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Mirsadeghi MN, Biazar G, Soltanipour S, Rad RS, Madani ZH, Nikbin L. The effect of aminophylline on the recovery profile after hysterectomy: A randomized controlled double-blinded study. Health Sci Rep 2023; 6:e1362. [PMID: 37351459 PMCID: PMC10282175 DOI: 10.1002/hsr2.1362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/14/2023] [Accepted: 06/08/2023] [Indexed: 06/24/2023] Open
Abstract
Background and Aims In anesthesia practice, aminophylline is clinically used to treat bronchospasm. However, due to its antagonistic effect on adenosine, studies have recently focused on the drug's ability to enhance the recovery profile. The aim of this study was to investigate the hypothesis that the administration of aminophylline leads to better recovery after general anesthesia in hysterectomy. Methods This randomized controlled double-blinded study, was conducted at Alzahra academic hospital in Guilan, Iran. During December 2022 to March 2023, 70 eligible women scheduled for elective abdominal hysterectomy were divided into two groups. Group A: received 3 mg/kg IV aminophylline diluted in 100 mL of normal saline and Group C: received 100 mL IV normal saline. The time to recovery of consciousness, tracheal extubation and discharge from post anesthesia care unit were recorded. In addition, heart rate, and mean arterial blood pressure were measured at 10 point times including; baseline (T0), immediately before the administration of aminophylline (T1), every 5 min until the end of the surgery(T2,T3,T4,T5,T6), and every 15 min in PACU(T7,T8,T9). Results There was no significant difference in terms of demographic data between the study groups. Comparing the two groups, the time of ROC was shorter in Group A than group C; 5.95 ± 1.12 and 8.5 ± 1.77 for Groups A and C, respectively (p < 0.001). The extubation time was shorter in Group A than group C; 7.79 ± 1.48 and 10.55 ± 3.02, for Groups A and C, respectively (p < 0.001). In addition, the discharge time was also shorter in group A than Group C; 30.17 ± 5.24 and 37.57 ± 4.41 for Groups A and C, respectively (p < 0.001). Not serious side effects were reported among 71.4% of cases in Group A and 51.4% in Group C (p = 0.086). Conclusion Administration of aminophylline at a dose of 3 mg/kg IV improves the recovery profile after abdominal hysterectomy without serious adverse effects.
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Affiliation(s)
- Misa Naghdipour Mirsadeghi
- Department of Gynecology, School of Medicine, Alzahra HospitalGuilan University of Medical SciencesRashtIran
| | - Gelareh Biazar
- Department of Anesthesiology, Anesthesiology Research Center, Alzahra hospitalGuilan University of Medical SciencesRashtIran
| | - Soheil Soltanipour
- Department of Community Medicine, School of MedicineGuilan University of Medical SciencesRashtIran
| | - Reyhaneh Shahrokhi Rad
- Department of Anesthesiology, Anesthesiology Research Center, Alzahra hospitalGuilan University of Medical SciencesRashtIran
| | - Zahra Hamidi Madani
- Department of Obstetrics and Gynecology, School of Medicine, Reproductive Health Research Center, Alzahra HospitalGuilan University of Medical SciencesRashtIran
| | - Laya Nikbin
- Student Research Committee, School of MedicineGuilan University of Medical SciencesRashtIran
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Kasim SA, Bahr MH, Abdelkader M, Rashwan DAE. The effect of preoperative aminophylline on the recovery profile after major pelvic-abdominal surgeries: a randomized controlled double-blinded study. BMC Anesthesiol 2021; 21:122. [PMID: 33874898 PMCID: PMC8054407 DOI: 10.1186/s12871-021-01340-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/09/2021] [Indexed: 11/23/2022] Open
Abstract
Background This study compared the effects of premedication with different doses of aminophylline on the recovery profile after general anaesthesia. Methods Forty-five patients scheduled for pelvic-abdominal surgeries were divided into 3 groups: Group C: the patients received 100 ml of IV normal saline, Group A1: the patients received 2 mg/kg IV aminophylline, and Group A2: the patients received 4 mg/kg IV aminophylline 30 min before induction of general anaesthesia. The following data were recorded: demographic data, ASA physical status, duration of anaesthesia and surgery, heart rate, mean arterial blood pressure, propofol dose, fentanyl dose, times to reach BIS (48 ± 2) after induction of anaesthesia and to reach a value of 80 after discontinuation of sevoflurane anaesthesia, time to recovery of consciousness and to tracheal extubation and to discharge from the post-anaesthesia care unit, and side effects of aminophylline. Results The time to reach a BIS of 48 ± 2 was significantly lower for the control group than group A2 (70.67 ± 22.50 and 106.67 ± 34.77 s for groups C and A2, respectively, p -value =0.01). The time to reach a BIS of 80 was significantly longer for the control group than group A1 andA2 (5.6 ± 1.40,3.5 ± 1.93and 2.53 ± 1.72 min for groups C,A1 and A2, respectively, p -value < 0.01). The time to ROC was significantly longer for the control group than groups A1 and A2 (8.93 ± 0.92, 5.6 ± 2.47 and 4.53 ± 3.33 min for groups C, A1 and A2, respectively; p -value < 0.01). The extubation time was significantly longer for the control group than groups A1 and A2 (12.4 ± 1.08, 7.87 ± 3.27 and 6.6 ± 2.47 min for groups C, A1 and A2, respectively; p -value < 0.01). Conclusion Premedication with aminophylline enhanced the recovery profile after pelvic-abdominal surgeries under general anaesthesia without cardiovascular complications. Clinical trial registration Name of the registry: Register@ClinicalTrials.gov Trial registration number: ClinicalTrials.gov Identifier: NCT04151381. Date of registration, November 5, 2019, ‘Retrospectively registered’.
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Affiliation(s)
- Samaa A Kasim
- Faculty of Medicine, Beni -Suef University, Beni - Suef, Egypt.
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Caffeine Accelerates Emergence from Isoflurane Anesthesia in Humans: A Randomized, Double-blind, Crossover Study. Anesthesiology 2019; 129:912-920. [PMID: 30044241 DOI: 10.1097/aln.0000000000002367] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
WHAT WE ALREADY KNOW ABOUT THIS TOPIC WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: There are currently no drugs clinically available to reverse general anesthesia. We previously reported that caffeine is able to accelerate emergence from anesthesia in rodents. This study was carried out to test the hypothesis that caffeine accelerates emergence from anesthesia in humans. METHODS We conducted a single-center, randomized, double-blind crossover study with eight healthy males. Each subject was anesthetized twice with 1.2% isoflurane for 1 h. During the final 10 min of each session, participants received an IV infusion of either caffeine citrate (15 mg/kg, equivalent to 7.5 mg/kg of caffeine base) or saline placebo. The primary outcome was the average difference in time to emergence after isoflurane discontinuation between caffeine and saline sessions. Secondary outcomes included the end-tidal isoflurane concentration at emergence, vital signs, and Bispectral Index values measured throughout anesthesia and emergence. Additional endpoints related to data gathered from postanesthesia psychomotor testing. RESULTS All randomized participants were included in the analysis. The mean time to emergence with saline was 16.5 ± 3.9 (SD) min compared to 9.6 ± 5.1 (SD) min with caffeine (P = 0.002), a difference of 6.9 min (99% CI, 1.8 to 12), a 42% reduction. Participants emerged at a higher expired isoflurane concentration, manifested more rapid return to baseline Bispectral Index values, and were able to participate in psychomotor testing sooner when receiving caffeine. There were no statistically significant differences in vital signs with caffeine administration and caffeine-related adverse events. CONCLUSIONS Intravenous caffeine is able to accelerate emergence from isoflurane anesthesia in healthy males without any apparent adverse effects.
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Burbiel JC, Ghattas W, Küppers P, Köse M, Lacher S, Herzner AM, Kombu RS, Akkinepally RR, Hockemeyer J, Müller CE. 2-Amino[1,2,4]triazolo[1,5-c]quinazolines and Derived Novel Heterocycles: Syntheses and Structure-Activity Relationships of Potent Adenosine Receptor Antagonists. ChemMedChem 2016; 11:2272-2286. [PMID: 27531666 DOI: 10.1002/cmdc.201600255] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/29/2016] [Indexed: 11/06/2022]
Abstract
2-Amino[1,2,4]triazolo[1,5-c]quinazolines were identified as potent adenosine receptor (AR) antagonists. Synthetic strategies were devised to gain access to a broad range of derivatives including novel polyheterocyclic compounds. Potent and selective A3 AR antagonists were discovered, including 3,5-diphenyl[1,2,4]triazolo[4,3-c]quinazoline (17, Ki human A3 AR 1.16 nm) and 5'-phenyl-1,2-dihydro-3'H-spiro[indole-3,2'-[1,2,4]triazolo[1,5-c]quinazolin]-2-one (20, Ki human A3 AR 6.94 nm). In addition, multitarget antagonists were obtained, such as the dual A1 /A3 antagonist 2,5-diphenyl[1,2,4]triazolo[1,5-c]quinazoline (13 b, Ki human A1 AR 51.6 nm, human A3 AR 11.1 nm), and the balanced pan-AR antagonists 5-(2-thienyl)[1,2,4]triazolo[1,5-c]quinazolin-2-amine (11 c, Ki human A1 AR 131 nm, A2A AR 32.7 nm, A2B AR 150 nm, A3 AR 47.5 nm) and 9-bromo-5-phenyl[1,2,4]triazolo[1,5-c]quinazolin-2-amine (11 q, Ki human A1 AR 67.7 nm, A2A AR 13.6 nm, A2B AR 75.0 nm, A3 AR 703 nm). In many cases, significantly different affinities for human and rat receptors were observed, which emphasizes the need for caution in extrapolating conclusions between different species.
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Affiliation(s)
- Joachim C Burbiel
- Pharmazeutische Chemie I, Universität Bonn, Pharma-Zentrum Bonn, Pharmazeutisches Institut, An der Immenburg 4, 53121, Bonn, Germany
| | - Wadih Ghattas
- Pharmazeutische Chemie I, Universität Bonn, Pharma-Zentrum Bonn, Pharmazeutisches Institut, An der Immenburg 4, 53121, Bonn, Germany
| | - Petra Küppers
- Pharmazeutische Chemie I, Universität Bonn, Pharma-Zentrum Bonn, Pharmazeutisches Institut, An der Immenburg 4, 53121, Bonn, Germany
| | - Meryem Köse
- Pharmazeutische Chemie I, Universität Bonn, Pharma-Zentrum Bonn, Pharmazeutisches Institut, An der Immenburg 4, 53121, Bonn, Germany
| | - Svenja Lacher
- Pharmazeutische Chemie I, Universität Bonn, Pharma-Zentrum Bonn, Pharmazeutisches Institut, An der Immenburg 4, 53121, Bonn, Germany
| | - Anna-Maria Herzner
- Pharmazeutische Chemie I, Universität Bonn, Pharma-Zentrum Bonn, Pharmazeutisches Institut, An der Immenburg 4, 53121, Bonn, Germany
| | - Rajan Subramanian Kombu
- University College of Pharmaceutical Sciences, Kakatiya University, 506 009, Warangal, India
| | - Raghuram Rao Akkinepally
- Pharmazeutische Chemie I, Universität Bonn, Pharma-Zentrum Bonn, Pharmazeutisches Institut, An der Immenburg 4, 53121, Bonn, Germany.,University College of Pharmaceutical Sciences, Kakatiya University, 506 009, Warangal, India
| | - Jörg Hockemeyer
- Pharmazeutische Chemie I, Universität Bonn, Pharma-Zentrum Bonn, Pharmazeutisches Institut, An der Immenburg 4, 53121, Bonn, Germany
| | - Christa E Müller
- Pharmazeutische Chemie I, Universität Bonn, Pharma-Zentrum Bonn, Pharmazeutisches Institut, An der Immenburg 4, 53121, Bonn, Germany.
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Saito S. Management of cognition as reported in Japanese historical documents and modern anesthesiology research papers. J Anesth 2016; 30:739-44. [DOI: 10.1007/s00540-016-2219-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 07/14/2016] [Indexed: 01/18/2023]
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Ciproxifan, an H3 receptor antagonist, improves short-term recognition memory impaired by isoflurane anesthesia. J Anesth 2016; 30:684-90. [DOI: 10.1007/s00540-016-2189-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 05/05/2016] [Indexed: 02/04/2023]
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El-Tahan MR, Regal M. Target-Controlled Infusion of Remifentanil Without Muscle Relaxants Allows Acceptable Surgical Conditions During Thoracotomy Performed Under Sevoflurane Anesthesia. J Cardiothorac Vasc Anesth 2015; 29:1557-66. [PMID: 26022912 DOI: 10.1053/j.jvca.2015.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To test the hypothesis that the use of a nonmuscle relaxant anesthetic technique (NMRT) during thoracotomy would be associated with comparable surgical conditions with the standard use of neuromuscular blocking drugs. DESIGN A prospective, randomized, single-blind, controlled study. SETTING A single university hospital. PARTICIPANTS Sixty-six patients scheduled for open thoracotomy under sevoflurane anesthesia with a target-controlled infusion (TCI) of remifentanil. INTERVENTIONS After ethical approval, patients were randomly assigned to receive cisatracurium or saline (n = 33 for each group) during the entire study period. MEASUREMENTS AND MAIN RESULTS The four-point ordinal surgical rating scale, the intubating conditions, the use of anesthetics and vasopressors, the incidence of light anesthesia (defined as an episode with state entropy values that exceeded 50 and/or mean arterial blood pressure and heart rate values that exceeded the baseline by 20% and lasted for more than 3 consecutive minutes), and the times to clinical recovery and postanesthesia care unit (PACU) discharge, hospital stays, and postoperative residual curarization (PORC) were recorded. Compared with the use of cisatracurium, the use of NMRT resulted in comparable good-to-excellent surgical rating scales (90.9% v 94.0%, respectively; p = 0.642), good-to-excellent laryngoscopy and endobronchial intubating conditions (93.9% v 100%, respectively; p>0.09), use of anesthetic and vasopressor medications, and hospital stays, together with shorter clinical recovery, extubation times (7.6 [95% CI 6.82 to 8.39] v 19.0 [95% CI 15.76 to 22.23] minutes, respectively; p<0.001), and PACU stays (37.4 [95% CI 35.09 to 39.79] v 70.9 [95% CI 56.90 to 84.91] minutes, respectively; p<0.001). The use of cisatracurium resulted in a nonstatistical number of light anesthesia episodes upon positioning, skin incision, and rib separation (p>0.624, with Fisher's exact test). There were no failed intubations in the 2 groups. No patient received cisatracurium in the NMRT group. Two patients (6.1%) in the cisatracurium group experienced PORC that required tracheal intubation in the PACU. CONCLUSION The use of TCI of remifentanil with NMRT offers acceptable laryngoscopy, intubating, and surgical conditions during sevoflurane anesthesia for open thoracotomy, especially when. the anesthesiologists have more than 10 years' experience.
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Affiliation(s)
- Mohamed R El-Tahan
- Departments of Anesthesiology; Department of Anesthesiology, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt.
| | - Mohamed Regal
- Surgery, King Fahd Hospital of the University of Dammam, Dammam, Saudi Arabia
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Ochoa-Cortes F, Liñán-Rico A, Jacobson KA, Christofi FL. Potential for developing purinergic drugs for gastrointestinal diseases. Inflamm Bowel Dis 2014; 20:1259-87. [PMID: 24859298 PMCID: PMC4340257 DOI: 10.1097/mib.0000000000000047] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Treatments for inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), functional dyspepsia, or motility disorders are not adequate, and purinergic drugs offer exciting new possibilities. Gastrointestinal symptoms that could be targeted for therapy include visceral pain, inflammatory pain, dysmotility, constipation, and diarrhea. The focus of this review is on the potential for developing purinergic drugs for clinical trials to treat gastrointestinal symptoms. Purinergic receptors are divided into adenosine P1 (A(1), A(2A), A(2B), A(3)), ionotropic ATP-gated P2X ion channel (P2X(1-7)), or metabotropic P2Y(1,2,4,6,11-14) receptors. There is good experimental evidence for targeting A(2A), A(2B), A(3), P2X(7), and P2X(3) receptors or increasing endogenous adenosine levels to treat IBD, inflammatory pain, IBS/visceral pain, inflammatory diarrhea, and motility disorders. Purine genes are also potential biomarkers of disease. Advances in medicinal chemistry have an accelerated pace toward clinical trials: Methotrexate and sulfasalazine, used to treat IBD, act by stimulating CD73-dependent adenosine production. ATP protects against NSAID-induced enteropathy and has pain-relieving properties in humans. A P2X(7)R antagonist AZD9056 is in clinical trials for Crohn's disease. A(3) adenosine receptor drugs target inflammatory diseases (e.g., CF101, CF102). Dipyridamole, a nucleoside uptake inhibitor, is in trials for endotoxemia. Drugs for pain in clinical trials include P2X(3)/P2X(2/3) (AF-219) and P2X(7) (GSK1482160) antagonists and A(1) (GW493838) or A(2A) (BVT.115959) agonists. Iberogast is a phytopharmacon targeting purine mechanisms with efficacy in IBS and functional dyspepsia. Purinergic drugs have excellent safety/efficacy profile for prospective clinical trials in IBD, IBS, functional dyspepsia, and inflammatory diarrhea. Genetic polymorphisms and caffeine consumption may affect susceptibility to treatment. Further studies in animals can clarify mechanisms and test new generation drugs. Finally, there is still a huge gap in our knowledge of human pathophysiology of purinergic signaling.
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Affiliation(s)
- Fernando Ochoa-Cortes
- Department of Anesthesiology, The Wexner Medical Center at The Ohio State University, Columbus, Ohio
| | - Andromeda Liñán-Rico
- Department of Anesthesiology, The Wexner Medical Center at The Ohio State University, Columbus, Ohio
| | - Kenneth A. Jacobson
- Laboratory of Bioorganic Chemistry & Molecular Recognition Section, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health
| | - Fievos L. Christofi
- Department of Anesthesiology, The Wexner Medical Center at The Ohio State University, Columbus, Ohio
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Studies on postoperative neurological complications, particularly cognitive dysfunction. J Anesth 2013; 27:647-9. [PMID: 23873004 DOI: 10.1007/s00540-013-1674-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 07/08/2013] [Indexed: 10/26/2022]
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