Drug syndrome of ephedra based on its property and pharmacology / 中国中药杂志

Ephedra is a classic herb in traditional Chinese medicine( TCM). The new effects of ephedra were gradually found,and the contraindications of the drug were broken in later ages. Because the principles of expanded application were not well elucidated,it is difficult to use in the clinical flexibility. Based on the characteristics of ephedra and its classic clinical application,the authors summarized the possible principles of clinical application of ephedra and the drug property and pharmacological characteristics of ephedra.Studies showed that ephedrine substances are an important material basis for the efficacy of ephedra,and its adrenergic action is the pharmacological basis of its efficacy. It is the key to grasp the autonomic function and the interaction between sympathetic/adrenal medulla and adrenal cortex for the clinical application of ephedra. The authors discussed the principles of clinical application of ephedra and the effects of processing of ephedra. Finally,the authors put forward the basic research process of clinical application of drugs,and provide ideas for the inheritance and further development of TCM experience.

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

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

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

[Pharmaceutical effects of ephedrine, atropine and mucosal phenilephrin on hemodynamic alterations of women during spinal anesthesia in cesarean section]

Hemodynamic alteration and hypotension due to spinal anesthesia can reduce tissue perfusion and increase ischemic risk, myocardial infraction, renal failures spinal damages and even deep veins thrombosis. This study was designed to compare pharmaceutical effects of ephedrine, atropine and mucosal phenilephrin on hemodynamic alteration of women during spinal anesthesia in cesarean section. This randomized clinical and double blind study was done on 90 singleton pregnant women with ASA I and II class .the subjects gone elective cesarean section and allocated into three groups. subjects were received 500 ml ringer lactate before spinal anesthesia. Subjects in group I, II and III first received 0.1 mg/kg atropine [IV] 0.01mg/kg ephedrine and 100 micro gr phenilephrin [mucosal] prior spinal anesthesia, respectively. Hemodaynamic indexes including blood pressure, heart Rate, oxygen saturation and drug side effects were determined every 5 minutes interval through the surgery. Data was analyzed by using SPSS-11.5, Chi-Square and ANOVA tests. Hemodaynamic indexes were changed during study, but three medicine showed similar effect on heart Rate, blood pressure and changes of oxygen saturation [P<0.05]. There was a significant differences among three groups for dosage of extra ephedrine to control of blood pressure [P<0.05]. This increase dosage of extra ephedrine was 56.7%, 20% and in ephedrine, phenilephrin and atropine groups,respectively. Nosia rate was 6.7%, 50% and 46.7% in phenilephrin, atropine and ephedrine groups, respectively [P<0.05]. This study showed that to prevent of blood pressure drop following spinal anestasia atropine, phenilephrin and ephedrine can be prescribed, but ephedrine is recommended for lowering the rate of nosia

[Effect of small-dose of ephedrine administered prior to induction of anesthesia on the onset time of succinylcholine]

Onset of action of relaxants is influenced by cardiac output and muscle blood flow. Ephedrine increases blood flow to muscles and may shorten the onset of action of succinylcholine. The aim of the study was to evaluate the effect of small-dose of ephedrine administered prior to rapid-sequence induction of anesthesia on the onset time of succinylcholine for endotracheal intubation. In this randomized clinical trial, 50 patients scheduled for elective gynecologic surgeries in Alzahra hospital in Tabriz 1385, were selected. In these patients ephedrine, 70 micro g/kg [study group, n=30], or saline [placebo group, n=30] was administered 3 minutes before induction of anesthesia with thiopentone/fentanyl. Succinylcholine, 0.6 mg/kg, was administrated to facilitate the tracheal intubation. Onset of succinylcholine, intubating conditions and hemodynamic variables were recorded in the subjects. Fasciculation was absent in 60% [36] of the patients. No significant differences were found between the onsets of fasciculation between two groups. Moreover, the difference in duration of fasciculation in two groups was not significant. Onset time of succinylcholine was significantly shorter in study group [19.53 +/- 3.91second], compared with placebo group [25.87 +/- 7.11second] [p<0.0001]. Patients in study group were intubated in 47.07 +/- 4.51 seconds compared with 58.73 +/- 9.04 seconds in placebo group [p<0.0001]. Intubation conditions were similar in both groups. Heart rate was slightly increased in study patients in the first and 3rd minutes after ephedrine administration, but there was no significant difference in systolic blood pressure values compared with the baseline value between two groups. The onset time of succinylcholine is shortened with small-dose of ephedrine pretreatment without significant adverse heamodynamic effects

The effect of ephedrine on the onset time of rocuronium in Thai patients.

The aim of this study was to determine the effect of ephedrine on the onset time of rocuronium. The study population was 60 ASA physical status 1 and 2 patients, aged 15-60 years scheduled for elective surgery under general anesthesia at Ramathibodi Hospital. The patients were randomly assigned into 2 groups. Group I (ephedrine group), ephedrine 70 microg/kg was given 1 minute before induction and group II (control group), saline was given instead of ephedrine and midazolam 7.5 mg was given orally 30-60 minutes before the induction. Anesthesia was induced with fentanyl 1 microg/kg and sodium thiopentone 3-5 mg/kg. The patient was intubated with 0.9 mg/kg of rocuronium. The intubation time (from rocuronium administration to the time of intubation) was predetermined by the Dixon's up and down method (with 5 seconds as a step size) for each patient and started at 60 seconds for the first patient in each group. The intubation time in the ephedrine group (39.41 +/- 4.64 seconds) was significantly different from the control group (59.17 +/- 9.00 seconds); p-value < 0.01. The hemodynamics were similar in both groups. Conclusion: Intravenous ephedrine shortened the onset time of rocuronium with no significant adverse hemodynamic effects. As an alternative to suxamethonium for rapid intubation, the authors recommend the use of ephedrine 70 microg/kg at one minute before induction followed by 0.9 mg/kg of rocuronium intravenously in healthy patients. The intubation could be achieved at 40 seconds after the administration.

Prevention of post-operative naausea and vomiting following laparoscopic surgery Ephedrine vs. propofol

Postoperative nausea and vomiting [PONV] are relatively common troublesome distressing symptoms. The incidence is reported to be as high as 20-51%. Ninety adult ASA I and II patients scheduled for laparascopic gynecological or surgical interventions, were randomly and equally assigned to one of the three groups in the immediate postoperative period: Group 1 received 0.1 ml. kg [-1] normal saline intravenously, while Group 2 received 0.5 mg. kg [-1] ephedrine intramuscularly and Group 3 received 0.25 mg. kg [-1] propofol intravenously as preventive antiemitic therapy. Sixty-six, 33 and 50 percent of patients experienced nausea and vomiting syndrome in Group 1, 2 and 3 respectively. Both ephedrine and propofol proved to have antiemetic properties. Ephedrine treated group of patient had significant less emetic score than propofol. No significant hemodynamic changes were recorded in both groups

Efeito inibidor de aminas simpatomiméticas nas respostas contráteis do duodeno de rato ao cálcio e ao bário / The inhibitory effect of sympathomimetics amines in the contractle responses of rat duodenum to calcium and barium

O duodeno de rato imerso em uma soluçäo de Tyrode sem cálcio responde com contraçöes equivalentes ao bário e ao cálcio. As respostas contráteis ao cálcio säo quantitativamente bloqueadas tanto por alfa como por beta simpatomiméticos. A açäo inibidora dos simpatomiméticos é reduzida pelos agentes simpatolíticos correspondentes e também pela efedrina, que näo possui atividade intrínseca. A açäo dos simpatomiméticos foi acentuadamente reduzida pela despolarizaçäo do duodeno com excesso de potássio. Os simpatolíticos fentolamina e propranolol têm efeito semelhante ao dos anestésicos locais, isto é, inibiçäo das contraçöes produzidas por bário tanto em soluçäo de Tyrode normal como com excesso de potássio; eles näo interferem com as respostas ao cálcio em condiçöes normais. Conclui-se que a despolarizaçäo do duodeno de rato rompe a interaçäo normal dos simpatomiméticos com os receptores adrenérgicos; a açäo das drogas na preparaçäo despolarizada é por uma interferência inespecífica à permeabilidade dos íons na membrana celular