Antinociceptive effects, metabolism and disposition of ketamine in ponies under target-controlled drug infusion

Ketamine is widely used as an anesthetic in a variety of drug combinations in human and veterinary medicine. Recently, it gained new interest for use in long-term pain therapy administered in sub-anesthetic doses in humans and animals. The purpose of this study was to develop a physiologically based pharmacokinetic (PBPk) model for ketamine in ponies and to investigate the effect of low-dose ketamine infusion on the amplitude and the duration of the nociceptive withdrawal reflex (NWR). A target-controlled infusion (TCI) of ketamine with a target plasma level of 1 microg/ml S-ketamine over 120 min under isoflurane anesthesia was performed in Shetland ponies. A quantitative electromyographic assessment of the NWR was done before, during and after the TCI. Plasma levels of R-/S-ketamine and R-/S-norketamine were determined by enantioselective capillary electrophoresis. These data and two additional data sets from bolus studies were used to build a PBPk model for ketamine in ponies. The peak-to-peak amplitude and the duration of the NWR decreased significantly during TCI and returned slowly toward baseline values after the end of TCI. The PBPk model provides reliable prediction of plasma and tissue levels of R- and S-ketamine and R- and S-norketamine. Furthermore, biotransformation of ketamine takes place in the liver and in the lung via first-pass metabolism. Plasma concentrations of S-norketamine were higher compared to R-norketamine during TCI at all time points. Analysis of the data suggested identical biotransformation rates from the parent compounds to the principle metabolites (R- and S-norketamine) but different downstream metabolism to further metabolites. The PBPk model can provide predictions of R- and S-ketamine and norketamine concentrations in other clinical settings (e.g. horses).

Effects of intra-PAG infusion of ovine CRF on defensive behaviors in Swiss-Webster mice

The midbrain dorsal periaqueductal gray (DPAG) is part of the brain defensive system involved in active defense reactions to threatening stimuli. Corticotrophin releasing factor (CRF) is a peptidergic neurotransmitter that has been strongly implicated in the control of both behavioral and endocrine responses to threat and stress. We investigated the effect of the nonspecific CRF receptor agonist, ovine CRF (oCRF), injected into the DPAG of mice, in two predator-stress situations, the mouse defense test battery (MDTB), and the rat exposure test (RET). In the MDTB, oCRF weakly modified defensive behaviors in mice confronted by the predator (rat); e.g. it increased avoidance distance when the rat was approached and escape attempts (jump escapes) in forced contact. In the RET, drug infusion enhanced duration in the chamber while reduced tunnel and surface time, and reduced contact with the screen which divides the subject and the predator. oCRF also reduced both frequency and duration of risk assessment (stretch attend posture: SAP) in the tunnel and tended to increase freezing. These findings suggest that patterns of defensiveness in response to low intensity threat (RET) are more sensitive to intra-DPAG oCRF than those triggered by high intensity threats (MDTB). Our data indicate that CRF systems may be functionally involved in unconditioned defenses to a predator, consonant with a role for DPAG CRF systems in the regulation of emotionality. (c) 2006 Elsevier B.V. All rights reserved.

Anti-platelet activity of infusion of Tithonia diversifolia's leaves

Tithonia diversifolia, also known as Mexican arnica, has been used in traditional medicine to treat inflammatory refractory with absence of citotoxicity. The possible health risks associated with the consumption of ingestion of the infusion (tea) plant makes it is necessary to identify the potential pharmacological activity or toxicity to prove certain plants that are acclimated in Brazil. Considering the limited number of pharmacological studies regarding the Tithonia diversifolia, the aim of this study was evaluate the effects of this infusion in platelet aggregation. Venous blood was collected with informed consent from healthy volunteers who denied taking any medication in the previous 14 days. Whole blood was transferred into polypropylene tubes containing one-tenth of final volume of acid citrate dextrose (ACD-C; citric acid 3%, trisodium citrate 4%, glucose 2%; 1:9 v/v) and centrifuged at 200g for 15 min. Platelet rich plasma was added of wash buffer solution (NaCl 140mM, KCl 5mM, sodium citrate 12mM, glucose 10mM and saccharose 12mM; pH 6; 5:7 v/v) and centrifuged at 800g for 12 min at 20°C. Platelet pellet was gently resuspended in Krebs-Ringer solution and counts were performed on a Neubauer chamber. Aggregation assay was carried out with 400 μL of platelet suspension (1.2x10 8 platelets/mL) in a cuvette at 37°C with constant stirring. Platelet suspension was incubated for 3 min with aqueous extract infusion (0.6-20μg/mL) prior to addition of thrombin (100 mU/mL). Percentage of platelet aggregation was recorded with an aggregometer (Chrono-log Lumi-Aggregometer model 560-Ca, USA). Our results show an inhibition of thrombin induced platelet aggregation in the presence of 0.6-20 ug/mL Tithonia diversifolia infusion leaves. The Tithonia diversifolia infusion leaves inhibits thrombin induced washed platelet aggregation.

Contribuição da Endotelina-1 para o tônus coronariano de seres humanos: experimentos com o antagonista dos receptores ET-A

Introdução. A endotelina-1, o mais potente vasoconstritor endógeno, atua através de dois receptores de afinidades distintas, conhecidos como ETA e ETB. Os receptores ETA estão localizados predominantemente na musculatura lisa vascular e são os principais mediadores do efeito vasoconstritor da endotelina-1. Diversos estudos demonstraram que a endotelina-1 exerce um papel importante na manutenção do tônus arterial basal. Entretanto, a contribuição da endotelina-1 para o tônus coronariano basal em seres humanos, especialmente em coronárias com lesões ateroscleróticas, permanece alvo de interesse. Objetivos. Os objetivos deste estudo foram avaliar a contribuição da endotelina-1 no tônus coronariano epicárdico e na microcirculação em coronárias livres de lesões obstrutivas e em coronárias com lesões ateroscleróticas e comparar o método da contagem TIMI com o Doppler intracoronário na detecção de alterações do fluxo sangüíneo em resposta à adenosina. Métodos. Um total de 16 pacientes, sendo oito destes no grupo com coronárias livres de lesões obstrutivas e oito pacientes com lesões coronarianas obstrutivas, foram incluídos neste estudo. Todos pacientes receberam a infusão seletiva intracoronária de BQ-123, um inibidor específico dos receptores ETA da endotelina-1, durante 60 minutos. Adenosina e nitroglicerina foram administradas em bolus no tronco da coronária esquerda. O efeito do BQ-123 no diâmetro coronário epicárdico foi avaliado por angiografia quantitativa realizada a cada 15 minutos ao longo da infusão da droga. O efeito na microcirculação coronária foi avaliado por variações no fluxo sangüíneo medido por guia-Doppler e pelo método da contagem TIMI. Resultados. A infusão de BQ-123 resultou em aumento de 7% do diâmetro coronário e de 19% no fluxo sangüíneo volumétrico em pacientes com artérias livres de lesões obstrutivas (P < 0,001 para comparação com basal). O aumento do calibre do vaso ocorreu de forma progressiva e uniforme ao longo do vaso. Os pacientes com lesão aterosclerótica apresentaram um aumento de 16% (P < 0,001 para comparação com artérias livres de lesões obstrutivas) no diâmetro coronário e 28% no local da estenose. A velocidade do fluxo sangüíneo em coronárias livres de lesões obstrutivas não se alterou significativamente tanto na medida por Doppler como pelo método de contagem TIMI. Houve uma correlação de 0,67 (P < 0,05) entre o método da contagem TIMI e o Doppler para detecção de alterações na velocidade do fluxo sangüíneo em resposta à adenosina. Conclusões. A infusão seletiva intracoronária do inibidor específico dos receptores ETA da endotelina-1 em seres humanos pode ser feita de maneira segura. A endotelina-1 exerce um papel importante na manutenção do tônus coronariano basal em artérias livres de lesões obstrutivas, sendo responsável pela quase totalidade do tônus constritor aumentado presente em coronárias com lesões ateroscleróticas. O método da contagem TIMI apresenta uma boa correlação com o Doppler para medida do fluxo sangüíneo em condições de hiperêmia.

Implementação de um sistema embarcado aplicado ao controle de pressão arterial

Hypertension is a dangerous disease that can cause serious harm to a patient health. In some situations the necessity to control this pressure is even greater, as in surgical procedures and post-surgical patients. To decrease the chances of a complication, it is necessary to reduce blood pressure as soon as possible. Continuous infusion of vasodilators drugs, such as sodium nitroprusside (SNP), rapidly decreased blood pressure in most patients, avoiding major problems. Maintaining the desired blood pressure requires constant monitoring of arterial blood pressure and frequently adjusting the drug infusion rate. Manual control of arterial blood pressure by clinical personnel is very demanding, time consuming and, as a result, sometimes of poor quality. Thus, the aim of this work is the design and implementation of a database of tuned controllers based on patients models, in order to find a suitable PID to be embedded in a Programmable Integrated Circuit (PIC), which has a smaller cost, smaller size and lower power consumption. For best results in controlling the blood pressure and choosing the adequate controller, tuning algorithms, system identification techniques and Smith predictor are used. This work also introduces a monitoring system to assist in detecting anomalies and optimize the process of patient care.

Anxiety-induced antinociception in mice: effects of systemic and intra-amygdala administration of 8-OH-DPAT and midazolam

Rationale: Mice exhibit antinociception after a single experience in the elevated plus maze (EPM), an animal model of anxiety. Objective: This study investigated the mechanisms involved in this form of anxiety-induced antinociception. Methods: Nociception was evaluated by means of the writhing test in mice confined either to the open or enclosed arms of the EPM. The effects of systemic (naloxone, midazolam and 8-OH-DPAT) or intra-amygdala (8-OH-DPAT. NAN-190 and midazolam) drug infusions were investigated in mice previously treated i.p. with 0.6% acetic acid, an algic stimulus that induces abdominal contortions. The effects of these drugs on conventional measures of anxiety (% entries and % time in open arms) in a standard EPM test were also independently investigated. Results: Open-arm confinement resulted in a high-magnitude antinociception (minimum 85%, maximum 450%) compared with enclosed arm confinement. The opiate antagonist naloxone (1 mg/kg and 10 mg/kg) neither blocked this open arm-induced antinociception (OAIA) nor modified indices of anxiety in EPM. Administration of midazolam (0.5-2 mg/kg, s.c.) increased OAIA and produced antinociception in enclosed confined animals, as well as attenuating anxiety in the EPM. The 5-HT(1A) receptor agonist 8-OH-DPAT (0.05-1 mg/kg, s.c.) had biphasic effects on OAIA, antagonising the response at the lowest dose and intensifying it at the highest dose. In addition, low doses of this agent reduced anxiety in the EPM. Although bilateral injections of 8-OH-DPAT (5.6 nmol/0.4 mu l) or NAN-190 (5.6 nmol and 10 nmol/0.4 mu l) into the amygdala did not alter OAIA, increased anxiety was observed in the EPM. In contrast, intra-amygdala administration of midazolam (10 nmol and 30 nmol/0.4 mu l) blocked both OAIA and anxiety. Conclusions: These results with systemic and intracerebral drug infusion suggest that 5-HT(1A) receptors localised in the amygdala are not involved in the pain inhibitory processes that are recruited during aversive situations. However, activation of these receptors does phasically increase anxiety. Although the intrinsic antinociceptive properties of systemically administered midazolam confounded interpretation of its effects on OAIA, intra-amygdala injections of this compound suggest that benzodiazepine receptors in this brain region modulate both the antinociceptive and behavioural (anxiety) responses to the EPM.

Physical environment modulates the behavioral responses induced by chemical stimulation of dorsal periaqueductal gray in mice

In order to investigate the relationship between behaviors elicited by chemical stimulation of the dorsal periaqueductal gray (dorsal PAG) and spontaneous defensive behaviors to a predator, the excitatory amino acid D,L-homocysteic acid (5 nmol in 0.1 mu l), was infused into the dorsal PAG and behavioral responses of mice were evaluated in two different situations, a rectangular novel chamber or the Mouse Defense Test Battery (MDTB) apparatus. During a 1-min period following drug infusion, more jumps were made in the chamber than in the MDTB runway but running time and distance traveled were significantly higher in the runway. Animals were subsequently tested using the standard MDTB procedure (anti-predator avoidance, chase and defensive threat/attack). No drug effects on these measures were significant. In a further test in the MDTB apparatus, the pathway of the mouse during peak locomotion response was blocked 3 times by the predator stimulus (anesthetized rat) to determine if the mouse would avoid contact. Ninety percent of D,L-homocysteic treated animals made direct contact with the stimulus (rat), indicating that D,L-homocysteic-induced running is not guided by relevant (here, threat) stimuli. These results indicate that running as opposed to jumping is the primary response in mice injected with D,L-homocysteic into the dorsal PAG when the environment enables flight. However, the lack of responsivity to the predator during peak locomotion suggests that D,L-homocysteic-stimulation into the dorsal PAG does not induce normal antipredator flight. (c) 2006 Published by Elsevier B.V.

Sidestream cigarette smoke effects on cardiovascular responses in conscious rats: involvement of oxidative stress in the fourth cerebral ventricle

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effects of the administration of a catalase inhibitor into the fourth cerebral ventricle on cardiovascular responses in spontaneously hypertensive rats exposed to sidestream cigarette smoke

OBJECTIVE: ,,,,,Previous studies have demonstrated a relationship between brain oxidative stress and cardiovascular regulation. We evaluated the effects of central catalase inhibition on cardiovascular responses in spontaneously hypertensive rats exposed to sidestream cigarette smoke. ,,,, ,,,, ,,,,,METHODS: ,,,,,Male Wistar Kyoto (WKY) rats and spontaneously hypertensive rats (SH) (16 weeks old) were implanted with a stainless steel guide cannula leading into the fourth cerebral ventricle (4th V). The femoral artery and vein were cannulated for arterial pressure and heart rate measurement and drug infusion, respectively. The rats were exposed to sidestream cigarette smoke for 180 minutes/day, 5 days/week for 3 weeks (CO: 100-300 ppm). The baroreflex was tested using a pressor dose of phenylephrine (8 μg/kg, bolus) and a depressor dose of sodium nitroprusside (50 μg/kg, bolus). Cardiovascular responses were evaluated before and 5, 15, 30 and 60 minutes after injection of a catalase inhibitor (3-amino-1,2,4-triazole, 0.001 g/100 μL) into the 4th V. ,,,, ,,,, ,,,,,RESULTS: ,,,,,Vehicle administration into the 4th V did not affect the cardiovascular response, whereas administration of the central catalase inhibitor increased the basal HR and attenuated the bradycardic peak (p<0.05) to a greater extent in WKY rats exposed to sidestream cigarette smoke than in WKY rats exposed to fresh air. However, in spontaneously hypertensive rats, the effect of the catalase inhibitor treatment was stronger in the fresh air condition (p<0.05). ,,,, ,,,, ,,,,,CONCLUSION: ,,,,,Administration of a catalase inhibitor into the 4th V combined with exposure to sidestream cigarette smoke has a stronger effect in WKY rats than in SH rats.

Uso de dexmedetomidina em anestesiologia

JUSTIFICATIVA E OBJETIVOS: A dexmedetomidina é um novo agonista alfa2-adrenérgico que apresenta relação de seletividade entre os receptores alfa2:alfa1 de 1600:1, com importante ação sedativa e analgésica, bom controle hemodinâmico frente ao estresse e que pode produzir, por si só, anestesia. Este agente tem sido empregado para promover analgesia e sedação no período pós-operatório e nas unidades de tratamento intensivo. Devido à suas propriedades, recentemente, a dexmedetomidina passou a ser utilizada também na sala de operações, como fármaco coadjuvante em anestesia. Assim, este artigo faz uma revisão da literatura com relação ao uso da dexmedetomidina na prática anestésica. CONTEÚDO: São apresentados os principais trabalhos com o emprego da dexmedetomidina em Anestesiologia, seja como medicação pré-anestésica, ou durante o ato anestésico-cirúrgico. O mecanismo de ação dos fármacos alfa2-agonistas e as propriedades farmacocinéticas e farmacodinâmicas da dexmedetomidina também são revistos neste artigo. CONCLUSÕES: O uso da dexmedetomidina como medicação pré-anestésica, durante anestesia, ou no período pós-operatório, promove boa estabilidade hemodinâmica. Há redução do consumo de anestésicos durante a anestesia. Os pacientes sedados com a dexmedetomidina podem ser despertados, quando solicitados, e tornarem-se cooperativos. Mesmo doses elevadas do fármaco não provocam depressão respiratória. Bradicardia é um efeito adverso observado com freqüência, problema amenizado pela administração lenta da droga. Assim, a dexmedetomidina torna-se importante recurso adicional para a prática clínica da Anestesiologia, com possibilidade de uso em diversos tipos de pacientes e procedimentos cirúrgicos.

Assessment of inotropic and vasodilating effects of milrinone lactate in patients with dilated cardiomyopathy and severe heart failure

OBJECTIVE: To assess the hemodynamic and vasodilating effects of milrinone lactate (ML) in patients with dilated cardiomyopathy (DCM) and New York Heart Association (NYHA) class III and IV heart failure. METHODS: Twenty patients with DCM and NYHA class III and IV heart failure were studied. The hemodynamic and vasodilating effects of ML, administered intravenously, were evaluated. The following variables were compared before and during drug infusion: cardiac output (CO) and cardiac index (CI); pulmonary capillary wedge pressure (PCWP); mean aortic pressure (MAP); mean pulmonary artery pressure (MPAP); mean right atrial pressure (MRAP); left ventricular systolic and end-diastolic pressures (LVSP and LVEDP, respectively); peak rate of left ventricular pressure rise (dP/dt); systemic vascular resistance (SVR); pulmonary vascular resistance (PVR); and heart rate (HR). RESULTS: All patients showed a significant improvement of the analysed parameters of cardiac performance with an increase of CO and CI; a significant improvement in myocardial contractility (dP/dt) and reduction of the LVEDP; PCWP; PAP; MAP; MRAP; SVR; PVR. Were observed no significant increase in HR occurred. CONCLUSION: Milrinone lactate is an inotropic dilating drug that, when administered intravenously, has beneficial effects on cardiac performance and myocardial contractility. It also promotes reduction of SVR and PVR in patients with DCM and NYHA class III and IV of heart failure.

Constituintes de Sorocea bomplandii Baillon

The chemical investigation of the leaves of Sorocea bomplandii Baillon (Moraceae) led to the identification of pentacyclic triterpenes, fatty acid ester and isoprenoids. Chromatographyc comparison between the infusion S. bomplandii with that of Maytenus aquifolium - a Celastraceae with proved antiulcer activity - has shown that they have different compositions: the first one is based on sugars and the last one is based on flavonoid glycosides.

Análise das vantagens de duas técnicas anestésicas - Venosa e inalatória - Para colecistectomia por videolaparoscopia

Background and Objectives - It is essential to reduce health care costs without impairing the quality of care. Propofol is associated to faster recovery and it is known that post-anesthesia care unit (PACU) costs are high. The aim of this study was to evaluate the advantages of two anesthesia regimens - propofol continuous infusion or isoflurane - taking into account the cost of both techniques on PACU stay. Methods - Forty seven patients, physical status ASA I, II and III, undergoing laparoscopic cholecystectomy were divided into 2 groups according to the anesthetic agent: G1, conventional propofol continuous infusion (100-150 μg.kg-1.min-1) and G2, isoflurane. All patients were induced with sufentanil (1 μg.kg-1) and propofol (2 mg.kg-1) and were kept in a re-inhalation circuit (2 L.min-1 of fresh gas flow) with 50% N2O in O2, sufentanil (0.01 μg.kg-1.min-1) and atracurium (0.5 mg.kg-1), or pancuronium (0.1 mg.kg-1) for asthma patients. All patients received atropine and neostigmine at the end of the surgery. Prophylactic ondansetron, dipyrone and tenoxican were administered and, when necessary, tramadol and N-butylscopolamine. Costs of anesthetic drugs (COST), total PACU stay (t-PACU), and PACU stay after extubation (t-EXT) were computed for both groups. Results - Costs were significantly lower in the isoflurane group but t-PACU was 26 minutes longer and t-EXT G1drug costs as compared to propofol. However, isoflurane group patients stayed longer in PACU as compared to propofol continuous infusion group.

Mecanismos envolvidos na cardiotoxidade aguda induzida pela doxorrubicina em ratos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Cardiovascular Responses Induced by Catalase Inhibitior into the Fourth Cerebral Ventricle is Changed in Wistar Rats Exposed to Sidestream Cigarette Smoke

Objectives: This experimental study aimed to evaluate the effects of central catalase inhibition on cardiovascular responses in rats exposed to sidestream cigarette smoke (SSCS) for 3 weeks. Methodology: A total of 20 males Wistar rats (320–370g) were implanted with a stainless steel guide cannula into the fourth cerebral ventricle (4thV). Femoral artery and vein were cannulated for mean arterial pressure (MAP) and heart rate (HR) measurement and drug infusion, respectively. Rats were exposed to SSCS for three weeks, 180 minutes per day, 5 days/week [carbon monoxide (CO): 100–300 ppm)]. Baroreflex was tested with one pressor dose of phenylephrine (PHE, 8 μg/kg, bolus) and one depressor dose of sodium nitroprusside (SNP, 50 μg/kg, bolus). Cardiovascular responses were evaluated before and 15 minutes after 3-amino-1, 2, 4-triazole (ATZ, catalase inhibitor, 0.001g/100μL) injection into the 4th V. Results: Vehicle treatment into the 4th V did not change cardiovascular responses. Central catalase inhibition increased tachycardic peak, attenuated bradycardic peak and reduced HR range at 15 minutes, increased MAP at 5, 15 and 30 min and increased HR at 5 and 15 min. In rats exposed to SSCS, central ATZ increased basal MAP after 5 min and increased HR at 5, 15 and 30 minutes, respectively, and attenuated bradycardic peak at 15 minutes. Conclusion: This study suggests that brain oxidative stress caused by SSCS influences autonomic regulation of the cardiovascular system.