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BACKGROUND: To enhance the utility of functional hemodynamic monitoring, the variables systolic slope (dP/dt) and dynamic arterial elastance (Eadyn) are calculated by the Hypotension Prediction Index (HPI) Acumen® Software. This study was designed to characterize the effects of phenylephrine and ephedrine on dP/dt and Eadyn. METHODS: This was a retrospective, non-randomized analysis of data collected during two clinical studies. All patients required intra-operative controlled mechanical ventilation and had an indwelling radial artery catheter connected to an Acumen IQ sensor. Raw arterial pressure waveform data was downloaded from the patient monitor and all hemodynamic measurements were calculated off-line. The anesthetic record was reviewed for bolus administrations of either phenylephrine or ephedrine. Cardiovascular variables prior to drug administration were compared to those following vasopressor administrations. The primary outcome was the difference for dP/dt and Eadyn at baseline compared with the average after the bolus administration. All data sets demonstrated non-normal distributions so statistical analysis of paired and unpaired data followed the Wilcoxon matched pairs signed-rank test or Mann-Whitney U test, respectively. RESULTS: 201 doses of phenylephrine and 100 doses of ephedrine were analyzed. All data sets are reported as median [95% CI]. Mean arterial pressure (MAP) increased from 62 [54,68] to 78 [76,80] mmHg following phenylephrine and from 59 [55,62] to 80 [77,83] mmHg following ephedrine. Stroke volume and cardiac output both increased. Stroke volume variation and pulse pressure variation decreased. Both drugs produced significant increases in dP/dt, from 571 [531, 645] to 767 [733, 811] mmHg/sec for phenylephrine and from 537 [509, 596] to 848 [779, 930] mmHg/sec for ephedrine. No significant changes in Eadyn were observed. CONCLUSION: Bolus administration of phenylephrine or ephedrine increases dP/dt but does not change Eadyn. dP/dt demonstrates potential for predicting the inotropic response to phenylephrine or ephedrine, providing guidance for the most efficacious vasopressor when treating hypotension. TRIAL REGISTRATION: Data was collected from two protocols. The first was deemed to not require written, informed consent by the Institutional Review Board (IRB). The second was IRB-approved (Effect of Diastolic Dysfunction on Dynamic Cardiac Monitors) and registered on ClinicalTrials.gov (NCT04177225).

Objective: To assess the impact of ejaculatory dysfunction (EjD; failure of emission or retrograde ejaculation) on health‐related quality of life (HRQoL) after retroperitoneal lymph node dissection (RPLND) for testicular cancer and explore the efficacy of pseudoephedrine hydrochloride as treatment. Patients and Methods: In a single arm, phase II trial, patients at ≥6 months after RPLND were invited to complete patient‐reported outcome measures (European Organisation for Research and Treatment of Cancer [EORTC] quality of life questionnaire [QLQ]‐30‐item core, EORTC QLQ‐testicular cancer‐26, and Brief Male Sexual Function Inventory) evaluating HRQoL and sexual function in follow‐up (ACTRN12622000537752/12622000542796). If EjD was reported, post‐ejaculatory urine ± semen analysis was undertaken. In eligible patients, pseudoephedrine hydrochloride 60 mg was administered orally every 6 h for six doses. The primary endpoint was sperm count >39 million sperm/ejaculate (>5th centile) following treatment. The trial was powered to detect a clinically relevant 36% achieving sperm count of >39 million sperm/ejaculate. Secondary endpoints included semen volume >1.5 mL, total motile sperm count, safety, and HRQoL impacts. Results: Of the 58 patients enrolled, the median (interquartile range [IQR]) age was 35 (29–41) years, with a median (IQR) of 37 (18–60) months from RPLND. EjD was reported in 33 (57%), including 27/52 (52%) receiving follow‐up at our centre. There were no differences in global HRQoL; however, role functioning (P = 0.045), sexual problems (P < 0.005), and sexual enjoyment (P = 0.005) was poorer if EjD was present. In all, 24/33 (73%) patients with EjD consented to pseudoephedrine treatment. Of 22 evaluable patients, four (18%) achieved a sperm count of >39 million/ejaculate (P = 0.20), and four (18%) had a semen volume of >1.5 mL (P = 0.20). There was a mean increase of 105 million sperm/ejaculate (P = 0.051) and 1.47 mL increase in semen volume (P = 0.01). No safety concerns arose. Conclusion: Ejaculatory dysfunction is common after RPLND but did not impact global HRQoL in our cohort. Pseudoephedrine improved EjD for some; however, its efficacy was lower than expected. Pseudoephedrine may be considered on an individualised basis. [ABSTRACT FROM AUTHOR]

Rationale: In recent years, ephedrine psychoactive substances have attracted much attention due to their prevalence in water bodies and potential threat to aquatic ecosystems. Psychoactive substances have been considered as a new type of environmental pollutant due to their unpredictable potential risks to the behavior and nervous system of non‐target organisms. A rapid, sensitive, selective, and robust method for the quantification of three ephedrine psychoactive substances in sewage is needed. Methods: An ultraperformance liquid chromatography‐tandem mass spectrometry (UPLC‐MS/MS) method was developed for the simultaneous determination of three ephedrine psychoactive substances in water. The optimal processing conditions were determined by optimizing the chromatography—mass spectrometry and solid‐phase extraction (SPE) conditions (e.g., the SPE column, sample pH, washing, and elution), and the treatment conditions were determined; this was achieved via positive ion scanning in multiple reaction monitoring mode. Poly‐Sery MCX was selected as the extraction column, with samples loaded at pH 3. And 4‐mL solution of 2% formic acid (FA) aqueous solution was used as the eluent; the target compounds were eluted with 5 mL of 5% NH4OH in acetonitrile (ACN) solution. The best results were obtained when the residue was resolubulization in ACN after nitrogen evaporation. Results: The developed UPLC‐MS/MS showed a good linear relationship in the range of 0–50.00 μg/L, with determination coefficients (R2) greater than 0.9990. The detection limit and quantitation limit were 0.05–0.10 and 0.20–0.50 μg/L, respectively. Recovery rates of the target compounds in blank sewage at three different concentrations ranged from 92.37% to 106.31%, with relative standard deviations (RSDs) of 0.77%–4.83% (n = 7). Conclusions: This method has been successfully applied to the analysis of surface water and domestic sewage, and the samples were processed stably, indicating that the method is practical for the determination of ephedrine psychoactive drugs in water bodies. [ABSTRACT FROM AUTHOR]

A ternary mixture incorporating Hydroxyzine hydrochloride (HYX), Ephedrine hydrochloride (EPH) and Theophylline (THP) frequently prescribed for the treatment of respiratory diseases. Herein, two spectrophotometric methods are designated and applied to resolve these three components in their mixture. Method A is ratio-subtraction combined with derivative spectrophotometry, where THP can be determined directly at its λmax 271 nm (neither HYX or EPH interfere), then for determination of HYX and EPH, the ternary mixture was divided by 22 μg/mL of THP and after subtraction of the plateau region, HYX can be determined directly at its λmax 234.2 nm (absence of EPH intervention). Finally, the third derivative (3D) spectrophotometric approach was utilized to estimate EPH by detecting the peak amplitude at 222 nm with Δλ = 4 and a scaling factor 100. Principal Component Regression (PCR) and Partial Least Squares (PLS), two multivariate calibration approaches, were applied effectively in Method B. This method effectively quantified the mixture under investigation by using the absorption spectra obtained from suitable solutions of the three components in the 210–230 nm region. The calibration models were evaluated using cross-validation with PCR and PLS, producing statistical characteristics that demonstrate the effectiveness of the calibration models. Synthetic and pharmaceutical preparations were also used to conduct external validation. In pharmaceutical formulation, these methods were successfully applied to analyze HYX, EPH, and THP without overlap from formulation's excipients. Moreover, the study's findings were statistically contrasted with those of earlier reported HPLC method. Appraisal approaches were used to determine whether the new spectrophotometric methods had an adverse environmental impact involving the Green Analytical Procedure Index (GAPI) and the AGREE (Analytical Greenness). These evaluations delivered information about the methods' eco-friendliness and sustainability, proving that they are in line with ecologically attributed practices. Furthermore, the Blue Applicability Grade Index (BAGI) was utilized to identify and verify the feasibility and practicality of the suggested approaches. [ABSTRACT FROM AUTHOR]

Takotsubo cardiomyopathy (TTC) is a rare condition associated with transient akinesia of apical segments and hyperkinesia of basal segments of the heart. Although several mechanisms have been proposed to cause direct and indirect myocardial damage owing to catecholamine excess, the underlying pathophysiology remains unknown. An 18-year-old female was referred to our otorhinolaryngology outpatient clinic for a septorhinoplasty. Apart from the fear of surgery, the patient had no other health issues. After the administration of local anesthesia (lidocaine and epinephrine mix), tachycardia storms occurred and soon ended with cardiac collapse. Further evaluation revealed TTC. TTC should be considered, especially in cases of treatment-resistant hemodynamic problems after cardiac resuscitation, and nurses can play a crucial role during the preanesthetic period in helping the patient cope with the stress factors related to the upcoming surgery. [ABSTRACT FROM AUTHOR]

Introduction: The use of push-dose vasopressors to treat anesthesia-induced hypotension is a common evidence-based practice among anesthesiologists. In more recent years, the use of push-dose vasopressors has transitioned to the emergency department (ED) and critical care setting. There is debate on the best choice of a push-dose vasopressor, with push-dose epinephrine or phenylephrine being more commonly used. This scoping review evaluated publications regarding the clinical use of push-dose norepinephrine. Methods: We queried research studies in both PubMed and Google Scholar on the use of push-dose norepinephrine in human subjects, with numerous randomized controlled trials that compare norepinephrine to other vasopressors including phenylephrine, ephedrine, and epinephrine. Results: A large majority of the studies were performed in the setting of spinal anesthesia prior to cesarean section, while several involved the administration of general anesthesia, with limited-to-no literature in the emergency and critical care setting. Of the 27 studies that we included in the review, 17 were randomized controlled trials. These studies demonstrated that norepinephrine was safe and effective. Conclusion: Prior research has demonstrated the superiority of norepinephrine as a pressor of choice for various shock states. In this review, the safety and efficacy of push-dose norepinephrine is demonstrated, and favorable hemodynamic markers are shown in comparison to other agents. In addition, there are some safety and efficiency benefits to using push-dose norepinephrine from an administration standpoint, as well as clinically in decreased need for repeat doses. Further high-quality studies in the emergency and critical care realm would be beneficial to confirm these findings. [ABSTRACT FROM AUTHOR]

Aim: Postoperative sore throat (POST) is a commonly encountered and significant complication following anesthesia, which can adversely affect the quality of a patient's recovery. Many factors contribute to the development of POST. Controlled hypotension (CH) is a surgical technique used to reduce blood flow, improve visibility, and shorten procedure time by safely lowering blood pressure. In this study, we aimed to investigate the effects of CH on POST, coughing, hoarseness, and vomiting in patients undergoing surgery in a supine position with a fixed endotracheal cuff pressure. Material and Method: A total of 124 patients, aged between 18 and 65 years, classified as American Society of Anesthesiologists (ASA) class I-II and scheduled for elective surgical procedures, were included in the study. The patients were divided into two groups: Group N (n=65), consisting of normotensive individuals, and Group H (n=59), which included patients subjected to CH. In both groups, the endotracheal cuff pressure was manually set to 25 cmH2O using a cuff pressure manometer. CH was achieved in Group H by administering glyceryl trinitrate (nitroglycerin) infusion, maintaining the mean arterial pressure (MAP) within the range of 55-65 mmHg. Patients were assessed for POST, coughing, hoarseness, and vomiting at postoperative 15 minutes, 2, 6, 12, and 24 hours. Results: Demographic data, smoking status, ASA scores, surgical and anesthesia durations were similar between the groups. Statistically significant differences were observed between the groups in the numeric rate scores (NRS) for throat pain at 15 minutes and 2 hours, as well as hoarseness scores at 2 and 6 hours. The groups were similar regarding vomiting rates and cough scores. Conclusion: In this study investigating the impact of CH on sore throat, we observed an increased incidence of POST and hoarseness in patients subjected to CH. [ABSTRACT FROM AUTHOR]

Background: Subarachnoid block, although being highly efficient, often has limitation such as hypotension which can result in adverse maternal and fetal outcome, continues to be a matter of concern to the Anesthesiologist. The study was to compare the effect of phenylephrine, ephedrine and mephentermine, for maintenance of arterial pressure during spinal anaesthesia for caesarean section. Methodology: A prospective randomized double blinded study involving 90 patients with hypotension after subarachnoid block under spinal anesthesia was conducted, dividing them into three groups: P (Phenylephrine) 100 mcg, E (Ephedrine) 6 mg, and M (Mephentermine) 6 mg. Patients were compared based on age, weight, height, hemodynamic parameters, complications, and neonatal APGAR scores. Results: On inter-group comparison rise in systolic, diastolic and mean arterial blood pressure at 1,2,4 and 6min after drug administration were significantly high in phenylephrine group (p /= 7 in the three groups at the 1st and 5th min. Conclusion: The study found that phenylephrine, ephedrine, and mephentermine effectively maintained arterial blood pressure in intravenous bolus form during subarachnoid block for caesarean section. Phenylephrine, a fast-acting, short-lived normotensive drug, significantly reduced heart rate compared to ephedrine and mephentermine, but did not cause significant adverse effects on mother and fetus.

Abstract Background To enhance the utility of functional hemodynamic monitoring, the variables systolic slope (dP/dt) and dynamic arterial elastance (Eadyn) are calculated by the Hypotension Prediction Index (HPI) Acumen® Software. This study was designed to characterize the effects of phenylephrine and ephedrine on dP/dt and Eadyn. Methods This was a retrospective, non-randomized analysis of data collected during two clinical studies. All patients required intra-operative controlled mechanical ventilation and had an indwelling radial artery catheter connected to an Acumen IQ sensor. Raw arterial pressure waveform data was downloaded from the patient monitor and all hemodynamic measurements were calculated off-line. The anesthetic record was reviewed for bolus administrations of either phenylephrine or ephedrine. Cardiovascular variables prior to drug administration were compared to those following vasopressor administrations. The primary outcome was the difference for dP/dt and Eadyn at baseline compared with the average after the bolus administration. All data sets demonstrated non-normal distributions so statistical analysis of paired and unpaired data followed the Wilcoxon matched pairs signed-rank test or Mann-Whitney U test, respectively. Results 201 doses of phenylephrine and 100 doses of ephedrine were analyzed. All data sets are reported as median [95% CI]. Mean arterial pressure (MAP) increased from 62 [54,68] to 78 [76,80] mmHg following phenylephrine and from 59 [55,62] to 80 [77,83] mmHg following ephedrine. Stroke volume and cardiac output both increased. Stroke volume variation and pulse pressure variation decreased. Both drugs produced significant increases in dP/dt, from 571 [531, 645] to 767 [733, 811] mmHg/sec for phenylephrine and from 537 [509, 596] to 848 [779, 930] mmHg/sec for ephedrine. No significant changes in Eadyn were observed. Conclusion Bolus administration of phenylephrine or ephedrine increases dP/dt but does not change Eadyn. dP/dt demonstrates potential for predicting the inotropic response to phenylephrine or ephedrine, providing guidance for the most efficacious vasopressor when treating hypotension. Trial registration Data was collected from two protocols. The first was deemed to not require written, informed consent by the Institutional Review Board (IRB). The second was IRB-approved (Effect of Diastolic Dysfunction on Dynamic Cardiac Monitors) and registered on ClinicalTrials.gov (NCT04177225).

This paper presents a novel sensor for the electrochemical detection of ephedrine (EPD), a precursor compound used in the illicit production of amphetamines and related drugs. The sensor is based on a modified glassy carbon electrode (GCE) modified with nickel oxide/nitrogen-doped graphene oxide nanocomposite (NiO/NGO). The NiO/NGO nanocomposite was created hydrothermally and examined using scanning electron microscopy (SEM), X-ray diffraction (XRD), and X-ray photoelectron spectroscopy (XPS) methods. The successful nitrogen doping of graphene oxide (GO) and the anchoring of NiO nanoparticles on GO nanosheets in the nanocomposite are confirmed by all characterization studies. Measurements using cyclic voltammetry (CV) and differential pulse voltammetry (DPV) were used to assess the electrochemical performance of the NiO/NGO/GCE. The NiO/NGO/GCE showed good sensitivity, stability, and selectivity for EPD detection, with a linear range of 10–2580 µM and a detection limit of 0.09 µM. Moreover, the NiO/NGO/GCE was effectively used to calculate EPD in actual blood serum samples, yielding findings that were both reproducible and adequate (the recovery values varied from 98.80% to 99.40%, and the RSD values from 3.591% to 4.21%). The suggested biosensor provides an easy, quick, and affordable way to detect EPD in sports doping control.

Objective: To investigate whether transcutaneous electrical acupoint stimulation (TEAS) at PC6 could reduce hypotension after spinal anesthesia (SA) in parturients and to compare the effect of TEAS at different frequencies. Methods: From February 20, 2023, to August 29, 2023, 90 parturients scheduled for c-section under SA were randomly assigned to receive no treatment (Control), TEAS at high frequency (TEAS-HF), or TEAS at low frequency (TEAS-LF). Treatments started immediately after SA and lasted for 30 min. The primary endpoint was incidence of hypotension by 30 min after SA. Secondary endpoints included lowest systolic blood pressure (SBP) during 30 min after SA, dose of ephedrine, dose of atropine, Apgar score at 1 min, and adverse events, including nausea, vomiting, dizziness, dyspnea, and chest congestion. Results: In the TEAS-HF group, the incidence of hypotension by 30 min after SA was lower (13.3%) than in the Control (53.3%, p = 0.001; OR 1.9, 95% confidence interval [CI]: 1.2–2.8) and TEAS-LF group (40.0%, p = 0.02, OR 1.4, 95% CI: 1.0–2.0). The lowest SBP during 30 min after SA was higher in the TEAS-HF group (100.0 ± 9.4 mm Hg) than in the Control group (91.5 ± 16.5 mm Hg) and TEAS-LF group (93.9 ± 16.6 mm Hg). Patients who received TEAS showed a lower score of nausea and vomiting (both p = 0.02). Patients in the group TEAS-HF showed a lower incidence of dizziness, dyspnea, and of chest congestion than those in the other two groups. There was no difference with respect to atropine consumption and neonatal Apgar score. Conclusions: TEAS-HF at PC6 reduced hypotension after SA in parturients, while TEAS-LF did not. Trial registration: ClinicalTrials.gov (NCT05724095) [ABSTRACT FROM AUTHOR]

A cost-effective, selective, sensitive, and operational TLC-densitometric approach has been adapted for the concurrent assay of Hydroxyzine Hydrochloride (HYX), Ephedrine Hydrochloride (EPH), and Theophylline (THP) in their pure powder and pharmaceutical forms. In the innovative TLC-densitometric approach, HYX, EPH, and THP were efficaciously separated and quantified on a 60F254 silica gel stationary phase with chloroform–ammonium acetate buffer (9.5:0.5, v/v) adjusted to pH 6.5 using ammonia solution as a mobile liquid system and UV detection at 220 nm. The novel TLC method validation has been performed in line with the international conference for harmonization (ICH) standards and has been effectively used for the estimation of the researched medicines in their pharmaceutical formulations without intervention from excipients. Additionally, parameters affecting the chromatographic analysis have been investigated. The new TLC approach's functionality and greenness were appraised using three modern and automated tools, namely the Blue Applicability Grade Index (BAGI), the Analytical Greenness metric (AGREE), and the Green Analytical Procedure Index (GAPI) tools. In short, the greenness characteristics were not achieved as a result of using mandatory, non-ecofriendly solvents such as ammonia and chloroform. On the contrary, the applicability and usefulness of the novel TLC approach were attained via concurrent estimation for the three drugs using simple and straightforward procedures. Moreover, the novel TLC method outperforms previously published HPLC ones in terms of the short run time per sample and moderate pH value for the liquid system. According to the conclusions of comparisons with previously recorded TLC methods, our novel HPTLC method has the highest AGREE score, so it is the greenest HPTLC strategy. Moreover, its functionality and applicability are very appropriate because of the simultaneous assessment of three drugs in one TLC run. Furthermore, no tedious and complicated extraction and evaporation processes are prerequisites. [ABSTRACT FROM AUTHOR]

Background: To reduce maternal-fetal morbidity and mortality, it is becoming increasingly important for anesthetists to understand and implement enhanced recovery after surgery (ERAS) cesarean delivery guidelines. Our aim was to reveal the knowledge of anesthesia assistants in Turkey about ERAS during cesarean delivery and to increase their awareness of ERAS. Methods: This descriptive study was conducted in the city of Isparta, Turkey in 2023. The survey, which was approved by the ethics committee, was distributed to participants across Turkey via e-mail and online messages. The survey comprises of a total of 42 questions evaluating perioperative ERAS recommendations. Results: Of the 404 participants in our survey, 59.9% were associated with university hospitals and 65.8% had completed three or more years of education. A total of 87.9% of the participants were familiar with ERAS; however, only 42.8% had received ERAS training. Although 93.8% of the participants' institutions performed a cesarean delivery, ERAS recommendations were only implemented at a rate of 48%. This may be due to the absence of an ERAS team, which was identified in our survey at a high rate of 66.6%. Conclusion: Awareness about ERAS was high among the participants, but the implementation rates of some recommendations were low. The reason for this may be the inability to form a multidisciplinary team and inadequate training of participants. For this purpose, we recommend the formation of a multidisciplinary team for ERAS protocol implementation and increased participant training opportunities. [ABSTRACT FROM AUTHOR]

Background: To enhance the utility of functional hemodynamic monitoring, the variables systolic slope (dP/dt) and dynamic arterial elastance (Eadyn) are calculated by the Hypotension Prediction Index (HPI) Acumen® Software. This study was designed to characterize the effects of phenylephrine and ephedrine on dP/dt and Eadyn. Methods: This was a retrospective, non-randomized analysis of data collected during two clinical studies. All patients required intra-operative controlled mechanical ventilation and had an indwelling radial artery catheter connected to an Acumen IQ sensor. Raw arterial pressure waveform data was downloaded from the patient monitor and all hemodynamic measurements were calculated off-line. The anesthetic record was reviewed for bolus administrations of either phenylephrine or ephedrine. Cardiovascular variables prior to drug administration were compared to those following vasopressor administrations. The primary outcome was the difference for dP/dt and Eadyn at baseline compared with the average after the bolus administration. All data sets demonstrated non-normal distributions so statistical analysis of paired and unpaired data followed the Wilcoxon matched pairs signed-rank test or Mann-Whitney U test, respectively. Results: 201 doses of phenylephrine and 100 doses of ephedrine were analyzed. All data sets are reported as median [95% CI]. Mean arterial pressure (MAP) increased from 62 [54,68] to 78 [76,80] mmHg following phenylephrine and from 59 [55,62] to 80 [77,83] mmHg following ephedrine. Stroke volume and cardiac output both increased. Stroke volume variation and pulse pressure variation decreased. Both drugs produced significant increases in dP/dt, from 571 [531, 645] to 767 [733, 811] mmHg/sec for phenylephrine and from 537 [509, 596] to 848 [779, 930] mmHg/sec for ephedrine. No significant changes in Eadyn were observed. Conclusion: Bolus administration of phenylephrine or ephedrine increases dP/dt but does not change Eadyn. dP/dt demonstrates potential for predicting the inotropic response to phenylephrine or ephedrine, providing guidance for the most efficacious vasopressor when treating hypotension. Trial registration: Data was collected from two protocols. The first was deemed to not require written, informed consent by the Institutional Review Board (IRB). The second was IRB-approved (Effect of Diastolic Dysfunction on Dynamic Cardiac Monitors) and registered on ClinicalTrials.gov (NCT04177225). [ABSTRACT FROM AUTHOR]

Background: To enhance the utility of functional hemodynamic monitoring, the variables systolic slope (dP/dt) and dynamic arterial elastance (Eadyn) are calculated by the Hypotension Prediction Index (HPI) Acumen® Software. This study was designed to characterize the effects of phenylephrine and ephedrine on dP/dt and Eadyn. Methods: This was a retrospective, non-randomized analysis of data collected during two clinical studies. All patients required intra-operative controlled mechanical ventilation and had an indwelling radial artery catheter connected to an Acumen IQ sensor. Raw arterial pressure waveform data was downloaded from the patient monitor and all hemodynamic measurements were calculated off-line. The anesthetic record was reviewed for bolus administrations of either phenylephrine or ephedrine. Cardiovascular variables prior to drug administration were compared to those following vasopressor administrations. The primary outcome was the difference for dP/dt and Eadyn at baseline compared with the average after the bolus administration. All data sets demonstrated non-normal distributions so statistical analysis of paired and unpaired data followed the Wilcoxon matched pairs signed-rank test or Mann-Whitney U test, respectively. Results: 201 doses of phenylephrine and 100 doses of ephedrine were analyzed. All data sets are reported as median [95% CI]. Mean arterial pressure (MAP) increased from 62 [54,68] to 78 [76,80] mmHg following phenylephrine and from 59 [55,62] to 80 [77,83] mmHg following ephedrine. Stroke volume and cardiac output both increased. Stroke volume variation and pulse pressure variation decreased. Both drugs produced significant increases in dP/dt, from 571 [531, 645] to 767 [733, 811] mmHg/sec for phenylephrine and from 537 [509, 596] to 848 [779, 930] mmHg/sec for ephedrine. No significant changes in Eadyn were observed. Conclusion: Bolus administration of phenylephrine or ephedrine increases dP/dt but does not change Eadyn. dP/dt demonstrates potential for predicting the inotropic response to phenylephrine or ephedrine, providing guidance for the most efficacious vasopressor when treating hypotension. Trial registration: Data was collected from two protocols. The first was deemed to not require written, informed consent by the Institutional Review Board (IRB). The second was IRB-approved (Effect of Diastolic Dysfunction on Dynamic Cardiac Monitors) and registered on ClinicalTrials.gov (NCT04177225). [ABSTRACT FROM AUTHOR]

In addition to stabilizing blood pressure (BP), ephedrine and phenylephrine have distinct effects on regional cerebral oxygen saturation (rSO2). However, whether its effect on rSO2 affects the occurrence of postoperative delirium (POD) remains unclear. Therefore, the aim of this study is to compare the effects of ephedrine and phenylephrine for BP maintenance on the incidence of POD in olderly adults who underwent knee arthroplasty under general anesthesia. One hundred twenty patients who were between 60 and 90 years old and underwent knee arthroplasty were included in this study. The patients were randomly divided into two groups: the ephedrine group and the phenylephrine group. After anesthesia induction, ephedrine and phenylephrine were continuously infused to maintain the intraoperative mean arterial pressure within the normal range (baseline mean arterial pressure ± 20%). The primary outcome measures included the incidence of POD within 1–3 days after surgery. The incidence of POD on the first day after surgery was lower in the ephedrine group than in the phenylephrine group (33% vs. 7%, P < 0.001). However, there was no significant difference in the incidence of POD between the two groups on the second and third postoperative days. Compared with the phenylephrine group, the ephedrine group experienced significantly greater cardiac output (CO) and rSO2 (P < 0.05). Clinical Trials Registry: ChiCTR2200064849, principal investigator: Changjian Zheng. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Perioperative hypotension is common and associated with adverse patient outcomes. Vasoactive agents are often used to manage hypotension, but the ideal drug, dose and duration of treatment has not been established. With this scoping review, we aim to provide an overview of the current body of evidence regarding the vasoactive agents used to treat perioperative hypotension in non‐cardiac surgery.We included all studies describing the use of vasoactive agents for the treatment of perioperative hypotension in non‐cardiac surgery. We excluded literature reviews, case studies, and studies on animals and healthy subjects. We posed the following research questions: (1) in which surgical populations have vasoactive agents been studied? (2) which agents have been studied? (3) what doses have been assessed? (4) what is the duration of treatment? and (5) which desirable and undesirable outcomes have been assessed?We included 124 studies representing 10 surgical specialties. Eighteen different agents were evaluated, predominantly phenylephrine, ephedrine, and noradrenaline. The agents were administered through six different routes, and numerous comparisons between agents, dosages and routes were included. Then, 88 distinct outcome measures were assessed, of which 54 were judged to be non‐patient‐centred.We found that studies concerning vasoactive agents for the treatment of perioperative hypotension varied considerably in all aspects. Populations were heterogeneous, interventions and exposures included multiple agents compared against themselves, each other, fluids or placebo, and studies reported primarily non‐patient‐centred outcomes. [ABSTRACT FROM AUTHOR]

It aimed to compare the trans anesthetic clinical and perioperative analgesic effects by prolonged continuous infusion of fentanyl (GF, bolus of 5 µg/kg and continuous infusion (CI) of 15 µg/kg/h) or remifentanil (GR, CI of 18 µg/kg/h) in dogs undergoing to elective ovariohysterectomy. Twenty female healthy dogs were premedicated with acepromazine, inducted to unconsciousness with propofol and kept under anesthesia with isoflurane. The M0 (baseline) was recorded and animals were randomly allocated in GF (n = 10) or GR (n = 10), recording clinical and blood gas parameters every 15 minutes (M15...M120) for two hours and, after, during surgery, adjusting the opioid rate according to surgical requirement. The isoflurane vaporization reduced by up to 47% and 42% in GF and GR, respectively, when compared to M0. During the first two hours of CI, six animals of each group required atropine intervention and three animals of GF required ephedrine. The number of rate adjustments during intraoperative was significant higher in GR when compared to GF (P = 0.0248). By the Log-rank test, there was a higher possibility of not receiving analgesic rescue in the first 30 minutes of postoperative in GF when compared to GR (P < 0.0001) and all animals required analgesic rescue during the firsts 3 and 6 hours in GR and GF, respectively. It is concluded that, when the proposal continuous infusions were compared, fentanyl required fewer analgesic rescues during perioperative, nonetheless, it is recommended rate adjustment during intraoperative and additional analgesia for postoperative for both treatments. [ABSTRACT FROM AUTHOR]

Over-the-counter drugs are medicines that are available to consumers without a prescription. The most common оver - the-counter preparations in self - medication are nasal decongestants that can be used systemically or locally in the form of drops or nasal sprays. The most common indications for nasal decongestants are viral infections and allergic conditions in order to alleviate the symptoms so it is necessary to inform the users about the type of drug, the active substance it contains and the correct dosage regimen. Given their availability and the prevailing safety precaution, these preparations can lead to numerous prolonged conditions and complications. The mechanism of action of nasal decongestants is based on the reduction of blood vessels' swelling in the nose, which helps the opening of the airway. As a result, most nasal decongestants cause vasoconstriction (narrowing of blood vessels). There are nasal decongestants that block histamine and have a good effect on people who suffer from seasonal allergies. Availability (free sale) and prolonged use of the decongestant lead to a decrease in the sensitivity of the alpha receptor, which leads to the need to increase the dose at shorter time intervals to achieve the same effect. As a consequence, patients use excessive, uncontrolled doses of nasal decongestants, which is a public problem and warns of the necessity of identification and the taking of measures to prevent their uncontrolled procurement and use. [ABSTRACT FROM AUTHOR]

Ephedra sinica and Ephedra intermedia are important medicinal plants and critical raw materials for ephedrine extraction in the pharmaceutical industry. Climate change will affect their distribution and quality. In our study, information on E. sinica and E. intermedia was collected through wilderness and online surveys. Using high-performance liquid chromatography, we determined the contents of ephedrine and pseudoephedrine. We then utilized the maximum entropy model to assess the potential impact of future climate on the distribution and quality of the two Ephedra. The results showed that the two Ephedra species were predominantly found in the arid and semiarid regions of northern China. The suitable habitats and quality area of E. intermedia will be severely degraded under RCP 2.6, RCP 4.5 and RCP 8.5 conditions and the results for E. sinica are the opposite. The accumulation of chemical components in E. sinica depends on the precipitation of the wettest month (Bio13) and soil sand content, while the accumulation of chemical components in E. intermedia depends on the mean temperature of the warmest quarter (Bio10) and the precipitation seasonality (Bio15). Overall, the research results provide the basis for the two high-quality Ephedra species for conservation and sustainable resource development. [ABSTRACT FROM AUTHOR]

Background: Spinal anaesthesia is commonly used in many surgeries especially caesarean section (CS). It is one of the most common complications of spinal anesthesia, and it is a challenge for anesthesiologists. It refers to low blood pressure after spinal anaesthesia hypotension, which may reach the point of shock that need rapid intervention to decrease peri-operative morbidity and mortality. A lot of techniques have been described to prevent such hypotension, but an effective method is yet to be found. Ketamine is one of the anaesthetic drugs that can be injected intrathecally due to its synergistic effect with the effects of local and analgesic anesthesia and has a sympathetic stimulating effect that can raise blood pressure. Objectives: The aim of the study is to evaluate the effect of using a sub-anesthetic dose of ketamine intrathecally on hypotension that follow spinal anaesthesia especially in CS delivery and other surgeries that receive spinal anaesthesia. Methods: This double-blinded randomized prospective study was conducted on 40 participation patients who were ASA 1 and 2, all the patients received spinal anesthesia. The patients were then randomly divided into two equal groups (n= 20 in each); ketamine group received a sub- anesthetic dose of ketamine of 0.5 mg/ kg intrathecal with local anaesthetic bupivacaine10 - 15 mg (2-3 ml 0.5%) and control (non ketamine) group received the same dose of local anaesthetics without ketamine. Mean arterial blood pressure (MAP) was recorded at baseline (5 minutes prior to the intrathecal injection), and at 5, 10, 15, 20 and 30 minutes after the injection. Incidences of hypotension and severe hypotension were recorded. The total doses of ephedrine and volume of infused fluid as cohydration were also recorded. Results: Compared to the control group, mild hypotension and severe hypotension were less frequent among the ketamine group. MAP was higher among ketamine group with statistical significance at 5 and 10 minutes. The number of cases who received ephedrine and the total ephedrine doses were significantly lower among the ketamine group. The volume of infused fluid and number of cases who received that volume were also significantly lower among the ketamine group. Conclusion: It is concluded that ketamine in a sub-anaesthetic dose intrathecally is an effective agent that can be used for alleviation of post-spinal anesthesia hypotension in patients undergoing spinal anaesthesia especially with CS delivery. [ABSTRACT FROM AUTHOR]

This paper presents a novel sensor for the electrochemical detection of ephedrine (EPD), a precursor compound used in the illicit production of amphetamines and related drugs. The sensor is based on a modified glassy carbon electrode (GCE) modified with nickel oxide/nitrogen-doped graphene oxide nanocomposite (NiO/NGO). The NiO/NGO nanocomposite was created hydrothermally and examined using scanning electron microscopy (SEM), X-ray diffraction (XRD), and X-ray photoelectron spectroscopy (XPS) methods. The successful nitrogen doping of graphene oxide (GO) and the anchoring of NiO nanoparticles on GO nanosheets in the nanocomposite are confirmed by all characterization studies. Measurements using cyclic voltammetry (CV) and differential pulse voltammetry (DPV) were used to assess the electrochemical performance of the NiO/NGO/GCE. The NiO/NGO/GCE showed good sensitivity, stability, and selectivity for EPD detection, with a linear range of 10–2580 µM and a detection limit of 0.09 µM. Moreover, the NiO/NGO/GCE was effectively used to calculate EPD in actual blood serum samples, yielding findings that were both reproducible and adequate (the recovery values varied from 98.80% to 99.40%, and the RSD values from 3.591% to 4.21%). The suggested biosensor provides an easy, quick, and affordable way to detect EPD in sports doping control. [ABSTRACT FROM AUTHOR]

Although various anti-inflammatory medications, such as ephedrine, are employed to manage cough-variant asthma, their underlying mechanisms are yet to be fully understood. Recent studies suggest that exosomes derived from airway epithelial cells (AECs) contain components like messenger RNAs (mRNAs), micro-RNAs (miRNAs), and long noncoding RNA (lncRNA), which play roles in the occurrence and progression of airway inflammation. This study investigates the influence of AEC-derived exosomes on the efficacy of ephedrine in treating cough-variant asthma. We established a mouse model of asthma and measured airway resistance and serum inflammatory cell levels. Real-time polymerase chain reaction (RT-qPCR), Western blotting, and enzyme-linked immunosorbent assay (ELISA) analyses were used to assess gene and protein expression levels. Exosomes were isolated and characterized. RNA immunoprecipitation (RIP) and RNA pull-down assays were conducted to examine the interaction between hnRNPA2B1 and lnc-TRPM2-AS1. In the ovalbumin (OVA)-challenged mouse model, ephedrine treatment reduced inflammatory responses, airway resistance, and Th1/Th2 cell imbalance. Exosomes from OVA-treated AECs showed elevated levels of lnc-TRPM2-AS1, which were diminished following ephedrine treatment. The exosomal lnc-TRPM2-AS1 mediated the Th1/Th2 imbalance in CD4+ T cells, with its packaging into exosomes being facilitated by hnRNPA2B1. This study unveils a novel mechanism by which ephedrine ameliorates OVA-induced CD4+ T cell imbalance by suppressing AEC-derived exosomal lnc-TRPM2-AS1. These findings could provide a theoretical framework for using ephedrine in asthma treatment. [ABSTRACT FROM AUTHOR]

INTROUCTION: Spinal anesthesia (SA) has become a popular technique for LSCS as it is advantageous being a quick, safe and a reliable option that also provides analgesia post-operatively. Hyperbaric drugs which are routinely used can produce very high blocks in pregnant women because of decreased volume and increased pressure of CSF due to engorged epidural veins which is a result of aorto-caval compression and high CSF pressure. Haemodynamic changes1,2,3 like hypotension, Bradycardia were commonly associated complication with spinal-anaesthesia in obstetric parturients. For minimizing spinal-induced haemodynamic changes with anticholinergic drugs may be of interest. Anticholinergics like atropine and Glycopyrrolate are routinely used in anaesthesia for premedication. Atropine easily crosses placental barrier and blood-brain barrier as it has a tertiary amine structure. However, Glycopyrrolate having a structure of quaternary amine, limits its ability to cross these barriers. Hence Glycopyrrolate is the desired option for obstetric parturients AIMS and OBJECTIVES: To study the haemodynamic stability, efficacy and other adverse effects of Glycopyrroate during spinal anaesthesia for caesarean delivery. MATERIAL SOURCE: All the partirients who are undergoing caesarean section divided in to 2 groups of 30 in each group G and Group C. They are included and excluded depending on their physical status and any contra indications to Spinal anaesthesia Results: showed more stable haemodynamics in Group G showing Glycopyrrolate5, 6, 7, 8 is better anticholinergic drug which does not cross placenta barrier. Conclusion: Pre-treatment before administering spinal anaesthesia (SA) in pregnant women who are posted for elective caesarean sections with 0.2 mg of Glycopyrrolate in patients decreases the incidence of hypotension before the extraction of the neonate. Glycopyrrolate also reduces the incidence of Bradycardia. [ABSTRACT FROM AUTHOR]

BACKGROUND: The most common complication after spinal Anesthesia is hypotension. In order to help and treat this complication different styles have been used. But, hypotension remains the most common problem, in spite of preloading the patient with Crystalloid and colloid. Among utmost of the cases, to treat spinal Anesthesia convinced hypotension, vasopressors are needed. Studies involving both administration of phenylephrine and ephedrine are multitudinous. But, studies regarding precautionary infusion of these medicines and their comparison on motherly hemodynamics and are rare. METHODOLOGY:This is a randomized control study conducted on 60 cases aged between 18-35years with normal singleton gestation beyond 36 weeks of gravidity and belonging to ASAII posted for caesarean sections under spinal anesthesia are aimlessly named and distributed to either Group A- Phenylephrine and Group B- Ephedrine. (By lottery method) RESULTS Maternal blood pressure was maintained in both the groups and was not statistically significant. Bradycardia was seen in 23% of group A and nausea of 20% was seen in group A, where as there was no prevalence of any complications in group B. Neonatal assessment was done using APGAR scoring and umbilical vein ABG and was plant statistically insignificant. CONCLUSION: It was observed that maternal blood pressure was maintained well with both ephedrine as well as phenylephrine, but there was prevalence of bradycardia and nausea with phenylephrine. There was no major effects APGAR score, fetal umbilical vein ABG in both groups. KEY WORDS: alpha adrenergic, maternal hypotension, foetal distress, APGAR INTRODUCTION Maternal hypotension results in dizziness, nausea, vomiting, may also interfere with surgical procedure and can also induce fetal bradycardia (1-4) and acidosis (4-6). Many trials comparing phenylephrine and ephedrine for management of hypotension during spinal Anesthesia for Caesarean section have shown favourable results. Some of the measures taken to drop the prevalence of maternal hypotension are preloading, left uterine relegation. Administration of precautionary vasopressors, leg contraction, trendelenberg position etc.(7-9) The vasopressor of choice in pregnant women has been ephedrine. The use of alpha agonists has been avoided because of their adverse effects on uterine blood flow. However, in a quantitative, systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of hypotension during spinal anaesthesia for cesarean delivery, Lee and colleagues showed that there was no difference between ephedrine and phenylephrine in efficacy. They did find, however, that women given phenylephrine had neonates with higher umbilical cord blood pH values than women given ephedrine, although the risk of true fetal acidosis (umbilical pH value of 7.20) was similar in both groups. Because acidotic changes in the umbilical arterial pH are sensitive indicators of reduced uteroplacental perfusion, the authors concluded that their finding was indirect evidence that uterine blood flow may in fact be better with phenylephrine compared with ephedrine. Utmost of the studies are grounded on the effects of preloading (10-12) or vasopressors.(13,14) Ephedrine which has both alpha and beta agonistic activity, increases cardiac output and heart rate and therefore maintains the blood pressure. Where as phenylephrine which is an alpha agonist, rectifies the drop in systemic vascular resistance convinced by spinal Anesthesia. Rather of treating the hypotension as done generally, it is better to help the hypotension induced by spinal Anesthesia. Therefore, we have studied the effects of precautionary infusion of phenylephrine versus ephedrine on maternal hemodynamics in elective Caesarean section under spinal Anesthesia. METHODS AND MATERIALS This is a randomized control study conducted at hospitals attached to Bangalore Medical College and Research Institute, Bangalore. A total of sixty cases aged between 18-35 years with normal singleton gestation beyond 36 weeks of gravidity and belonging to ASA II posted for caesarean sections under spinal anesthesia. They were randomly allocated to two groups: A received Phenylephrine and B received Ephedrine. Cases are explained about the procedure and informed / spoken concurrence attained. Two intravenous lines are established. Cases are pre-loaded with 500ml Ringer lactate and Pre-medicated with Inj-Pantoprazole 40mg I.V and Inj-Metaclopromide 10mg I.V 15 minutes after pre-medication, baseline parameters -Heart rate, saturation, blood pressure and ECG, monitored using pulseoximetry, Noninvasive blood pressure and ECG monitor. [ABSTRACT FROM AUTHOR]

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Background: Anesthesia for spinal muscular atrophy (SMA) patients undergoing spinal deformity surgery is challenging. We report an unusual case of an SMA girl who developed severe intraoperative hypoxemia and hypotension during posterior spinal fusion related with surgical positioning. Case presentation: A 13-yr-old girl diagnosed with SMA type 2, severe kyphoscoliosis and thoracic deformity was scheduled for elective posterior spinal fusion. She developed severe hypoxemia and profound hypotension intraoperatively in the prone position with surgical table tilted 45° to the right. Though transesophageal echocardiography (TEE) could not be performed due to limited mouth opening, her preoperative computed tomography revealed a severely distorted thoracic cavity with much reduced volume of the right side. A reasonable explanation was when the surgeons performed surgical procedure with the tilted surgical table, the pressure was directly put on the shortest diameter of the significantly deformed thoracic cavity, causing severe compression of the pulmonary artery, resulting in both hypoxemia and hypotension. The patient stabilized when the surgical table was tilted back and successfully went through the surgery in the leveled prone position. Conclusions: Spinal fusion surgery is beneficial for SMA patients in preventing scoliosis progression and improving ventilation. However, severe scoliosis and thoracic deformities put them at risk of both hemodynamic and respiratory instability during surgical positioning. When advanced monitoring like TEE is not practical intraoperatively, preoperative imaging may help with differential diagnosis, and guide the surgical positioning to minimize mechanical compression of the thoracic cavity, thereby helping the patient complete the surgery safely. [ABSTRACT FROM AUTHOR]

Background: We aimed to evaluate the effect of glucose-containing crystalloid infusion before anesthesia induction on hemodynamics and postanesthesia complications. Methods: This double-blind, randomized clinical trial was conducted on 60 parturient cases scheduled for elective Cesarean delivery under spinal anesthesia who were referred to the teaching hospitals of Mashhad University of Medical Sciences (Iran). The parturients were randomized into two groups. Both groups received 5 - 7 mL/kg of intravenous bolus serum before spinal anesthesia. The parturients in the glucose-containing normal saline (GcNS) group received 1% glucose solution in normal saline. The normal saline (NS) group received only normal saline. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), blood glucose concentrations, neonatal Apgar scores, postanesthesia complications, and ephedrine and atropine consumption were evaluated. Results: Sixty patients were recruited (30 in each group), with a mean age of 29.14 ± 6.01 and 29.76 ± 6.15 years in the GcNS and NS groups, respectively. There was no significant difference between the two groups in SBP, DBP, or HR after baseline adjustment. The incidence of hypotension was higher in the NS (70.0%) compared to the GcNS group (46.6%), but the difference was not significant. There was no significant difference in Apgar scores. The incidence of nausea, vomiting, pallor, and shivering was higher in the NS group. However, only nausea and vomiting 10 minutes after anesthesia induction were significant. Ephedrine and atropine consumption was higher in the NS group, but not significantly. Conclusions: The present study did not show any clear benefit for adding 1% glucose to normal saline solution preload for hypotension in parturients undergoing Cesarean delivery with spinal anesthesia. [ABSTRACT FROM AUTHOR]

A spectrophotometric platform based on two smart techniques namely Double Divisor ratio difference spectra spectrophotometry (DDRD) and Derivative ratio amplitude difference method (DR-AD) was applied and validated. These techniques were used for determining and resolving the overlapped spectra of the 3 drugs paracetamol (PAR), pseudoephedrine (PSE) and pholcodine (PHO) in their ternary mixture. DDRD is a successive technique while DR-AD is a progressive one. In DDRD, the mixtures' spectrum underwent division by a double divisor, and then the ratio difference method was applied. For DR-AD, consequent steps were performed to resolve each drug stepwise. DR-AD technique included division using a single divisor. The linearity ranges encompassed 5-25, 100-800 and 5-50 µg/mL for PAR, PSE and PHO, respectively. These methods were conducted according to ICH guidelines to ascertain accuracy, precision, and specificity. The analysis involved varied concentrations of drug mixtures and a pharmaceutical product. Statistical evaluation revealed no notable distinction between the suggested methodologies and those previously documented. Additionally, adherence to green analytical chemistry principles was demonstrated, establishing them as environmentally friendly analytical approaches. [ABSTRACT FROM AUTHOR]