The role of opioid receptor agonists in ischemic preconditioning.

Opioids and their receptor agonists have been widely used because of their beneficial effects on pain management and control. Over the past decade, there has been an increasing interest on the experimental use of opioid agonists in the laboratory setting of ischemia and reperfusion; existing data suggest that there is a potential association between opioid agonism and the reduction of infarct size in several animal models of regional ischemia similar to that following ischemic preconditioning. Most of these studies seem to attribute these beneficial and cardioprotective effects to the stimulation of a specific opioid receptor type, the delta (δ) opioid receptor. This review focuses on the role of the delta opioid receptor agonism in several models of ischemia and reperfusion, as well as on hemorrhagic shock models, on the potential mechanisms of action following delta opioid receptor activation and on the time window for opioid administration in various animal studies.

Evaluation of a defibrillator-basic cardiopulmonary resuscitation programme for non medical personnel.

To improve the outcome for out-of-hospital patients with ventricular fibrillation/pulseless ventricular tachycardia (VF/VT), the use of automated external defibrillators (AEDs) by first responders including non-medical personnel with a duty to respond to an emergency is recommended. A special CPR-AED course has been developed. We wanted to test the results (quality and speed of operating an AED and CPR) after completion of such a course and retention after approximately 1-year. At the same time we wanted to see if personnel could use an AED after receiving written information without having attended the course. Study subjects were divided randomly into groups, and tested pre-course (n=54), post-course (n=50), and unannounced 10+/-3 months after the course (retention group, n=61). For statistical analysis two sample tests for binomial proportions and Wilcoxon-Mann-Whitney test was used as appropriate. Fifteen of the 27 pairs (56%) in the pre-course group with no previous exposure to an AED decided to use it. There was no difference between the groups in electrode pad positioning, and all stayed clear of the manikin during the process of AED charging and shock delivery. The post-course group had a higher rate of checking for responsiveness (vs. pre-course), not to check for a pulse (vs. both other groups), the shortest time interval from arrival on scene to start of CPR and shock delivery, and in parallel the shortest hands-off interval (without chest compressions and ventilations) before shock delivery. The quality of chest compressions was improved by the course but decreased to a similar standard as in the pre-course when tested 10+/-3 months later, except for correct depth which was similar to post course. Most ventilation attempts in all groups were scored as incorrect due to the high incidence of excessively rapid inflations. The retention group had a lower frequency of correct inflations than the pre-course group, and the post-course group the highest number of correct ventilations per minute. These findings suggest that use of an AED by untrained laypersons may be feasible and that complex and time-consuming training programmes may not be necessary. The present study also supports the need for annual training and recertification.