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Silva A, Costa B, Castro I, Mourão J, Vale N. New Perspective for Drug-Drug Interaction in Perioperative Period. J Clin Med 2023; 12:4810. [PMID: 37510925 PMCID: PMC10381519 DOI: 10.3390/jcm12144810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
In this review, we aim to discuss current information on drug interactions in the perioperative period. During this period, patients receive several drugs that may interact with each other and affect the efficacy and safety of the treatment. There are three types of drug interactions: pharmacodynamic, pharmacokinetic, and pharmaceutical. It is important to recognize that drug interactions may increase the toxicity of the drug or reduce its efficacy, increasing the risk of complications in the perioperative period. This review describes the most commonly used perioperative drugs approved by the FDA and some of the described interactions between them. Thoroughly reviewing a patient's medication list and identifying potential interactions are essential steps in minimizing risks. Additionally, vigilant monitoring of patients during and after surgery plays a pivotal role in early detection of any signs of drug interactions. This article emphasizes the significance of addressing DDIs in the perioperative period to ensure patient well-being and advocates for the implementation of careful monitoring protocols to promptly identify and manage potential interactions.
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Affiliation(s)
- Abigail Silva
- OncoPharma Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Bárbara Costa
- OncoPharma Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Irene Castro
- OncoPharma Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
- Department of Anesthesiology and Intensive Care Medicine, Instituto Português de Oncologia do Porto (IPO-Porto), 4200-072 Porto, Portugal
| | - Joana Mourão
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Anesthesiology, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Surgery and Physiology Department, Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
| | - Nuno Vale
- OncoPharma Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Department of Community Medicine, Health Information and Decision (MEDCIDS), Faculty of Medicine, University of Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
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Burlacu CC, Neag MA, Mitre AO, Sirbu AC, Badulescu AV, Buzoianu AD. The Role of miRNAs in Dexmedetomidine's Neuroprotective Effects against Brain Disorders. Int J Mol Sci 2022; 23:5452. [PMID: 35628263 PMCID: PMC9141783 DOI: 10.3390/ijms23105452] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 02/04/2023] Open
Abstract
There are limited neuroprotective strategies for various central nervous system conditions in which fast and sustained management is essential. Neuroprotection-based therapeutics have become an intensively researched topic in the neuroscience field, with multiple novel promising agents, from natural products to mesenchymal stem cells, homing peptides, and nanoparticles-mediated agents, all aiming to significantly provide neuroprotection in experimental and clinical studies. Dexmedetomidine (DEX), an α2 agonist commonly used as an anesthetic adjuvant for sedation and as an opioid-sparing medication, stands out in this context due to its well-established neuroprotective effects. Emerging evidence from preclinical and clinical studies suggested that DEX could be used to protect against cerebral ischemia, traumatic brain injury (TBI), spinal cord injury, neurodegenerative diseases, and postoperative cognitive disorders. MicroRNAs (miRNAs) regulate gene expression at a post-transcriptional level, inhibiting the translation of mRNA into functional proteins. In vivo and in vitro studies deciphered brain-related miRNAs and dysregulated miRNA profiles after several brain disorders, including TBI, ischemic stroke, Alzheimer's disease, and multiple sclerosis, providing emerging new perspectives in neuroprotective therapy by modulating these miRNAs. Experimental studies revealed that some of the neuroprotective effects of DEX are mediated by various miRNAs, counteracting multiple mechanisms in several disease models, such as lipopolysaccharides induced neuroinflammation, β-amyloid induced dysfunction, brain ischemic-reperfusion injury, and anesthesia-induced neurotoxicity models. This review aims to outline the neuroprotective mechanisms of DEX in brain disorders by modulating miRNAs. We address the neuroprotective effects of DEX by targeting miRNAs in modulating ischemic brain injury, ameliorating the neurotoxicity of anesthetics, reducing postoperative cognitive dysfunction, and improving the effects of neurodegenerative diseases.
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Affiliation(s)
- Codrin-Constantin Burlacu
- Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Maria-Adriana Neag
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
| | - Andrei-Otto Mitre
- Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Alexandru-Constantin Sirbu
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
| | - Andrei-Vlad Badulescu
- Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Anca-Dana Buzoianu
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
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Chen F, Fan Y, Zhu S. Postoperative analgesic effect of parecoxib sodium local anesthesia in patients with breast cancer through systematic review and meta-analysis. Gland Surg 2021; 10:3082-3096. [PMID: 34926224 DOI: 10.21037/gs-21-632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/29/2021] [Indexed: 11/06/2022]
Abstract
Background Postoperative pain can seriously affect a patient's recovery, and parecoxib sodium has a good analgesic effect. However, there is a lack of clinically systematic analyses of the effects of parecoxib sodium on postoperative pain in breast cancer patients. The aim of the present study was to systematically evaluate the efficacy and safety of parecoxib sodium local anesthesia in the treatment of postoperative pain in breast cancer patients. Methods Literature published from January 2010 to December 2020 was searched in the China National Knowledge Infrastructure database, Wanfang database, PubMed, and Cochrane Library. Literature on randomized controlled trials of parecoxib sodium local anesthesia in patients with breast cancer was collected. Method of treatment was extracted and literature quality was assessed. Meta-analyses of included literature were performed using RevMan 5.3. Results A total of 17 randomized controlled trials were included, with a total of 1,032 breast cancer surgery patients. The experimental group was treated with parecoxib sodium anesthesia, and the control group was treated with other anesthesia methods. The meta-analysis results showed that there were obvious differences among visual analogue scale (VAS) score of the experimental group and control group 2 h after surgery [mean difference (MD): -0.79; 95% confidence interval (CI): -1.29 to -0.29; P=0.002], 4 h (MD =-0.77; 95% CI: =-1.51 to -0.03; P=0.04), 6 h (MD: -1.10; 95% CI: -1.41 to -0.80; P<0.00001), 8 h (MD: -0.66; 95% CI: -1.00 to -0.33; P=0.0001), 12 h (MD: -0.92; 95% CI: -1.24 to -0.60; P<0.00001), 24 h (MD: -0.86; 95% CI: -1.15 to -0.58; P<0.00001), and 48 h (MD: -0.90; 95% CI: -1.47 to -0.33; P=0.002). Moreover, visual analog scale score and the postoperative controlled analgesia frequency of patients in the experimental group (MD: -2.08; 95% CI: -2.88 to -1.27; P<0.00001) and the incidence of adverse reactions (odds ratio: 0.52; 95% CI: 0.34-0.80; P=0.002) were significantly reduced. Discussion Parecoxib sodium local anesthesia for breast cancer patients has good postoperative analgesia and treatment safety.
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Affiliation(s)
- Fangfang Chen
- Department of Surgery, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yangfan Fan
- Department of Surgery, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Saisa Zhu
- Department of Surgery, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Hu J, Su XJ, Si HL, Song RX, Zhang F, Qiu XJ, Chen XP. Simultaneous Determination of Celecoxib, Dezocine and Dexmedetomidine in Beagle Plasma Using UPLC-MS/MS Method and the Application in Pharmacokinetics. Drug Des Devel Ther 2021; 15:2529-2541. [PMID: 34163139 PMCID: PMC8214532 DOI: 10.2147/dddt.s314562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/28/2021] [Indexed: 01/31/2023] Open
Abstract
Background An efficient, fast and sensitive ultra high-performance liquid chromatography-mass spectrometry (UPLC-MS/MS) method for simultaneous determination of celecoxib (CEL), dezocine (DEZ) and dexmedetomidine (DEX) in beagle plasma were established. Methods The beagle dogs plasmawas precipitated by acetonitrile. The column was Acquity UPLC BEH C18 column and the mobile phase was acetonitrile-formic acid with gradient mode, and the flow rate was set at 0.4 mL/min. Under the positive ion mode, CEL, DEZ, DEX and Midazolam (internal standard, IS) were monitored by multiple reaction monitoring (MRM) as the following mass transition pairs: m/z 381.10→282.10 for CEL, m/z 246.20→147.00 for DEZ, m/z 201.10→94.90 for DEX, and m/z 326.10→291.10 for IS. Results This UPLC-MS/MS method had good linearity for CEL, DEZ and DEX. The RSDs of inter-day and intra-day precision were the values of 0.31–7.66% and 0.11–9.63%, respectively; the RE values were from −6.05% to 10.98%. The extraction recovery was more than 79%, and the matrix effect was around 100%. The RSDs of stability were less than 8.96%. All of them met the acceptance standard of biological analysis method recommended by FDA. Conclusion This UPLC-MS/MS method is an effective tool for the simultaneous determination of CEL, DEX and DEX, and has been successfully applied to the study of pharmacokinetics in beagle dogs.
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Affiliation(s)
- Jie Hu
- Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China.,Department of Anesthesiology, Luoyang Central Hospital, Luoyang, Henan Province, 471003, People's Republic of China
| | - Xin-Juan Su
- Department of Anesthesiology, Luoyang Central Hospital, Luoyang, Henan Province, 471003, People's Republic of China
| | - Hui-Ling Si
- Department of Anesthesiology, Luoyang Central Hospital, Luoyang, Henan Province, 471003, People's Republic of China
| | - Rui-Xiang Song
- School of Basic Medical Sciences, Henan University of Science and Technology, Luoyang, 471023, People's Republic of China
| | - Fang Zhang
- School of Basic Medical Sciences, Henan University of Science and Technology, Luoyang, 471023, People's Republic of China
| | - Xiang-Jun Qiu
- School of Basic Medical Sciences, Henan University of Science and Technology, Luoyang, 471023, People's Republic of China
| | - Xing-Peng Chen
- Department of Anesthesiology, Luoyang Central Hospital, Luoyang, Henan Province, 471003, People's Republic of China
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An JX, Williams JP, Fang QW, Wang Y, Liu H, Shi L, Zhang WH. Feasibility of Patient-Controlled Sleep with Dexmedetomidine in Treating Chronic Intractable Insomnia. Nat Sci Sleep 2020; 12:1033-1042. [PMID: 33239930 PMCID: PMC7682602 DOI: 10.2147/nss.s262991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/31/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Patient-controlled analgesia (PCA) is an "on-demand" system which allows patients to self-administer intravenous medications in small bolus doses. Based on the principles of PCA, we developed Patient-Controlled Sleep (PCSL) for chronic intractable insomnia where the traditional analgesics in PCA were replaced with dexmedetomidine (Dex), an alpha-2 agonist widely used for premedication, sedation, anxiolysis and analgesia. The purpose of this study was to assess the feasibility of the new method for the treatment of chronic intractable insomnia. PATIENTS AND METHODS Patients with chronic intractable insomnia undergoing PCSL (n=20) were evaluated with the Pittsburgh Sleep Quality Index (PSQI), Symptom Checklist 90 (SCL-90), Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) before and after the treatment. The patient characteristics, overall outcomes and related side effects were also assessed. RESULTS Fifteen patients completed the treatment protocol. The duration of PCSL varied from a few days to four months, and the dosage of Dex gradually decreased without eliciting signs or symptoms of tolerance or physical dependence. The sleep quality improvement occurred immediately after the therapy in 12/15 patients, and of which, 7/12 patients achieved continuously improved sleep quality in follow-up. CONCLUSION PCSL with Dex might be a potential treatment for patients with chronic intractable insomnia. However, it is an off-label use, and the potential side effects of dexmedetomidine with long-term use needs further evaluation.
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Affiliation(s)
- Jian-Xiong An
- Department of Anesthesiology, Pain and Sleep Medicine, Aviation General Hospital of China Medical University & Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing, People's Republic of China.,Savaid Medical School, University of Chinese Academy of Sciences, Beijing, People's Republic of China.,School of Medical Science & Engineering, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, People's Republic of China
| | - John P Williams
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Qi-Wu Fang
- Department of Anesthesiology, Pain and Sleep Medicine, Aviation General Hospital of China Medical University & Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Yong Wang
- Department of Anesthesiology, Pain and Sleep Medicine, Aviation General Hospital of China Medical University & Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Hui Liu
- Department of Anesthesiology, Pain and Sleep Medicine, Aviation General Hospital of China Medical University & Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Le Shi
- Key Laboratory of Mental Health, Peking University Sixth Hospital, Peking University Institute of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, People's Republic of China
| | - Wen-Hao Zhang
- Department of Anesthesiology, Pain and Sleep Medicine, Aviation General Hospital of China Medical University & Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing, People's Republic of China.,Savaid Medical School, University of Chinese Academy of Sciences, Beijing, People's Republic of China
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