piperidines and Cerebellar-Diseases

Remifentanil hydrochloride is an ultra-short-acting esterase metabolized mu-opioid receptor agonist. The purpose of this study was to provide preliminary information regarding the effects of this drug on intracranial pressure (ICP) and mean arterial pressure (MAP) in patients scheduled for craniotomy. Twenty-six patients undergoing excision of supratentorial space-occupying lesions were anesthetized with 0.3-0.8 vol% isoflurane in a 2:1 mixture of nitrous oxide:oxygen. Ventilation was adjusted to provide a Paco2 of < 30 mm Hg. After the first burr hole was drilled, patients (n = 5-6 per group) were administered an intravenous infusion of study drug (placebo, remifentanil 0.5 micrograms/kg or 1.0 micrograms/kg, or alfentanil 10 micrograms/kg or 20 micrograms/kg) over 1 min. Epidural ICP and MAP values were recorded at baseline, at completion of infusion, and every minute for the next 10 min. Blood study drug concentrations were measured immediately after completion of infusion. Neither opioid caused a significant increase in ICP. Both drugs were associated with a dose-dependent decrease in MAP. Remifentanil was 31 times more potent than alfentanil for effects on MAP. We conclude that remifentanil produces similar cerebral perfusion pressure effects as does alfentanil.

Topics: Adult; Alfentanil; Analgesics, Opioid; Anesthesia, Inhalation; Blood Pressure; Cerebellar Diseases; Craniotomy; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Infusions, Intravenous; Intracranial Pressure; Male; Middle Aged; Piperidines; Placebos; Receptors, Opioid; Remifentanil

Topics: Aged; Brain Infarction; Cerebellar Diseases; Cholinesterase Inhibitors; Cilostazol; Donepezil; Female; Fluorodeoxyglucose F18; Humans; Indans; Magnetic Resonance Angiography; Neurologic Examination; Neuroprotective Agents; Piperidines; Stereotyped Behavior; Tetrazoles; Tomography, Emission-Computed, Single-Photon

Topics: Abnormalities, Multiple; Adolescent; Anesthesia, Intravenous; Anesthetics, Intravenous; Cerebellar Diseases; Cerebellum; Eye Abnormalities; Female; Humans; Intellectual Disability; Kidney Diseases, Cystic; Oral Surgical Procedures; Piperidines; Propofol; Remifentanil; Retina

The purpose of these studies was to characterize the effects of agonists of the CB(1) cannabinoid receptor on cerebellar function in mice. We used two measures specific for cerebellar function: gait analysis and the bar cross test. CB(1) receptor agonists CP55940, Win 55212-2, Delta(9)-tetrahydrocannabinol, arachidonylethanolamide (AEA), and two AEA analogs with high affinity for the CB(1) receptor (arachidonyl-2-chloroethylamide and arachidonylcyclopropylamide) all produced increases in gait width, a measure of truncal ataxia. All of the CB(1) agonists tested significantly increased the number of slips on the bar cross test, which is consistent with motor incoordination. Pretreatment with the CB(1) receptor antagonist SR141716 attenuated both the change in gait width and number of slips induced by CP55940 and AEA. Neither cannabidiol nor Win 55212-3 affected these measures, further evidence that this effect is mediated by the CB(1) receptor. Pretreatment with the dopamine receptor agonists apomorphine or bromocriptine did not attenuate the diminished performance on the bar cross or the gait abnormality induced by CP55940. These data indicate that the assays used in this study are specific for cerebellar-mediated behavioral deficits, and that these deficits are not mediated by the basal ganglia or cannabinoid-induced alterations in nigrostriatal dopaminergic transmission. Other well known effects of cannabinoids in mice, such as hyperreflexia exemplified by jumping or "popcorn" behavior and postural hypotonia are discussed in relationship to cerebellar dysfunction and a working model of the effects of CB(1) receptor activation on cerebellar circuitry is presented.

Topics: Animals; Behavior, Animal; Benzoxazines; Calcium Channel Blockers; Cannabinoids; Cerebellar Diseases; Cyclohexanols; Dopamine Agonists; Gait; Male; Mice; Mice, Inbred ICR; Morpholines; Naphthalenes; Piperidines; Pyrazoles; Receptors, Cannabinoid; Receptors, Drug; Rimonabant

Ten new cases of perhexiline induced peripheral neuropathies are reported. The authors emphasize the possible association of other neurological disorders: cerebellar symptoms in one case, complex tremor in two other cases, marked decrease of photomotor reflexes in one case and disgeusia in another one. The pharmacocinetic study of 4 cases revealed the presence of a low metabolism of the drug in one of them. Polymorphous inclusions have been seen in Schwann cell and endothelial cell cytoplasm in the three patients with electron microscopic study of the nerves. The pathological study of one case showed the demyelination of spinal cord posterior columns. In another case, who died from hepatic coma, the biochemical study of cerebral lipids revealed the low values of cerebrosides and sulfatides in cerebellum and cerebral white matter.

Topics: Cerebellar Diseases; Coronary Disease; Demyelinating Diseases; Endothelium; Humans; Inclusion Bodies; Perhexiline; Peripheral Nerves; Peripheral Nervous System Diseases; Piperidines; Schwann Cells; Spinal Cord Diseases