Bronchomotor, haemodynamic and neuromuscular effects of atracurium and cis-atracurium [51/W89]: comparative experimental and clinical studies in critically ill mechanically ventilated patients

The effects of atracurium and cis-atracurium on histamine- induced submaximal contractions of isolated tracheal strips and on the airway resistance were tested in guinea pigs. Clinical studies included 24 chronic obstructive pulmonary disease [COPD] and 24 head injury patients, mechanically ventilated with the use of Puritan Bennett, 7200ae ventilator. Flow-volume loops were recorded and analyzed to determine the bronchomotor effects of atracurium 0.6 mg kg-1 or cis- atracurium 0.12 mg kg-1. Heart rate was monitored continuously and noninvasive blood pressure was recorded at specified time intervals. An acceleration piezo-electric transducer was used to monitor neuromuscular transmission. Atracurium produced potentiation of histamine-induced submaximal contractions of isolated tracheal strips and a dose-related increase in the airway resistance of intact anesthetized guinea pigs. The bronchoconstrictor effect of atracurium was abolished by mepyramine maleate. In clinical studies expiratory flow rates from a mean base-line value of 0.52 +/- SD 0.08 l sec-1 to reach 0.41 +/- 0.06 l sec-1, p <0.05. Further atracurium produced significant reductions in mean arterial pressure with a compensatory rise in heart rate in COPD and head injury patients. In contrast, cis-atracurium was not associated with any evidence of histamine-induced bronchospastic or hemodynamic effects. Cis- atracurium had significantly longer onset time than atracurium, with a mean difference ranging between 1.1-1.5 minutes. Time to 25% and 75% first twitch [T1] recovery, recovery index, and the time required for 70% recovery of train-of-4 ratio [T4/T1] were all shorter in head injury than COPD patients. Cis-atracurium appears to be the closest to the ideal neuromuscular blocking agent for use in critically ill patients

Effect of long acting calcium channel blocker [amlodipine] on mild to moderate essential hypertension, on glucose tolerance and lipid profile

Thirty patients with mild to moderate essential hypertension joined this study. They were 27 males [90 percent] and 3 females [10 percent]. Their ages ranged between 28 and 73 years with a mean age of 49.5 years. They were given one tablet of Amlodipine 5 mg daily which was increased to 10 mg tablet once daily if no control of blood pressure occurred after 4 weeks treatment. Patients were followed up for 10 weeks. Twenty four patients [80 percent] were controlled by Amlodipine tablets 5 mg daily while 6 patients [20 percent] were controlled by a 10 mg tablet of Amlodipine daily. No significant change in heart rate was reported in patients after treatment with Amlodipine. Amlodipine had not significantly altered the lipid profile, glucose tolerance curve or serum creatinine. Adverse events reported were mild to moderate in severity and were tolerated by the patients and did not necessitate interruption of therapy. They included ankle oedema in 2 patients [6.66 percent], headache in 2 patients [6.66 percent] and flushing in one patient [3.33 percent]. Amlodipine has proved to be of high efficacy, safety and tolerability in the treatment of mild to moderate essential hypertension

Reduction of coronary heart disease risk factors by doxazosin therapy, an alpha-1-adrenoceptor inhibitor in diabetic hypertensive patients

Twenty five diabetic patients with mild to moderate essential hypertension were the subject of our study. 22 [88 percent] were females and 3 [12 percent] were males. While the diabetic state was controlled by oral hypoglycaemic drugs, the patients were concomitantly given doxazosin; a new alpha-1-adrenoceptor inhibitor as monotherapy for their hypertension for a period of 7-16 weeks. Significant drop in both the diastolic and systolic blood pressures was elicited at the first week follow up and further drop continued till the end of the observation period [P > 0.001]. Significant decrease in total cholesterol [TC] and low density lipoprotein cholesterol [LDLC] with insignificant change of triglycerides had been observed. The ratios: TC/HDLC, HDLC /TC and LDLC/HDLC were improved. The calculation of the risk scores for the probability of development of coronary heart disease [CHD] in 10 years showed significant drop in the post treatment values. Doxazosin produced no effect on body weight, haemogram, glucose tolerance, renal or hepatic functions. Such metabolic benefits would suggest that doxazosin may provide additional protection against coronary heart disease in addition to its antihypertensive effect in mild and moderate hypertensive diabetic patients. The incidence of transient symptoms such as headache, palpitation and dizziness were not significantly observed during therapy with doxazosin compared to placebo