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Bond SL, Greco-Otto P, MacLeod J, Galezowski A, Bayly W, Léguillette R. Efficacy of dexamethasone, salbutamol, and reduced respirable particulate concentration on aerobic capacity in horses with smoke-induced mild asthma. J Vet Intern Med 2020; 34:979-985. [PMID: 31953974 PMCID: PMC7096652 DOI: 10.1111/jvim.15696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 12/20/2019] [Indexed: 12/14/2022] Open
Abstract
Background Mild asthma in horses decreases racing performance and impairs gas exchange. The efficacy of treatment on performance is unknown. Hypothesis Treatment targeting lung inflammation improves V˙O2peak in horses with mild asthma. Animals Thoroughbred polo horses (n = 12) with smoke‐induced mild asthma. Horses were exposed to increased ambient particulate matter (35.51 μg/m3 [PM2.5]; day mean, centrally measured) from day −33 to 0, from bushfire smoke (natural model). Methods Prospective, randomized, placebo‐controlled, double‐blinded clinical trial. All horses completed 3 V˙O2peak tests, measuring aerobic and anaerobic variables: day 0 ‐baseline; day 16 ‐after dexamethasone (20 mg IM q24h; DEX, n = 6) or saline treatment (SALINE, n = 6), under improved ambient PM2.5 concentrations (7.04 μg/m3); day 17‐15‐30mins after inhaled salbutamol (1500 μg). Bronchoalveolar lavage and mucus scoring were performed on day −8 and day 20. Linear mixed effects models were used to examine the effects of timepoint and treatment group on BAL differential cell counts, mucus scores, aerobic and anaerobic variables. Results Horses’ mucus scores improved significantly from day −8 to 20 by 1.27 ± .38 (P = .01). There was a significant increase in V˙O2peak of 15.5 ± 4.0 mL(min.kg)−1 from day 0 to 17 (P = .002), representing an average (mean) increase in V˙O2peak of 13.2%. There was no difference in V˙O2peak between treatment groups (SALINE versus DEX) at any timepoint. Conclusions and Clinical Importance This study highlighted the key role of improved air quality on functionally important airway inflammation. Evidence provided is central to increasing owner compliance regarding improved air quality for the treatment and prevention of mild asthma.
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Affiliation(s)
- Stephanie L Bond
- Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Jacqueline MacLeod
- Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Angelica Galezowski
- Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Warwick Bayly
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington
| | - Renaud Léguillette
- Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
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Peñuelas O, Keough E, López-Rodríguez L, Carriedo D, Gonçalves G, Barreiro E, Lorente JÁ. Ventilator-induced diaphragm dysfunction: translational mechanisms lead to therapeutical alternatives in the critically ill. Intensive Care Med Exp 2019; 7:48. [PMID: 31346802 PMCID: PMC6658639 DOI: 10.1186/s40635-019-0259-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 02/08/2023] Open
Abstract
Mechanical ventilation [MV] is a life-saving technique delivered to critically ill patients incapable of adequately ventilating and/or oxygenating due to respiratory or other disease processes. This necessarily invasive support however could potentially result in important iatrogenic complications. Even brief periods of MV may result in diaphragm weakness [i.e., ventilator-induced diaphragm dysfunction [VIDD]], which may be associated with difficulty weaning from the ventilator as well as mortality. This suggests that VIDD could potentially have a major impact on clinical practice through worse clinical outcomes and healthcare resource use. Recent translational investigations have identified that VIDD is mainly characterized by alterations resulting in a major decline of diaphragmatic contractile force together with atrophy of diaphragm muscle fibers. However, the signaling mechanisms responsible for VIDD have not been fully established. In this paper, we summarize the current understanding of the pathophysiological pathways underlying VIDD and highlight the diagnostic approach, as well as novel and experimental therapeutic options.
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Affiliation(s)
- Oscar Peñuelas
- Intensive Care Unit, Hospital Universitario de Getafe, Carretera de Toledo, km 12.5, 28905, Getafe, Madrid, Spain. .,Centro de Investigación en Red de Enfermedades Respiratorias [CIBERES], Instituto de Salud Carlos III [ISCIII], Madrid, Spain.
| | - Elena Keough
- Intensive Care Unit, Hospital Universitario de Getafe, Carretera de Toledo, km 12.5, 28905, Getafe, Madrid, Spain
| | - Lucía López-Rodríguez
- Intensive Care Unit, Hospital Universitario de Getafe, Carretera de Toledo, km 12.5, 28905, Getafe, Madrid, Spain
| | - Demetrio Carriedo
- Intensive Care Unit, Hospital Universitario de Getafe, Carretera de Toledo, km 12.5, 28905, Getafe, Madrid, Spain
| | - Gesly Gonçalves
- Intensive Care Unit, Hospital Universitario de Getafe, Carretera de Toledo, km 12.5, 28905, Getafe, Madrid, Spain
| | - Esther Barreiro
- Centro de Investigación en Red de Enfermedades Respiratorias [CIBERES], Instituto de Salud Carlos III [ISCIII], Madrid, Spain.,Pulmonology Department-Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, IMIM-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department [CEXS], Barcelona, Spain.,Universitat Pompeu Fabra [UPF], Barcelona Biomedical Research Park [PRBB], Barcelona, Spain
| | - José Ángel Lorente
- Intensive Care Unit, Hospital Universitario de Getafe, Carretera de Toledo, km 12.5, 28905, Getafe, Madrid, Spain.,Centro de Investigación en Red de Enfermedades Respiratorias [CIBERES], Instituto de Salud Carlos III [ISCIII], Madrid, Spain.,Universidad Europea, Madrid, Spain
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Suneby Jagers JV, Ji M, Rothwell B, Easton PA. Aminophylline increases parasternal muscle action in awake canines. Pulm Pharmacol Ther 2019; 56:1-7. [PMID: 30797981 DOI: 10.1016/j.pupt.2019.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 12/23/2018] [Accepted: 02/10/2019] [Indexed: 11/30/2022]
Abstract
The traditional theophylline bronchodilator, aminophylline, is still widely used, especially in the treatment of COPD. The effects of aminophylline on ventilation and action of the costal diaphragm have been previously defined, but other respiratory muscles - notably the chest wall, are not well determined. Therefore, we investigated the effects of aminophylline on the Parasternal intercostal, a key obligatory inspiratory muscle, examining muscle length, shortening and EMG. We studied 11 awake canines, chronically implanted with sonomicrometer crystals and fine-wire EMG electrodes in the parasternal muscle. Ventilatory parameters, muscle length (shortening), and moving average muscle EMG activity, were measured at baseline and with aminophylline, during resting and hypercapnic stimulated breathing. Experiments were carried out prior to administration of aminophylline (baseline), and 1.5 h after loading and ongoing infusion. Minute ventilation, tidal volume and respiratory frequency all increased significantly with aminophylline, both during resting breathing and at equivalent levels of hypercapnic stimulated breathing. Parasternal baseline muscle length was entirely unchanged with aminophylline. Parasternal shortening increased significantly with aminophylline while corresponding parasternal EMG activity remained constant, consistent with increased contractility. Thus, in awake, intact mammals, aminophylline, in the usual therapeutic range, elicits increased ventilation and increased contractility of all primary inspiratory respiratory muscles, including both chest wall and diaphragm.
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Affiliation(s)
- Jenny V Suneby Jagers
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael Ji
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bruce Rothwell
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul A Easton
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada.
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Yu TJ, Liu YC, Chu CM, Hu HC, Kao KC. Effects of theophylline therapy on respiratory muscle strength in patients with prolonged mechanical ventilation: A retrospective cohort study. Medicine (Baltimore) 2019; 98:e13982. [PMID: 30633180 PMCID: PMC6336648 DOI: 10.1097/md.0000000000013982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Mechanical ventilation may cause diaphragm weakness an effect termed ventilator-induced diaphragm dysfunction (VIDD). The prevalence of VIDD among patients receiving mechanical ventilation is very high, with the degree of diaphragmatic atrophy being associated with the length of mechanical ventilation. Theophylline is known to increase diaphragmatic contractility and reduce fatigue, so in this study, we evaluated the effect of theophylline in patients with prolonged mechanical ventilation.Patients who depended on mechanical ventilation were included in the study. We compared the maximum inspiratory pressure (PImax) values, rapid shallow breathing index (RSBI) values, and successful weaning rates of theophylline-treated and non-theophylline-treated patients.Eighty-four patients received theophylline and 76 patients did not. These 2 groups' clinical characteristics, including their PImax and RSBI at initial admission, were similar. The results showed that the theophylline-treated group had significantly better PImax and RSBI, with a higher last PImax (30.1 ± 9.7 cmH2O vs 26.9 ± 9.1 cmH2O; P = .034) and lower last RSBI (107.0 ± 68.4 vs 131.4 ± 77.7; P = .036). The improvements to each respective patient's PImax and RSBI were also significantly higher in the theophylline-treated group (PImax: 20.1 ± 5.7% vs 3.2 ± 1.1%, P = .005; RSBI: 11.2 ± 3.0% vs 2.7 ± 1.6%, P = .015). The weaning success rate of the theophylline-treated group was also higher, but not significantly so.Theophylline might improve respiratory muscle strength in patients with prolonged mechanical ventilation and it needs further prospective studies to confirm.
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Affiliation(s)
- Teng-Jen Yu
- Department of Pulmonary and Critical Care Medicine, Chang-Gung Memorial Hospital, Keelung
| | - Yu-Chih Liu
- Department of Pulmonary and Critical Care Medicine, Chang-Gung Memorial Hospital, Keelung
| | - Chien-Min Chu
- Department of Pulmonary and Critical Care Medicine, Chang-Gung Memorial Hospital, Keelung
| | - Han-Chung Hu
- Department of Thoracic Medicine, Chang-Gung Memorial Hospital
- Department of Respiratory Therapy, Chang-Gung University, Taoyuan, Taiwan
| | - Kuo-Chin Kao
- Department of Thoracic Medicine, Chang-Gung Memorial Hospital
- Department of Respiratory Therapy, Chang-Gung University, Taoyuan, Taiwan
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Aghabiklooei A, Sangsefidi J. The effects of intravenous aminophylline on level of consciousness in acute intentional benzodiazepines poisoning in comparison to flumazenil. Hum Exp Toxicol 2017; 36:311-316. [PMID: 27142356 DOI: 10.1177/0960327116646619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM Acute intentional benzodiazepine poisoning is marked by a significant loss of consciousness, aspiration pneumonia, and increased rates of mortality and morbidity, especially in older patients with underlying heart or lung disease. These patients may need flumazenil to reverse the respiratory effects of benzodiazepines. The positive effects of aminophylline on respiration and neonatal apnea improvement have been shown previously. However, its possible effects on increasing the level of consciousness have never been evaluated. METHODS In a placebo-controlled study, we assessed the effectiveness of aminophylline on increasing the level of consciousness. RESULTS Time to full awakening was significantly shorter in those who received aminophylline (72 min vs. 881 min, p = 0.001), compared to those who received a placebo. CONCLUSION When "flumazenil" is contraindicated or unavailable, intravenous aminophylline can be used as a second choice.
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Affiliation(s)
- A Aghabiklooei
- 1 Department of Legal Medicine and Toxicology, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - J Sangsefidi
- 2 Tehran University of Medical Sciences, Tehran, Iran
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Yuzkat N, Kati I, Isik Y, Kavak S, Goktas U, Cengiz N. Effects of Theophylline with Methylprednisolone Combination Therapy on Biomechanics and Histopathology in Diaphragm Muscles of Rats. Inflammation 2016; 39:1635-41. [DOI: 10.1007/s10753-016-0397-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kim WY, Park SH, Kim WY, Huh JW, Hong SB, Koh Y, Lim CM. Effect of theophylline on ventilator-induced diaphragmatic dysfunction. J Crit Care 2016; 33:145-50. [PMID: 26948253 DOI: 10.1016/j.jcrc.2016.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 11/13/2015] [Accepted: 01/06/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the effect of theophylline in patients with ventilator-induced diaphragmatic dysfunction (VIDD). MATERIALS AND METHODS Patients who required mechanical ventilation at least 72 hours, met the criteria for a spontaneous breathing trial, and had evidence of VIDD by ultrasonography were included in the study. RESULTS Of the 40 patients, 21 received theophylline and 19 did not. Clinical characteristics were similar in the 2 groups. Assessment of VIDD showed no between-group differences in baseline diaphragmatic excursion (DE) of both hemidiaphragms. Changes in DE from baseline to 72 hours (ΔDE) were significantly higher in the theophylline group than in the nontheophylline group in the right (3.5 ± 4.5 mm vs 0.4 ± 2.1 mm; P = .004) and left (3.2 ± 5.1 mm vs 0.1 ± 4.0 mm; P = .03) hemidiaphragms and in the total DE of both diaphragms (6.9 ± 9.1 mm vs 0.5 ± 5.7 mm; P = .02). In the theophylline group, theophylline was effective for the diaphragms with VIDD, whereas it was not effective for the diaphragms without VIDD. ΔDE in the right (rs = -0.49, P = .006) hemidiaphragm and total Δ DE in both diaphragms (rs = -0.46, P = .01) correlated negatively with weaning time. CONCLUSIONS Theophylline significantly improved diaphragmatic movements in patients with VIDD. Our results warrant a larger study to determine whether theophylline use has benefits during weaning from mechanical ventilation.
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Affiliation(s)
- Won-Young Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea.
| | - So Hee Park
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea.
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea.
| | - Jin Won Huh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea.
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea.
| | - Younsuck Koh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea.
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea.
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Dong Y, Li Y, Sun Y, Mao J, Yao F, Tian Y, Wang L, Li L, Li S, Li J. Bufei Jianpi granules improve skeletal muscle and mitochondrial dysfunction in rats with chronic obstructive pulmonary disease. Altern Ther Health Med 2015; 15:51. [PMID: 25888379 PMCID: PMC4378020 DOI: 10.1186/s12906-015-0559-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 02/18/2015] [Indexed: 12/31/2022]
Abstract
Background Bufei Jianpi granules has been confirmed effective in improving pulmonary function, alleviating acute exacerbations, improving six-minute walk distance and quality of life, and benefited in 12-month follow-up in chronic obstructive pulmonary disease (COPD) patients with syndrome of lung-spleen qi deficiency. Skeletal muscle dysfunction (SMD), an important extrapulmonary complication, occurs in the very initiation of COPD and is closely related to morbidity and mortality. To evaluate the efficacy of Bufei Jianpi granules on SMD, we observed skeletal muscular function and histomorphology, mitochondrial morphormetry and proteins in COPD rats induced by cigarette-smoke and Klebsiella pneumoniae. Methods Seventy-two Sprague–Dawley rats were randomized into Control + Saline, Control + Bufei Jianpi, Control + Aminophylline, COPD + Saline, COPD + Bufei Jianpi and COPD + Aminophylline groups. From week 9 to 20, rats were administrated intragastricly by normal saline, Bufei Jianpi granules and aminophylline, respectively. Muscular tension and fatigue index of intercostal muscle, quadriceps, biceps and soleus were detected by using electrophysiological technology. Pathological and ultrastructural changes and expressions of mitochondrial Bcl-2 nineteen-kilodalton interacting protein 3 (Bnip3) and cytoplasm cytochrome C (Cyto C) in the four skeletal muscles were observed by using optical and electron microscope and western blotting. Results There was no statistical difference among the control rats treated with saline, Bufei Jianpi granules or aminophylline in above-mentioned parameters. Muscular tension, mitochondria volume density (Vv) and compared membrane surface (δm) of the four muscles were significantly lower in COPD + Saline group compared to Control + Saline group, while fatigue index, mitochondria surface area (δ), Bnip3 and Cyto C were higher (P < 0.05). COPD rats showed more morphological changes in muscle tissues than controls, such as atrophy, degeneration, necrosis and matrix hyperplasia. Utrastructurally, mitochondria populations decreased significantly in the four muscles, and were shrunken and even cavitation changed. The up-mentioned parameters were improved in Bufei Jianpi group (P < 0.05) in the four muscles. Conclusions Bufei Jianpi granules can improve skeletal muscle function via improving mitochondria population and function, reducing apoptotic factors such as Bnip3 and Cyto C, and is more effective than aminophylline.
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Sarwal A, Cartwright MS, Walker FO, Mitchell E, Buj-Bello A, Beggs AH, Childers MK. Ultrasound assessment of the diaphragm: Preliminary study of a canine model of X-linked myotubular myopathy. Muscle Nerve 2014; 50:607-9. [PMID: 24861988 DOI: 10.1002/mus.24294] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2014] [Indexed: 12/14/2022]
Abstract
INTRODUCTION We tested the feasibility of using neuromuscular ultrasound for non-invasive real-time assessment of diaphragmatic structure and function in a canine model of X-linked myotubular myopathy (XLMTM). METHODS Ultrasound images in 3 dogs [wild-type (WT), n=1; XLMTM untreated, n=1; XLMTM post-AAV8-mediated MTM1 gene replacement, n=1] were analyzed for diaphragm thickness, change in thickness with respiration, muscle echogenicity, and diaphragm excursion amplitude during spontaneous breathing. RESULTS Quantitative parameters of diaphragm structure were different among the animals. WT diaphragm was thicker and less echogenic than the XLMTM control, whereas the diaphragm measurements of the MTM1-treated XLMTM dog were comparable to those of the WT dog. CONCLUSIONS This pilot study demonstrates the feasibility of using ultrasound for quantitative assessment of the diaphragm in a canine model. In the future, ultrasonography may replace invasive measures of diaphragm function in canine models and in humans for non-invasive respiratory monitoring and evaluation of neuromuscular disease.
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Affiliation(s)
- Aarti Sarwal
- Department of Neurology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, 27157, USA; Department of Anesthesiology, Section on Critical Care, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Yokoba M, Katagiri M, Ichikawa T, Takakura A, Ishii N, Kurosaki Y, Yamada Y, Tsukushi T, Masuda N, Easton PA, Nishii Y, Okada Y, Abe T. Aminophylline increases respiratory muscle activity during hypercapnia in humans. Pulm Pharmacol Ther 2014; 30:96-101. [PMID: 24721495 DOI: 10.1016/j.pupt.2014.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/12/2014] [Accepted: 03/31/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Theophylline is an old drug traditionally used as a bronchodilator, although it was recently shown to possess anti-inflammatory properties, enhance the actions of corticosteroid actions, and stimulate the respiratory neuronal network. Theophylline has been recognized as an important drug for not only asthma but also corticosteroid-insensitive chronic obstructive pulmonary disease (COPD). To clarify the role of theophylline in hypercapnic ventilatory responses in humans, we analyzed the effects of aminophylline administered at the usual clinical therapeutic doses on ventilation and augmentation of respiratory muscle contractility in room air and under 3 conditions of hypercapnia. STUDY DESIGN We performed electromyography (EMG) of the parasternal intercostal muscle (PARA) and transversus abdominis muscle (TA) in 7 healthy subjects and recorded both ventilatory parameters and EMG data in room air and under 3 conditions of hypercapnia before (control) and during aminophylline administration. RESULTS Before aminophylline administration (control), hypercapnic stimulation elicited ventilatory augmentation in a hypercapnia intensity-dependent manner. Ventilatory parameters (tidal volume, frequency of respiration, and minute ventilation) showed significant increases from lower PaCO2 levels during aminophylline administration when compared with the corresponding values before aminophylline administration. EMG activity of both PARA and TA increased significantly at each level of hypercapnia, and those augmentations were shown from lower PaCO2 levels during aminophylline administration. CONCLUSION Aminophylline administered at the usual clinical therapeutic dose increases ventilation and EMG activity of both inspiratory and expiratory muscles during hypercapnia in healthy humans.
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Affiliation(s)
- Masanori Yokoba
- Kitasato University School of Allied Health Sciences, Kanagawa, Japan; Division of Respiratory Medicine, Kitasato University Hospital, Kanagawa, Japan.
| | - Masato Katagiri
- Kitasato University School of Allied Health Sciences, Kanagawa, Japan; Division of Respiratory Medicine, Kitasato University Hospital, Kanagawa, Japan
| | - Tsuyoshi Ichikawa
- Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan; Rehabilitation Medicine, Tokai University Oiso Hospital, Kanagawa, Japan
| | - Akira Takakura
- Division of Respiratory Medicine, Kitasato University Hospital, Kanagawa, Japan
| | - Naohito Ishii
- Kitasato University School of Allied Health Sciences, Kanagawa, Japan
| | | | - Yuya Yamada
- Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
| | - Tomoaki Tsukushi
- Department of Clinical Laboratories, Kitasato University Hospital, Kanagawa, Japan
| | - Noriyuki Masuda
- Division of Respiratory Medicine, Kitasato University Hospital, Kanagawa, Japan
| | - Paul A Easton
- Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
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Kongenitale myotone Dystrophie mit Zwerchfellparese. Monatsschr Kinderheilkd 2012. [DOI: 10.1007/s00112-012-2721-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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El Tahan MR. Effects of aminophylline on cognitive recovery after sevoflurane anesthesia. J Anesth 2011; 25:648-56. [PMID: 21755342 DOI: 10.1007/s00540-011-1190-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 06/06/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE Aminophylline accelerates the recovery from sevoflurane anesthesia. We studied the effects of escalating doses of aminophylline on cognitive and clinical recovery after sevoflurane anesthesia. METHODS After ethical approval and informed consent, 150 patients scheduled for elective surgery under sevoflurane-fentanyl anesthesia were randomly allocated to receive saline or 2, 3, 4 or 5 mg/kg of aminophylline (n = 30 for each) at the end of anesthesia (T (0)). Short Orientation Memory Concentration Test (SOMCT) scores, entropy values, end-tidal sevoflurane concentrations (EtSevo), times to eyes opening and extubation, respiratory rate (RR) and tidal volume (TV) were recorded. RESULTS Compared to placebo, patients receiving 2, 3, 4 and 5 mg/kg of aminophylline had higher SOMCT scores [median (25th percentile/75th percentile) 20.6 (19/23), 21.5 (21/22), 24.5 (24-25), 25.5 (25/26), respectively, vs. 13.5 (13/14) at 30 min after extubation, and 24 (22/26), 25 (24/26), 27.5 (27-28), 27.5 (27/28), respectively, vs. 18.5 (18/19) at 45 min after extubation], higher entropy values for the first 10 min after T (0), lower EtSevo for the first 4 min after T (0), shorter times to eyes opening [5 (4.0/6.0), 5 (4.0/6.0), 4 (2.0/5.5), and 4 (2.0/6.0), respectively, vs. 9.8 (8.0/11.0) min], shorter times to extubation, shorter times to home discharge (P < 0.001), and higher RR and larger TV values. Patients who received 4 and 5 mg/kg of aminophylline showed higher SOMCT scores, 6 min shorter times to eyes opening and to extubation, and 58 min shorter times to home discharge. CONCLUSION The administration of escalating doses of aminophylline accelerates postoperative cognitive recovery from sevoflurane anesthesia, as measured by the SOMCT, due to increased ventilatory elimination of sevoflurane.
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Affiliation(s)
- Mohamed R El Tahan
- Anesthesiology Department, College of Medicine, University of Dammam, P.O. 40289, Dammam, Al Khobar, 31952, Saudi Arabia.
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