Pub Date : 2016-06-01DOI: 10.1016/j.aat.2016.06.002
Kambiz Hassanzadeh , Bashir Khodadadi , Mohammad Raman Moloudi , Hassan Amini , Mohammad Reza Rahmani , Esmael Izadpanah
Objective
Tolerance to the analgesic effect is the main side effect of chronic administration of opioids. Several drugs have been studied to try to find agents to prevent the development of this phenomenon. In the present study we aimed to evaluate the effect of thalidomide on morphine-induced tolerance to the analgesic effect.
Methods
Groups of male rats were randomly rendered and received daily morphine in combination with thalidomide vehicle or thalidomide (2.5 mg/kg, 5 mg/kg, or 10 mg/kg, intraperitoneally). Nociception was measured using the plantar test apparatus. Latency time was recorded when the animal reacted to the light stimulus; licking or raising its hind paw. Treatments and evaluations continued until completion of tolerance to the analgesic effect of morphine.
Results
Our findings indicated that tolerance was achieved following 11 days of morphine administration, while thalidomide postponed the day of tolerance completion for 4 days (2.5 mg/kg and 5 mg/kg thalidomide) or 10 days (10 mg/kg thalidomide). Moreover, thalidomide prevented the morphine-induced shift to the right of the ED50 in the dose–response curve.
Conclusion
It was concluded that thalidomide attenuated the morphine-induced tolerance to the analgesic effect.
{"title":"A new pharmacological role for thalidomide: Attenuation of morphine-induced tolerance in rats","authors":"Kambiz Hassanzadeh , Bashir Khodadadi , Mohammad Raman Moloudi , Hassan Amini , Mohammad Reza Rahmani , Esmael Izadpanah","doi":"10.1016/j.aat.2016.06.002","DOIUrl":"10.1016/j.aat.2016.06.002","url":null,"abstract":"<div><h3>Objective</h3><p>Tolerance to the analgesic effect is the main side effect of chronic administration of opioids. Several drugs have been studied to try to find agents to prevent the development of this phenomenon. In the present study we aimed to evaluate the effect of thalidomide on morphine-induced tolerance to the analgesic effect.</p></div><div><h3>Methods</h3><p>Groups of male rats were randomly rendered and received daily morphine in combination with thalidomide vehicle or thalidomide (2.5 mg/kg, 5 mg/kg, or 10 mg/kg, intraperitoneally). Nociception was measured using the plantar test apparatus. Latency time was recorded when the animal reacted to the light stimulus; licking or raising its hind paw. Treatments and evaluations continued until completion of tolerance to the analgesic effect of morphine.</p></div><div><h3>Results</h3><p>Our findings indicated that tolerance was achieved following 11 days of morphine administration, while thalidomide postponed the day of tolerance completion for 4 days (2.5 mg/kg and 5 mg/kg thalidomide) or 10 days (10 mg/kg thalidomide). Moreover, thalidomide prevented the morphine-induced shift to the right of the ED<sub>50</sub> in the dose–response curve.</p></div><div><h3>Conclusion</h3><p>It was concluded that thalidomide attenuated the morphine-induced tolerance to the analgesic effect.</p></div>","PeriodicalId":87042,"journal":{"name":"Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists","volume":"54 2","pages":"Pages 65-69"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.aat.2016.06.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34689007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-06-01DOI: 10.1016/j.aat.2016.05.002
Chih-Peng Lin , Chih-Hung Hsu , Wen-Mei Fu , Ho-Min Chen , Ying-Hui Lee , Mei-Shu Lai , Yu-Yun Shao
Background
Opioids are crucial in cancer pain management. We examined the nationwide prescription patterns of opioids in Taiwan cancer patients to find the potential concerns.
Methods
We reviewed the claims database of the National Health Insurance of Taiwan for patients diagnosed with cancer from 2003 to 2011. The use and cost of analgesics were analyzed. Opioids were classified into recommended strong opioids (morphine and transdermal fentanyl), recommended weak opioids (tramadol, buprenorphine, and codeine), and unrecommended opioids (propoxyphene, nalbuphine, and meperidine).
Results
We enrolled 1,424,048 patients with cancer, and ∼50% of them took analgesics. Among analgesic users, patients who used opioids increased from 48.2% in 2003 to 52.0% in 2010. Approximately 92% of the opioid use came from recommended opioids, either strong (51%) or weak opioids (41%). The ratio of the use of short-acting strong opioids to that of long-acting opioids increased from 0.41 in 2003 to 0.63 in 2011. Transdermal fentanyl accounted for > 50% of the use of strong opioids. Among weak opioids, the use of tramadol gradually increased to 71% in 2011. On average, opioids contributed to 0.79‰ of all medical expenditures and 2.94‰ of all medication costs.
Conclusion
The use of short-acting strong opioids increased during the study period. Instead of oral opioids, transdermal fentanyl was the most commonly used opioid among Taiwan cancer patients. The use of weak opioids, particularly tramadol, was high. These concerns should be the focus of pain management education.
{"title":"Key opioid prescription concerns in cancer patients: A nationwide study","authors":"Chih-Peng Lin , Chih-Hung Hsu , Wen-Mei Fu , Ho-Min Chen , Ying-Hui Lee , Mei-Shu Lai , Yu-Yun Shao","doi":"10.1016/j.aat.2016.05.002","DOIUrl":"10.1016/j.aat.2016.05.002","url":null,"abstract":"<div><h3>Background</h3><p>Opioids are crucial in cancer pain management. We examined the nationwide prescription patterns of opioids in Taiwan cancer patients to find the potential concerns.</p></div><div><h3>Methods</h3><p>We reviewed the claims database of the National Health Insurance of Taiwan for patients diagnosed with cancer from 2003 to 2011. The use and cost of analgesics were analyzed. Opioids were classified into recommended strong opioids (morphine and transdermal fentanyl), recommended weak opioids (tramadol, buprenorphine, and codeine), and unrecommended opioids (propoxyphene, nalbuphine, and meperidine).</p></div><div><h3>Results</h3><p>We enrolled 1,424,048 patients with cancer, and ∼50% of them took analgesics. Among analgesic users, patients who used opioids increased from 48.2% in 2003 to 52.0% in 2010. Approximately 92% of the opioid use came from recommended opioids, either strong (51%) or weak opioids (41%). The ratio of the use of short-acting strong opioids to that of long-acting opioids increased from 0.41 in 2003 to 0.63 in 2011. Transdermal fentanyl accounted for > 50% of the use of strong opioids. Among weak opioids, the use of tramadol gradually increased to 71% in 2011. On average, opioids contributed to 0.79‰ of all medical expenditures and 2.94‰ of all medication costs.</p></div><div><h3>Conclusion</h3><p>The use of short-acting strong opioids increased during the study period. Instead of oral opioids, transdermal fentanyl was the most commonly used opioid among Taiwan cancer patients. The use of weak opioids, particularly tramadol, was high. These concerns should be the focus of pain management education.</p></div>","PeriodicalId":87042,"journal":{"name":"Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists","volume":"54 2","pages":"Pages 51-56"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.aat.2016.05.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34589132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-06-01DOI: 10.1016/j.aat.2016.06.003
Prerana N. Shah, Yamini Dhengle
Background
Magnesium has been proven to have antinociceptive effects in animal and human models of pain. Its effect is primarily based on the regulation of calcium influx into the cell, which is natural physiological calcium antagonism and N-methyl-d-aspartate (NMDA) receptor antagonism.
Methods
One hundred and eight patients undergoing surgery with spinal anesthesia received either 250 mg of intravenous magnesium sulfate followed by an infusion of 500 mg magnesium sulfate (25 mg/mL) at the rate of 20 mL/hour; or the same volume of normal saline (control group) as bolus and infusion. The primary end-points in the study were to evaluate the analgesic effect and duration of sensory and motor blockade. The secondary end-points included assessment of hemodynamic effects of intravenous magnesium sulfate and rescue analgesia requirement.
Results
Sensory and motor blockade, respectively, were 25 minutes and 34 minutes shorter in the control group. Less patients in the magnesium group (33% vs. 53.7%) than in control group required rescue analgesia in the postoperative period. The control group required rescue analgesia nearly 3 hours earlier than the magnesium group. Only one patient in the control group experienced bradycardia. There was no event of intraoperative hypotension in either of the groups.
Conclusion
Intravenous magnesium sulfate when given as a bolus, followed by an infusion, delayed and decreased the need of rescue analgesics after spinal anesthesia.
在动物和人类疼痛模型中，镁已被证明具有抗痛觉作用。其作用主要基于钙流入细胞的调节，这是一种天然的生理性钙拮抗作用和n -甲基-d-天冬氨酸(NMDA)受体拮抗作用。方法108例脊柱麻醉手术患者先静脉注射硫酸镁250 mg，再以20 mL/h的速率输注硫酸镁500 mg (25 mg/mL);或等量生理盐水(对照组)作丸、输注。该研究的主要目的是评估感觉和运动阻断的镇痛效果和持续时间。次要终点包括静脉注射硫酸镁的血流动力学效果评估和急救镇痛需求。结果对照组感觉阻滞时间缩短25分钟，运动阻滞时间缩短34分钟。镁治疗组术后需要抢救性镇痛的患者少于对照组(33% vs. 53.7%)。对照组需抢救性镇痛时间比镁组早近3小时。对照组中仅有1例患者出现心动过缓。两组均未发生术中低血压。结论静脉注射硫酸镁丸后再输注可延迟和减少脊髓麻醉后对抢救性镇痛药物的需求。
{"title":"Magnesium sulfate for postoperative analgesia after surgery under spinal anesthesia","authors":"Prerana N. Shah, Yamini Dhengle","doi":"10.1016/j.aat.2016.06.003","DOIUrl":"10.1016/j.aat.2016.06.003","url":null,"abstract":"<div><h3>Background</h3><p>Magnesium has been proven to have antinociceptive effects in animal and human models of pain. Its effect is primarily based on the regulation of calcium influx into the cell, which is natural physiological calcium antagonism and <em>N</em>-methyl-<span>d</span>-aspartate (NMDA) receptor antagonism.</p></div><div><h3>Methods</h3><p>One hundred and eight patients undergoing surgery with spinal anesthesia received either 250 mg of intravenous magnesium sulfate followed by an infusion of 500 mg magnesium sulfate (25 mg/mL) at the rate of 20 mL/hour; or the same volume of normal saline (control group) as bolus and infusion. The primary end-points in the study were to evaluate the analgesic effect and duration of sensory and motor blockade. The secondary end-points included assessment of hemodynamic effects of intravenous magnesium sulfate and rescue analgesia requirement.</p></div><div><h3>Results</h3><p>Sensory and motor blockade, respectively, were 25 minutes and 34 minutes shorter in the control group. Less patients in the magnesium group (33% vs. 53.7%) than in control group required rescue analgesia in the postoperative period. The control group required rescue analgesia nearly 3 hours earlier than the magnesium group. Only one patient in the control group experienced bradycardia. There was no event of intraoperative hypotension in either of the groups.</p></div><div><h3>Conclusion</h3><p>Intravenous magnesium sulfate when given as a bolus, followed by an infusion, delayed and decreased the need of rescue analgesics after spinal anesthesia.</p></div>","PeriodicalId":87042,"journal":{"name":"Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists","volume":"54 2","pages":"Pages 62-64"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.aat.2016.06.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34744249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study compared the cardiac output (CO) obtained from PiCCO with that obtained from the noninvasive NICOM method.
Methods
Twenty-one cirrhotic patients receiving liver transplantation were enrolled. During the operation, their CO was measured by the PiCCO system via the thermodilution method as the standard and by the NICOM method. Two parameters including cardiac index (CI) and stroke volume index (SVI) were collected simultaneously at three phases during the surgery including the dissection phase (T1), the anhepatic phase (T2), and the reperfusion phase (T3). Correlation, Bland and Altman methods, and linear mixed model were used to evaluate the monitoring ability of both systems.
Results
Poor correlation was noted between the data measured by NICOM and PiCCO; the correlation coefficients for CI and SVI measured between the two systems were 0.32 and 0.39, respectively. Bland and Altman analysis showed the percentage error of CI as 63.7%, and that of SVI as 66.6% for NICOM compared to PiCCO. Using the linear mixed model, the CI and SVI measured using NICOM were significantly higher than those using PiCCO (estimated regression coefficient 0.92 and 10.77, both p < 0.001). Mixed model analysis showed no differences between the trends of CI and SVI measured by the two methods.
Conclusions
NICOM provided a comparable CI and SVI trend when compared to the gold standard PiCCO, but it raises concerns as an effective CO monitor because of its tendency to overestimate CI and SVI especially during the state of high cardiac output.
{"title":"Evaluation of cardiac output by bioreactance technique in patients undergoing liver transplantation","authors":"Po-Yuan Shih, Wen-Ying Lin, Ming-Hui Hung, Ya-Jung Cheng, Kuang-Cheng Chan","doi":"10.1016/j.aat.2016.06.001","DOIUrl":"10.1016/j.aat.2016.06.001","url":null,"abstract":"<div><h3>Background</h3><p>This study compared the cardiac output (CO) obtained from PiCCO with that obtained from the noninvasive NICOM method.</p></div><div><h3>Methods</h3><p>Twenty-one cirrhotic patients receiving liver transplantation were enrolled. During the operation, their CO was measured by the PiCCO system via the thermodilution method as the standard and by the NICOM method. Two parameters including cardiac index (CI) and stroke volume index (SVI) were collected simultaneously at three phases during the surgery including the dissection phase (T1), the anhepatic phase (T2), and the reperfusion phase (T3). Correlation, Bland and Altman methods, and linear mixed model were used to evaluate the monitoring ability of both systems.</p></div><div><h3>Results</h3><p>Poor correlation was noted between the data measured by NICOM and PiCCO; the correlation coefficients for CI and SVI measured between the two systems were 0.32 and 0.39, respectively. Bland and Altman analysis showed the percentage error of CI as 63.7%, and that of SVI as 66.6% for NICOM compared to PiCCO. Using the linear mixed model, the CI and SVI measured using NICOM were significantly higher than those using PiCCO (estimated regression coefficient 0.92 and 10.77, both <em>p</em> < 0.001). Mixed model analysis showed no differences between the trends of CI and SVI measured by the two methods.</p></div><div><h3>Conclusions</h3><p>NICOM provided a comparable CI and SVI trend when compared to the gold standard PiCCO, but it raises concerns as an effective CO monitor because of its tendency to overestimate CI and SVI especially during the state of high cardiac output.</p></div>","PeriodicalId":87042,"journal":{"name":"Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists","volume":"54 2","pages":"Pages 57-61"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.aat.2016.06.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34596651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-03-01DOI: 10.1016/j.aat.2015.11.001
W.P. Zhang, S.M. Zhu
Background
High peak airway pressure (Ppeak) and high end-tidal carbon dioxide tension (PETCO2) are the common problems encountered in the obese patients undergoing gynecological laparoscopy with conventional volume-controlled ventilation. This study was designed to investigate whether volume-controlled inverse ratio ventilation (IRV) with inspiratory to expiratory (I:E) ratio of 2:1 could reduce Ppeak or the plateau pressure (Pplat), improve oxygenation, and alleviate lung injury in patients with normal lungs.
Methods
Sixty obese patients undergoing gynecological laparoscopy were enrolled in this study. After tracheal intubation, the patients were randomly divided into the IRV group (n = 30) and control group (n = 30). They were ventilated with an actual tidal volume of 8 mL/kg, respiratory rate of 12 breaths/min, zero positive end-expiratory pressure and I:E of 1:2 or 2:1. Arterial blood samples, hemodynamic parameters, and respiratory mechanics were recorded before and during pneumoperitoneum. The concentrations of tumor necrosis factor-α, and interleukins 6 and 8 in bronchoalveolar lavage fluid were measured immediately before and 60 minutes after onset of CO2 pneumoperitoneum.
Results
IRV significantly increased arterial partial pressure of oxygen, mean airway pressure, and dynamic compliance of respiratory system with concomitant significant decreases in Ppeak and Pplat compared to conventional ventilation with I:E of 1:2 (p < 0.05). Additionally, the levels of tumor necrosis factor-α, and interleukins 6 and 8 were significantly lower than those in control group (p < 0.05).
Conclusion
Volume-controlled IRV not only reduces Ppeak, Pplat, and the release of inflammatory cytokines, but also increases mean airway pressure, and improves oxygenation and dynamic compliance of respiratory system in obese patients undergoing gynecologic laparoscopy without adverse respiratory and hemodynamic effects. It is superior to conventional ratio ventilation in terms of oxygenation, respiratory mechanics and inflammatory cytokine in obese patients undergoing gynecologic laparoscopy.
{"title":"The effects of inverse ratio ventilation on cardiopulmonary function and inflammatory cytokine of bronchoaveolar lavage in obese patients undergoing gynecological laparoscopy","authors":"W.P. Zhang, S.M. Zhu","doi":"10.1016/j.aat.2015.11.001","DOIUrl":"10.1016/j.aat.2015.11.001","url":null,"abstract":"<div><h3>Background</h3><p>High peak airway pressure (Ppeak) and high end-tidal carbon dioxide tension (P<sub>ET</sub>CO<sub>2</sub>) are the common problems encountered in the obese patients undergoing gynecological laparoscopy with conventional volume-controlled ventilation. This study was designed to investigate whether volume-controlled inverse ratio ventilation (IRV) with inspiratory to expiratory (I:E) ratio of 2:1 could reduce Ppeak or the plateau pressure (Pplat), improve oxygenation, and alleviate lung injury in patients with normal lungs.</p></div><div><h3>Methods</h3><p>Sixty obese patients undergoing gynecological laparoscopy were enrolled in this study. After tracheal intubation, the patients were randomly divided into the IRV group (<em>n</em> = 30) and control group (<em>n</em> = 30). They were ventilated with an actual tidal volume of 8 mL/kg, respiratory rate of 12 breaths/min, zero positive end-expiratory pressure and I:E of 1:2 or 2:1. Arterial blood samples, hemodynamic parameters, and respiratory mechanics were recorded before and during pneumoperitoneum. The concentrations of tumor necrosis factor-α, and interleukins 6 and 8 in bronchoalveolar lavage fluid were measured immediately before and 60 minutes after onset of CO<sub>2</sub> pneumoperitoneum.</p></div><div><h3>Results</h3><p>IRV significantly increased arterial partial pressure of oxygen, mean airway pressure, and dynamic compliance of respiratory system with concomitant significant decreases in Ppeak and Pplat compared to conventional ventilation with I:E of 1:2 (<em>p</em> < 0.05). Additionally, the levels of tumor necrosis factor-α, and interleukins 6 and 8 were significantly lower than those in control group (<em>p</em> < 0.05).</p></div><div><h3>Conclusion</h3><p>Volume-controlled IRV not only reduces Ppeak, Pplat, and the release of inflammatory cytokines, but also increases mean airway pressure, and improves oxygenation and dynamic compliance of respiratory system in obese patients undergoing gynecologic laparoscopy without adverse respiratory and hemodynamic effects. It is superior to conventional ratio ventilation in terms of oxygenation, respiratory mechanics and inflammatory cytokine in obese patients undergoing gynecologic laparoscopy.</p></div>","PeriodicalId":87042,"journal":{"name":"Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists","volume":"54 1","pages":"Pages 1-5"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.aat.2015.11.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87163996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Proximal approach for ultrasound-guided infraclavicular brachial plexus block","authors":"Takayuki Yoshida, Yoshiko Watanabe, Kenta Furutani","doi":"10.1016/j.aat.2015.11.003","DOIUrl":"10.1016/j.aat.2015.11.003","url":null,"abstract":"","PeriodicalId":87042,"journal":{"name":"Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists","volume":"54 1","pages":"Pages 31-32"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.aat.2015.11.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76620885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Joint assembly of suction catheter and endotracheal tube: Aid for tracheostomy tube exchange","authors":"Kiranpreet Kaur, Asha Anand, Mamta Bhardwaj, Suresh Kumar Singhal","doi":"10.1016/j.aat.2015.11.005","DOIUrl":"10.1016/j.aat.2015.11.005","url":null,"abstract":"","PeriodicalId":87042,"journal":{"name":"Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists","volume":"54 1","pages":"Pages 38-39"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.aat.2015.11.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76867472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-03-01DOI: 10.1016/j.aat.2015.12.002
Wei-Han Chou , Feng-Sheng Lin , Chih-Peng Lin , Wen-Ying Lin , Jr-Chi Yie , Wei-Zen Sun
Background
Perioperative psychological distress is associated with preoperative anxiety, depression, and postoperative pain. Mirtazapine is effective as an antidepressant, anxiolytic agent, and sleep enhancer. Moreover, mirtazapine can be made as orodispersible tablets with a fast onset for patients in nil per os status. This study is to determine whether mirtazapine can help psychologically distressed patients reduce perioperative anxiety, depression, and postoperative pain.
Materials and methods
Patients with preoperative psychological distress, undergoing major abdominal surgery, were inquired and assigned to two groups according to their own choice. In the treatment group, patients could choose to take orodispersible mirtazapine 30 mg at each night from Preoperative Day 0 to Postoperative Day 3. There was no other intervention in the nontreatment group. Hospital Anxiety and Depression Scale (HADS), Athens Insomnia Scale (AIS), and pain scores were accessed on the day before operation (Day 0), and on the 1st day (Day 2) and 3rd day (Day 4) after operation. We compared the HADS, AIS, and pain scores, and morphine consumptions between the two groups on a daily basis. Marginal regression models were fitted to our correlated longitudinal data alone with the generalized estimating equations method to estimate the population average effects of time-varying mirtazapine usage on the mean values of HADS, AIS, and pain scores, and daily morphine consumptions.
Results
From September 2007 to December 2008, 86 patients agreed to be enrolled and 79 of them completed the study. Propensity scores and multivariate analysis showed that mirtazapine reduced HADS scores of patients in 2 days. Trial results indicated that mirtazapine lowered the AIS day index and tended to decrease night index as well. Mirtazapine may reduce patients' morphine consumption, but this effect was not statistically significant (p = 0.2).
Conclusion
Mirtazapine helps reduce anxiety, depression, and insomnia scores for patients with perioperative psychological distress.
{"title":"Mirtazapine, in orodispersible form, for patients with preoperative psychological distress: A pilot study","authors":"Wei-Han Chou , Feng-Sheng Lin , Chih-Peng Lin , Wen-Ying Lin , Jr-Chi Yie , Wei-Zen Sun","doi":"10.1016/j.aat.2015.12.002","DOIUrl":"10.1016/j.aat.2015.12.002","url":null,"abstract":"<div><h3>Background</h3><p>Perioperative psychological distress is associated with preoperative anxiety, depression, and postoperative pain. Mirtazapine is effective as an antidepressant, anxiolytic agent, and sleep enhancer. Moreover, mirtazapine can be made as orodispersible tablets with a fast onset for patients in nil per os status. This study is to determine whether mirtazapine can help psychologically distressed patients reduce perioperative anxiety, depression, and postoperative pain.</p></div><div><h3>Materials and methods</h3><p>Patients with preoperative psychological distress, undergoing major abdominal surgery, were inquired and assigned to two groups according to their own choice. In the treatment group, patients could choose to take orodispersible mirtazapine 30 mg at each night from Preoperative Day 0 to Postoperative Day 3. There was no other intervention in the nontreatment group. Hospital Anxiety and Depression Scale (HADS), Athens Insomnia Scale (AIS), and pain scores were accessed on the day before operation (Day 0), and on the 1<sup>st</sup> day (Day 2) and 3<sup>rd</sup> day (Day 4) after operation. We compared the HADS, AIS, and pain scores, and morphine consumptions between the two groups on a daily basis. Marginal regression models were fitted to our correlated longitudinal data alone with the generalized estimating equations method to estimate the population average effects of time-varying mirtazapine usage on the mean values of HADS, AIS, and pain scores, and daily morphine consumptions.</p></div><div><h3>Results</h3><p>From September 2007 to December 2008, 86 patients agreed to be enrolled and 79 of them completed the study. Propensity scores and multivariate analysis showed that mirtazapine reduced HADS scores of patients in 2 days. Trial results indicated that mirtazapine lowered the AIS day index and tended to decrease night index as well. Mirtazapine may reduce patients' morphine consumption, but this effect was not statistically significant (<em>p</em> = 0.2).</p></div><div><h3>Conclusion</h3><p>Mirtazapine helps reduce anxiety, depression, and insomnia scores for patients with perioperative psychological distress.</p></div>","PeriodicalId":87042,"journal":{"name":"Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists","volume":"54 1","pages":"Pages 16-23"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.aat.2015.12.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81127483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-03-01DOI: 10.1016/j.aat.2015.11.002
Hung-Tsung Hsiao, Hung Wu, Pei-Chi Huang, Yu-Chuang Tsai, Yen-Chin Liu
Objectives
Ischemia–reperfusion (IR) features massive oxidative stress of tissues and cytokine response. Propofol and sevoflurane, both of which are commonly used anesthetics, are thought to have different antioxidant activities. The aim of this study is to delineate the influence of these two drugs on the production of free radicals and proinflammatory cytokines in IR conditions via in vitro and in vivo models.
Methods
An in vitro IR model was performed by incubating porcine cells (including mononuclear cells, and coronary and aortic smooth muscle cells) with either propofol 25 μM or sevoflurane 2% in the hypoxia chamber (1% O2, 37°C) for 1 hour, followed by room temperature air for 2 hours. Reactive oxygen species (ROS) and tumor necrosis factor-α (TNF-α) were also measured via flow cytometry and enzyme-linked immunosorbent assay methods, respectively. Ten pigs were used for the in vivo study. After anesthesia with either propofol (10–15 mg/kg/h) or sevoflurane (2%), internal carotid and femoral arterial catheters were inserted for direct blood pressure monitoring and blood sampling. The IR models were produced via descending thoracic aorta clamping for 1 hour and declamping for 2 hours during the procedure for left ventricular assist device implantation. Blood serum was sampled from upper and lower body vessels for ROS and TNF-α evaluation via thiobarbituric acid reacting substances method and enzyme-linked immunosorbent assay, respectively.
Results
The results showed significant reduction of both ROS and TNF-α levels in the propofol group in vitro IR model. However, there was no difference in lipid peroxidation and TNF-α level between propofol and sevoflurane for the in vivo IR model.
Conclusion
We concluded that propofol, compared with sevoflurane, can significantly inhibit ROS formation on a cell level. In addition, propofol can significantly inhibit TNF-α formation of monocytes and coronary smooth muscle cells but not aortic smooth muscle cells.
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