Cardiovascular effects of hyoscine butylbromide in patients under general anaesthesia.

BACKGROUND: Cardiovascular effects for drugs such as hyoscine butylbromide are poorly documented in the literature, unlike atropine, which is considered the antimuscarinic of choice in the presence of intraoperative bradycardia. AIM: The aim of the study was to describe the dose-related cardiovascular effect of hyoscine butylbromide in patients between 18 and 65 years of age, with low perioperative risk undergoing elective surgery under general anaesthesia on an outpatient basis or hospitalised at our institution between 1 January and 31 May 2019. METHODS: Descriptive, cross-sectional, retrospective study; 28 patients with low perioperative risk who underwent general anaesthesia were selected. Changes in heart rate and blood pressure were analysed during the first 6 minutes after the administration of hyoscine butylbromide. The data obtained was recorded in a Microsoft Excel database and analysed using the Excel analysis tool and IBM SPSS. RESULTS: The average dose of 0.15mg/kg of hyoscine butylbromide achieved an increase in heart rate and mean arterial pressure in 96% and 92.8%, respectively, in the first 6 minutes after the administration. Significant changes in heart rate and blood pressure were obtained during the first 6 minutes at doses between 0.05mg/kg and 0.15mg/kg. CONCLUSION: Hyoscine butylbromide generates positive effects on the heart rate and blood pressure of patients under general anaesthesia, representing a possible alternative in the management of intraoperative bradycardia.

The genus Datura L. (Solanaceae) in Mexico and Spain - Ethnobotanical perspective at the interface of medical and illicit uses.

ETHNOPHARMACOLOGICAL RELEVANCE: The different species of the genus Datura have been used traditionally by some pre-Columbian civilizations, as well as in medieval rituals linked to magic and witchcraft in both Mexico and Europe. It is also noteworthy the use of different alkaloids obtained from the plants for medicinal purposes in the treatment of various groups of diseases, especially of the respiratory and muscularskeletal systems. AIM OF THE STUDY: A review of the ethnobotanical uses of the genus Datura in Mexico and Spain has been conducted. We focus on the medicinal and ritualistic uses included in modern ethnobotanical studies, emphasizing the historical knowledge from post-colonial American Codices and medieval European texts. Datura's current social emergency as a drug of recreation and leisure, as well as its link to crimes of sexual abuse is also considered. The work is completed with some notes about the distribution and ecology of the different species and a phytochemical and pharmacological review of Datura alkaloids, necessary to understand their arrival in Europe and the ethnobotanical uses made since then MATERIALS AND METHODS: A literature review and compilation of information on traditional medicinal uses of the genus has been carried out from the main electronic databases. Traditional volumes (codices) have also been consulted in libraries of different institutions. Consultations have been made with the National Toxicological Services of Spain and Mexico for toxicological data. RESULTS: A total of 118 traditional uses were collected in both territories, 111 medicinal ones to be applied in 76 conditions or symptoms included in 13 pathological groups. Although there are particular medicinal uses in the two countries, we found up to 15 similar uses, of which 80% were previously mentioned in post-Colonial American codices. Applications in the treatment of asthma and rheumatism are also highlighted. Apart from medicinal uses, it is worth noting their cultural and social uses, in the case of Mexico relating to diseases such as being scared, astonishment or falling in love, and in the case of Spain, as a recreational drug and lately, for criminal purposes. CONCLUSIONS: This review highlights the variety of uses traditionally given to the different species in both territories. The fact that most of the coincident or similar uses in both countries also appear in the classical codices can be found an example of the flow, not only of the plants from America to Europe, but also of their associated information. It is also relevant that particular uses have derived in both countries, reflecting the difference in the cultural factors and traditions linked to rituals and cultural practices. Finally, the significant growth of Datura consumption in recent years as a drug of leisure and recreation, as well as in crimes of sexual submission, should be considered as research of maximum relevance in the field of forensic botany and toxicology.

Uso de N-butilbromuro de hioscina en premedicación anestésica en un equino con un bloqueo atrioventricular Mobitz tipo II / The use of hyoscine N-butylbromide in anesthetic premedication of an equine with Mobitz II AV block / Uso de N-butylbromide de hyoscine em pré-medicação anestésica em um equino com um bloqueio AV Mobitz tipo II

Resumen: El bloqueo atrioventricular (AV) segundo grado Mobitz tipo II, a diferencia del bloqueo Mobitz tipo I, se caracteriza por presentar un intervalo PR normal antes de una onda P no conductiva y después de esta. Algunos bloqueos se producen por causas fisiológicas, metabólicas, estructurales y por la administración de medicamentos a2-adrenérgicos. Se ha registrado que la mayoría de los bloqueos y bradicardias responden a la atropina o glicopirrolato. En este informe de caso se presenta un equino macho, raza cuarto de milla, de cinco años de edad, remitido al Centro de Veterinaria y Zootecnia de la Universidad CES para una artroscopia del carpo izquierdo. Tras el derribo del paciente con la administración de xilacina, diazepam y ketamina, para iniciar el procedimiento quirúrgico, el paciente presenta una bradicardia marcada (10 latidos por minuto). Por lo tanto, se decide posponer la cirugía. Posterior a su reincorporación, se le diagnostica un bloqueo AV de segundo grado Mobitz tipo II, el cual al momento de tratarse solo responde a N-butilbromuro de hioscina.

Abstract: Second-degree Mobitz II atrioventricular (AV) block, unlike the Mobitz I block, is characterized by presenting a normal PR interval before a non-conducted P wave and after this. Some blocks occur for physiological, metabolic, and structural causes, and due to the administration of a2-adrenergic medication. It has been recorded that most of the blocks and bradycardias are responsive to atropine or glycopyrrolate. This case report presents a five-year-old, male, quarter-mile race horse, referred to the Center for Veterinary and Animal Science at the Universidad CES for arthroscopy of his left carpus. After administering xylazine, diazepam, and ketamine to the patient in order to initiate the surgical procedure, the patient presents marked bradycardia (10 beats per minute). Therefore, it was decided to postpone the surgery. After his recovery from anesthesia, he is diagnosed with seconddegree Mobitz II AV block, which only responds to hyoscine N-butylbromide as treatment.

Resumo: O bloqueio atrioventricular (AV) segundo grau Mobitz tipo II, diferente do bloqueio Mobitz tipo I, se caracteriza por apresentar um intervalo PR normal antes de uma onda P não condutiva e depois desta. Alguns bloqueios se produzem por causas fisiológicas, metabólicas, estruturais e pela administração de medicamentos a2-adrenérgicos. Há registro de que a maioria dos bloqueios e bradicardias respondem à atropina ou glicopirrolato. Neste informe de caso se presenta um equino macho, raça quarto de milha, de cinco anos de idade, remitido ao Centro de Veterinária e Zootecnia da Universidade CES para uma artroscopia do carpo esquerdo. Após a queda do paciente com a administração de xilazina, diazepam e cetamina, para iniciar o procedimento cirúrgico, o paciente apresenta uma bradicardia marcada (10 latidos por minuto). Portanto, se decide adiar a cirurgia. Posterior à sua reincorporação, se diagnostica um bloqueio AV de segundo grau Mobitz tipo II, o que ao momento de tratar-se solo responde a N-butylbromide de hyoscina.

Hyoscine-N-butylbromide premedication on cardiovascular variables of horses sedated with medetomidine.

OBJECTIVE: To evaluate the effects of intravenous (IV) or intramuscular (IM) hyoscine premedication on physiologic variables following IV administration of medetomidine in horses. STUDY DESIGN: Randomized, crossover experimental study. ANIMALS: Eight healthy crossbred horses weighing 330 ± 39 kg and aged 7 ± 4 years. METHODS: Baseline measurements of heart rate (HR), cardiac index (CI), respiratory rate, systemic vascular resistance (SVR), percentage of patients with second degree atrioventricular (2(o) AV) block, mean arterial pressure (MAP), pH, and arterial partial pressures of carbon dioxide (PaCO2 ) and oxygen (PaO2 ) were obtained 5 minutes before administration of IV hyoscine (0.14 mg kg(-1) ; group HIV), IM hyoscine (0.3 mg kg(-1) ; group HIM), or an equal volume of physiologic saline IV (group C). Five minutes later, medetomidine (7.5 µg kg(-1) ) was administered IV and measurements were recorded at various time points for 130 minutes. RESULTS: Medetomidine induced bradycardia, 2(o) AV blocks and increased SVR immediately after administration, without significant changes in CI or MAP in C. Hyoscine administration induced tachycardia and hypertension, and decreased the percentage of 2(o) AV blocks induced by medetomidine. Peak HR and MAP were higher in HIV than HIM at 88 ± 18 beats minute(-1) and 241 ± 37 mmHg versus 65 ± 16 beats minute(-1) and 192 ± 38 mmHg, respectively. CI was increased significantly in HIV (p ≤ 0.05). Respiratory rate decreased significantly in all groups during the recording period. pH, PaCO2 and PaO2 were not significantly changed by administration of medetomidine with or without hyoscine. CONCLUSION AND CLINICAL RELEVANCE: Hyoscine administered IV or IM before medetomidine in horses resulted in tachycardia and hypertension under the conditions of this study. The significance of these changes, and responses to other dose rates, requires further investigation.

Efficacy of three different alpha 1-adrenergic blockers and hyoscine N-butylbromide for distal ureteral stones

PURPOSE: To evaluate hyoscine N-butyl bromide (HBB) and three different alpha-1 blockers in the treatment of distal ureteral stones. MATERIALS AND METHODS: A total of 140 patients with stones located in the distal tract of the ureter with stone diameters of 5 to 10mm were enrolled in the present study and were randomized into 4 equal groups. Group 1 received HBB, Group 2 received alfuzosin, Group 3 received doxazosin and Group 4 received terazosin. The subjects were prescribed diclofenac injection (75 mg) intramuscularly on demand for pain relief and were followed-up after two weeks with x-rays of the kidneys, ureters, bladder and urinary ultrasonography every week. The number of pain episodes, analgesic dosage and the number of days of spontaneous passage of the calculi through the ureter were also recorded. RESULTS: The average stone size for groups 1, 2, 3 and 4 was comparable (6.13, 5.83, 5.59 and 5.48 mm respectively). Stone expulsion was observed in 11 percent, 52.9 percent, 62 percent, and 46 percent in groups 1, 2, 3 and 4 respectively. The average time to expulsion was 10.55 ± 6.21 days in group 1, 7.38 ± 5.55 days in group 2, 7.85 ± 5.11 days in group 3 and 7.45 ± 5.32 days in group 4. Alpha blockers were found to be superior to HBB (p < 0.05). CONCLUSIONS: Medical treatment of distal ureteral calculi with alfuzosin, doxazosin and terazosin resulted in a signi?cantly increased stone-expulsion rate and decreased expulsion time when compared with HBB. HBB seems to have a negative effect on stone-expulsion rate.