piperidines and Shock

Increase in total cardiac output can improve oxygen delivery to the cells. Although inotropic drugs increase primarily myocardial contractility, they can adversely affect cardiac preload and afterload. Moreover, they can dangerously increase myocardial oxygen requirements. The combined use of vasodilating agents, with fluid challenge represents a challenging but more efficient treatment of acute circulatory failure.

Topics: Cardiac Output; Depression, Chemical; Dobutamine; Dopamine; Fluid Therapy; Humans; Ketanserin; Nitroglycerin; Nitroprusside; Phentolamine; Piperidines; Shock; Stimulation, Chemical; Sympathomimetics; Vasodilator Agents

Remifentanil has a unique metabolic pathway that holds potential benefits for long-term sedation. We compared remifentanil-midazolam to sufentanil-midazolam in 41 critically ill adults requiring mechanical ventilation.. Randomized double-blind trial.. Infusion rates were titrated every 4 hours to achieve the desired Ramsay score. Five fold increases in dose requirement was considered as the development of tolerance. Drugs requirement, development of tolerance and weaning time of ventilation were compared.. The study was stopped after an interim analysis. The remifentanil and sufentanil groups were comparable regarding IGS II: 56+/-22 vs 64+/-26, mean+/-SD, ICU length of stay: 26 (8-45) vs 19 (11-34) days, and sedation duration: 6 (4-19) vs 6 (3-16)days, median [interquartile range, IQR]). There was a shorter weaning time in the remifentanil group as compared to sufentanil group: 22 h (12-53) vs 96 (47-142) h, median [IQR], p=0.04). The daily opioid infusion rate needed to be decreased over time only in sufentanil group, p < 0.001. Tolerance occurred in 6 (30%; CI(95), 10 to 40%) remifentanil and no sufentanil patients (P=0.02).. Sufentanil infusion needed to be reduced over time and prolonged the weaning time when compared to remifentanil.

Topics: Adult; Aged; Conscious Sedation; Critical Care; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Drug Tolerance; Female; Hospital Mortality; Humans; Lung Diseases; Male; Midazolam; Middle Aged; Piperidines; Postoperative Complications; Remifentanil; Respiration, Artificial; Shock; Sufentanil; Ventilator Weaning

We reported the case of a 61-year-old woman, who has been hospitalized in ICU because of an extensive mesenteric ischaemia, involving the small bowel, secondary to a naratriptan overuse. This mesenteric ischaemia was complicated by multiple organ failure and was responsible for extensive small bowel resection and left colectomy. A concomitant abundant absorption of grapefruit juice, a well-known P450 inhibitor, may have enhanced this naratriptan toxicity. This case underscore that an abdominal pain occurring in the context of headache treatment may be related to a mesenteric ischaemia.

Topics: Abdominal Pain; Citrus paradisi; Colectomy; Electrocardiography; Female; Food-Drug Interactions; Humans; Intestines; Ischemia; Middle Aged; Multiple Organ Failure; Piperidines; Serotonin Agents; Shock; Splanchnic Circulation; Tryptamines

The use of anabolic steroids is a growing problem in Denmark. The effects and side effects caused by anabolic steroids in relation to anaesthesia are poorly described. This article describes a case of circulatory collapse in a young bodybuilder during anaesthesia. The primary cause of the collapse remains undetermined, but different hypotheses are proposed based on previously published literature.

Topics: Adult; Anabolic Agents; Anesthesia, Intravenous; Anesthetics, Intravenous; Humans; Ileus; Male; Neuromuscular Depolarizing Agents; Piperidines; Propofol; Remifentanil; Shock; Succinylcholine; Weight Lifting

Poly (ADP-ribose) polymerase-1 (PARP-1), a nuclear enzyme activated by DNA strand breaks, plays a detrimental role during inflammation. As inflammation is important in the development of colitis and ischemia/reperfusion (I/R) injury of the intestine, we investigated the effects of 10-(4-methyl-piperazin-1-ylmethyl)-2H-7-oxa-1,2-diaza-benzo[de]anthracen-3-one (GPI 15427) and 2-(4-methyl-piperazin-1-yl)-5H-benzo[c][1,5]naphthyridin-6-one (GPI 16539), two novel and potent inhibitors of PARP-1, in a rat model of gut injury and inflammation, splanchnic artery occlusion (SAO)shock and dinitrobenzene sulfonic acid (DNBS)-induced colitis. We report here for the first time that post-injury administration of GPI 15427 and GPI 16539 exerts potent anti-inflammatory effects by reducing inflammatory cell infiltration and histological injury, and delaying the development of clinical signs in both in vivo models. Furthermore, GPI 15427 and GPI 16539 treatment diminished the accumulation of poly(ADP-ribose) in the ileum of splanchnic artery occlusion-shocked rats and in the colons of dinitrobenzene sulfonic acid-treated rats. Thus, GPI 15427 and GPI 16539 exhibited anti-inflammation activity against damage caused by intestinal ischemia/reperfusion and colitis. GPI 15427 and GPI 16539 may be useful for treating gut ischemia and inflammation.

Topics: Animals; Anti-Inflammatory Agents; Colitis; Colon; Disease Models, Animal; Immunohistochemistry; Intestines; Male; Naphthyridines; Organic Chemicals; Piperazines; Piperidines; Poly(ADP-ribose) Polymerase Inhibitors; Poly(ADP-ribose) Polymerases; Rats; Rats, Sprague-Dawley; Shock; Splanchnic Circulation

Eisenmenger's syndrome consists of high pulmonary vascular resistance with reversed or bidirectional shunt at aortopulmonary, ventricular or atrial level. We describe the anaesthetic management of two adult females with Eisenmenger's syndrome admitted for laparoscopic cholecystectomy. One patient suffered post-operative complications, but the other case was uncomplicated. We used sevoflurane and total intravenous anaesthesia to provide general anaesthesia. Both techniques were tolerated.

Topics: Adult; Analgesics; Anesthesia, General; Anesthetics, Inhalation; Anesthetics, Intravenous; Cholecystectomy, Laparoscopic; Echocardiography; Eisenmenger Complex; Female; Fentanyl; Humans; Intermittent Positive-Pressure Ventilation; Intubation, Intratracheal; Ketamine; Methyl Ethers; Piperidines; Postoperative Complications; Propofol; Remifentanil; Sevoflurane; Shock

Cerebral ischemia may lead to glutamate-induced excitotoxic damage in vulnerable brain areas. Lubeluzole is not an N-methyl-D-aspartate antagonist but prevents postischemic increase in extracellular glutamate concentrations. The present study examined whether lubeluzole, administered after global incomplete ischemia in rats, is capable of preserving the structural integrity of CA1 hippocampus.. Ischemia was induced by bilateral carotid artery occlusion and severe hypotension for a duration of 9 minutes. Delayed neuronal cell death was histologically evaluated 7 days later. This was done by scoring acidophilic cell change and coagulative necrosis and by counting the number of surviving neurons in the CA1 subfield. Experiments were performed according to a paired design (13 animals per treatment group).. Posttreatment with lubeluzole (0.31 mg/kg i.v. bolus at 5 minutes and 0.31 mg/kg i.v. infusion during 1 hour) resulted in significant neuroprotection. Whereas in the untreated rats there were 42 (median) viable neurons per millimeter CA1 layer in the left and 69 in the right hemisphere, in the drug-treated rats 99 viable neurons per millimeter were found in the left (P = .002) and 113 in the right hemisphere (P = .013). Histological scores, reflecting altered staining properties of the hippocampal cells, correlated strongly with the quantitative data, reflecting the structural integrity of CA1 pyramidal neurons.. Lubeluzole, when administered after an ischemic insult in rats, protects vulnerable brain regions against delayed structural injury. The results support the potential clinical use of this new drug in stroke treatment.

Topics: Animals; Brain Damage, Chronic; Brain Ischemia; Carotid Stenosis; Cell Death; Drug Evaluation, Preclinical; Hippocampus; Ligation; Male; Neurons; Neuroprotective Agents; Piperidines; Rats; Rats, Wistar; Shock; Thiazoles; Time Factors

E5880 (1-ethyl-2-[N-(2-methoxy)benzoyl-N-[(2R)-2-methoxy-3-(4- octadecylcarbamoyloxy) piperidinocarbonyloxypropyloxy] carbonyl]aminomethylpyridinium chloride, CAS 128420-61-1) is a novel analog-type antagonist of platelet activating factor (PAF). This paper describes the in vitro PAF antagonistic activity of E5880 and its in vivo effect in various experimentally induced shock models. Inhibition by E5880 of [3H]platelet activating factor (PAF) binding to human platelet PAF receptor was extremely potent; its IC50 value was 0.27 nmol/l, so that it was about 5 times more potent than PAF itself. Its IC50 value in inhibition of washed human platelet aggregation induced by PAF was 0.66 nmol/l. Intravenous treatment with E5880 dose-dependently reversed PAF-induced hypotension in rats and protected mice from lethality caused by PAF. Lipopolysaccharide (LPS)-induced hypotension in rats was inhibited by both pre- and post-treatment with E5880. It was also confirmed that blood PAF level, measured by the GC-NICI-MS method, was increased after LPS challenge in this model. Furthermore, E5880 was extremely effective in preventing passive anaphylactic lethality in mice. Blood PAF level in this model was also increased immediately after antigen challenge, and this was coincident with the time at which signs of shock became apparent. These findings support the concept that PAF is an important mediator in the development of LPS-induced shock and anaphylactic shock, and suggest that E5880, a novel and potent PAF antagonist, may be effective in clinical treatment for shock states.

Topics: Animals; Gas Chromatography-Mass Spectrometry; Hypotension; Lipopolysaccharides; Mice; Mice, Inbred ICR; Passive Cutaneous Anaphylaxis; Piperidines; Platelet Activating Factor; Platelet Aggregation; Platelet Aggregation Inhibitors; Platelet Membrane Glycoproteins; Pyridinium Compounds; Rats; Rats, Inbred F344; Receptors, Cell Surface; Receptors, G-Protein-Coupled; Shock

Topics: Alcoholic Intoxication; Aluminum; Aminopyrine; Anti-Inflammatory Agents; Ascorbic Acid; Benzyl Compounds; Child; Child, Preschool; Cosmetics; Female; Hallucinations; Humans; Hyperkinesis; Male; Methylamines; Nalidixic Acid; Perfume; Phenethylamines; Piperidines; Poisoning; Pyrazoles; Rutin; Shock; Speech Disorders

Topics: Adult; Alkaloids; Anti-Bacterial Agents; Anti-Infective Agents, Local; Bandages; Burns; Burns, Chemical; Burns, Electric; Child; Electrolytes; Eye Injuries; Facial Injuries; First Aid; Humans; Pain; Piperidines; Plasma Substitutes; Pyrazoles; Respiratory System; Shock; Tetanus; Transportation of Patients; Wounds and Injuries

Topics: Blood-Brain Barrier; Brain; Chlordiazepoxide; Chlorpromazine; Cyproheptadine; Dopamine; Electricity; Fluorometry; Norepinephrine; Pharmacology; Piperidines; Rats; Research; Shock; Tetrabenazine; Thioridazine; Tranquilizing Agents

Topics: Brain; Brain Chemistry; Chlorpromazine; Electricity; Electroshock; Pharmacology; Piperidines; Rats; Research; Serotonin; Shock; Tetrabenazine