Long-range Angular Correlations On The Near And Away Side In P-pb Collisions At √snn=5.02 Tev

7191/Mar294

Inclusive J/psi production in pp collisions at sqrt(s) = 2.76 TeV

The ALICE Collaboration has measured inclusive J/psi production in pp collisions at a center of mass energy sqrt(s)=2.76 TeV at the LHC. The results presented in this Letter refer to the rapidity ranges |y|<0.9 and 2.5<y<4 and have been obtained by measuring the electron and muon pair decay channels, respectively. The integrated luminosities for the two channels are L^e_int=1.1 nb^-1 and L^mu_int=19.9 nb^-1, and the corresponding signal statistics are N_J/psi^e+e-=59 +/- 14 and N_J/psi^mu+mu-=1364 +/- 53. We present dsigma_J/psi/dy for the two rapidity regions under study and, for the forward-y range, d^2sigma_J/psi/dydp_t in the transverse momentum domain 0<p_t<8 GeV/c. The results are compared with previously published results at sqrt(s)=7 TeV and with theoretical calculations.Comment: 7 figures, 3 tables, accepted for publication in Phys. Lett.

Neutral pion and η\eta meson production in proton-proton collisions at s=0.9\sqrt{s}=0.9 TeV and s=7\sqrt{s}=7 TeV

The first measurements of the invariant differential cross sections of inclusive $\pi^0$ and $\eta$ meson production at mid-rapidity in proton-proton collisions at $\sqrt{s}=0.9$ TeV and $\sqrt{s}=7$ TeV are reported. The $\pi^0$ measurement covers the ranges $0.4<p_T<7$ GeV/$c$ and $0.3<p_T<25$ GeV/$c$ for these two energies, respectively. The production of $\eta$ mesons was measured at $\sqrt{s}=7$ TeV in the range $0.4<p_T<15$ GeV/$c$. Next-to-Leading Order perturbative QCD calculations, which are consistent with the $\pi^0$ spectrum at $\sqrt{s}=0.9$ TeV, overestimate those of $\pi^0$ and $\eta$ mesons at $\sqrt{s}=7$ TeV, but agree with the measured $\eta/\pi^0$ ratio at $\sqrt{s}=7$ TeV.Comment: 17 pages, 5 captioned figures, 2 tables, authors from page 12, published version, figures at http://aliceinfo.cern.ch/ArtSubmission/node/310

J/psi Production as a Function of Charged Particle Multiplicity in pp Collisions at sqrt{s} = 7 TeV

The ALICE collaboration reports the measurement of the inclusive J/psi yield as a function of charged particle pseudorapidity density dN_{ch}/deta in pp collisions at sqrt{s} = 7 TeV at the LHC. J/psi particles are detected for p_t > 0, in the rapidity interval |y| < 0.9 via decay into e+e-, and in the interval 2.5 < y < 4.0 via decay into mu+mu- pairs. An approximately linear increase of the J/psi yields normalized to their event average (dN_{J/psi}/dy)/ with (dN_{ch}/deta)/ is observed in both rapidity ranges, where dN_{ch}/deta is measured within |eta| < 1 and p_t > 0. In the highest multiplicity interval with = 24.1, corresponding to four times the minimum bias multiplicity density, an enhancement relative to the minimum bias J/psi yield by a factor of about 5 at 2.5 < y < 4 (8 at |y| < 0.9) is observed.Comment: Submitted to Phys. Lett.

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Influence Of Propofol And Etomidate On Rocuronium-induced Neuromuscular Block. Evaluation With Acceleromyography [influência Do Propofol E Do Etomidato No Bloqueio Neuromuscular Produzido Pelo Rocurônio. Avaliação Pela Aceleromiografia]

Background and Objectives - Some hypnotics may interact with neuromuscular blockers and potentiate their effects. This study aimed at evaluating the influence of propofol and etomidate on rocuronium-induced neuromuscular block. ++Methods - Participated in this study 60 patients, physical status ASA I and II, scheduled for elective surgeries under general anesthesia, who were randomly distributed in two groups according to the hypnotic drug: Group I (propofol) and Group II (etomidate). All patients were premedicated with intramuscular midazolam (0.1 mg.kg -1), 30 minutes before surgery. Anesthesia was induced with propofol (2.5 mg.kg -1) or etomidate (0.3 mg.kg -1) preceded by alfentanil (50 mg.kg -1) and followed by rocuronium (0.6 mg.kg -1). Patients were ventilated under mask with 100% oxygen until achieving a decrease of 75% or more in the adductor pollicis muscle response amplitude. Neuromuscular function was monitored by accelerometry. The following parameters were evaluated: rocuronium onset (T 1≤ 25%); time for complete neuromuscular block; neuromuscular block degree at tracheal intubation; tracheal intubation conditions and hemodynamic effects. Results - Complete rocuronium -induced neuromuscular block onset times (in seconds) were: Group I (48.20 ± 10.85 s and 58.87 ± 10.73 s) and Group II (51.20 ± 13.80 s and 64.27 ± 18.55 s). Neuromuscular block degree at tracheal intubation was: Group I (77.50%) and Group II (76.96%). Tracheal intubation conditions were satisfactory in 100% of Group I patients and in 83.33% of Group II patients. There has been a significant decrease in mean blood pressure, followed by an increase after hypnotic injection, in both groups. Conclusions - Propofol and etomidate had a similar behavior regarding time for rocuronium -induced neuromuscular block and tracheal intubation conditions.526673680Mirakhur, R.K., Dose-response and time-course of action of rocuronium bromide (1995) Eur J Anaesthesiol, 12 (SUPPL. 11), pp. 23-25Theroux, M.C., Zgnoev, M., Brandom, B.W., Comparison of rapid endotracheal intubations using succinylcholine, mivacurium and vecuronium to combinations of mivacurium and vecuronium (1994) Anesth Analg, 78, pp. S436Glass, P.S.A., Wlilson, W., Mace, J.A., Is the priming principle effective and safe? (1989) Anesth Analg, 68, pp. 127-134Braga, A.F.A., Potério, G.M.B., Emprego do pancurônio e alcurônio em doses fracionadas na obtenção de relaxamento muscular para intubação traqueal (1993) Rev Bras Anestesiol, 43 (SUPPL. 17), pp. CBA76Muir, A.W., Anderson, K.A., Pow, E., Interaction between rocuronium bromide and some drugs, used during anaesthesia (1994) Eur J Anaesthesiol, 11 (SUPPL. 9), pp. 93-98Gill, R.S., Scott, R.P.F., Etomidate short the onset time of neuromuscular block (1992) Br J Anaesth, 69, pp. 444-446Dilger, J.P., Liu, Y., Vidal, A.M., Interactions of general anaesthetics with single acetylcholine receptor channels (1995) Eur J Anaesthesiol, 12, pp. 31-39Abdel-Zaher, A.O., Askar, F.G., The myoneural effects of propofol emulsion (Diprivan) on the nerve-muscle preparations of rats (1997) Pharmacol Res, 36, pp. 323-332Braga, A.F.A., Potério, G.M.B., Braga, F.S.S., Intubação traqueal sem relaxantes musculares, utilizando propofol como agente de indução (1991) Rev Bras Anestesiol, 41 (SUPPL. 13), pp. CBA130Braga, A.F.A., Braga, F.S.B., Potério, G.M.B., The effect of different doses of propofol on tracheal intubating conditions without muscle relaxant in children (2001) Eur J Anaesthesiol, 18, pp. 384-388Mallampati, S.R., Gatt, S.P., Gugino, L.D., A clinical sign to predict difficult tracheal intubation: A prospective study (1985) Can J Anaesth, 32, pp. 429-434Helbo-Hansen, S., Ravlo, O., Trap-Andersen, S., The influence of alfentanil on the intubating conditions after priming with vecuronium (1988) Acta Anaesthesiol Scand, 32, pp. 41-44Curran, M.J., Donati, F., Bevan, D.R., Onset and recovery of atracurium and suxamethonium-induced neuromuscular blockade with simultaneous train-of-four and single twitch stimulation (1987) Br J Anaesth, 59, pp. 989-994Girling, K.J., Mahajan, R.P., The effect of stabilization on the onset of neuromuscular block when assessed using accelerometry (1996) Anesth Analg, 82, pp. 1257-1260McCoy, E.P., Mirakhur, R.K., Maddineni, V.R., Pharmacokinetics of rocuronium after bolus and continuous infusion during halothane anaesthesia (1995) Br J Anaesth, 76, pp. 29-33Saxena, P.R., Dhasmana, K.M., Prakash, O., A comparison of systemic and regional haemodynamic effects of d-tubocurarine, pancuronium and vecuronium (1983) Anesthesiology, 59, pp. 102-108Ali, H.H., Savarese, J.J., Monitoring of neuromuscular function (1976) Anesthesiology, 45, pp. 216-249De Mey, J.C., De Baerdemaeker, L., De Laat, M., The onset of neuromuscular block at the masseter muscle as a predictor of optimal intubating conditions with rocuronium (1999) Eur J Anaesthesiol, 16, pp. 387-389Bali, I.M., Dundeee, J.W., Effect of I.V. induction regimens on endotracheal intubation with alcuronium and atracurium (1985) Br J Anaesth, 57, pp. 830-831Fuchs-Buder, T., Sparr, H.J., Ziegenfuss, T., Thiopental or etomidate for rapid sequence induction with rocuronium (1998) Br J Anaesth, 80, pp. 504-506Skinner, H.J., Biswas, A., Mahajan, R.P., Evaluation of intubating conditions with rocuronium and either propofol or etomidate for rapid sequence induction (1998) Anaesthesia, 53, pp. 702-710Keaveny, J.P., Knell, P.J., Intubation under induction doses of propofol (1988) Anaesthesia, 43, pp. S80-S81McKeating, K., Bali, I.M., Dundee, J.W., The effects of thiopentone and propofol on upper airway integrity (1988) Anaesthesia, 43, pp. 638-640Scheller, M.S., Zornow, M.H., Saidman, L.J., Tracheal intubation without the use of muscle relaxants: A technique using propofol and varying doses of alfentanil (1992) Anesth Analg, 75, pp. 788-793Dobson, A.P., McCluskey, A., Meakin, G., Effective time to satisfactory intubation conditions after administration of rocuronium in adults. Comparison of propofol and thiopentone for rapid sequence induction of anaesthesia (1999) Anaesthesia, 54, pp. 172-197Sparr, H.J., Luger, T.J., Heidegger, T., Comparison of intubating conditions after rocuronium and suxamethonium following "rapid-sequence induction" with thiopentone in elective cases (1996) Acta Anaesthesiol Scand, 40, pp. 425-430Acalovschi, I., Bodolea, C., Cristea, T., Induction with propofol does not improve the intubating conditions of rocuronium (1997) Eur J Anaesthesiol, 14 (SUPPL. 16), p. 13Crul, J.F., Vanbelleghem, V., Buyse, L., Rocuronium with alfentanil and propofol allows intubation with 45 seconds (1995) Eur J Anaesthesiol, 12 (SUPPL. 11), pp. 111-112Cantineau, J.P., Porte, F., D'Honneur, G., Neuromuscular effect of rocuronium on the diaphragm and adductor pollicis muscles in anesthetized patients (1994) Anesthesiology, 81, pp. 585-590Guidon-Attali, C., Morillac, F., Quilichini, D., Propofol as the main anaesthetic agent in dental surgery (1990) Acta Anaesthesiol Scand, 34, pp. 397-39

Hemodynamic Effects Of Aortic Occlusion During Inhalational Anesthesia With Isoflurane And Sevoflurane. Experimental Study In Dogs [efeitos Hemodinâmicos Da Oclusão Da Aorta Durante Anestesia Inalatória Com Isoflurano E Sevoflurano. Estudo Experimental Em Cães]

BACKGROUND AND OBJECTIVES: Aortic flow suppression and release during aortic procedures promote major hemodynamic disorders. This study aimed at evaluating these disorders in dogs anesthetized with isoflurane or sevoflurane. METHODS: This study involved 41 dogs divided in two groups according to the anesthetic agent used for maintenance with 1 MAC: GI (n = 21) isoflurane; GS (n = 20) sevoflurane. Aorta was occluded by intra-arterial infra-diafragmatic cuff inflation for 30 minutes. Hemodynamic parameters were observed in moments M1 (control), M2 and M3, 15 and 30 minutes after aortic occlusion, M4 and M5, 15 and 30 minutes after cuff deflation. RESULTS: During aortic occlusion there has been increased mean blood pressure (MBP), central venous pressure (CVP), pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PCWP) and systemic vascular resistance (SVR), without increase in pulmonary vascular resistance (PVR) and cardiac output (CO). CO was more stable with isoflurane as compared to sevoflurane where it has decreased after occlusion. Heart rate has initially decreased followed by increase during occlusion, being more expressive in GS as compared to GI, however without statistically significant difference between groups. Systolic volume was not importantly changed; left and right ventricular function have similarly increased after occlusion for both groups. With flow release, MBP, CVP, PAP, PCWP and SVR have decreased, and PVR has increased for both groups; ventricular function has abruptly decreased. CONCLUSIONS: This study has shown that isoflurane is a better indication for such interventions for promoting less hemodynamic changes. © Sociedade Brasileira de Anestesiologia, 2006.563239252Raby, K.E., Goldman, L., Creager, M.A., Correlation between preoperative ischemia and major cardiac events after peripheral vascular surgery (1989) N Engl J Med, 321, pp. 1296-1300Rao, T.L., Jacobs, K.H., El-Etr, A.A., Reinfarction following anesthesia in patients with myocardial infarction (1983) Anesthesiology, 59, pp. 499-505Gelman, S., The pathophysiology of aortic cross-clamping and unclamping (1995) Anesthesiology, 82, pp. 1026-1060Jamieson, W.R., Janusz, M.T., Miyagishima, R.T., Influence of ischemic heart disease on early and late mortality after surgery for peripheral occlusive vascular disease (1982) Circulation, 66 (2 SUPPL.), pp. I92-I97Kwitka, G., Roseberg, J.N., Negent, M., Thoracic Aortic Disease (1993) Cardiac Anesthesia, 3 rd Ed., pp. 758-780. , Kapplan JA - Philadelphia, WB SaundersRoizen, M.F., Beaupre, P.N., Alpert, R.A., Monitoring with two-dimensinal transesophageal echocardiography. Comparison of myocardial function in patients undergoing supraceliac, suprarenal-infraceliac or infrarenal aortic occlusion (1984) J Vasc Surg, 1, pp. 300-305Amaral, R.V.G., Pereira, J.C.D., Anestesia para Cirurgia Vascular (2001) Anestesiologia, 5 a Ed, pp. 931-970. , Yamashita AM, Takaoka F, Auler Jr JOC et al - São Paulo, AtheneuColson, P., Capdevilla, X., Barlet, H., Effects of halothane and isoflurane on transient renal dysfunction associated with infrarenal aortic cross-clamping (1992) J Cardiothorac Vasc Anesth, 6, pp. 295-298Sundeman, H., Biber, B., Henriksson, B.A., Effects of desflurane on systemic, preportal and renal circulatory responses to infrarenal aortic cross-clamping in the pig (1996) Acta Anaesthesiol Scand, 40, pp. 876-882Eyraud, D., Benmalek, F., Teugels, K., Does desflurane alter left ventricular function when used to control surgical stimulation during aortic surgery? (1999) Acta Anaesthesiol Scand, 43, pp. 737-743Brunson, D.B., Pharmacology of Inhalation Anesthetics (1997) Anesthesia and Analgesia in Laboratory Animals, 1 st Ed, pp. 29-41. , Kohn DF, Wixson SK, White WJ et al - New York, Academic PressShepherd, A.P., Mailman, D., Burks, T.F., Effects of norepinephrine and sympathetic stimulation on extraction of oxygen and 86Rb in perfused canine small bowel (1973) Circ Res, 33, pp. 166-174Roizen, M.F., Ellis, J.E., Foss, J.F., Intraoperative Management of the Patient Requiring Supraceliac Aortic Occlusion (1994) Vascular Surgery, 2 nd Ed, pp. 256-278. , Veith FJ, Hobson RW, Willians RA et al - New York, McGraw-HillKien, N.D., White, D.A., Reitan, J.A., The influence of adenosine triphosphate on left ventricular function and blood flow distribution during aortic crossclamping in dogs (1987) J Cardiothorac Anesth, 1, pp. 114-122Quintin, L., Bonnet, F., Macquin, I., Aortic surgery: Effect of clonidine on intraoperative catecholaminergic and circulatory stability (1990) Acta Anaesthesiol Scand, 34, pp. 132-137Vandermeer, T.J., Maini, B.S., Hendershott, T.H., Evaluation of right ventricular function during aortic operations (1993) Arch Surg, 128, pp. 582-585Heerdt, P.M., Gandhi, C.D., Dickstein, M.L., Disparity of isoflurane effects on left and right ventricular afterload and hydraulic power generation in swine (1998) Anesth Analg, 87, pp. 511-521Malan, T.P., DiNardo, J.A., Isner, R.J., Cardiovascular effects of sevoflurane compared with those of isoflurane in volunteers (1995) Anesthesiology, 83, pp. 918-928Rooke, G.A., Ebert, T., Muzi, M., The hemodynamic and renal effects of sevoflurane and isoflurane in patients with coronary artery disease and chronic hypertension (1996) Anesth Analg, 82, pp. 1159-1165. , Sevoflurane Ischemia Study GroupNielsen, V.G., Weinbroum, A., Tan, S., Xanthine oxidoreductase release after descending thoracic aorta occlusion and reperfusion in rabbits (1994) J Thorac Cardiovasc Surg, 107, pp. 1222-1227Perry, M.O., The hemodynamics of temporary abdominal aortic occlusion (1968) Ann Surg, 168, pp. 193-200Gottlieb, A., Aortic reconstructive surgery: Anesthetic considerations (1993) Curr Opin Anesth, 6, pp. 35-46Reiz, S., Peter, T., Rais, O., Hemodynamic and cardiometabolic effects of infrarenal aortic and common iliac artery desclamping in man - An approach to optimal volume loading (1979) Acta Anaesthesiol Scand, 23, pp. 579-586Colson, P., Capdevilla, X., Cuchet, D., Does choice of the anesthetic influence renal function during infrarenal aortic surgery? (1992) Anesth Analg, 74, pp. 481-485Bisinotto, F.M.B., Braz, J.R.C., Efeitos do halotano, isoflurano e sevoflurano nas respostas cardiovasculares ao pinçamento aórtico infra-renal. Estudo experimental em cães (2003) Rev Bras Anestesiol, 53, pp. 467-48

Comparison Of The Hemodynamic Effects In Acute Intoxication With Racemic Bupivacaine And With 50% Enantiomeric Excess Mixture (s75-r25). An Experimental Study In Dogs [comparação Entre Os Efeitos Hemodinâmicos Da Intoxicação Aguda Com Bupivacaína Racêmica E A Mistura Com Excesso Enatiomérico De 50% (s75-r25). Estudo Experimental Em Cães]

BACKGROUND AND OBJECTIVES: Racemic bupivacaine has been widely used in locoregional anesthesia due to the quality and duration of its anesthetic action. However, its cardiovascular toxicity has worried anesthesiologists for a long time, and new options have been sought. One of them is the use of its levorotatory isomer that, due to a lesser affinity for the sodium channel receptors in the cardiac cell, would be less toxic. The presentation containing 75% of the levorotatory isomer and 25% of the dextrorotatory isomer, named 50% enantiomeric excess mixture (S75-R25), is available in our country. The objective of this study was to compare the hemodynamic effects of the acute intoxication with racemic bupivacaine and with the S75-R25 mixture in animals. METHODS: Forty-four dogs were anesthetized with pentobarbital, intubated and placed on mechanical ventilation. Hemodynamic monitorization was accomplished with a Swan-Ganz catheter and intra-arterial blood pressure measurements. After a period of rest, they were randomly and blindly divided in two groups, according to the intoxication with either agent at a dose of 5 mg.Kg -1. Hemodynamic data were collected during 30 minutes and analyzed statically to allow for the comparison of both agents. RESULTS: The mixture S75-R25 had more hemodynamic repercussions causing, especially, a significant reduction of the mean arterial pressure, cardiac index, and the left ventricle work index. CONCLUSIONS: These results contradict those found in human beings regarding the pure levorotatory isomer, but confirm recent animal studies. One must be very careful when extrapolating data to human beings. Further studies involving larger samples and more homogeneous groups are necessary. © Sociedade Brasileira de Anestesiologia, 2006.564391401Groban, L., Deal, D.D., Vernon, J.C., Cardiac resuscitation after incremental overdosage with lidocaine, bupivacaine, levobupivacaine, and ropivacaine in anesthetized dogs (2001) Anesth Analg, 92, pp. 37-43Chang, D.H., Ladd, L.A., Copeland, S., Direct cardiac effects of intracoronary bupivacaine, levobupivaciane and ropivacaine in the sheep (2001) Br J Pharmacol, 132, pp. 649-658Albright, G.A., Cardiac arrest following regional anesthesia with etidocaine or bupivacaine (1979) Anesthesiology, 51, pp. 285-287Ohmura, S., Kawada, M., Ohta, T., Systemic toxicity and resuscitation in bupivacaine-, levobupivacaine, or ropivacaine-infused rats (2001) Anesth Analg, 93, pp. 743-748Aberg, G., Toxicological and local anaesthetic effects of optically active isomers of two local anaesthetic compounds (1972) Acta Pharmacol Toxicol, 31, pp. 273-286Luduena, F.P., Bogado, E.F., Tullar, B.F., Optical isomers of mepivacaine and bupivacaine (1972) Arch Int Pharmacodyn, 200, pp. 359-369Foster, R.H., Markham, A., Levobupivacaine: A review of its pharmacology and use as a local anaesthetic (2000) Drugs, 59, pp. 551-579Bardsley, H., Gristwood, R., Baker, H., A comparison of the cardiovascular effects of levobupivacaine and rac-bupivacaine following intravenous administration to healthy volunteers (1998) Br J Clin Pharmacol, 46, pp. 245-249Harvey, R.C., Paddleford, R.R., Popilskis, S.J., Anesthesia and Analgesia in Dogs, Cats and Ferrets (1997) Anesthesia and Analgesia in Laboratory Animals, 1 st Ed, pp. 257-273. , Kohn DF, Wixson SK, White WJ et al - New York, Academic PressEttinger, S.J., (1975) Textbook of Veterinary Internal Medicine, 1 st Ed, p. 146. , Philadelphia, WB SaundersSkarda, R.T., Local and Regional Anesthetic and Analgesic Techniques: Dogs (1996) Veterinary Anesthesia, 3 rd Ed, pp. 426-447. , Thurmon JC, Tranquilli WJ, Benson GJ - Philadelphia, Willians & WilkinsDelfino, J., Vale, N.B., Bupivacaína levógira a 0,5% pura versus mistura enantiomérica de bupivacaína (S75-R25) a 0,5% em anestesia peridural para cirurgia de varizes (2001) Rev Bras Anestesiol, 51, pp. 474-481Tanaka, P.P., Souza, R.O., Salvalaggio, M.F.O., Estudo comparativo entre bupivacaína a 0,5% e a mistura enantiomérica de bupivacaína (S75-R25) a 05% em anestesia peridural em pacientes submetidos a cirurgia ortopédica de membros inferiores (2003) Rev Bras Anestesiol, 53, pp. 331-337Gonçalves, R.F., Lauretti, G.R., Mattos, Al., Estudo comparativo entre bupivacaína a 0,5% e mistura enantiomérica de bupivacaína (S75-R25) em anestesia peridural (2003) Rev Bras Anestesiol, 53, pp. 169-176Lacassie, H.J., Columb, M.O., The relative motor blocking potencies of bupivacaine and levobupivacaine in labor (2003) Anesth Analg, 97, pp. 1509-1513Valenzuela, C., Snyders, D.J., Bennett, P.B., Stereosectivite block of cardiac sodium channels by bupivacaine in guinea pig ventricular myocytes (1995) Circulation, 92, pp. 3014-3024Royse, C.F., Royse, A.G., The myocardial and vascular effects of bupivacaine, levobupivacaine, and ropivacaine using pressure volume loops (2005) Anesth Analg, 101, pp. 679-687Masuda, R., Takeda, S., Yoshii, S., Levobupivacaine exerts the most detrimental effect on the cardiovascular system among enantiomers of bupivacaína in anesthetized dogs (2004) Anesthesiology, 101 (SUPPL.), pp. A652Jung, C.W., Lee, K.H., Choe, Y.S., Comparison of resuscitative effect of insulin between bupivacaine and levobupivacaína induced cardiovascular collapse in dogs (2004) Anesthesiology, 101 (SUPPL.), pp. A649Cox, B., Durieux, M.E., Marcus, M.A., Toxicity of local anaesthetics (2003) Best Pract Res Clin Anaesthesiol, 17, pp. 111-13

Influence Of Hypnotics On Cisatracurium-induced Neuromuscular Block. Use Of Acceleromyograhpy

Background and objective: Different drugs, including hypnotics, may influence the pharmacodynamic effects of neuromuscular blockers (NMB). The aim of this study was to evaluate the influence of propofol and etomidate on cisatracurium-induced neuromuscular blockade. Method: We included 60 patients, ASA I and II, undergoing elective surgery under general anesthesia in the study and randomly allocated them into two groups, according to their hypnotic drug: GI (propofol) and GII (etomidate). Patients received intramuscular (IM) midazolam (0.1mg.kg-1) as premedication and we performed induction with propofol (2.5mg.kg-1) or etomidate (0.3mg.kg1), preceded by fentanyl (250mg) and followed by cisatracurium (0.1mg.kg-1). The patients were ventilated with 100% oxygen until obtaining a reduction of 95% or more in the adductor pollicis response amplitude, with subsequent laryngoscopy and tracheal intubation. Neuromuscular function was monitored by acceleromyograhpy. We evaluated the onset of action of cisatracurium, tracheal intubation conditions, and hemodynamic repercussions. Results: The mean time and standard deviations of cisatracurium onset were: GI (86.6. ±. 14.3. s) and GII (116.9. ±. 11.6. s), with a significant difference (p. &lt;. 0, 0001). Intubation conditions were acceptable in 100% of GI and 53.3% of GII patients (p. &lt;. 0.0001). Conclusion: Induction of neuromuscular blockade with cisatracurium was faster, with better intubation conditions in patients receiving propofol compared to those receiving etomidate, without hemodynamic repercussions. © 2013 Elsevier Editora Ltda.633249253Fuchs-Buder, T., Claudius, C., Skovgaard, L.T., Good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II: the Stockholm revision (2007) Acta Anaesthesiol Scand, 51, pp. 789-808Viby-Mogensen, J., Engbaek, J., Eriksson, L.I., Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents (1996) Acta Anaesthesiol Scand, 40, pp. 59-74Viby-Mogensen, J., Ostergaard, D., Donati, F., Pharmacokinetic studies of neuromuscular blocking agents: good clinical research practice (GCRP) (2000) Acta Anaesthesiol Scand, 44, pp. 1169-1190Muir, A.W., Anderson, K.A., POW, E., Interaction between rocuronium bromide and some drugs, used during anaesthesia (1994) Eur J Anaesthesiol, 11 (SUPPL 9), pp. 93-98Gill, R.S., Scott, R.P.F., Etomidate short the onset time of neuromuscular block (1992) Br J Anaesth, 69, pp. 444-446Dilger, J.P., Liu, Y., Vidal, A.M., Interactions of general anaesthetics with single acetylcholine receptor channels (1995) Eur J Anaesthesiol, 12, pp. 31-39Abdel-Zaher, A.O., Askar, F.G., The myoneural effects of propofol emulsion (Diprivan) on the nerve-muscle preparations of rats (1997) Pharmacol Res, 36 (4), pp. 323-332Braga, A.F.A., Braga, F.S.B., Potério, G.M.B., The effect of different doses of propofol on tracheal intubating conditions without muscle relaxant in children (2001) Eur J Anaesthesiol, 18, pp. 384-388Savarese, J.J., Lien, C.A., Belmont, M.R., The clinical pharmacology of new benzylisoquinoline-diester compounds, with special consideration of cisatracurium and mivacurium (1997) Anaesthesist, 46, pp. 840-849Munhoz, D.C., Braga, A.F.A., Potério, G.M.B., Influência do propofol e do etomidato no bloqueio neuromuscular produzido pelo rocurônio Avaliação pela aceleromiografia (2002) Rev Bras Anestesiol, 52, pp. 673-680Bluestein, L.S., Stinson, L.W., Lennon, R.L., Evaluation of cisatracurium, a new neuromuscular blocking agent, for tracheal intubation (1996) Can J Anaesth, 43, pp. 925-931Kirov, K., Motamed, C., Decailliot, F., Comparison of the neuromuscular blocking effect of cisatracurium and atracurium on the larynx and adductor pollicis (2004) Acta Anaesthesiol Scand, 48, pp. 577-581Taha, S.K., Siddik-Sayyid, S.M., Alameddine, M., Propofol is superior to thiopental for intubation without muscle relaxants (2005) Can J Anaesth, 52, pp. 249-253Erhan, E., Ugur, G., Gunusen, I., Propofol - not thiopental or etomidate - with remifentanil provides adequate intubating conditions in the absence of neuromuscular blockade (2003) Can J Anaesth, 50, pp. 108-115Barker, P., Langton, J.A., Wilson, I.G., Movements of the vocal cords on induction of anaesthesia with thiopentone or propofol (1992) Br J Anaesth, 69, pp. 23-25Brown, G.W., Patel, Ellis, F.R., Comparison of propofol and thiopentone for laryngeal mask insertion (1991) Anaesthesia, 46, pp. 771-772Kallar, M.D., Propofol allows intubation without relaxants (1990) Anesthesiology, 73, pp. A21Woods, A.W., Allam, S., Tracheal intubation without the use neuromuscular blocking agents (2005) Br J Anaesth, 94, pp. 151-158Sneyd, R., O' Sullivan, E., Tracheal intubation without neuromuscular blocking agents: is there any point? (2010) Br J Anaesth, 104, pp. 535-537Siddik-Sayyid, S.M., Taha, S.K., Aouad, M.T., Propofol 2m/kg is superior to propofol 2mg/kg for tracheal intubation in children during sevoflurane induction (2011) Acta Anaesthesiol Scand, 55, pp. 535-538De Mey, J.C., De Baerdemaeker, L., De Laat, M., The onset of neuromuscular block at the masseter muscle as a predictor of optimal intubating conditions with rocuronium (1999) Eur J Anaesthesiol, 16, pp. 387-389Braga Ade, F., Munoz, D.C., Braga, F.S., Influence of stimulus frequency on blockade induced by pancuronium and rocuronium: study on rats phrenic nerve-diaphragm preparation (2007) Acta Cir Bras, 22, pp. 446-450Curran, M.J., Donati, F., Bevan, D.R., Onset and recovery of atracurium and suxamethonium - induced neuromuscular blockade with simultaneous train-of-four and single twitch stimulation (1987) Br J Anaesth, 59, pp. 989-994Girling, K.J., Mahajan, R.P., The effect of stabilization on the onset of neuromuscular block when assessed using accelerometry (1996) Anesth Analg, 82, pp. 1257-1260McCoy, E.P., Mirakhur, R.K., Maddineni, V.R., Pharmacokinetics of rocuronium after bolus and continuous infusion during halothane anaesthesia (1995) Br J Anaesth, 76, pp. 29-33Saxena, P.R., Dhasmana, K.M., Prakash, O., A comparison of systemic and regional haemodynamic effects of d-tubocurarine, pancuronium. and vecuronium (1983) Anesthesiology, 59, pp. 102-108Scott, R.P.F., Savarese, J.J., Basta, S.J., Clinical pharmacology of atracurium given high dose (1986) Br J Anaesth, 58, pp. 834-838Tullock, W.C., Diana, P., Cook, D.R., Neuromuscular and cardiovascular effects of high-dose vecuronium (1990) Anesth Analg, 70, pp. 86-90Aun, C.S.T., Sung, R.Y.T., O'Meara, M.E., Cardiovascular effects of intravenous induction in children: comparison between propofol and thiopentone (1993) Br J Anaesth, 70, pp. 647-653Fuchs-Buder, T., Claudius, C., Skovgaard, L.T., Good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II: the Stockholm revision (2007) Acta Anaesthesiol Scand, 51, pp. 789-808Viby-Mogensen, J., Engbaek, J., Eriksson, L.I., Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents (1996) Acta Anaesthesiol Scand, 40, pp. 59-74Viby-Mogensen, J., Ostergaard, D., Donati, F., Pharmacokinetic studies of neuromuscular blocking agents: good clinical research practice (GCRP) (2000) Acta Anaesthesiol Scand, 44, pp. 1169-1190Muir, A.W., Anderson, K.A., POW, E., Interaction between rocuronium bromide and some drugs, used during anaesthesia (1994) Eur J Anaesthesiol, 11 (SUPPL 9), pp. 93-98Gill, R.S., Scott, R.P.F., Etomidate short the onset time of neuromuscular block (1992) Br J Anaesth, 69, pp. 444-446Dilger, J.P., Liu, Y., Vidal, A.M., Interactions of general anaesthetics with single acetylcholine receptor channels (1995) Eur J Anaesthesiol, 12, pp. 31-39Abdel-Zaher, A.O., Askar, F.G., The myoneural effects of propofol emulsion (Diprivan) on the nerve-muscle preparations of rats (1997) Pharmacol Res, 36 (4), pp. 323-332Braga, A.F.A., Braga, F.S.B., Potério, G.M.B., The effect of different doses of propofol on tracheal intubating conditions without muscle relaxant in children (2001) Eur J Anaesthesiol, 18, pp. 384-388Savarese, J.J., Lien, C.A., Belmont, M.R., The clinical pharmacology of new benzylisoquinoline-diester compounds, with special consideration of cisatracurium and mivacurium (1997) Anaesthesist, 46, pp. 840-849Munhoz, D.C., Braga, A.F.A., Potério, G.M.B., Influência do propofol e do etomidato no bloqueio neuromuscular produzido pelo rocurônio Avaliação pela aceleromiografia (2002) Rev Bras Anestesiol, 52, pp. 673-680Bluestein, L.S., Stinson, L.W., Lennon, R.L., Evaluation of cisatracurium, a new neuromuscular blocking agent, for tracheal intubation (1996) Can J Anaesth, 43, pp. 925-931Kirov, K., Motamed, C., Decailliot, F., Comparison of the neuromuscular blocking effect of cisatracurium and atracurium on the larynx and adductor pollicis (2004) Acta Anaesthesiol Scand, 48, pp. 577-581Taha, S.K., Siddik-Sayyid, S.M., Alameddine, M., Propofol is superior to thiopental for intubation without muscle relaxants (2005) Can J Anaesth, 52, pp. 249-253Erhan, E., Ugur, G., Gunusen, I., Propofol - not thiopental or etomidate - with remifentanil provides adequate intubating conditions in the absence of neuromuscular blockade (2003) Can J Anaesth, 50, pp. 108-115Barker, P., Langton, J.A., Wilson, I.G., Movements of the vocal cords on induction of anaesthesia with thiopentone or propofol (1992) Br J Anaesth, 69, pp. 23-25Brown, G.W., Patel, Ellis, F.R., Comparison of propofol and thiopentone for laryngeal mask insertion (1991) Anaesthesia, 46, pp. 771-772Kallar, M.D., Propofol allows intubation without relaxants (1990) Anesthesiology, 73, pp. A21Woods, A.W., Allam, S., Tracheal intubation without the use neuromuscular blocking agents (2005) Br J Anaesth, 94, pp. 151-158Sneyd, R., O' Sullivan, E., Tracheal intubation without neuromuscular blocking agents: is there any point? (2010) Br J Anaesth, 104, pp. 535-537Siddik-Sayyid, S.M., Taha, S.K., Aouad, M.T., Propofol 2m/kg is superior to propofol 2mg/kg for tracheal intubation in children during sevoflurane induction (2011) Acta Anaesthesiol Scand, 55, pp. 535-538De Mey, J.C., De Baerdemaeker, L., De Laat, M., The onset of neuromuscular block at the masseter muscle as a predictor of optimal intubating conditions with rocuronium (1999) Eur J Anaesthesiol, 16, pp. 387-389Braga Ade, F., Munoz, D.C., Braga, F.S., Influence of stimulus frequency on blockade induced by pancuronium and rocuronium: study on rats phrenic nerve-diaphragm preparation (2007) Acta Cir Bras, 22, pp. 446-450Curran, M.J., Donati, F., Bevan, D.R., Onset and recovery of atracurium and suxamethonium - induced neuromuscular blockade with simultaneous train-of-four and single twitch stimulation (1987) Br J Anaesth, 59, pp. 989-994Girling, K.J., Mahajan, R.P., The effect of stabilization on the onset of neuromuscular block when assessed using accelerometry (1996) Anesth Analg, 82, pp. 1257-1260McCoy, E.P., Mirakhur, R.K., Maddineni, V.R., Pharmacokinetics of rocuronium after bolus and continuous infusion during halothane anaesthesia (1995) Br J Anaesth, 76, pp. 29-33Saxena, P.R., Dhasmana, K.M., Prakash, O., A comparison of systemic and regional haemodynamic effects of d-tubocurarine, pancuronium. and vecuronium (1983) Anesthesiology, 59, pp. 102-108Scott, R.P.F., Savarese, J.J., Basta, S.J., Clinical pharmacology of atracurium given high dose (1986) Br J Anaesth, 58, pp. 834-838Tullock, W.C., Diana, P., Cook, D.R., Neuromuscular and cardiovascular effects of high-dose vecuronium (1990) Anesth Analg, 70, pp. 86-90Aun, C.S.T., Sung, R.Y.T., O'Meara, M.E., Cardiovascular effects of intravenous induction in children: comparison between propofol and thiopentone (1993) Br J Anaesth, 70, pp. 647-65