial infarction with sevoflurane (SEV, n=5) and infarcted without sevoflurane (INF, n=5). Myocardial ischemia (60 min) and reperfusion were performed by temporary coronary occlusion. Twenty-one days later, the systolic and diastolic function were evaluated by echocardiography; spectral analysis of the systolic arterial pressure (SAPV) and heart rate variability (HRV) were assessed. After the recording period, the infarct size (IS) was evaluated. RESULTS: The INF group presented greater cardiac dysfunction and increased sympathetic modulation of the SAPV, as well as decreased alpha index and worse vagal modulation of the HRV. The SEV group exhibited attenuation of the systolic and diastolic dysfunction and preserved vagal modulation (square root of the mean squared differences of successive R-R intervals and high frequency) of HRV, as well as a smaller IS. CONCLUSION: Sevoflurane preconditioning better preserved the cardiac function and autonomic modulation of the heart in post-acute myocardial infarction period.

Animals , Male , Autonomic Nervous System/drug effects , Myocardial Ischemia/physiopathology , Anesthetics, Inhalation/pharmacology , Ischemic Preconditioning, Myocardial/methods , Methyl Ethers/pharmacology , Myocardial Infarction/physiopathology , Pulse , Autonomic Nervous System/physiology , Time Factors , Blood Pressure/drug effects , Blood Pressure/physiology , Echocardiography , Random Allocation , Rats, Wistar , Myocardial Ischemia/etiology , Myocardial Ischemia/diagnostic imaging , Models, Animal , Heart Rate/drug effects , Heart Rate/physiology , Myocardial Infarction/pathology , Myocardial Infarction/prevention & control , Myocardial Infarction/diagnostic imaging