The Effects of Oral Atenolol or Enalapril Premedication on Blood Loss and Hypotensive Anesthesia in Orthognathic Surgery

PURPOSE: The aim of this study was to evaluate the effects of premedication with oral atenolol or enalapril, in combination with remifentanil under sevoflurane anesthesia, on intraoperative blood loss by achieving adequate deliberate hypotension (DH) during orthognathic surgery. Furthermore, we investigated the impact thereof on the amount of nitroglycerin (NTG) administered as an adjuvant agent. MATERIALS AND METHODS: Seventy-three patients undergoing orthognathic surgery were randomly allocated into one of three groups: an angiotensin converting enzyme inhibitor group (Group A, n=24) with enalapril 10 mg, a beta blocker group (Group B, n=24) with atenolol 25 mg, or a control group (Group C, n=25) with placebo. All patients were premedicated orally 1 h before the induction of anesthesia. NTG was the only adjuvant agent used to achieve DH when mean arterial blood pressure (MAP) was not controlled, despite the administration of the maximum remifentanil dose (0.3 microg kg-1min-1) with sevoflurane. RESULTS: Seventy-two patients completed the study. Blood loss was significantly reduced in Group A, compared to Group C (adjusted p=0.045). Over the target range of MAP percentage during DH was significantly higher in Group C than in Groups A and B (adjusted p-values=0.007 and 0.006, respectively). The total amount of NTG administered was significantly less in Group A than Group C (adjusted p=0.015). CONCLUSION: Premedication with enalapril (10 mg) combined with remifentanil under sevoflurane anesthesia attenuated blood loss and achieved satisfactory DH during orthognathic surgery. Furthermore, the amount of NTG was reduced during the surgery.

Development and in vitro permeation studies of proniosomal based transdermal delivery system of Atenolol

Proniosomes refer to a flexible vesicular carrier with the potential for drug administration through the transdermal route. A proniosome gel type transdermal delivery system of Atenolol was prepared and extensively studied both in vitro drug release and ex vivo permeation studies. The prepared formulations were evaluated for vesicle size, entrapment efficiency, in vitro drug loading, and drug release studies. The release of drug had shown considerable improvement in controlled manner from the prepared gel formulation. It was observed that Span 40 and 60 [A 8] based formulations shows vesicles of minimum size and higher entrapment efficiency compared to the other formulations. Proniosomal transdermal therapeutic system [A 8] was found to be the optimized formulation as it posses good drug release and shows permeation in a steady-state manner over a desired period of time. Also the drug diffusion across snake sheded skin, guinea pig abdomen skin, albino rat, porcine ear correlates better with in vitro drug release studies. The formulation was found to be stable when stored at room temperature and at refrigeration temperature [4 +/- 2degreeC] for 90 days.

Oxitocina u oxitocina-atenolol en la inducción del trabajo de parto en embarazo a término / Oxytocin or oxytocin-atenolol in the induction of childbirth labour in a term pregnancies

El objetivo fue comparar la efectividad de la oxitocina-atenolol con oxitocina en la inducción del trabajo de parto en embarazos a términos en la Maternidad "Dr. Nerio Belloso" Hospital Central "Dr. Urquinaona" Maracaibo, Esatdo Zulia. Se seleccionaron 160 pacientes y fueron asignados al azar para recibir: oxitocina endovenosa + atenolol oral (grupo A, n = 80) u oxitocina endovenosa (grupo B, n = 80). Se evaluaron los intervalos entre el inicio dela inducción hasta el inicio de la fase activa del parto y entre el inicio de la inducción y el parto y efectos adversos maternos y neonatales. No se encontraron diferencias estadísticamente significativas entre los grupos con relación a la edad materna, edad gestacional y puntuación de Bishop al momento de la admisión. Las embarazadas en el grupo A presentaron un intervalo entre el inicio de la inducción y el inicio de la fase activa del trabajo de parto y duración de la primera fase del trabajo de parto más corto que las embarazadas del grupo B (P<0,0001). No se encontraron diferencias entre los grupos en el peso al nacer, Apgar al minuto y Apgar a los 5 minutos. No se reportaron efectos adversos maternos en los dos grupos de tratamiento. La combinación oxitacina-atenolol es más efectiva en la inducción del trabajo de parto en embarazos a término comparado con la oxitocina endovenosa sola

The objetive was to compare the effectiveness of oxytocin-atenolol or oxytocin for labor induction in term pregnant women in the Maternidad "Dr. Nerio Belloso" Hospital Central "Dr. Urquinaona", Maracaibo, Estado Zulia. One hundred sixty patients were selected and randomly assigend to recieve intravenous oxytocin + oral atenolol (group A; n = 80) or intravenous oxytocin (group B; n = 80). Interval between beginning of induction to active phase of labor and between beginning of induction and delivery and maternal and neonatal adverse effects were evaluated. There were not found significant differences between groups related to maternal age, gestational age and Bishop score at the moment of admission. Pregnant patens in group a presented a interval between beginning of induction to active phase of labor and between beginning of induction and delivery shorter than pregnant patients in group B (P<0.0001). There were not found differences in newborn weight, Apgar at minute and at 5 minutes. There were not maternal side effects in both groups of treatment. In conclusion oxytocin-atenolol combination is more effective for induction of labor in term pregnant patients compared with oxytocin alone

Atenolol, una droga mal prescripta / Atenolol, a wrong prescripted drug

Se realizó un estudio cuantitativo, retrospectivo y descriptivo para determinar el la incorrecta prescripción del atenolol en el área sur de Morón, se distribuyeron los pacientes según sexo, edad, criterio de prescripción, se precisó la dosis indicada, se determinó el tiempo de duración de la terapia y se describieron las interacciones y reacciones medicamentosas encontradas. Se determinó que el sexo más afectado fue el masculino con un 50,87 por ciento, el grupo de edad más afectado fue el de 25 a 59 con un 54, 31%, el criterio que prevaleció fue la epilepsia con un total de 70 pacientes y un 60,74 por ciento, la dosis que con mayor frecuencia se usó fue la de 3 tabletas diarias, la interacción medicamentosa más frecuente fue con el fenobarbital en un 70,69 por ciento y la reacción medicamentosa más común fue el ras cutáneo para un 14, 65 por ciento.

Análise do índice de amplificação sistólico em pacientes acima de 55 anos utilizando atenolol associado ou não a diurético / Systolic augmentation index analysis in patients over 55 years old using atenolol, associated with a diuretic or not

Fundamentos: A pressão arterial (PA) é um dos principais fatores de risco cardiovascular modificáveis. Entretanto,a redução do risco de doenças cardiovasculares não pode ser explicada apenas pela redução da PA periférica; éimportante a avaliação da PA em outros segmentos da árvore arterial, como a análise da pressão central (PC). Amedida estimada da PC pode ser obtida por meio da tonometria de aplanação, na artéria radial. O aumento da PC pode ser determinado pelo índice derivado daanálise da curva da pressão central da aorta, o “índice de incremento” ou augmentation index (AI). Objetivo: Verificar se a medida da PA realizadatradicionalmente na artéria braquial representa a medida fidedigna da PC em pacientes acima de 55 anos, usandoo betabloqueador atenolol associado ou não a diurético hidroclorotiazida/ clortalidona. Métodos: Foram incluídos pacientes com idade >55 anos,em uso isolado de atenolol ou de sua associação com diuréticos específicos. Trinta e três pacientes, com média de idade de 64 anos, escolhidos a partir de um banco de dados de uma clínica de cardiologia, foram submetidos aos procedimentos de tonometria de aplanação, utilizando-se o aparelho validado pelo FDA modeloHEM9000AI, da marca OMRON.Resultados: Os valores médios obtidos foram 122,2mmHg para PAS; 68,9mmHg para a PAD; 118,0mmHg para a PC e 92 para o AI. Conclusão: Demonstrou-se pela tonometria de aplanação que o atenolol provocou redução da pressão na artériabraquial, mas não na raiz da aorta (AI elevado).

Influência da circulação extracorpórea sobre as concentrações plasmáticas de atenolol / Influence of cardiopulmonary bypass on the plasma concentrations of atenolol

FUNDAMENTO: Os betabloqueadores são usados no tratamento da angina pectoris e outras doenças coronarianas isquêmicas, reduzindo mortalidade e eventos cardiovasculares. O atenolol é um betabloqueador hidrofílico, de absorção gastrointestinal, extensão de distribuição pequena e eliminação função renal-dependente. OBJETIVO: O objetivo deste estudo é o de determinar a variabilidade inter-individual do atenolol em pacientes coronarianos. MÉTODOS: Quantificou-se o atenolol plasmático em 6 amostras sangüíneas coletadas no pré-operatório de sete indivíduos portadores de insuficiência coronariana e indicação cirúrgica de revascularização do miocárdio, tratados cronicamente com atenolol, com doses diárias variando entre 25 a 100 mg PO. Todos os pacientes apresentavam função renal dentro da normalidade ou levemente reduzida. RESULTADOS: As concentrações plasmáticas obtidas evidenciaram decaimento monoexponencial, confirmando que o atenolol apresenta farmacocinética de primeira ordem nas doses empregadas para o controle da insuficiência coronariana grave (médias ± DP): 123 ± 56, 329 ± 96, 288 ± 898, 258 ± 85, 228 ± 79 e 182 ± 73 ng/mL, nos tempos zero, 2, 4, 6, 8 e 12 horas após a administração da dose. Registrou-se pequena variabilidade inter-pacientes nas concentrações plasmáticas de atenolol no grupo investigado tratado em regime de doses múltiplas, devido à característica hidrofílica do fármaco. Registrou-se ainda, maior persistência do atenolol nos pacientes coronarianos investigados, comparado a indivíduos saudáveis. CONCLUSÃO: Em virtude da sua cardioseletividade e baixa variabilidade, sugere-se que o atenolol deve ser empregado como fármaco de primeira escolha para o tratamento da síndrome coronariana aguda e outras doenças cardiovasculares.

BACKGROUND: Betablockers are used in the treatment of angina pectoris and others ischemic coronary diseases, reducing mortality and cardiovascular events. Atenolol is a hydrophilic betablocker which is characterized by gastrointestinal absorption, small extent of distribution and renal function-dependent elimination. OBJECTIVE: The study objective was to determine the inter-individual variability of atenolol in coronary patients. METHODS: Plasma atenolol was quantified in six blood samples collected during the preoperative period from seven patients with coronary insufficiency and surgical indication, chronically treated with atenolol PO 25 to 100 mg/day. All patients presented a normal or slightly reduced renal function. RESULTS: All enrolled patients presented normal or slightly reduced renal function as a result of age and underlying disease. Atenolol plasma concentrations showed a monoexponential decline, confirming the first-order pharmacokinetics at the doses employed for the control of coronary insufficiency (mean ± SD): 123 ± 56, 329 ± 96, 288 ± 898, 258 ± 85, 228 ± 79 and 182 ± 73 ng/ml at times zero, 2, 4, 6, 8 and 12h after dose administration. The investigated group showed a small inter-patient variability of atenolol administrated at multiple regimens due to the hydrophilic characteristic of the drug. Furthermore, accumulation of atenolol administered chronically was greater in coronary patients, compared to healthy subjects. CONCLUSION: In view of its cardio-selectivity and low-variability, atenolol should be used as the first-choice drug for the treatment of acute coronary syndrome and other cardiovascular diseases.

Comparative effects of conventional B-blockers and nebivolol on psychomotor performances in healthy volunteers: a preliminary report.

The present study was under taken to assess the comparative effects of nebivolol with propranolol and atenolol on psychomotor performances. Thirty healthy volunteers were randomized into three groups with n=10 in each group. Each subject received single dose of one of the three medications (nebivolol 5 mg, atenolol 50 mg and propranolol 40 mg) in morning (9:00 AM). Just before administering the drug, the pre-drug scores were taken, followed by post drug score obtained for consecutive six hours. Psychomotor assessment was carried out by three tests Simple Reaction Timer (SRT), Critical Flicker Fusion Frequent Threshold (CFFT) and Digit Cancellation Test (DCT). The results of present study indicate that single doses of atenolol and propranolol produced significant impairment of psychomotor performance. Nebivolol also impaired psychomotor performance tests in the similar fashion to atenolol and propranolol. Hence, the findings of the present study correlate with the lipophilic nature of the nebivolol.

Angina estável: abordagem por um novo fármaco - Ivabradina / Stable angina: a new drug approcach - Ivabradine

O tratamento atual da doença coronariana crônica - angina estável, envolve o uso de medicamentos com ação hemodinâmica, como os nitratos, os betabloqueadores (BB) e os bloqueadores dos canais de cálcio (BCC). O presente artigo apresenta Ivabradina, um novo medicamento para a abordagem da angina estável, revisa o seu modo de ação e os resultados da literatura médica recente.

Comparison of the effect of sympathetic agonist and antagonist on rabbits perfused heart: a study on simple and succussed dilutions

The pharmacological effect of Adrenaline and Atenolol dilutions / succussion is still unexplainable for their reverse effect on tissues. This effect of potentization is observed in the recent study with differences in the effect of simple and succussed dilutions on heart rate. For this purpose, both simple and succussed dilutions of Adrenaline and Atenolol were prepared serially, ranging from 10 [-3] to 10 [-36] for testing on the isolated perfused Rabbit's heart. Langendorff heart assembly was used to perfuse the heart and its activity was recorded on Oscillograph through isotonic transducer. The significant difference between the effects of simple and succussed dilutions of Adrenaline at 10 [-3] and 10 [-4] and for Atenolol 10 [-5], 10 [-11], 10 [-27], 10 [-30], 10 [-33] and 10 [-36] was observed on heart rate respectively. This study confirms that there are differences in the effects of simple and succussed dilutions. While potentization or reverse effect observed than normal has been found in-consistently throughout the range of dilutions used. Thus in-consistency expresses the instability of change in parent drug molecule on succussion

Atenolol or butoxamine injection at the lateral septum doesn't inhibit male sexual behavior in rats.

To investigate the role of specific adrenoreceptors subtypes on sexual behavior, atenolol, butoxamine, a mixture of atenolol and butoxamine, and saline (vehicle) were injected into the lateral septum in four different groups of sexually active male rats. Application of a mixture of atenolol and butoxamine produced inhibition of copulatory activity. On the other hand, application of either atenolol or butoxamine alone did not inhibit copulatory activity. But it produced stimulation of some of the components of male sexual behavior. Inability of either atenolol or butoxamine to inhibit the male sexual behavior, and inhibition of the same by the mixture of atenolol and butoxamine, indicate that both beta-adrenoreceptors at the lateral septum are involved in the elaboration of male sexual behavior. Stimulation of some components of sexual behavior on application of atenolol or butoxamine could be attributed to an unbalanced activity of beta-adrenoreceptors.

Paro circulatorio por fibrilación ventricular (1ª parte) / Circulatory arrest due to ventricular fibrillation (Part I)

La velocidad y la amplitud de las ondas fibrilatorias son una expresión, en cierta manera, de las condiciones funcionales del miocardio y de su grado de oxigenación. Se reconocen tres tipos de ondas fibrilatorias. A) Fibrilación convulsiva o gruesa: con ondas fibrilatorias de alta frecuencia (>150/minuto y entre 0,5 y 1 mV de amplitud). Observando directamente al corazón, el órgano se sacude violentamente como si convulsivara. B) Fibrilación trémula o fina: la frecuencia sigue siendo alta (>100/minuto) pero de menor amplitud y las ondas recorren en forma anárquica la superficie de la pared ventricular. Esta fase es consecuencia del gran consumo de oxígeno de la fase anterior. Dura de 3 a 5 minutos. C) Fibrilación hipotónica o lenta: las ondas fibrilatorias son anchas, de baja amplitud y baja frecuencia. (>100/minuto), el corazón luce cianótico, dilatado e hipotónico. Puede durar entre 5 y 15 minutos hasta que el corazón para totalmente en asistolia. Un corazón globalmente hipóxico difícilmente se fibrile en forma espontánea. El corazón debe ser desfibrilado durante las fases de fibrilación rápida. La desfibrilación es un intento de despolarizar globalmente a todo el corazón mediante una descarga eléctrica, y con ello producir una asistolia de breve duración durante la cual el corazón tiene la oportunidad de reanudar su actividad normal a partir de la activación espontánea del marcapaso natural, es decir, el nodo sinusal, y arrancar con ritmo sinusal. Estudios anteriores con descargas de baja energía (175-200 joules para un adulto) no lograron demostrar beneficio alguno de choques iniciales inferiores a 2 j/kg y choques en rápida sucesión de 3 a 4 j/kg (apróximadamente 200 a 400 joules de energía). Según el protocolo de la American Heart Association, el paciente debe ser desfibrilado con dos primeros choques de 2 a 3 j/kg. en rápida sucesión. Y si éstos fracasan deberá recibir un tercero de 4 j/kg. Los tres choques deben hacerse en rápida sucesión (no todos los autores concuerdan con este criterio), sin intervención medicamentosa intermedia y sin levantar las paletas del lugar, para evitar modificaciones en la impedancia transtorácica y lesiones de la piel (eritema, edema) en otras regiones del tórax. En el texto se analiza también el efecto de los medicamentos habitualmente utilizados en la reanimación cardíaca, sus indicaciones e inconvenientes.

Enhancer aided in vitro permeation of atenolol and prazosin hydrochloride through mice skin.

Effect of penetration enhancers were studied on the permeation of antihypertensive drugs prazosin hydrochloride and atenolol through full thickness skin of swiss albino mice. Atenolol was delivered to skin from saturated alcoholic solution containing 5% of 1-decanol and alcohol alone, while prazosin hydrochloride was saturated in dimethyl formamide(DMF, 5% v/v in water) and dimethyl sulfoxide(DMSO, 5% v/v in water). Atenolol permeation was augmented significantly in decanolic solution and also in pure alcohol. In case of prazosin hydrochloride, significant enhancement of permeation was shown by DMSO but not by DMF.