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[PMID]:29444390
[Au] Autor:Goode J; Veyckemans F; Tourtchaninoff M; Grosu I
[Ti] Título:The use of alpha 2 agonists during idiopathic scoliosis repair : a narrative review of the literature.
[So] Source:Acta Anaesthesiol Belg;67(2):53-62, 2016.
[Is] ISSN:0001-5164
[Cp] País de publicação:Belgium
[La] Idioma:eng
[Ab] Resumo:Alpha 2 agonists are appreciated drugs designed for the peri-operative period, because of their anxiolytic, sedative and analgesic properties. However, they are usually avoided during scoliosis surgery, a longlasting major procedure involving healthy patients, because of their potential effects on Somatosensory and Motorevoked potentials. The absence ofrecommendations suggests that their effects on evoked potentials are still unclear. Thus, we tried in this narrative review to identify the literature representative of the effects of clonidine and dexmedetomidine on evoked potentials, on human beings, published between 1988 and 2015 in English or French, using GOOGLE SCHOLAR and PUBMED. Paucity of literature prevented any conclusion about Clonidine's effects on evoked potentials, but no data suggested a noxious effect of Clonidine on evoked potentials, used in oral premedication (300 µg) or during the procedure (2 to 5 µg/kg). If literature was more extensive for dexmedetomidine, studies were still controversial. Although the majority of the studies did not find statistically significant differences concerning the effects of this drug on evoked potentials (loading dose of 0.3 to 1 µg/ kg followed by continuous infusion of 0.3 to 0.8 µg/kg/h), 2 case reports and 2 studies described substantial decreases. However, dexmedetomidine's shorter duration of action allowed a quick return to basal situation within an hour. In conclusion, more studies are needed in order to evaluate the effects of alpha 2 agonists on evoked potentials and to assess the safety of their use in this setting.
[Mh] Termos MeSH primário: Agonistas de Receptores Adrenérgicos alfa 2/farmacologia
Clonidina/farmacologia
Dexmedetomidina/farmacologia
Potencial Evocado Motor/efeitos dos fármacos
Potenciais Somatossensoriais Evocados/efeitos dos fármacos
Escoliose/cirurgia
[Mh] Termos MeSH secundário: Agonistas de Receptores Adrenérgicos alfa 2/efeitos adversos
Seres Humanos
Monitorização Fisiológica
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Adrenergic alpha-2 Receptor Agonists); 67VB76HONO (Dexmedetomidine); MN3L5RMN02 (Clonidine)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180215
[St] Status:MEDLINE


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[PMID]:28455405
[Au] Autor:Li Kam Wa ME; Taraborrelli P; Hayat S; Lim PB
[Ad] Endereço:Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK.
[Ti] Título:Respiration driven excessive sinus tachycardia treated with clonidine.
[So] Source:BMJ Case Rep;2017, 2017 Apr 28.
[Is] ISSN:1757-790X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:A 26-year-old man presented to our syncope service with debilitating daily palpitations, shortness of breath, presyncope and syncope following a severe viral respiratory illness 4 years previously. Mobitz type II block had previously been identified, leading to a permanent pacemaker and no further episodes of frank syncope. Transthoracic echocardiography, electophysiological study and repeated urine metanepherines were normal. His palpitations and presyncope were reproducible on deep inspiration, coughing, isometric hand exercise and passive leg raises. We demonstrated rapid increases in heart rate with no change in morphology on his 12 lead ECG. His symptoms were resistant to fludrocortisone, flecainide, ß blockers and ivabradine. Initiation of clonidine in combination with ivabradine led to rapid resolution of his symptoms. We suggest that an excessive respiratory sinus arrhythmia was responsible for his symptoms and achieved an excellent response with the centrally acting sympatholytic clonidine, where previous peripherally acting treatments had failed.
[Mh] Termos MeSH primário: Inalação/fisiologia
Síncope/fisiopatologia
Taquicardia Sinusal/complicações
[Mh] Termos MeSH secundário: Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem
Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico
Adulto
Benzazepinas/administração & dosagem
Benzazepinas/uso terapêutico
Fármacos Cardiovasculares/administração & dosagem
Fármacos Cardiovasculares/uso terapêutico
Clonidina/administração & dosagem
Clonidina/uso terapêutico
Tosse/complicações
Tosse/etiologia
Quimioterapia Combinada/métodos
Dispneia/diagnóstico
Dispneia/etiologia
Ecocardiografia/métodos
Eletrocardiografia/métodos
Seres Humanos
Masculino
Síncope/etiologia
Taquicardia/etiologia
Taquicardia/fisiopatologia
Taquicardia Sinusal/diagnóstico por imagem
Taquicardia Sinusal/tratamento farmacológico
Taquicardia Sinusal/fisiopatologia
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Adrenergic alpha-2 Receptor Agonists); 0 (Benzazepines); 0 (Cardiovascular Agents); 3H48L0LPZQ (ivabradine); MN3L5RMN02 (Clonidine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE


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[PMID]:28880902
[Au] Autor:Andersen JH; Jaeger P; Sonne TL; Dahl JB; Mathiesen O; Grevstad U
[Ad] Endereço:Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark.
[Ti] Título:Clonidine used as a perineural adjuvant to ropivacaine, does not prolong the duration of sensory block when controlling for systemic effects: A paired, blinded, randomized trial in healthy volunteers.
[So] Source:PLoS One;12(9):e0181351, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Clonidine used as an adjuvant to ropivacaine have been shown to prolong the duration of peripheral nerve blocks. The mechanism of action remains unclear. We hypothesized, that clonidine used as an adjuvant to ropivacaine extends the duration of an adductor canal block (ACB) by a peripheral mechanism, compared to ropivacaine alone when controlling for systemic effects. METHODS: We conducted a paired, blinded, randomized trial in healthy volunteers. Participants received bilateral ACBs containing 20 ml ropivacaine 0.5% + 1 ml clonidine 150µg/ml in one leg and 20 ml ropivacaine 0.5% + 1 ml saline in the other leg. The primary outcome measure was duration of sensory block assessed by temperature sensation (alcohol swab). Secondary outcome measures were duration of sensory block assessed by: pinprick, maximum pain during tonic heat stimulation, warmth detection threshold and heat pain detection threshold. RESULTS: We enrolled 21 volunteers and all completed the trial. There was no difference in duration of sensory block assessed with an alcohol swab: Mean duration in the leg receiving ropivacaine + clonidine was 19.4h (SD 2.7) compared to 19.3h (SD 2.4) in the leg receiving ropivacaine + placebo with a mean difference of 0.1h (95% CI: -1.0 to 1.3), P = 0.83. No differences in block duration were detected when assessed by: Pinprick, mean difference 0.0 h (95% CI: -1.3 to 1.3), maximum pain during tonic heat stimulation, mean difference -0.7 h (95% CI: -2.1 to 0.8), warmth detection threshold, mean difference -0.1 h (95% CI: -1.8 to 1.6) or heat pain detection threshold, mean difference -0.2 h (95% CI: -1.7 to 1.4). CONCLUSIONS: Administering clonidine perineurally as an adjuvant to ropivacaine in an ACB did not prolong the duration of sensory block in a setup controlling for systemic effects of clonidine.
[Mh] Termos MeSH primário: Adjuvantes Farmacêuticos/uso terapêutico
Amidas/uso terapêutico
Clonidina/uso terapêutico
Bloqueio Nervoso/métodos
[Mh] Termos MeSH secundário: Adulto
Amidas/administração & dosagem
Anestésicos Locais/administração & dosagem
Anestésicos Locais/uso terapêutico
Clonidina/administração & dosagem
Método Duplo-Cego
Quimioterapia Combinada
Feminino
Voluntários Saudáveis
Hemodinâmica/efeitos dos fármacos
Seres Humanos
Masculino
Limiar da Dor
Nervos Periféricos/efeitos dos fármacos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Adjuvants, Pharmaceutic); 0 (Amides); 0 (Anesthetics, Local); 7IO5LYA57N (ropivacaine); MN3L5RMN02 (Clonidine)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170908
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0181351


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[PMID]:28834857
[Au] Autor:Yeo QM; Wiley TL; Smith MN; Hammond DA
[Ad] Endereço:Department of Pharmacy, Changi General Hospital, Singapore (Dr Yeo); Department of Pharmacy, The University of Mississippi Medical Center, Jackson (Dr Wiley); Department of Pharmacy, Medical University of South Carolina, Charleston (Dr Smith); and Department of Pharmacy, Rush University Medical Center, Chicago, Illinois (Dr Hammond).
[Ti] Título:Oral Agents for the Management of Agitation and Agitated Delirium in Critically Ill Patients.
[So] Source:Crit Care Nurs Q;40(4):344-362, 2017 Oct/Dec.
[Is] ISSN:1550-5111
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Agitation is one of the most common issues that critically ill patients experience. Medications used to manage agitation are often administered intravenously or intramuscularly in the acutely agitated, critically ill patient. However, a multimodal approach that utilizes multiple routes of administration may be appropriate. This review summarizes the available literature on oral antipsychotics, clonidine, and valproic acid to manage agitation in critically ill patients while also focusing on their pharmacology and appropriate monitoring. Despite inconclusive findings from different studies, antipsychotics, clonidine, and valproic acid may provide benefit for specific patient populations. As more evidence emerges, these agents may start playing a greater role in the management of agitation, which is not amenable to first-line agents. As health care professionals, it is prudent to be familiar with their dosing regimens, common adverse effects, and the monitoring required to maximize patient benefits and minimize harms.
[Mh] Termos MeSH primário: Administração Oral
Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico
Antipsicóticos/uso terapêutico
Clonidina/uso terapêutico
Estado Terminal
Delírio/tratamento farmacológico
GABAérgicos/uso terapêutico
Agitação Psicomotora/tratamento farmacológico
Ácido Valproico/uso terapêutico
[Mh] Termos MeSH secundário: Protocolos Clínicos
Cuidados Críticos
Enfermagem de Cuidados Críticos
Delírio/etiologia
Seres Humanos
Agitação Psicomotora/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Adrenergic alpha-2 Receptor Agonists); 0 (Antipsychotic Agents); 0 (GABA Agents); 614OI1Z5WI (Valproic Acid); MN3L5RMN02 (Clonidine)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170824
[St] Status:MEDLINE
[do] DOI:10.1097/CNQ.0000000000000172


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[PMID]:28700791
[Au] Autor:Dunn KE; Tompkins DA; Bigelow GE; Strain EC
[Ad] Endereço:Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
[Ti] Título:Efficacy of Tramadol Extended-Release for Opioid Withdrawal: A Randomized Clinical Trial.
[So] Source:JAMA Psychiatry;74(9):885-893, 2017 Sep 01.
[Is] ISSN:2168-6238
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Opioid use disorder (OUD) is a significant public health problem. Supervised withdrawal (ie, detoxification) from opioids using clonidine or buprenorphine hydrochloride is a widely used treatment. Objective: To evaluate whether tramadol hydrochloride extended-release (ER), an approved analgesic with opioid and nonopioid mechanisms of action and low abuse potential, is effective for use in supervised withdrawal settings. Design, Setting, and Participants: A randomized clinical trial was conducted in a residential research setting with 103 participants with OUD. Participants' treatment was stabilized with morphine, 30 mg, administered subcutaneously 4 times daily. A 7-day taper using clonidine (n = 36), tramadol ER (n = 36), or buprenorphine (n = 31) was then instituted, and patients were crossed-over to double-blind placebo during a post-taper period. The study was conducted from October 25, 2010, to June 23, 2015. Main Outcomes and Measures: Retention, withdrawal symptom management, concomitant medication utilization, and naltrexone induction. Results were analyzed over time and using area under the curve for the intention-to-treat and completer groups. Results: Of the 103 participants, 88 (85.4%) were men and 43 (41.7%) were white; mean (SD) age was 28.9 (10.4) years. Buprenorphine participants (28 [90.3%]) were significantly more likely to be retained at the end of the taper compared with clonidine participants (22 [61.1%]); tramadol ER retention was intermediate and did not differ significantly from that of the other groups (26 [72.2%]; χ2 = 8.5, P = .01). Time-course analyses of withdrawal revealed significant effects of phase (taper, post taper) for the Clinical Opiate Withdrawal Scale (COWS) score (taper mean, 5.19 [SE, .26]; post-taper mean, 3.97 [SE, .23]; F2,170 = 3.6, P = .03) and Subjective Opiate Withdrawal Scale (SOWS) score (taper mean,8.81 [SE, .40]; post-taper mean, 4.14 [SE, .30]; F2,170 = 15.7, P < .001), but no group effects or group × phase interactions. Analyses of area under the curve of SOWS total scores showed significant reductions (F2,159 = 17.7, P < .001) in withdrawal severity between the taper and post-taper periods for clonidine (taper mean, 13.1; post-taper mean, 3.2; P < .001) and tramadol ER (taper mean, 7.4; post-taper mean, 2.8; P = .03), but not buprenorphine (taper mean, 6.4; post-taper mean, 7.4). Use of concomitant medication increased significantly (F2,159 = 30.7, P < .001) from stabilization to taper in the clonidine (stabilization mean, 0.64 [SE, .05]; taper mean, 1.54 [SE, .10]; P < .001) and tramadol ER (stabilization mean, 0.53 [SE, .05]; taper mean, 1.19 [SE, .09]; P = .003) groups and from stabilization to post taper in the buprenorphine group (stabilization mean, 0.46 [SE, .05] post-taper mean, 1.17 [SE, .09]; P = .006), suggesting higher withdrawal for those groups during those periods. Naltrexone initiation was voluntary and the percentage of participants choosing naltrexone therapy within the clonidine (8 [22.2%]), tramadol ER (7 [19.4%]), or buprenorphine (3 [9.7%]) groups did not differ significantly (χ2 = 2.5, P = .29). Conclusions and Relevance: The results of this trial suggest that tramadol ER is more effective than clonidine and comparable to buprenorphine in reducing opioid withdrawal symptoms during a residential tapering program. Data support further examination of tramadol ER as a method to manage opioid withdrawal symptoms. Trial Registration: Clinicaltrials.gov Identifier: NCT01188421.
[Mh] Termos MeSH primário: Tratamento de Substituição de Opiáceos/métodos
Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico
Síndrome de Abstinência a Substâncias/tratamento farmacológico
Tramadol/uso terapêutico
[Mh] Termos MeSH secundário: Adulto
Analgésicos/uso terapêutico
Analgésicos Opioides/uso terapêutico
Buprenorfina/uso terapêutico
Clonidina/uso terapêutico
Preparações de Ação Retardada/uso terapêutico
Método Duplo-Cego
Feminino
Seres Humanos
Masculino
Naltrexona/uso terapêutico
Antagonistas de Entorpecentes/uso terapêutico
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Analgesics); 0 (Analgesics, Opioid); 0 (Delayed-Action Preparations); 0 (Narcotic Antagonists); 39J1LGJ30J (Tramadol); 40D3SCR4GZ (Buprenorphine); 5S6W795CQM (Naltrexone); MN3L5RMN02 (Clonidine)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170713
[St] Status:MEDLINE
[do] DOI:10.1001/jamapsychiatry.2017.1838


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[PMID]:28697832
[Au] Autor:Guo JM; Shi XX; Yang SW; Qian QF; Huang Y; Xie YQ; Ou P
[Ad] Endereço:Fujian Provincial Maternity and Children's Hospital of Fujian Medical University, Fuzhou, Fujian 350001, China. eve1019@126.com.
[Ti] Título:[Efficacy of clonidine transdermal patch in treatment of moderate to severe tic disorders in children].
[So] Source:Zhongguo Dang Dai Er Ke Za Zhi;19(7):786-789, 2017 Jul.
[Is] ISSN:1008-8830
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:OBJECTIVE: To investigate the difference in the efficacy between clonidine transdermal patch and haloperidol tablets in the treatment of moderate to severe tic disorders in children. METHODS: A total of 134 children with moderate to severe tic disorders were randomly divided into clonidine group (n=70) and haloperidol group (n=64). The clonidine and haloperidol groups were treated with clonidine transdermal patch and haloperidol tablets respectively, and the treatment lasted for 8 weeks in both groups. The Yale Global Tic Severity Scale (YGTSS) was used to evaluate the conditions of the children before and after treatment, and the adverse events during the treatment were recorded. RESULTS: The haloperidol group had a significantly better treatment outcome than the clonidine group after one week of treatment (P<0.05); the treatment outcome showed no significant difference between the two groups after 3, 5, and 8 weeks of treatment (P>0.05). The clonidine group had significantly less reductions in the motor tics, vocal tics, and function impairment scores and total score of YGTSS than the haloperidol group after one week of treatment (P<0.05); there were no significant differences in YGTSS score reductions between the two groups after 3, 5, and 8 weeks of treatment (P>0.05). The clonidine group had a significantly lower overall incidence of adverse events than the haloperidol group (8% vs 37%; P<0.01). CONCLUSIONS: Clonidine transdermal patch and haloperidol are both effective in the treatment of moderate to severe tic disorders in children. The clonidine transdermal patch, despite slow action, has comparable efficacy and fewer adverse effects compared with haloperidol.
[Mh] Termos MeSH primário: Clonidina/administração & dosagem
Transtornos de Tique/tratamento farmacológico
Adesivo Transdérmico
[Mh] Termos MeSH secundário: Criança
Pré-Escolar
Feminino
Haloperidol/uso terapêutico
Seres Humanos
Masculino
Índice de Gravidade de Doença
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
J6292F8L3D (Haloperidol); MN3L5RMN02 (Clonidine)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171026
[Lr] Data última revisão:
171026
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170713
[St] Status:MEDLINE


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Maia, Lucianne Cople
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[PMID]:28686702
[Au] Autor:Viana KA; Daher A; Maia LC; Costa PS; Martins CC; Paiva SM; Costa LR
[Ad] Endereço:Programa de Pós-graduação em Odontologia, Universidade Federal de Goiás (UFG), Goiânia, Goiás (GO), Brazil.
[Ti] Título:What is the level of evidence for the amnestic effects of sedatives in pediatric patients? A systematic review and meta-analyses.
[So] Source:PLoS One;12(7):e0180248, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Studies have suggested that benzodiazepines are amnestic drug par excellence, but when taken together, what level of evidence do they generate? Are other sedatives as amnestic as benzodiazepines? The aim of this study was to assess the level of scientific evidence for the amnestic effect of sedatives in pediatric patients who undergo health procedures. METHODS: The literature was searched to identify randomized controlled trials that evaluated anterograde and retrograde amnesia in 1-19-year-olds who received sedative drugs during health procedures. Electronic databases, including PubMed, Scopus and Cochrane Library besides clinical trial registries and grey literature were searched. Two independent reviewers performed data extraction and risk of bias assessment using the Cochrane Collaboration's Tool. The meta-analyses were performed by calculating relative risk (RR) to 95% confidence intervals (CI). The quality of the evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Fifty-four studies were included (4,168 participants). A higher occurrence of anterograde amnesia was observed when benzodiazepines, the most well-studied sedatives (n = 47), were used than when placebo was used (n = 12) (RR = 3.10; 95% CI: 2.30-4.19, P<0.001; I2 = 14%), with a moderate level of evidence. Higher doses of alpha2-adrenergic agonists (clonidine/dexmedetomidine) produced more anterograde amnesia than lower doses (n = 2) (RR = 1.83; 95% CI: 1.03-3.25; P = 0.038; I2 = 0%), with a low level of evidence; benzodiazepines' amnestic effects were not dose-dependent (n = 3) (RR = 1.54; 95% CI: 0.96-2.49; P = 0.07; I2 = 12%) but the evidence was low. A qualitative analysis showed that retrograde amnesia did not occur in 8 out of 10 studies. CONCLUSIONS: In children, moderate evidence support that benzodiazepines induce anterograde amnesia, whereas the evidence for other sedatives is weak and based on isolated and small studies. Further clinical trials focused on the amnesia associated with non-benzodiazepine sedatives are therefore needed. TRIAL REGISTRATION: PROSPERO CRD42015017559.
[Mh] Termos MeSH primário: Amnésia Anterógrada/diagnóstico
Amnésia Retrógrada/diagnóstico
Benzodiazepinas/efeitos adversos
Hipnóticos e Sedativos/efeitos adversos
[Mh] Termos MeSH secundário: Adolescente
Amnésia Anterógrada/induzido quimicamente
Amnésia Retrógrada/induzido quimicamente
Criança
Pré-Escolar
Clonidina/efeitos adversos
Dexmedetomidina/efeitos adversos
Feminino
Seres Humanos
Lactente
Masculino
Ensaios Clínicos Controlados Aleatórios como Assunto
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Hypnotics and Sedatives); 12794-10-4 (Benzodiazepines); 67VB76HONO (Dexmedetomidine); MN3L5RMN02 (Clonidine)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170927
[Lr] Data última revisão:
170927
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170708
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0180248


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[PMID]:28666582
[Au] Autor:Loftus TJ; Thomson AJ; Kannan KB; Alamo IG; Millar JK; Plazas JM; Whitley EE; Efron PA; Mohr AM
[Ad] Endereço:University of Florida Health, Department of Surgery and Sepsis and Critical Illness Research Center, Gainesville, FL, USA. Electronic address: Tyler.Loftus@surgery.ufl.edu.
[Ti] Título:Clonidine restores vascular endothelial growth factor expression and improves tissue repair following severe trauma.
[So] Source:Am J Surg;214(4):610-615, 2017 Oct.
[Is] ISSN:1879-1883
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: We hypothesized that clonidine and propranolol would increase VEGF and VEGF-receptor expression and promote lung healing following severe trauma and chronic stress. METHODS: Sprague-Dawley rats were subjected to lung contusion (LC), lung contusion/hemorrhagic shock (LCHS), or lung contusion/hemorrhagic shock/daily restraint stress (LCHS/CS). Clonidine and propranolol were administered daily. On day seven, lung VEGF, VEGFR-1, VEGFR-2, and HMGB1 were assessed by PCR. Lung injury was assessed by light microscopy (*p < 0.05). RESULTS: Clonidine increased VEGF expression following LCHS (43%*) and LCHS/CS (46%*). Clonidine increased VEGFR-1 and R-2 expression following LCHS/CS (203%* and 47%*, respectively). Clonidine decreased HMGB1 and TNF-alpha expression following LCHS/CS (22%* and 58%*, respectively.) Clonidine decreased inflammatory cell infiltration and total Lung Injury Score following LCHS/CS. Propranolol minimally affected VEGF and did not improve lung healing. CONCLUSIONS: Clonidine increased VEGF and VEGF-receptor expression, decreased HMGB1 expression, decreased lung inflammation, and improved lung tissue repair.
[Mh] Termos MeSH primário: Clonidina/farmacologia
Lesão Pulmonar/tratamento farmacológico
Fator A de Crescimento do Endotélio Vascular/metabolismo
Receptor 1 de Fatores de Crescimento do Endotélio Vascular/metabolismo
Receptor 2 de Fatores de Crescimento do Endotélio Vascular/metabolismo
[Mh] Termos MeSH secundário: Animais
Proteína HMGB1/metabolismo
Inflamação/tratamento farmacológico
Propranolol/farmacologia
Edema Pulmonar/tratamento farmacológico
Ratos
Ratos Sprague-Dawley
Restrição Física
Fator de Necrose Tumoral alfa/metabolismo
Cicatrização/efeitos dos fármacos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (HMGB1 Protein); 0 (Hbp1 protein, rat); 0 (Tumor Necrosis Factor-alpha); 0 (Vascular Endothelial Growth Factor A); 9Y8NXQ24VQ (Propranolol); EC 2.7.10.1 (Vascular Endothelial Growth Factor Receptor-1); EC 2.7.10.1 (Vascular Endothelial Growth Factor Receptor-2); MN3L5RMN02 (Clonidine)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170702
[St] Status:MEDLINE


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[PMID]:28575101
[Au] Autor:Yoo YJ; Yang HK; Hwang JM
[Ad] Endereço:Department of Ophthalmology, Kangwon National University Hospital, Kangwon National University Graduate School of Medicine, Chuncheon, Korea.
[Ti] Título:Efficacy of digital pupillometry for diagnosis of Horner syndrome.
[So] Source:PLoS One;12(6):e0178361, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To evaluate the efficacy of digital pupillometry in the diagnosis of anisocoria related to Horner syndrome in adult patients. DESIGN: Retrospective, observational, case control study. METHODS: Nineteen patients with unilateral Horner syndrome (Horner group) and age-matched controls of 30 healthy individuals with normal vision and neither optic nerve dysfunction nor pupillary abnormalities were included. Pupillary light reflex (PLR) of the Horner group and controls were measured by a dynamic pupillometer (PLR-200; NeurOptics Inc., Irvine, USA). Minimal and maximal (min/max) pupil diameters, latency, constriction ratio, constriction velocity, dilation velocity, and total time taken by the pupil to recover 75% of maximal pupil diameter (T75) were noted. PLR were measured at baseline in both groups and at 30-45 minutes later after 0.5% apraclonidine (Iopidine®; Alcon Laboratories, Fort Worth, TX, USA) instillation in the Horner group. MAIN OUTCOME MEASURES: The PLR parameters in the affected eye and inter-eye difference before and after 0.5% apraclonidine instillation. RESULTS: In the Horner group, pupil diameters and T75 showed significant difference between the affected eye and unaffected contralateral eye at baseline (all P<0.00625). Compared to controls, inter-eye difference values of pupil diameters and T75 were significantly larger in the Horner group (all P<0.001). After 0.5% apraclonidine instillation, changes in pupil diameter and constriction ratio were significantly larger in the affected eye compared to the unaffected contralateral eye (all P<0.00625). The area under the receiver operating characteristic curves for diagnosing Horner syndrome were largest for baseline inter-eye difference in min/max pupil sizes (AUC = 0.975, 0.994), T75 (AUC = 0.838), and change in min/max pupil sizes after apraclonidine instillation (AUC = 0.923, 0.929, respectively). The diagnostic criteria for Horner syndrome relying on baseline pupillary measurements was defined as one of the two major findings; 1) smaller maximal pupil diameter in the affected eye with an inter-eye difference of > 0.5 mm, or 2) T75 > 2.61 seconds in the affected eye, which showed a sensitivity of 94.7% and specificity of 93.3%. The diagnostic accuracy of apraclonidine testing showed a sensitivity of 84.6% and specificity of 92.3%. CONCLUSIONS: Digital pupillometry is an objective method for quantifying PLR. Baseline inter-eye difference in maximal pupil sizes and dilation lag measured by T75 was equally effective in the diagnosis of Horner syndrome compared to the reversal of anisocoria after apraclonidine instillation.
[Mh] Termos MeSH primário: Síndrome de Horner/diagnóstico
Pupila
Reflexo Pupilar
[Mh] Termos MeSH secundário: Estudos de Casos e Controles
Clonidina/análogos & derivados
Clonidina/farmacologia
Feminino
Síndrome de Horner/fisiopatologia
Seres Humanos
Luz
Masculino
Pupila/efeitos dos fármacos
Pupila/fisiologia
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
843CEN85DI (apraclonidine); MN3L5RMN02 (Clonidine)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170915
[Lr] Data última revisão:
170915
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170603
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0178361


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[PMID]:28553701
[Au] Autor:Gowing L; Ali R; White JM
[Ad] Endereço:Discipline of Pharmacology, University of Adelaide, Frome Road, Adelaide, South Australia, Australia, 5005.
[Ti] Título:Opioid antagonists with minimal sedation for opioid withdrawal.
[So] Source:Cochrane Database Syst Rev;5:CD002021, 2017 05 29.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Managed withdrawal is a necessary step prior to drug-free treatment or as the endpoint of long-term substitution treatment. OBJECTIVES: To assess the effects of opioid antagonists plus minimal sedation for opioid withdrawal. Comparators were placebo as well as more established approaches to detoxification, such as tapered doses of methadone, adrenergic agonists, buprenorphine and symptomatic medications. SEARCH METHODS: We updated our searches of the following databases to December 2016: CENTRAL, MEDLINE, Embase, PsycINFO and Web of Science. We also searched two trials registers and checked the reference lists of included studies for further references to relevant studies. SELECTION CRITERIA: We included randomised and quasi-randomised controlled clinical trials along with prospective controlled cohort studies comparing opioid antagonists plus minimal sedation versus other approaches or different opioid antagonist regimens for withdrawal in opioid-dependent participants. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: Ten studies (6 randomised controlled trials and 4 prospective cohort studies, involving 955 participants) met the inclusion criteria for the review. We considered 7 of the 10 studies to be at high risk of bias in at least one of the domains we assessed.Nine studies compared an opioid antagonist-adrenergic agonist combination versus a treatment regimen based primarily on an alpha -adrenergic agonist (clonidine or lofexidine). Other comparisons (placebo, tapered doses of methadone, buprenorphine) made by included studies were too diverse for any meaningful analysis. This review therefore focuses on the nine studies comparing an opioid antagonist (naltrexone or naloxone) plus clonidine or lofexidine versus treatment primarily based on clonidine or lofexidine.Five studies took place in an inpatient setting, two studies were in outpatients with day care, two used day care only for the first day of opioid antagonist administration, and one study described the setting as outpatient without indicating the level of care provided.The included studies were heterogeneous in terms of the type of opioid antagonist treatment regimen, the comparator, the outcome measures assessed, and the means of assessing outcomes. As a result, the validity of any estimates of overall effect is doubtful, therefore we did not calculate pooled results for any of the analyses.The quality of the evidence for treatment with an opioid antagonist-adrenergic agonist combination versus an alpha -adrenergic agonist is very low. Two studies reported data on peak withdrawal severity, and four studies reported data on the average severity over the period of withdrawal. Peak withdrawal induced by opioid antagonists in combination with an adrenergic agonist appears to be more severe than withdrawal managed with clonidine or lofexidine alone, but the average severity over the withdrawal period is less. In some situations antagonist-induced withdrawal may be associated with significantly higher rates of treatment completion compared to withdrawal managed with adrenergic agonists. However, this result was not consistent across studies, and the extent of any benefit is highly uncertain.We could not extract any data on the occurrence of adverse events, but two studies reported delirium or confusion following the first dose of naltrexone. Delirium may be more likely with higher initial doses and with naltrexone rather than naloxone (which has a shorter half-life), but we could not confirm this from the available evidence.Insufficient data were available to make any conclusions on the best duration of treatment. AUTHORS' CONCLUSIONS: Using opioid antagonists plus alpha -adrenergic agonists is a feasible approach for managing opioid withdrawal. However, it is unclear whether this approach reduces the duration of withdrawal or facilitates transfer to naltrexone treatment to a greater extent than withdrawal managed primarily with an adrenergic agonist.A high level of monitoring and support is desirable for several hours following administration of opioid antagonists because of the possibility of vomiting, diarrhoea and delirium.Using opioid antagonists to induce and accelerate opioid withdrawal is not currently an active area of research or clinical practice, and the research community should give greater priority to investigating approaches, such as those based on buprenorphine, that facilitate the transition to sustained-release preparations of naltrexone.
[Mh] Termos MeSH primário: Agonistas alfa-Adrenérgicos/uso terapêutico
Antagonistas de Entorpecentes/uso terapêutico
Transtornos Relacionados ao Uso de Opioides/reabilitação
Síndrome de Abstinência a Substâncias/tratamento farmacológico
[Mh] Termos MeSH secundário: Clonidina/análogos & derivados
Clonidina/uso terapêutico
Seres Humanos
Naloxona/uso terapêutico
Naltrexona/uso terapêutico
Ensaios Clínicos Controlados não Aleatórios como Assunto
Estudos Prospectivos
Ensaios Clínicos Controlados Aleatórios como Assunto
Índice de Gravidade de Doença
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Adrenergic alpha-Agonists); 0 (Narcotic Antagonists); 36B82AMQ7N (Naloxone); 5S6W795CQM (Naltrexone); MN3L5RMN02 (Clonidine); UI82K0T627 (lofexidine)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170803
[Lr] Data última revisão:
170803
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170530
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD002021.pub4



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