piperidines and Airway-Obstruction

Topics: Airway Obstruction; Animals; Asthma; Benzodiazepinones; Bronchi; Gallamine Triethiodide; Humans; Muscarinic Antagonists; Muscle, Smooth; Piperidines; Trachea

To compare the safety and efficacy of dexmedetomidine/propofol (DP)-total i.v. anaesthesia (TIVA) vs remifentanil/propofol (RP)-TIVA, both with spontaneous breathing, during airway foreign body (FB) removal in children.. Seventy-seven children undergoing rigid bronchoscopy for FB removal were randomly allocated to receive either RP-TIVA and spontaneous ventilation (Group RP, n=38) or DP-TIVA and spontaneous ventilation (Group DP, n=39). Heart rate, arterial pressure, pulse oxygen saturation (Sp(O2)), respiratory rate, end-tidal CO2 (E'(CO2)), and induction time were recorded. Adverse events, the intervention for these events, and postoperative care duration were also assessed.. The mean induction times were comparable between the two groups (Group RP 12.2 min vs Group DP 13.1 min, P>0.05). At the end of the procedure, the mean (E'(CO2)) was higher in Group RP (Group RP 6.8 kPa vs Group DP 5.8 kPa, P<0.001), and respiratory rate was lower in Group RP (Group RP 20.4 vs Group DP 35.8, P<0.001). Additionally, the perioperative haemodynamic profile was more stable in Group DP than that in Group RP. The incidence rate of breath-holding and intervention were comparable between the two groups. In the post-anaesthesia care unit (PACU), no hypoxaemia was observed, and emergence time increased in Group DP (Group DP 65.1 min vs Group RP 23.8 min, P<0.0001). The incidence of cough in PACU was higher in Group RP (Group RP 55.3% vs Group DP 10.3%, P<0.0001).. Compared with RP-TIVA, DP-TIVA provided more stable respiratory and haemodynamic profiles, but required a longer recovery time. Clinical trial registration China Clinical Research Information Service, ChiCTR-TRC-13003018.

Topics: Airway Obstruction; Anesthesia Recovery Period; Anesthesia, Intravenous; Blood Pressure; Bronchoscopy; Child, Preschool; Dexmedetomidine; Female; Foreign Bodies; Heart Rate; Humans; Hypnotics and Sedatives; Infant; Length of Stay; Male; Piperidines; Remifentanil; Respiration; Respiratory Rate; Tidal Volume; Time Factors; Treatment Outcome

When stimulated, excitatory nonadrenergic noncholinergic (e-NANC) nerves locally release tachykinins like Neurokinin (NK) A and Substance P, causing neurogenic inflammation and airway obstruction via activation of specific NK-1 and NK-2 receptors. The recently developed nonpeptide NK-2 receptor antagonist SR 48968C has a high affinity for the NK-2 receptor, and is a strong and selective antagonist of NK-2 receptor mediated airway obstruction. In a placebo-controlled cross-over study, we investigated the effect of SR 48968C, administrated orally once-daily in a dosage of 100 mg during 9 days, on airway responsiveness to adenosine 5'-monophosphate (AMP) in 12 allergic asthmatic patients. Furthermore, we assessed its effect on airway obstruction, by measuring FEV1 on the first and last day of each treatment period and by peak flow registration at home throughout the study period. SR 48968C had no significant effect on PC20AMP or on FEV1 measured on day 1 and 9, and morning and evening peakflow measured at home on day 2-8. Thus, although SR 48968C was administrated in a dosage that might cause a demonstrable blocking effect on airway NK-2 receptors in asthma, it did not have a significant bronchodilatory or bronchoprotective effect against adenosine hyperresponsiveness in this study. Further studies are needed to assess the value of SR 48968C and other NK receptor antagonists in the treatment of asthma

Topics: Adenosine Monophosphate; Adult; Airway Obstruction; Asthma; Benzamides; Bronchial Hyperreactivity; Bronchial Provocation Tests; Cross-Over Studies; Forced Expiratory Volume; Humans; Male; Middle Aged; Peak Expiratory Flow Rate; Piperidines; Receptors, Neurokinin-2

Topics: Adult; Aerosols; Aged; Airway Obstruction; Airway Resistance; Catechols; Clinical Trials as Topic; Ethanolamines; Female; Fenoterol; Humans; Male; Middle Aged; Piperidines; Placebos; Time Factors

1. The bronchodilator effects of 500 microgram rimiterol by pressurized aerosol, 375 mg oral theophylline and both drugs in combination were compared in a randomized, placebo-controlled, double-blind trial in eight patients with chronic, partially reversible airways obstruction. 2. The four treatments were (i) oral theophylline, placebo aerosol (TP); (ii) oral placebo, rimiterol aerosol (PR); (iii) oral theophylline, rimiterol aerosol (TR) and; (iv) oral placebo, placebo aerosol (PP). The aerosol was administered 2 h after the oral treatment. 3. Significant bronchodilatation (% FEV1 change from control) compared to PP occurred with TP from 60 to 480 min and with TR from 60 to 300 min, whereas with PR only for 45 min (P less than 0.05). 4. The mean, peak % FEV1 increases from control were 51.8% at 125 min, 31.7% at 125 min, 26.1% at 210 min and 0.9% at 30 min for TR, PR, TP and PP respectively. 5. At 125 min (5 min after aerosol inhalation) the mean % FEV1 change from control with TR (51.8%) Was significantly greater than with PR (31.7%), TP (22.2%) (P less than 0.05) and PP (-2.4%) (P less than 0.01). 6. The mean, peak plasma theophylline levels were 10.19 microgram/ml at 120 min and 9.98 microgram/ml at 180 min with TR and TP respectively. Theophylline half-life ranged between 4.3 and 12.5 h (mean +/- s.e. mean, 8.0 +/- 0.8 h). 7. Additive bronchodilatation was produced when rimiterol was administered with theophylline at a time when therapeutic plasma theophylline levels were achieved.

Topics: Administration, Oral; Adult; Aerosols; Aged; Airway Obstruction; Bronchodilator Agents; Catechols; Chronic Disease; Clinical Trials as Topic; Double-Blind Method; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Piperidines; Theophylline

Topics: Adult; Aerosols; Aged; Airway Obstruction; Albuterol; Bronchodilator Agents; Catechols; Forced Expiratory Volume; Heart Rate; Humans; Middle Aged; Piperidines; Placebos; Receptors, Adrenergic; Receptors, Adrenergic, beta

A comparison between the acute effects of rimiterol (0.5 mg) and salbutamol (0.2 mg.) has been made using metered dose aerosols. In this dosage it was found that the peak effect of the two drugs was the same but that the effect of rimiterol was less prolonged than that of sulbutamol. No increase in blood pressure occurred and heart rate changes were minimal after both drugs. Rimiterol is an acceptable alternative to the short-acting isoprenaline but lacks the cardiovascular effects of isoprenaline and is an alternative to salbutamol where very prolonged action is unnecessary.

Topics: Adult; Aerosols; Airway Obstruction; Albuterol; Asthma; Blood Pressure; Bronchi; Bronchitis; Bronchodilator Agents; Cardiovascular System; Catechols; Dose-Response Relationship, Drug; Female; Heart Rate; Humans; Isoproterenol; Male; Methanol; Middle Aged; Piperidines; Respiratory Function Tests; Respiratory Therapy

Anesthetic management with airway stenosis is challenging. Techniques for maintaining spontaneous respiration are required under sedative and analgesic conditions.. A 35-year-old Chinese woman presented to our hospital with difficulty breathing. Computerized tomography showed a tumor in the frontal area of her neck, which was causing extreme narrowing of her trachea. She was immediately scheduled for emergency surgery to remove the tumor. Fiberscopic intubation was carefully performed with dexmedetomidine sedation and remifentanil analgesia. Spontaneous respiration was successfully maintained.. In cases of extreme airway stenosis, intubation can be safely achieved with dexmedetomidine sedation and remifentanil analgesia.

Topics: Adult; Airway Obstruction; Constriction, Pathologic; Dexmedetomidine; Female; Head and Neck Neoplasms; Humans; Hypnotics and Sedatives; Intubation, Intratracheal; Piperidines; Remifentanil; Tomography, X-Ray Computed

Crouzon syndrome is a rare, autosomal dominant disease from a fibroblast growth factor receptor 2 gene mutation, characterized by premature craniosynostosis, hypertelorism, orbital proptosis, psittichorina, hypoplastic maxilla, and mandibular prognathism. We present an adult 32-year-old Crouzon syndrome patient who underwent an elective High Le Fort I and bilateral split sagittal osteotomy for midface advancement with a background of jaw malocclusion and obstructive respiratory symptoms. The operation features a potential dynamic movement of the secured airway in the surgical field and close proximity to exposed ocular structures. Permissive hypotensive anesthesia was employed to improve the surgical field and reduce intraoperative blood loss and dose of long-acting opioids. He was extubated at the end of an uneventful surgery and was monitored in the high dependency overnight before he was discharged to the general ward. Perioperative issues include potential difficult airway management; ocular, auditory, and neurological injury prevention; surgery-specific anesthetic technique; and postoperative analgesia. Understanding the multisystemic issues facilitates the dynamic anesthetic management during surgery. Good communication among the multidisciplinary team is essential to ensure a successful operation and uneventful recovery.

Topics: Adult; Airway Management; Airway Obstruction; Analgesia, Patient-Controlled; Anesthetics, Intravenous; Atracurium; Blood Loss, Surgical; Craniofacial Dysostosis; Humans; Hypotension, Controlled; Intubation, Intratracheal; Male; Malocclusion; Morphine; Narcotics; Neuromuscular Nondepolarizing Agents; Orthognathic Surgical Procedures; Osteotomy, Le Fort; Osteotomy, Sagittal Split Ramus; Piperidines; Prognathism; Remifentanil

Topics: Airway Obstruction; Analgesics, Opioid; Anesthetics, Intravenous; Humans; Models, Biological; Piperidines; Propofol; Remifentanil; Respiratory Mechanics; Sleep Apnea, Obstructive

Topics: Abnormalities, Multiple; Airway Management; Airway Obstruction; Anesthesia, Inhalation; Bone Diseases, Developmental; Catheters, Indwelling; Child; Contraindications; Craniofacial Abnormalities; Female; Humans; Laryngeal Masks; Methyl Ethers; Neuromuscular Blocking Agents; Piperidines; Radiology Department, Hospital; Radiology, Interventional; Remifentanil; Septo-Optic Dysplasia; Sevoflurane; Subclavian Vein

Topics: Airway Obstruction; Dexmedetomidine; Female; Humans; Hypnotics and Sedatives; Intubation, Intratracheal; Laryngoscopy; Piperidines; Propofol; Remifentanil; Takotsubo Cardiomyopathy

Topics: Airway Obstruction; Anesthetics, Intravenous; Bradycardia; Cardiotonic Agents; Cholangiopancreatography, Endoscopic Retrograde; Choledocholithiasis; Decerebrate State; Flumazenil; GABA Agonists; Humans; Hypnotics and Sedatives; Hypoxia; Intraoperative Complications; Intubation, Intratracheal; Male; Midazolam; Middle Aged; Naloxone; Piperidines; Propofol; Remifentanil; Sleep Apnea, Obstructive

Topics: Adolescent; Airway Obstruction; Anesthetics, Intravenous; Child, Preschool; Conscious Sedation; Female; Humans; Intubation, Intratracheal; Male; Piperidines; Remifentanil

Topics: Airway Obstruction; Anesthetics, Inhalation; Anesthetics, Intravenous; Failure to Thrive; Fiber Optic Technology; Glaucoma; Humans; Infant; Intellectual Disability; Intubation, Intratracheal; Laryngeal Masks; Male; Maxillofacial Abnormalities; Methyl Ethers; Monitoring, Physiologic; Piperidines; Rare Diseases; Remifentanil; Sevoflurane; Syndrome

For a predicted difficult airway, oral intubation techniques are well established in pediatric anesthesia, but nasotracheal intubation remains a problem. There are many reports concerning this, but the risk of bleeding, added to the lack of cooperation make this procedure difficult and hazardous. We describe a modification of the nasal intubation technique in two stages. First an oral intubation and then exchanging the oral for a nasal tube, in the case of a 13-year-old boy affected by an advanced stage of cherubism. Oral intubation using a laryngeal mask technique has already been reported, but problems appear during the exchange procedure and even more when direct laryngoscopy is impossible. Fiberscopic control of the exchange, and the introduction of a Cook Exchange Catheter into the trachea through the oral tube before withdrawal, permits oxygenation of the patient and acts as a guide for oral tube reintroduction if required.

Topics: Adjuvants, Anesthesia; Adolescent; Airway Obstruction; Anesthetics, Intravenous; Atropine; Cherubism; Fiber Optic Technology; Humans; Intubation; Jaw Abnormalities; Laryngeal Masks; Magnetic Resonance Imaging; Male; Mouth; Nasal Cavity; Orthognathic Surgical Procedures; Piperidines; Propofol; Remifentanil; Tomography, X-Ray Computed

Topics: Adult; Airway Obstruction; Analgesia, Obstetrical; Anesthesia, Epidural; Anesthesia, Intravenous; Anesthesia, Obstetrical; Anesthetics, Intravenous; Delivery, Obstetric; Female; Fetal Diseases; Fetoscopy; Fetus; Gestational Age; Humans; Hysterotomy; Pain; Perception; Piperidines; Postoperative Complications; Pregnancy; Remifentanil

Cannabinoids have been shown to inhibit sensory nerve activation in guinea-pigs and humans. Their effects are mediated by specific activation of two types of receptors, named CB(1) and CB(2). The purpose of this study was to investigate the effects of WIN 55,212-2, (R)-(+)-[2,3-dihydro-5methyl-3-[(4-morpholino)methyl]pyrrolo-[1,2,3-de]-1,4-benzoxazin-6-yl](1-naphthyl)methanone, a non selective agonist of cannabinoid receptors, and JWH 133, (6aR,10aR)-3-(1,1-dimethylbutyl)-6a,7,10,10a-tetrahydro-6,6,9-trimethyl-6H-dibenzo[b,d]pyran a selective cannabinoid CB(2) receptor agonist, on the sensory nerve component of intraoesophageal (i.oe.) HCl-induced airway microvascular leakage and bronchoconstriction in guinea-pigs. We also tested the effect of WIN 55,212-2 on substance P-induced plasma extravasation and bronchoconstriction. Airway microvascular leakage and bronchoconstriction induced by i.oe. HCl was inhibited by the cannabinoid CB(1)/CB(2) agonist WIN 55,212-2 (0.3-3 mg/kg i.p.) in a dose-dependent manner (maximal inhibition at the dose of 3 mg kg(-1), P<0.01). The effect of WIN 55,212-2 was inhibited by a cannabinoid CB(2) receptor antagonist SR 144528, [N-[(1S)-endo-1,3,3-trimethylbicyclo[2,2,1] heptan-2yl]-5-(-4-chloro-3-methylphenyl)-1-(4-methylbenzyl)pyrazole-3-carboxamide], but not by a CB(1) receptor antagonist, SR 141716, [N-(piperidin-1yl)-5-(-4-chlorophenyl)-1-(2,4dichlorophenyl)-4-methyl-1H-pyrazole-3-carboxamide hydrochloride]. The cannabinoid CB(2) agonist JWH 133 (0.3-3 mg/kg i.p.) mimicked the inhibitory effect of WIN 55,212-2 on HCl-induced microvascular leakage. Under similar conditions, WIN 55,212-2 (1 mg kg (-1) i.p.) was unable to counteract the airway microvascular leakage and bronchoconstriction induced by substance P. These results suggest that inhibition by WIN 55,212-2 of airway plasma extravasation and bronchoconstriction induced by i.oe. HCl instillation in guinea-pigs is mediated through cannabinoid CB(2) receptor activation.

Topics: Airway Obstruction; Animals; Benzoxazines; Bronchi; Bronchoconstriction; Camphanes; Cannabinoids; Capillary Permeability; Disease Models, Animal; Dose-Response Relationship, Drug; Esophagus; Extravasation of Diagnostic and Therapeutic Materials; Gastroesophageal Reflux; Guinea Pigs; Hydrochloric Acid; Male; Morpholines; Naphthalenes; Piperidines; Pulmonary Edema; Pyrazoles; Receptor, Cannabinoid, CB1; Receptor, Cannabinoid, CB2; Respiratory Function Tests; Rimonabant; Trachea

The effects of an orally administered novel and selective NK1 antagonist, NKP608, on cough and airway obstruction, induced by citric acid in guinea pigs, were investigated. Guinea pigs were pre-treated with 0.03, 0.3 and 1 mg kg(-1) of NKP608, the NK2 antagonist, SR48968 or both 2 h prior to challenge with citric acid (0.6 M) for a 10 min period. Guinea pigs pre-treated with 0.03, 0.3 and 1mgkg(-1) of NKP608 exhibited a significant reduction of 77, 74 and 79%, respectively, in the numbers of cough compared to vehicle pre-treated animals (P<0.05). SR48968, 10 mg kg(-1), alone did not significantly affect the citric acid-induced cough but when co-administered with 1 mg kg(-1) of NKP608, there was a significant 90% reduction in cough. NKP608 did not significantly reduce the citric acid-induced increase in Penh at any of the doses used. SR48968 significantly reduced the citric acid induced airway obstruction by about 50%. However, when SR48968 was co-administered with NKP608, there was a greater (73%) decrease in the airway obstruction compared with SR48968 alone. These data show that NKP608, a selective NK1 receptor antagonist, is a potent inhibitor of citric acid induced cough in guinea pigs and may therefore have value in the therapy of clinical cough.

Topics: Airway Obstruction; Animals; Benzamides; Citric Acid; Cough; Guinea Pigs; Male; Neurokinin-1 Receptor Antagonists; Piperidines; Plethysmography; Quinolines

Remifentanil is an ultra-short-acting opioid that is frequently used in adults for surgical anesthesia or conscious sedation, but its use in children is much less common. We report the case of a 7-year-old boy with lateral cervical tumors displacing all cervical and facial structures. An emergency tracheostomy was performed when he developed respiratory difficulty due to partial airway obstruction. Because of the size and location of the intraoral tumors and a history of bleeding, orotracheal intubation and other airway management techniques were ruled out. The tracheostomy was performed under local anesthesia and sedation with a perfusion of 0.05 x microgKg(-1) x min(-1) provided the necessary relaxation and immobility for surgery. Sedation under observation with monitoring is among the indications of remifentanil. Spontaneous breathing is maintained with infusions less than 0.05 to 0.1 microg x Kg(-1) x min(-1). In the case we report, the patient's risk of complete airway obstruction due to bleeding upon manipulation had to be assessed and compared with the respiratory depression that might possibly have been caused by remifentanil perfusion. We judged that the option of sedation would cause less morbidity and offered greater safety for the patient. The outcome of this case is consistent with reports that remifentanil is a good option for adequately sedating children who are breathing spontaneously.

Topics: Airway Obstruction; Child; Conscious Sedation; Head and Neck Neoplasms; Humans; Hypnotics and Sedatives; Male; Piperidines; Remifentanil; Risk Factors; Tracheostomy

Mast cell activation, bronchoconstriction, inflammation and airway hyperreactivity are prominent features of non-atopic hypersensitivity reactions in mouse airways. We studied the role of tachykinin receptors in mice that were skin-sensitized with dinitrofluorobenzene (or vehicle) and challenged intranasally with dinitrobenzene sulfonic acid. Tachykinin NK1 receptor blockade, by treatment with the antagonist RP67580, or absence of the tachykinin NK1 receptor resulted in a strong reduction in the accumulation of neutrophils in the bronchoalveolar lavage fluid, and in the development of tracheal hyperreactivity in mice 48 h after challenge. In contrast, treatment with the tachykinin NK2 receptor antagonist SR48968 did not affect the dinitrofluorobenzene-induced hypersensitivity reaction. We have previously shown that mast cells play a crucial role in the development of non-atopic asthma. However, we did not observe an inhibitory effect of the tachykinin receptor antagonists or the genetic absence of tachykinin NK1 receptors on mast cell protease release. In conclusion, distal from mast cell activation, the tachykinin NK1 receptor is crucial for the infiltration of pulmonary neutrophils and the development of tracheal hyperreactivity in non-atopic asthma.

Topics: Administration, Intranasal; Airway Obstruction; Animals; Benzamides; Dinitrofluorobenzene; Hypersensitivity; In Vitro Techniques; Indoles; Inflammation; Isoindoles; Leukocytes; Male; Mast Cells; Mice; Mice, Inbred BALB C; Mice, Knockout; Neurokinin-1 Receptor Antagonists; Piperidines; Receptors, Neurokinin-1; Receptors, Neurokinin-2; Trachea

Impending upper airway obstruction due to odontogenic facial and cervical spreading infection is a potential fatal situation that requires urgent treatment. In particular, securing the threatened airway is a priority and a precondition to the pressing need for surgery. The best approach to establish the difficult airway is awake fiberoptic intubation or scheduled tracheotomy under local anesthesia. We report a critical case of severe swelling of the neck in a morbidly obese patient with no alternative to awake fiberoptic intubation. The primary goals of optimal safety for the patient and appropriate intubating conditions for the anesthesiologist made us to consider a new method of patient medication.

Topics: Airway Obstruction; Analgesics, Opioid; Fiber Optic Technology; Hemodynamics; Humans; Inflammation; Intubation, Intratracheal; Male; Middle Aged; Neck; Obesity, Morbid; Piperidines; Remifentanil; Respiratory Mechanics; Tomography, X-Ray Computed

In order to investigate whether treatment with terbutaline (1 mg subcutaneously) in patients with bronchial obstruction is accompanied by changes in the densities of receptors of the autonomic nervous system, beta-adrenergic receptors or m-cholinergic receptors were measured in membrance preparations of human peripheral lung tissue from patients undergoing lung resection for bronchial carcinoma. The density of beta-adrenergic receptors and mononuclear leukocytes (MNLs) of treated and untreated patients and beta-adrenergic receptors and m-cholinergic receptors in lung strips from the same patients exposed to terbutaline in vitro were studied for comparison. In patients, treatment with terbutaline did not have any effect on human lung beta-adrenergic receptors and m-cholinergic receptors, whereas a 57 percent decline was measured in the number of beta-receptors on MNLs of the very same patients. In contrast, in vitro exposure of human peripheral lung strips to terbutaline (100 mumol/L for 36 hours) evoked a time-dependent and concentration-dependent decline of 46 percent in beta-adrenergic receptors. Again, there was no change in the number of m-cholinergic receptors. The antagonist affinities, as judged from the KD values, did not differ under either condition. We concluded that lung beta-adrenergic receptors are subject to down-regulation when exposed to agonists in vitro. This down-regulation in the human lung is not accompanied by alterations in m-cholinergic receptors. Down-regulation of beta-adrenergic receptors or up-regulation of m-cholinergic receptors appears not to play a role in the proposed tolerance to beta-adrenergic receptor agonist treatment in clinical situations. The reduction of beta-adrenergic receptors in MNLs provides evidence that treatment with terbutaline was sufficient to affect beta-adrenergic receptors in vivo in certain cell types but also shows that alterations in blood cells do not necessarily reflect the situation in the lung.

Topics: Aged; Aged, 80 and over; Airway Obstruction; Dose-Response Relationship, Drug; Down-Regulation; Electrophoresis, Polyacrylamide Gel; Humans; In Vitro Techniques; Leukocytes, Mononuclear; Lung; Middle Aged; Parasympatholytics; Piperidines; Pirenzepine; Receptors, Adrenergic, beta; Receptors, Cholinergic; Terbutaline

Topics: Adrenergic beta-Agonists; Adult; Aerosols; Airway Obstruction; Airway Resistance; Blood Pressure; Bronchodilator Agents; Catechols; Humans; Isoproterenol; Male; Methanol; Piperidines; Plethysmography, Whole Body; Pulse; Respiratory Function Tests; Spirometry; Time Factors; Vital Capacity

Topics: Airway Obstruction; Animals; Asthma; Behavior, Animal; Humans; Parasympatholytics; Piperidines; Social Behavior