piperidines and Heart-Valve-Diseases

Serotonin (5-hydroxytryptamine, or 5-HT) receptors mediate a plethora of physiological phenomena in the brain and the periphery. Additionally, serotonergic dysfunction has been implicated in nearly every neuropsychiatric disorder. The effects of serotonin are mediated by fourteen GPCRs. Both the therapeutic actions and side effects of commonly prescribed drugs are frequently due to nonspecific actions on various 5-HT receptor subtypes. For more than 20 years, the search for clinically efficacious drugs that selectively target 5-HT receptor subtypes has been only occasionally successful. This review provides an overview of 5-HT receptor pharmacology and discusses two recent 5-HT receptor subtype-selective drugs, lorcaserin and pimavanserin, which target the 5HT2C and 5HT2A receptors and provide new treatments for obesity and Parkinson's disease psychosis, respectively.

Topics: Benzazepines; Diabetes Mellitus, Type 2; Heart Valve Diseases; Humans; Molecular Structure; Obesity; Parkinson Disease; Piperidines; Receptors, Serotonin; Schizophrenia; Serotonin; Serotonin 5-HT2 Receptor Agonists; Serotonin 5-HT2 Receptor Antagonists; Urea

To lower the incidence and severity of fetal cardiovascular depression during maternal fetal surgery under general anesthesia.. We hypothesized that supplemental intravenous anesthesia (SIVA) with propofol and remifentanil would lower the need for high-dose inhalational anesthesia and provide adequate maternal depth of anesthesia and uterine relaxation. SIVA technique would minimize prolonged fetal exposure to deep inhalational anesthetics and significant intraoperative fetal cardiovascular depression.. Fetal hypoxia and significant fetal hemodynamic changes occur during open fetal surgery because of the challenges such as surgical manipulation, hysterotomy, uterine contractions, and effects of anesthetic drugs. Tocolysis, a vital component of fetal surgery, is usually achieved using volatile anesthetic agents. High concentrations of volatile agents required to provide an appropriate degree of uterine relaxation may cause maternal hypotension and placental hypoperfusion, as well as direct fetal cardiovascular depression.. We reviewed medical records of 39 patients who presented for ex utero intrapartum treatment and mid-gestation open fetal surgery between April 2004 and March 2009. Out of 39 patients, three were excluded because of the lack of echocardiographic data; 18 patients received high-concentration desflurane anesthesia and 18 patients had SIVA with desflurane for uterine relaxation. We analyzed the following data: demographics, fetal medical condition, anesthetic drugs, concentration and duration of desflurane, maternal arterial blood pressure, intraoperative fetal echocardiogram, presence of fetal bradycardia, and need for intraoperative fetal resuscitation.. Adequate uterine relaxation was achieved with about 1.5 MAC of desflurane in the SIVA group compared to about 2.5 MAC in the desflurane only anesthesia group (P = 0.0001). More fetuses in the high-dose desflurane group compared to the SIVA group developed moderate-severe left ventricular systolic dysfunction over time intraoperatively (P = 0.02). 61% of fetuses in the high-dose desflurane group received fetal resuscitative interventions compared to 26% of fetuses in the SIVA group (P = 0.0489).. SIVA as described provides adequate maternal anesthesia and uterine relaxation, and it allows for decreased use of desflurane during open fetal surgery. Decreased use of desflurane may better preserve fetal cardiac function.

Topics: Adult; Anesthesia, General; Anesthesia, Intravenous; Anesthetics, Inhalation; Anesthetics, Intravenous; Desflurane; Echocardiography; Female; Fetal Diseases; Fetus; Gestational Age; Heart Diseases; Heart Valve Diseases; Hemodynamics; Humans; Intraoperative Complications; Isoflurane; Monitoring, Intraoperative; Piperidines; Pregnancy; Propofol; Remifentanil; Treatment Outcome; Uterus

Topics: Adult; Analgesics, Opioid; Anesthesia; Anesthetics, Intravenous; Anticonvulsants; Cardiopulmonary Bypass; Diazepam; Etomidate; Female; Fentanyl; Heart Valve Diseases; Heparin; Humans; Midazolam; Morphine; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Pancuronium; Piperidines; Propofol; Remifentanil; Stiff-Person Syndrome

A 36 year old parturient with known valvular heart disease was admitted with respiratory distress and fatigue after 35 weeks of pregnancy. Echocardiography revealed severe tricuspid regurgitation, mitral stenosis and aortic valve insufficiency. Following clinical examination and insertion of a radial and pulmonary artery catheter it was decided to perform a Caesarean Section. The pulmonary artery pressure upon arrival in the operating theatre was 105/50 mm Hg whereas cardiac output was 3.5 l/min. Induction of anesthesia was performed with a target controlled infusion of remifentanil and propofol combined with rocuronium bromide. Haemodynamic variables remained very stable during and after intubation. The lungs of the apnoeic baby were manually ventilated until spontaneous respiration began at 1 minute post delivery. Apgar scores were 3, 7 and 9 after 1, 5 and 10 minutes respectively. Umbilical artery pH was 7.29. The patient's haemodynamic status gradually improved over the following few days. Two months following delivery she underwent unevenful valvular surgery.

Topics: Adult; Anesthesia, Intravenous; Anesthesia, Obstetrical; Anesthetics, Combined; Anesthetics, Intravenous; Cesarean Section; Female; Heart Valve Diseases; Humans; Hypertension, Pulmonary; Infusion Pumps; Piperidines; Pregnancy; Pregnancy Complications, Cardiovascular; Propofol; Remifentanil

Topics: Adrenal Cortex Hormones; Adult; Amides; Body Weight; Clopamide; Coronary Disease; Diabetes Insipidus; Diuretics; Edema; Female; Heart Valve Diseases; Humans; Hypertension; Male; Middle Aged; Obesity; Piperidines; Pulmonary Heart Disease

Topics: Adolescent; Adult; Blood Pressure; Child; Female; Heart Defects, Congenital; Heart Valve Diseases; Humans; Hypertension, Pulmonary; Male; Middle Aged; Oxygen Consumption; Piperidines; Pyrazoles; Vascular Resistance