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1.
J Clin Anesth ; 87: 111091, 2023 08.
Article in English | MEDLINE | ID: mdl-36870274

ABSTRACT

STUDY OBJECTIVE: Semaglutide is a long-acting glucagon-like peptide-1 receptor agonist used for management of type 2 diabetes and/or obesity. To test the hypothesis that perioperative semaglutide use is associated with delayed gastric emptying and increased residual gastric content (RGC) despite adequate preoperative fasting, we compared the RGC of patients who had and had not taken semaglutide prior to elective esophagogastroduodenoscopy. The primary outcome was the presence of increased RGC. DESIGN: Single-center retrospective electronic chart review. SETTING: Tertiary hospital. PATIENTS: Patients undergoing esophagogastroduodenoscopy under deep sedation/general anesthesia between July/2021-March/2022. INTERVENTIONS: Patients were divided into two (SG = semaglutide, NSG = non-semaglutide) groups, according to whether they had received semaglutide within 30 days prior to the esophagogastroduodenoscopy. MEASUREMENTS: Increased RGC was defined as any amount of solid content, or > 0.8 mL/Kg (measured from the aspiration/suction canister) of fluid content. MAIN RESULTS: Of the 886 esophagogastroduodenoscopies performed, 404 (33 in the SG and 371 in the NSG) were included in the final analysis. Increased RGC was observed in 27 (6.7%) patients, being 8 (24.2%) in the SG and 19 (5.1%) in the NSG (p < 0.001). Semaglutide use [5.15 (95%CI 1.92-12.92)] and the presence of preoperative digestive symptoms (nausea/vomiting, dyspepsia, abdominal distension) [3.56 (95%CI 2.2-5.78)] were associated with increased RGC in the propensity weighted analysis. Conversely, a protective [0.25 (95%CI 0.16-0.39)] effect against increased RGC was observed in patients undergoing esophagogastroduodenoscopy combined with colonoscopy. In the SG, the mean time of preoperative semaglutide interruption in patients with and without increased RGC was 10.5 ± 5.5 and 10.2 ± 5.6 days, respectively (p = 0.54). There was no relationship between semaglutide use and the amount/volume of RGC found on esophagogastroduodenoscopy (p = 0.99). Only one case (in the SG) of pulmonary aspiration was reported. CONCLUSIONS: Semaglutide was associated with increased RGC in patients undergoing elective esophagogastroduodenoscopy. Digestive symptoms prior to esophagogastroduodenoscopy were also predictive of increased RGC.


Subject(s)
Diabetes Mellitus, Type 2 , Humans , Diabetes Mellitus, Type 2/complications , Retrospective Studies , Endoscopy, Gastrointestinal/adverse effects , Colonoscopy , Anesthesia, General , Hypoglycemic Agents/adverse effects
2.
PLoS One ; 8(1): e53226, 2013.
Article in English | MEDLINE | ID: mdl-23308166

ABSTRACT

Carvedilol has beneficial effects on cardiac function in patients with heart failure but its effect on ovariectomy-induced myocardial contractile dysfunction remains unclear. Estrogen deficiency induces myocardial contractile dysfunction and increases cardiovascular disease risk in postmenopausal women. Our aim was to investigate whether carvedilol, a beta receptor blocker, would prevent ovariectomy-induced myocardial contractile dysfunction. Female rats (8 weeks old) that underwent bilateral ovariectomy were randomly assigned to receive daily treatment with carvedilol (OVX+CAR, 20 mg/kg), placebo (OVX) and SHAM for 58 days. Left ventricle papillary muscle was mounted for isometric tension recordings. The inotropic response to Ca(2+) (0.62 to 3.75 mM) and isoproterenol (Iso 10(-8) to 10(-2 )M) were assessed. Expression of calcium handling proteins was measured by western blot analysis. Carvedilol treatment in the OVX animals: prevented weight gain and slight hypertrophy, restored the reduced positive inotropic responses to Ca(2+) and isoproterenol, prevented the reduction in SERCA2a expression, abolished the increase in superoxide anion production, normalized the increase in p22(phox) expression, and decreased serum angiotensin converting enzyme (ACE) activity. This study demonstrated that myocardial contractile dysfunction and SERCA2a down regulation were prevented by carvedilol treatment. Superoxide anion production and NADPH oxidase seem to be involved in this response.


Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Carbazoles/therapeutic use , Heart Diseases/prevention & control , Heart/drug effects , Myocardial Contraction/drug effects , Myocardium/pathology , Ovariectomy/adverse effects , Propanolamines/therapeutic use , Animals , Body Weight/drug effects , Calcium/metabolism , Carvedilol , Female , Heart/physiopathology , Heart Diseases/blood , Heart Diseases/etiology , Heart Diseases/physiopathology , Hemodynamics/drug effects , Malondialdehyde/blood , Myocardium/metabolism , Organ Size/drug effects , Peptidyl-Dipeptidase A/blood , Rats , Rats, Wistar , Receptors, Adrenergic, beta/metabolism , Superoxides/metabolism
3.
Cell Physiol Biochem ; 30(1): 1-12, 2012.
Article in English | MEDLINE | ID: mdl-22759951

ABSTRACT

BACKGROUND/AIM: Estrogen deficiency induces myocardial contractile dysfunction and increases cardiovascular disease risk. However, the mechanism underlying this response is unclear. Our aim was to investigate whether AT(1)receptor blockade would prevent ovariectomy-induced myocardial contractile dysfunction. METHODS: Female rats (8 weeks old, 280 g) that underwent bilateral ovariectomy were randomly assigned to receive daily treatment with losartan (OVX + LOS, 15 mg/kg, s.c., in 0.9 % NaCl), placebo (OVX), estrogen replacement (OVX + E2, 1 mg/ kg, once a week, i.m.) and SHAM for 58 days. RESULTS: Losartan and estrogen treatment 1) prevented ovariectomy-induced weight gain and slight hypertrophy, 2) restored the positive inotropic responses to Ca(2+) and isoproterenol in the isolated papillary muscle in the OVX group, 3) prevented the reduction in SERCA2a levels and the increase in phospholamban (PLB) expression in the OVX group, 4) abolished the increase in superoxide anion that was increased in the OVX group, and 5) normalized the increase in p22(phox) expression after ovariectomy. Estrogen treatment but not losartan restored the increase in serum angiotensin converting enzyme activity in the OVX group. CONCLUSION: This study demonstrated that myocardial contractile dysfunction induced by ovariectomy and expression of key Ca(2+)-handling proteins were prevented by losartan treatment and that AT(1) receptor activation is involved in this response.


Subject(s)
Myocardial Contraction , Receptor, Angiotensin, Type 1/metabolism , Ventricular Dysfunction, Left/metabolism , Adrenergic beta-Agonists/pharmacology , Animals , Calcium/pharmacology , Estrogens/deficiency , Female , In Vitro Techniques , Isoproterenol/pharmacology , Malondialdehyde/blood , Myocardium/metabolism , Myocardium/pathology , NADPH Oxidases/metabolism , Organ Size , Ovariectomy , Peptidyl-Dipeptidase A/blood , Rats , Rats, Wistar , Sarcoplasmic Reticulum Calcium-Transporting ATPases/metabolism , Superoxides/metabolism
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