Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2012
Comparative StudyIn vivo and in vitro pharmacological studies of methoxycarbonyl-carboetomidate.
We previously developed 2 etomidate analogs that retain etomidate's favorable hemodynamic properties but whose adrenocortical effects are reduced in duration or magnitude. Methoxycarbonyl (MOC)-etomidate is rapidly metabolized and ultrashort acting whereas (R)-ethyl 1-(1-phenylethyl)-1H-pyrrole-2-carboxylate (carboetomidate) does not potently inhibit 11β-hydroxylase. We hypothesized that MOC-etomidate's labile ester could be incorporated into carboetomidate to produce a new agent that possesses favorable properties individually found in each agent. We describe the synthesis and pharmacology of MOC-(R)-ethyl 1-(1-phenylethyl)-1H-pyrrole-2-carboxylate (MOC-carboetomidate), a "soft" analog of carboetomidate. ⋯ MOC-carboetomidate is a GABA(A) receptor modulator with potent hypnotic activity that is more rapidly metabolized and cleared from the brain than carboetomidate, maintains hemodynamic stability similar to carboetomidate, and does not suppress adrenocortical function.
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Anesthesia and analgesia · Aug 2012
Prior lumbar discectomy surgery does not alter the efficacy of neuraxial labor analgesia.
Lumbar discectomy surgery is a common neurosurgical procedure. Neuraxial labor analgesia may be less effective in parturients with a history of discectomy surgery because of postsurgical scarring and anatomical distortion. In this prospective observational case-controlled study, we compared bupivacaine consumption per hour of labor analgesia as an indirect measure of labor analgesic effectiveness between women with prior discectomy surgery and those who did not have back surgery. ⋯ There was no difference in hourly bupivacaine consumption in parturients with prior lumbar discectomy surgery undergoing neuraxial labor analgesia in comparison with controls. Time to placement of the epidural catheter was not different either, but more interspaces were attempted in the discectomy group. Our findings suggest that standard clinical neuraxial analgesic methods are effective in women with discectomy surgery.
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Anesthesia and analgesia · Aug 2012
The systemic and regional hemodynamic effects of phenylephrine in sheep under normal conditions and during early hyperdynamic sepsis.
Phenylephrine treatment of hypotension in sepsis raises concern because it may decrease vital organ bloodflow. Accordingly, we investigated the effects of phenylephrine on systemic and regional bloodflow in normal and septic sheep. ⋯ In sheep with early hyperdynamic sepsis, phenylephrine, at a dose that restored MAP, increased stroke volume and renal bloodflow while decreasing HR and coronary bloodflow but not mesenteric bloodflow. Similar responses were seen in normal animals.
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Anesthesia and analgesia · Aug 2012
The effects of MDCO-2010, a serine protease inhibitor, on activated clotting time in blood obtained from volunteers and cardiac surgical patients.
The activated clotting time (ACT) is widely used for monitoring heparin anticoagulation during cardiac surgery. Celite-based ACT values are prolonged when aprotinin is administered. MDCO-2010, a novel serine protease inhibitor, is currently being evaluated as a possible alternative to aprotinin. Therefore, we evaluated the in vitro effects of this novel agent on ACT values using 3 different point-of-care instruments with kaolin or celite as an activator. ⋯ MDCO-2010 causes less ACT prolongation with kaolin than with celite activation.
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Anesthesia and analgesia · Aug 2012
Antihyperalgesic effects of myrsinoic acid B in pain-like behavior induced by inflammatory and neuropathic pain models in mice.
Myrsinoic acid B (MAB) is a diprenylated benzoic acid widely found in the vegetal kingdom. Recent studies demonstrate that MAB has important antinociceptive effects in models of chemically or thermally induced nociception in mice. ⋯ MAB reduced mechanical and thermal hypersensitivity in mice submitted to models of inflammatory and neuropathic pain, showing excellent potential for treating persistent pain in humans.