Análise Comparativa do Padrão de Fluxo de Artérias Coronárias das Hipertrofias Miocárdicas Secundárias e por Mutação Sarcomérica / Comparative Analysis of the Coronary Arteries Flow Pattern in Secondary Myocardial Hypertrophies and by Sarcomeric Mutation

Fundamento: O fluxo coronariano com predomínio diastólico aumenta duas a cinco vezes na hiperemia, mediada por vasodilatação (reserva de fluxo coronariano), podendo, na hipertrofia, ocorrer isquemia relativa. Na hipertrofia secundária, o fluxo em repouso torna-se isquêmico pelo aumento da demanda. Na cardiomiopatia hipertrófica com fibrose perivascular, há funcionalização de vasos colaterais, para aumentar a irrigação dos segmentos hipertrofiados. Objetivo: Determinar o padrão do fluxo coronariano em pacientes com hipertrofia secundária e cardiomiopatia hipertrófica, avaliando a reserva de fluxo coronariano. Métodos: Avaliamos o fluxo coronariano em 34 pacientes com hipertrofia secundária, em 24 com cardiomiopatia hipertrófica e em 16 controles. A artéria descendente anterior foi detectada com Doppler transtorácico com calibração adequada do equipamento. Nos grupos controle e com hipertrofia secundária, foi calculada a reserva de fluxo coronariano com dipiridamol (0,84 mg/kg) endovenoso. O mesmo procedimento foi realizado em seis pacientes do grupo com cardiomiopatia hipertrófica, nos quais também foi avaliado o fluxo das colaterais da região hipertrófica. Os dados foram comparados por variância com significância de 5%. Resultados: Na hipertrofia secundária, houve aumento do índice de massa e, na cardiomiopatia hipertrófica, predominou o aumento da espessura relativa. A fração de ejeção e a disfunção diastólica foram maiores no grupo com cardiomiopatia hipertrófica. A reserva de fluxo coronariano foi menor no grupo com cardiomiopatia hipertrófica, sendo detectado, também, fluxo de colaterais com redução da reserva de fluxo coronariano. Conclusão: A análise da circulação coronariana com Doppler transtorácico é possível em indivíduos normais e hipertróficos. Pacientes com hipertrofia secundária e cardiomiopatia hipertrófica apresentam diminuição da reserva de fluxo coronariano, e aqueles com cardiomiopatia hipertrófica mostram fluxo de vasos colaterais dilatados observados na região hipertrófica, com diminuição da reserva de fluxo coronariano.(AU)

Background: Coronary flow with a diastolic predominance increases two to five times in hyperemia, mediated by vasodilation (coronary flow reserve, CFR) and, in hypertrophy, relative ischemia may occur. In secondary hypertrophy (LVH), the flow, normal at rest, becomes ischemic due to increased demand. In hypertrophic cardiomyopathy (HCM) with perivascular fibrosis, collateral vessels appear to increase the irrigation of hypertrophied segments. Objective: To determine the coronary flow pattern in patients with secondary hypertrophy and hypertrophic cardiomyopathy, evaluating the coronary flow reserve. Methods: Coronary flow was evaluated in 34 patients with secondary hypertrophy, 24 with hypertrophic cardiomyopathy and in 16 controls. The anterior descending artery was detected with transthoracic Doppler with adequate equipment calibration. In the hypertrophic cardiomyopathy group, the flow of collaterals from the hypertrophic region was evaluated. In the control and secondary hypertrophy groups and in six patients in the hypertrophic cardiomyopathy group, the intravenous dipyridamole (0.84 mg) coronary flow reserve was calculated. The data were compared by variance with a significance of 5%Results: In secondary hypertrophy there was an increase in mass index and blood pressure, and in hypertrophic cardiomyopathy an increase in relative thickness predominated. Ejection fraction and diastolic dysfunction were higher in the hypertrophic cardiomyopathy group. The coronary flow reserve was lower in the hypertrophic cardiomyopathy group, and flow of collaterals was also detected, with a reduction in the coronary flow reserve. Conclusion: the analysis of coronary circulation with transthoracic Doppler is possible in normal and hypertrophic individuals. Patients with secondary hypertrophy and hypertrophic cardiomyopathy have a decrease in the coronary flow reserve, and patients with hypertrophic cardiomyopathy show a hyper flow of dilated collateral vessels observed in the hypertrophic region, with a decrease in the coronary flow reserve.(AU)

Análise de segurança do ecocardiograma sob estresse farmacológico com dipiridamol em octogenários / Safety analysis of pharmacological stress echocardiography with dipyridamole in octogenarians

Fundamento: O ecocardiograma sob estresse farmacológico, utilizando dipiridamol, é reconhecido como teste acurado e seguro para investigação diagnóstica e prognóstica de doença arterial coronariana, especialmente útil na avaliação de indivíduos com idade avançada que apresentam comorbidades limitantes ao uso do estresse físico. Poucos estudos avaliaram a segurança desse método em pacientes com mais de 80 anos. Objetivo: Avaliar a segurança do ecocardiograma sob estresse farmacológico com dipiridamol em octogenários. Métodos: Estudo descritivo retrospectivo. Resultados: Foram avaliados 262 pacientes com idade média de 82,8 ± 2,9 anos submetidos à realização de ecocardiograma sob estresse farmacológico com dipiridamol 0,84 mg/kg em 4 minutos. A incidência de complicações foi de 3,4% (9 casos), com apenas uma complicação maior (0,4%), que foi um caso de isquemia prolongada necessitando tratamento invasivo de urgência. As demais complicações foram 2 casos de isquemia prolongada tratadas com betabloqueador; 3 casos de taquicardias supraventriculares transitórias; 1 caso de taquicardia supraventricular sustentada revertida com adenosina; 1 caso de fibrilação atrial; e 1 caso de bloqueio atrioventricular 2:1 transitório. Conclusão: No presente estudo o ecocardiograma sob estresse com dipiridamol mostrou ser um teste seguro na população selecionada de octogenários.

Background: The pharmacological stress echocardiography with dipyridamole is known as safe and accurate test for diagnostic and prognostic investigation of coronary artery disease, particularly useful for elderly who have comorbidities that limit the use of physical stress. Few studies have evaluated the safety of this method in patients over 80 years. Objective: Evaluate the safety of pharmacological stress echocardiography with dipyridamole in octogenarians. Methods: A retrospective descriptive study. Results: The study included 262 patients with a mean age of 82.9 ± 2.9 years who under went a pharmacological stress echocardiogram with dipyridamole 0.84 mg/kg over 4 minutes. The incidence of complications was 3.4% (nine cases), only one major complication (0.4%), which was a case of prolonged ischemia requiring urgent invasive treatment. Other complications were two cases of prolonged ischemia treated with beta blocker, three cases of transient supraventricular tachycardias, one case of sustained supraventricular tachycardia reversed with adenosine,one case of atrial fibrillation and one case of transitory atrioventricular block 2:1. Conclusion: In this study the stress echocardiography with dipyridamole was shown to be a safe test in the selected population of octogenarians.

Aminophylline Partially Prevents the Decrease of Body Temperature during Laparoscopic Abdominal Surgery

Aminophylline can elicit thermogenesis in rats or increase metabolic rate during cold stress in lambs. We tested the hypothesis that aminophylline would reduce the change in core body temperature during laparoscopic abdominal surgery requiring pneumoperitoneum. Fifty patients were randomly divided into an aminophylline group (n=25) and a saline control group (n=25). Esophageal temperature, index finger temperature, and hemodynamic variables, such as mean blood pressure and heart rate, were measured every 15 min during sevoflurane anesthesia. In the aminophylline group, esophageal temperatures at T45 (36.1+/-0.38 vs. 35.7+/-0.29, P=0.024), T60 (36.0+/-0.39 vs. 35.6+/-0.28, P=0.053), T75 (35.9+/-0.34 vs. 35.5+/-0.28, P=0.025), T90 (35.8+/-0.35 vs. 35.3+/-0.33, P=0.011), and T105 (35.8+/-0.36 vs. 35.1+/-0.53, P=0.017) and index finger temperatures at T15 (35.8+/-0.46 vs. 34.9+/-0.33, P<0.001), T30 (35.7+/-0.36 vs. 35.0+/-0.58, P=0.029), T45 (35.8+/-0.34 vs. 35.2+/-0.42, P=0.020), T60 (35.7+/-0.33 vs. 34.9+/-0.47, P=0.010), T75 (35.6+/-0.36 vs. 34.8+/-0.67, P=0.028), T90 (35.4+/-0.55 vs. 34.4+/-0.89, P=0.042), and T105 (34.9+/-0.53 vs. 33.9+/-0.85, P=0.024) were significantly higher than in the saline control group. Aminophylline is effective in maintaining the core temperature through a thermogenic effect, despite reduced peripheral thermoregulatory vasoconstriction.

Aminophylline Partially Prevents the Decrease of Body Temperature during Laparoscopic Abdominal Surgery

Aminophylline can elicit thermogenesis in rats or increase metabolic rate during cold stress in lambs. We tested the hypothesis that aminophylline would reduce the change in core body temperature during laparoscopic abdominal surgery requiring pneumoperitoneum. Fifty patients were randomly divided into an aminophylline group (n=25) and a saline control group (n=25). Esophageal temperature, index finger temperature, and hemodynamic variables, such as mean blood pressure and heart rate, were measured every 15 min during sevoflurane anesthesia. In the aminophylline group, esophageal temperatures at T45 (36.1+/-0.38 vs. 35.7+/-0.29, P=0.024), T60 (36.0+/-0.39 vs. 35.6+/-0.28, P=0.053), T75 (35.9+/-0.34 vs. 35.5+/-0.28, P=0.025), T90 (35.8+/-0.35 vs. 35.3+/-0.33, P=0.011), and T105 (35.8+/-0.36 vs. 35.1+/-0.53, P=0.017) and index finger temperatures at T15 (35.8+/-0.46 vs. 34.9+/-0.33, P<0.001), T30 (35.7+/-0.36 vs. 35.0+/-0.58, P=0.029), T45 (35.8+/-0.34 vs. 35.2+/-0.42, P=0.020), T60 (35.7+/-0.33 vs. 34.9+/-0.47, P=0.010), T75 (35.6+/-0.36 vs. 34.8+/-0.67, P=0.028), T90 (35.4+/-0.55 vs. 34.4+/-0.89, P=0.042), and T105 (34.9+/-0.53 vs. 33.9+/-0.85, P=0.024) were significantly higher than in the saline control group. Aminophylline is effective in maintaining the core temperature through a thermogenic effect, despite reduced peripheral thermoregulatory vasoconstriction.

Comparison of aminophylline and insulin-dextrose infusions in acute therapy of hyperkalemia in end-stage renal disease patients.

OBJECTIVE: This study was performed to compare the efficacy of aminophylline and insulin-dextrose infusion as acute treatment modality of hyperkalemia in patients with end-stage renal disease (ESRD). METHODS: This study was conducted on 30 ESRD patients with serum potassium > 6.0 mEq/L. These patients were divided in two groups of 15 each. Group A patients were treated with aminophylline infusion, whereas group B patients were treated with insulin-dextrose infusion. Serum potassium and other biochemical parameters such as blood sugar were measured at beginning of treatment followed by at 60 minutes, 180 minutes, and 360 minutes after treatment. RESULTS: Intervenous infusion of aminophylline lowered plasma potassium from 6.48 +/- 0.39 mEq/L to 5.92 +/- 0.40 mEq/L at 180 minutes (p < 0.001 Vs basal) and 6.05 +/- 0.53 mEq/L at 360 minutes (p < 0.01 Vs basal). Whereas, intravenous infusion of insulin-dextrose decreased plasma potassium from 6.59 +/- 0.31 mEq/L to 5.76 +/- 0.32 mEq/L (p < 0.001 Vs basal) and 5.84 +/- 0.21 mEq/L (p < 0.001 Vs basal). Thus in both groups, plasma potassium levels were significantly less than basal levels throughout the study. The decrease in plasma potassium was significantly more in group B patients (p value is < 0.001 after 60 minutes, < 0.05 after 180 minutes and < 0.05 after 360 minutes) when compared to group A patients. There was one episode of hypoglycemia (blood sugar < 60 mg%) in insulin-dextrose infusion group. No other side effects were observed throughout the study. CONCLUSION: Aminophylline is an effective modality for acute treatment of hyperkalemia, though it is less effective than insulin-dextrose infusion. However, more studies are required to confirm these results.

Apnea severa: signo precoz de neumonía por pneumocystis carinnii en un lactante VIH negativo / Apnea as an early sign of pneumocystis carinii pneumonia in an HIV negative infant

A few reports in the medical literature suggest an association between Pneumocystis caring and apnea in small infants. This patient, a 1 month 20 days old, HIV negative, infant girl weighing 2,000 grams was admitted to hospital after presenting a severe episode of apnea with cyanosis and bradicardia. She progressively developed bronchopneumonia by P. carinii that required prolonged mechanical ventilation with high ventilatory parameters. The clinical course of this patient illustrates that apnea can be an early sign of P. carinii infection in small infants. Early diagnosis and specific therapy might prevent morbidity and mortality and also decrease the length of hospitalization

Estudo prospectivo e controlado dos resultados maternos e perinatais de gestantes asmaticas tratadas / Assessment of maternal and perinatal outcomes in actively managed pregnant asthmatic women

Os resultados maternos e perinatais de 125 gestantes asmaticas, tratadas com beta2-agonistas e corticosteroides, foram comparados com 45 gestantes do grupo controle. O estudo foi prospectivo e controlado, realizado no Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo. Nao foi encontrada diferenca significante entre os grupos nas incidencias pre-eclampsia e diabete gestacional, cesarea e suas indicacoes, prematuridade, recem-nascidos pequenos para a idade gestacional, intercorrencias perinatais, indice de Apgar e malformacoes. Foi observada elevada incidencia de anestesia geral no grupo de asmaticas (22,8 por cento)

Kinetics of theophylline in apnea of prematurity in small for gestational age babies.

OBJECTIVES: To study the pharmacokinetics of theophylline and its correlations to pharmacodynamic effects in apnea of prematurity in small for gestational age babies. DESIGN: Prospective case control study. SETTING: Level III Neonatal Intensive Care Unit. SUBJECTS: Ten small for gestational age (SGA) babies and 10 gestation matched appropriate for gestational age (AGA) babies with recurrent apnea of prematurity. METHODS: All babies were investigated to exclude secondary causes of apnea. 5 mg/kg of aminophylline loading dose followed by 2 mg/kg as maintenance dose every 8 hourly intravenously was used. The trough and peak levels of theophylline were assessed on different days of therapy. Clinical monitoring was done for the efficacy and toxicity of the drug. Analysis was done using unpaired Student's 't' test and the correlation between plasma theophylline levels of different days was performed by using ANOVA. RESULTS: The therapeutic drug levels were achieved within 24 hours in all babies. The SGA babies showed 25% higher drug levels as compared to AGA babies. The mean trough plasma theophylline levels ranged from 8.15 +/- 1.59 to 12.37 +/- 1.54 micrograms/ml in SGA babies while in AGA babies they ranged from 6.26 +/- 1.93 to 9.96 +/- 1.96 micrograms/ml in first 8 days of therapy. The mean peak levels in SGA babies ranged from 11.91 +/- 1.84 to 17.13 +/- 1.63 micrograms/ml and in AGA babies ranged from 8.17 +/- 1.84 to 13.02 +/- 1.48 micrograms/ml. Twenty per cent SGA and AGA babies each developed clinical toxicity though toxic drug levels were found in 50% SGA and 30% AGA babies. CONCLUSION: There is a need to modify dosage schedule for these babies.

Aminophylline alters pharmacokinetics of carbamazepine but not that of sodium valproate--a single dose pharmacokinetic study in human volunteers.

Pharmacokinetic interaction of aminophylline with single dose sodium valproate (400 mg) and carbamazepine (200 mg) was evaluated in normal healthy volunteers using a cross over design. Neither the serum concentrations nor the pharmacokinetic parameters of sodium valproate (SV) were altered by the coadministration of aminophylline (AMP). In contrast AMP significantly decreased the plasma concentrations of carbamazepine (CBZ). The Cmax of CBZ was significantly lowered from 1.73 +/- 0.18 to 0.94 +/- 0.08 microgram/ml and the AUC o-t was significantly decreased from 76.19 +/- 6.20 to 52.66 +/- 1.84 micrograms/h/ml (P < 0.05). The pharmacokinetic parameters of CBZ that were altered in the presence of AMP were: the Tmax and t1/2 which was prolonged about threefold from 5.60 +/- 1.60 to 16.80 +/- 7.94 h and 44.88 +/- 4.50 to 125.07 +/- 29.09 h, respectively. The Vd was marginally increased from 2.19 +/- 0.13 to 3.85 +/- 0.57 L/kg and the Cl was decreased from 34.07 +/- 3.78 to 25.26 +/- 5.15 mL/min. None of these alterations are statistically significant. Bioavailability of CBZ was reduced by 29% in the presence of AMP, while that of SV was increased by about 8%. Results are of clinical significance because simultaneous administration of CBZ and AMP may reduce the efficacy of CBZ in epileptic patients.

Combinación de aminofilina intravenosa y salbutamol en altas dosis administrado mediante un inhalador de dosis media con inhalocámara en la crisis asmática: ausencia de beneficio terapéutico e incremento de la toxicidad / Combination of intravenous aminophylline and salbutamol in high doses with spacer device in the acute asthma: adds to the toxicity but not the efficacy

La aminofilina intravenosa (i/v) es todavía ampliamente utilizada sola o en combinación con b2 en el tratamiento de la crisis asmática. Si bien la superioridad de los b2 sobre la aminofilina ha sido claramente demostrada, recientes investigaciones han reabiero la discusión al mostrar que la adición de aminofilina a los b2 acorta el tiempo de tratamiento disminuyendo el porcentaje de hospitalizaciones. El objetivo del estudio fue determinar si elagregado de aminofilina i/v a la terapéutica beta-agonista, genera algún beneficio clínico y/o espirométrico o evolutivo. Se utilizó un diseño aleatorizado, doble ciego, con grupo control. Se estudiaron 94 pacientes (rango 18-50 años, media 35,6 ñ 11,2) con diagnóstico de crisis asmática, que consultaron en la emergencia. Se incorporaron al estudio pacientes con: reducción del 50 por ciento o más del PEF y del FEV1, sin historia de bronquitits crónica y otra enfermedad médica. Todos los pacientes recibieron el mismo plan terapéutico: salbutamol administrado con IDM e inhalocámara (Volumatic), 4 disparos (400 microgramos) cada 10 minutos, e hidrocortisona i/v 500 mg. Luego, el grupo I recibió aminofilina i/v (dosis de carga 5,6 mg/kg de peso en 20 minutos seguido por una infusión continua de 0,9 mg/kg por hora) o (grupo II) un volumen equivalente de placebo. No hubieron diferencias espirométricas o clínicas entre ambos grupos. La duración del tratamiento fue 2,5 ñ 1,83 h, grupo I, y 2,37 ñ 1,75 h, grupo II, (p>0,2). El número de pacientes hospitalizados fue similar, 4 (9 por ciento) grupo I y 5 (10,2 por ciento) grupo II, (p>0,2). La dosis final de salbutamol fue 6,3 ñ 44,1 mg, grupo II y 5,8 ñ 42,8 mg, grupo I (p>0,2). Al alta, la concentración plasmática media de teofilina fue de 14,7 ñ 7,4 mg/L, grupo I y 3,3 ñ 4,53 mg/L, grupo II, (p<0,001). Similares resultados se obtuvieron cuando los pacientes dados de alta u hospitalizados se examinaron separadamente. Cuando se consideraron solamente aquellos con FEV1 inicial < 30 por ciento del predicto y se dividieron de acuerdo con la concentración final de teofilina (grupo placebo con teofilinemia < 10 mg/L vs. grupo I con teofilinemia > 10 mg/L, tampoco se constataron diferencias. Por el contrario, los efectos secundarios fueron mayores en el grupo I (mayores náuseas, cefaleas, palpitaciones y ansiedad) que en el grupo II (p<0,05). En suma, como en estudios previos, nuestros datos apoyan la noción de que el agregado de aminofilina i/v en dosis estándard a un régimen de altas dosis de salbutamol inhalado, no presenta ningún beneficio terapéutico, pero sí incrementa la incidencia de efectos secundarios

Theophylline pharmacokinetics in Thai children.

To validate a previously suggested dosing regimen of aminophylline administration for Thai children, we enrolled 13 asthmatic Thai children (5 girls and 8 boys) between the ages of 7.5-13.4 years (mean = 10.4 years) into a 36-hour, multiple-dose, oral theophylline pharmacokinetic study using plain aminophylline tablets at a dosage of 5 mg of theophylline base/kg every 8 hours. All patients were studied in the steady state. Blood samples were obtained every 2 hours for 24 hours; thereafter, samples were obtained more frequently for another 12 hours to determine theophylline pharmacokinetic parameters. Serum theophylline concentrations (STC) were assayed with a fluorescence polarization immunoassay method (TDX). Significant interpatient variations in STCs were observed. Five patients had peak STCs in the toxic range (> 20 micrograms/ml). Most patients had reproducible STC patterns during the study period; however, marked variations of STCs were observed with a mean percent of fluctuations [(Cmax-Cmin)/Cmin *100] of 535.6%. Using the PC Nonlin computer interpolation program by a modification with a baseline decay method and the Lagrange polynominal interpolation technique, approximate pharmacokinetic parameters were calculated and the results were as follows: plasma half life (t1/2) = 3.08 hours, elimination rate constant (Kel) = 0.26 hour-1, absorption rate constant (Ka) = 2.21 hour-1, volume of distribution (Vd) = 0.23 l/kg and plasma clearance (CI) = 56 ml/kg/hour. Since these calculated parameters could be imprecise due to delayed absorption of oral theophylline dosages, a single-dose intravenous theophylline pharmacokinetic study was further examined in another 18 patients (age range = 7-12 years, mean = 8.9 years) to determine more accurate pharmacokinetic data using intravenous aminophylline at dosage of 5.8 mg/kg.(ABSTRACT TRUNCATED AT 250 WORDS)

A Aminofilina Antagoniza a Açäo do Midazolan / Aminophylline Antagonizes Midazolan-Induced Sedation

The efficacy of aminophylline in antagonizing midazolam-induced sedation was evaluated in a double-blind study involving 60 patients scheduled for epidural anesthesia. Premedication consisted of sublingual flunitrazepam 2mg. Intraoperative sedation was achieved with intermitent intravenous bolus of midazolam 1mg. At the end of the surgery patients received either aminophyline 2mg/Kg (Group A), flumazenil 0.01mg/Kg (Group F) or placebo 0.1 ML/Kg (Group P) intravenously. Central nervous system functions were evaluated according to the degree of sedation, orientation, and cooperation presented. At the end of the surgery sedation was such that no patient was "completely awake". Fifteen minutes after the "antagonist" drug was administered, 35 percent of the patients in Group A, 100 percent in Group F, and 0 percent in Group P were "completely awake". Regarding orientation, 5 percent vs 55 percent in Group A, 0 percent vs 100 percent in Group F and 10 percent vs - 15 percent in Group P were "completely oriented" before vs after the drugs. Regarding cooperation, 5 percent vs 70 percent in Group A, 5 percent vs 100 percent in Group F, and 15 percent vs 15 percent in Group P were "completely cooperative" before vs after drugs. It is suggested that aminophylline can be used for reversal of midazolam action, although it is less effective than flumazenil

Estudio retrospectivo multicentrico del asma bronquial en la infancia / Multicentric retrospective study of bronquial asthma in infants

Trabajo Retropectivos multicentrico. Fueron estudiados un total de 2.544 pacientes atendidos en los 4 hospitales mas grandes de Santa cruz de la Sierra en 1992. Encontrandose 1.267 pacientes en consulta externa y 1.140 en emergencia. La proporcion de consultas por asma Bronquial en estos Hospitales fue de 2.34 por ciento con un indice de internacion de 5.77 por ciento (147 pacientes internados). Se encontro una leve predominancia del sexo masculino 58.8por ciento sobre el femenino (41.2 por ciento). El grupo etereo mas acometido fueron los mayores de 5 anos. En mas de 60 por ciento de los pacientes internados los principales sintomas fueron Disnea. Sibilancia, Tos y Tiraje. La droga mas utilizada fue la Aminofilina en 93.2 por ciento, seguida de los B2 adrenergicos en 76.9 y los corticoides en 59.2. La mortlidad fue del 1.2 por ciento. La gran mayoria de los pacientes recibio alta con un tiempo medio de internacion de 2,86 dias. Conclusiones que el Asma Bronquial prevalente en Santa Cruz de la Sierra con indice de Internacion y de mortalidad bajos indicando que la mayoria de los ninos responden adecuadamente al tratamiento de la crisis asmatica.

Comparative study of intravenous aminophylline, subcutaneous adrenaline and nebulized salbutamol in the treatment of acute asthma in children

One - hundred and twenty children presenting with acute asthma were studied. There were 73 males and 47 females, aged between 5 and 12 years. The patients were randomized into three groups to receive either subcutaneous adrenal in [AD], intravenous aminophylline [AN], or nebulized salbutamol [SAL]. Forty patients were examined in each group. Vital signs, pulmonary function [PEFR] and clinical assessment were recorded prior to treatment and repeated at 10, 30, and 120 minutes [min] after treatment. There was no significant difference between the groups in age, sex, height or baseline PEFR. Each group showed highly significant improvement in PEFR at 10, 30 and 120 min compared to the baseline. Between groups, SAL produced PEFR response near its maximum value at 10 mitt and it was significantly better than that of both AD and AM at both 10 and 30 min. It was equipotent to that of AM at 120 sin. Adrenaline produced a response similar to AM at 10 mm. but it caused significant tachycardia and tremors. Salbutamol aerosol proved to be an effective and tolerable bronchodilator in the treatment to be used in emergency units of regional hospitals. Adrenaline, also potent, but much less expensive than SAL remains the drug of choice for nation - wide use in all health units in the country

Reversión de la sedación por aminofilina en pacientes que recibieron diazepan, fentanil y tiopental

La aminofilina, un antagonista no específico de las benzodiazepinas, fue evaluada para determinar su acción en la reversión de la sedacción de pacientes sometidos a legrados uterinos o braquiterapia intrauterina bajo anestesia general. Veintiocho pacientes recibieron Fentanil 3ug.kg-1, Diazepán 0.2 mg.kg-1 y Tiopental 4mg.kg-1, y fueron ventiladas con Oxido Nitroso- Oxígeno (66/33 por ciento). Después del procedimiento quirúrgico, cada paciente recibió en forma randomizada y doble ciego, ®droga activa¼ (aminofilina 4 mg.kg-1n=14) o ®placebo¼ (solución Salina isotónica; n = 14). Ambos grupos fueron similares en sus variables demográficas y no se detectaron diferencias en las determinaciones de presión arterial, frecuencia cardíaca y frecuencia respiratoria después de la administración de aminofilina. La recuperación fue bien tolerada y significativamente más rápida en el grupo aminofilina (30.9 min+DS4.91) que en el grupo control (39.0 min. + DS 8.06) (p<0.01). Los niveles de sedación revirtieron antes que en el grupo control <0.05), pero esta deferencia desaparecio 30 minutos después de finalizado el procedimiento anestésico quirúrgico. Se infiere que en las pacientes que recibieron fentanil, diazepán y tiopental, la aminofilina acelera el despertar, probablemente debido al bloqueo de los receptores de adenosina