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The New England Journal of Medicine Dec 2007
Topics: Administration, Inhalation; Almitrine; Extracorporeal Membrane Oxygenation; Humans; Neuromuscular Blocking Agents; Nitric Oxide; Positive-Pressure Respiration; Respiration, Artificial; Respiratory Distress Syndrome; Respiratory System Agents; Tidal Volume
PubMed: 18077819
DOI: 10.1056/NEJMc072900 -
Zhongguo Zhong Yao Za Zhi = Zhongguo... Apr 2007To find a good way to diagnose VD, value the effect of Yishen Yangnao capsule on VD and try to find some rules of changes in Chinese medicine syndromes. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To find a good way to diagnose VD, value the effect of Yishen Yangnao capsule on VD and try to find some rules of changes in Chinese medicine syndromes.
METHOD
Patients were randomly divided into treating group and western medicine comparison group. It's the phase III clinical research of Rishen Yangnao capsule curing VD, judging the validity and security of it, using dukexi slice as comparison drug. Some of the patients did the examination of P300.
RESULT
The total validity of Yishen Yangnao capsule is 56.3% (contract team is 60.0%). The improve rate of ADL is 0.1069% (contract team is 0.1134%). The scores of Chinese medicine syndrome descend.
CONCLUSION
Yishen Yangnao capsule has the same effect as dukexi slice in curing VD at the side of intelligence situation and life ability.
Topics: Activities of Daily Living; Aged; Almitrine; Capsules; Dementia, Vascular; Drug Combinations; Drugs, Chinese Herbal; Event-Related Potentials, P300; Female; Humans; Male; Medicine, Chinese Traditional; Middle Aged; Neuroprotective Agents; Phytotherapy; Treatment Outcome; Yohimbine
PubMed: 17608233
DOI: No ID Found -
Zhonghua Nei Ke Za Zhi Aug 2006To explore the effect of antidepressant treatment on antihypertensive therapy of senile hypertension. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To explore the effect of antidepressant treatment on antihypertensive therapy of senile hypertension.
METHODS
138 cases of senile hypertension complicating with depression were studied. 103 senile hypertensive patients without depression in the same period served as controls. The patients were randomly divided into 3 groups as A, B and C for study. 12.5 mg/d hydrochlorothiazide and 30 mg/d release-controlling tablets of nifedipine were orally administrated as basic antihypertensive medication each group. Besides, 20 mg/d fluoxetine was additionally given to groups A and one tablet of almitrine l/d and 20 mg oryzanol 3/d were given to group B. The treatment lasted 12 weeks.
RESULTS
In comparison with pre-treatment, the blood pressure at base line in sitting position and the average circadian SBP and DBP monitored with 24-hour ambulatory blood pressure monitoring (ABPM) was remarkably decreased in group A with statistical significance (P < 0.01). These blood pressure parameters in group B were also decreased as compared ith the pretreatment level brt with less statistical significance (P > 0.05). It was also noted tha with the addition of antidepressant fluoxetine, the manifestations of depression ere alleviated as shown by Hamilton depression (HAMD) scale. untoward reactions such as nausea, perspiration and skin rash were noted in a few patients, but none withdrew from the study.
CONCLUSIONS
Antidepressant and antianxiety treatment is of benefit to the antihypertensive therapy in senile hypertensive patients with complications of depression and/or anxiety neurosis. Based on the results of this study, it is suggested that routine administration of antidepressants and antianxiety drugs should be carried out in senile hypertensive patients complicating with depression or anxiety.
Topics: Aged; Antidepressive Agents; Antidepressive Agents, Second-Generation; Antihypertensive Agents; Blood Pressure Monitoring, Ambulatory; Depressive Disorder; Female; Fluoxetine; Humans; Hydrochlorothiazide; Hypertension; Male; Middle Aged; Nifedipine; Treatment Outcome
PubMed: 17074147
DOI: No ID Found -
Current Opinion in Anaesthesiology Feb 1999Hypoxia-induced by acute lung injury results from abnormal ventilation/perfusion ratio distribution towards shunt or low ventilation/perfusion zones. Pharmacological...
Hypoxia-induced by acute lung injury results from abnormal ventilation/perfusion ratio distribution towards shunt or low ventilation/perfusion zones. Pharmacological modification of pulmonary blood flow distribution improving ventilation/perfusion ratio should correct hypoxia. The development of inhaled nitric oxide therapy had confirmed this concept, but with a relatively high proportion of 'non responders'. Then development of other drugs used alone or in association with nitric oxide may reinforce the benefit of nitric oxide. This has been tested with almitrine bismesylate, a lipophilic drug that reinforce hypoxic pulmonary vasoconstriction. Using inhaled nitric oxide in combination with almitrine, several studies in adult respiratory distress syndrome or acute lung injury patients have shown spectacular results in term of PaO2 and pulmonary shunt reduction. Moreover, the proportion of responders to this combination seems largely great than those observed for each drug alone. In conclusion, pulmonary blood flow manipulation improving ventilation/perfusion mismatching is one of the major strategies to correct severe hypoxia.
PubMed: 17013295
DOI: 10.1097/00001503-199902000-00007 -
Current Opinion in Anaesthesiology Feb 2006Hypoxic pulmonary vasoconstriction is the pulmonary circulation's homeostatic mechanism for matching regional perfusion to ventilation and optimizing systemic PaO2. The... (Review)
Review
PURPOSE OF THE REVIEW
Hypoxic pulmonary vasoconstriction is the pulmonary circulation's homeostatic mechanism for matching regional perfusion to ventilation and optimizing systemic PaO2. The role of hypoxic pulmonary vasoconstriction in anesthesiology is reviewed.
RECENT FINDINGS
In hypoxic pulmonary vasoconstriction, airway hypoxia causes resistance pulmonary arteries to constrict, diverting blood to better-oxygenated alveoli. Hypoxic pulmonary vasoconstriction optimizes O2 uptake in atelectasis, pneumonia, asthma, and adult respiratory distress syndrome. During single-lung anesthesia, hypoxic pulmonary vasoconstriction helps maintain systemic oxygenation. When hypoxic pulmonary vasoconstriction is weak, systemic hypoxemia is exacerbated. Although not widely used, the peripheral chemoreceptor agonist almitrine enhances hypoxic pulmonary vasoconstriction and improves PaO2 during single-lung anesthesia. The mechanism of hypoxic pulmonary vasoconstriction involves a redox-based O2 sensor within pulmonary artery smooth muscle cells. Pulmonary artery smooth muscle cells mitochondria vary production of reactive O2 species in proportion to PaO2. Hypoxic withdrawal of these redox second messengers inhibits voltage-gated potassium channels, depolarizing the pulmonary artery smooth muscle cells. Depolarization activates L-type calcium channels, increasing cytosolic calcium and triggering hypoxic pulmonary vasoconstriction.
SUMMARY
An understanding of hypoxic pulmonary vasoconstriction is clinically relevant for anesthesiologists. Randomized clinical trials with robust endpoints are required to assess strategies for enhancing hypoxic pulmonary vasoconstriction in thoracic surgery patients.
Topics: Anesthesia, Inhalation; Humans; Hypoxia; Intraoperative Complications; Oxygen Consumption; Pulmonary Atelectasis; Pulmonary Circulation; Respiration, Artificial; Vascular Resistance; Vasoconstriction; Vasodilator Agents
PubMed: 16547431
DOI: 10.1097/01.aco.0000192777.09527.9e -
British Journal of Anaesthesia Sep 2005Almitrine combined with inhaled nitric oxide (NO) can prevent hypoxia during one-lung ventilation (OLV). The optimal dose of almitrine that would provide therapeutic... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
BACKGROUND
Almitrine combined with inhaled nitric oxide (NO) can prevent hypoxia during one-lung ventilation (OLV). The optimal dose of almitrine that would provide therapeutic advantage with few side-effects during open-chest OLV has not been established.
METHODS
Forty-two patients undergoing thoracotomy were randomly allocated to three groups: placebo, almitrine 4 microg kg(-1) min(-1) and inhaled NO 10 p.p.m. (ALM4+NO), and almitrine 16 microg kg(-1) min(-1) and inhaled NO 10 p.p.m. (ALM16+NO). Gas exchange, haemodynamic and respiratory variables and plasma concentrations of almitrine and lactate were monitored. Measurements were obtained with the patient awake (baseline), after induction of anaesthesia with two-lung ventilation (control 2LV), 20 min after treatment (2LV+T), and then at 10, 20 and 30 min of OLV (OLV10', OLV20' and OLV30') with FI(O2)1.
RESULTS
In the placebo group, OLV impaired Pa(O2) and increased pulmonary shunt [16 (SD 7) kPa and 42 (10)% respectively]. These improved with ALM4+NO [26 (10) kPa and 31 (7)%; P<0.001]. ALM16+NO further improved PaO2) to 36 (13) kPa (P<0.0001) but gave no improvement in the shunt. Mean pulmonary artery pressure was similar in the placebo and ALM4+NO groups [20 (4) vs 23 (5) mm Hg], whereas it was increased in the ALM16+NO group to 28 (8) mm Hg (P<0.01). Plasma concentrations of almitrine and lactate were unaltered by the treatments.
CONCLUSIONS
Low-dose almitrine (4 microg kg(-1) min(-1)) together with inhaled NO significantly improves oxygenation during open-chest OLV, without modifying pulmonary haemodynamics. An increased dose of almitrine (16 microg kg(-1) min(-1)) with inhaled NO further improves arterial oxygenation, but also increases mean pulmonary artery pressure.
Topics: Adolescent; Adult; Aged; Almitrine; Anthropometry; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Female; Hemodynamics; Humans; Hypoxia; Intraoperative Complications; Male; Middle Aged; Nitric Oxide; Oxygen; Partial Pressure; Prospective Studies; Respiration, Artificial; Thoracotomy
PubMed: 16024585
DOI: 10.1093/bja/aei194 -
Current Medical Research and Opinion Mar 2004Stroke is a major cause of disability. Certain experimental studies have suggested that a combination of almitrine + raubasine (Duxil) increases the supply of oxygen to... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
BACKGROUND AND OBJECTIVES
Stroke is a major cause of disability. Certain experimental studies have suggested that a combination of almitrine + raubasine (Duxil) increases the supply of oxygen to cerebral tissues and may be beneficial in post-stroke rehabilitation. This multicentre clinical study was carried out in order to assess the efficacy of this combination on poststroke rehabilitation.
METHODS
The trial was a randomised, double-blind, placebo-controlled study. Patients that had experienced an ischaemic cerebrovascular accident (confirmed by CT scan) were included 4-6 weeks after the acute onset and received randomised treatment of either almitrine + raubasine or placebo 2 tablets daily for 3 months. Before treatment, there was a 2-week washout period for stopping all other drugs, except for antihypertensive and antidiabetic drugs. We assessed the patients by Barthel Index (BI), Neurological Functional Deficit Scores (NFDS), and Hasagawa Dementia Scales (HDS) each month after treatment.
RESULTS
A total of 83 patients were entered into the study and data were available for 74. Of these, 38 patients received almitrine + raubasine and 36 received placebo. The baseline characteristics were comparable between both groups. Almitrine + raubasine was significantly more effective than placebo at increasing BI at 1, 2 or 3 months (14.6 +/- 13.8 versus 3.3 +/- 13.2, p = 0.01; 19.3 +/- 13.6 versus 8.8 +/- 14.0, p = 0.02; 22.6 +/- 14.7 versus 10.7 +/- 17.0, p = 0.02 respectively) and reducing NFDS at 1 month (3.6 +/- 3.2 versus 1.9 +/- 3.5, p = 0.034) after treatment. More almitrine + raubasine-treated patients' NFDS had improved compared with placebo-treated patients at 2 and 3 months (97 versus 78%, p = 0.013; 100 versus 86%, p = 0.023 respectively). Compared with pretreatment, there was a strong tendency towards an improvement of HDS with almitrine + raubasine. The number of adverse events reported was low for the almitrine + raubasine-treated group and the placebo group and all events were mild, of short duration and resolved without treatment. Almitrine + raubasine had no clinically significant effect on blood pressure, heart rate or other laboratory tests.
CONCLUSION
The results indicate that almitrine + raubasine can accelerate neurological function recovery after stroke to some degree and is well tolerated.
Topics: Aged; Almitrine; Double-Blind Method; Drug Combinations; Female; Humans; Male; Middle Aged; Neuroprotective Agents; Recovery of Function; Stroke; Stroke Rehabilitation; Treatment Outcome; Yohimbine
PubMed: 15025850
DOI: 10.1185/030079904125003080 -
Anesthesia and Analgesia Mar 2004We performed this prospective randomized double-blinded study to assess the ability of almitrine to treat hypoxemia during one-lung ventilation (OLV). Twenty-eight... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
UNLABELLED
We performed this prospective randomized double-blinded study to assess the ability of almitrine to treat hypoxemia during one-lung ventilation (OLV). Twenty-eight patients were anesthetized with propofol, sufentanil, and atracurium; lung separation was achieved with a double-lumen tube. A transesophageal Doppler probe was inserted to evaluate cardiac index. If SpO(2) was equal to or decreased to <95% during OLV (inspired fraction of oxygen of 0.6), patients were included in the study and received a placebo or almitrine (12 microg x kg(-1) x min(-1) for 10 min followed by 4 microg x kg(-1) x min(-1)) infusion until SpO(2) reached 90% or decreased to <90% (exclusion from the study). Eighteen of the 28 patients were included and received either almitrine (n = 9) or a placebo (n = 9). Treatment was discontinued in 1 patient in the almitrine group and 6 in the placebo group (P < 0.05). Treatment was successful (SpO(2) remaining >or=95% during OLV) in 8 patients in the almitrine group and 1 in the placebo group (P < 0.01). Heart rate, arterial blood pressure, and cardiac index did not change throughout the study, but we could obtain an adequate aortic blood flow signal in only half of the patients. Almitrine could be used to treat hypoxemia during OLV.
IMPLICATIONS
IV almitrine improves oxygenation during one-lung ventilation without hemodynamic modification. Such treatment could be used when conventional ventilatory strategy fails to treat hypoxemia or cannot be used.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Almitrine; Anesthesia; Blood Gas Analysis; Cardiac Output; Double-Blind Method; Echocardiography, Transesophageal; Female; Hemodynamics; Humans; Hypoxia; Male; Middle Aged; Prospective Studies; Respiration, Artificial; Respiratory System Agents
PubMed: 14980903
DOI: 10.1213/01.ane.0000099715.40831.2a -
Respiration; International Review of... 2003
Topics: Almitrine; Humans; Oxygen; Respiration; Respiratory Muscles; Respiratory System Agents
PubMed: 14665766
DOI: 10.1159/000074197 -
Anaesthesia and Intensive Care Oct 2003We present a case of orthodeoxia (postural hypoxaemia) which resulted from a combination of lung collapse/consolidation and blunted hypoxic pulmonary vasoconstriction...
We present a case of orthodeoxia (postural hypoxaemia) which resulted from a combination of lung collapse/consolidation and blunted hypoxic pulmonary vasoconstriction due to partial interruption of the sympathetic nerve supply to the lung by bilateral thoracic sympathectomy.
Topics: Adolescent; Almitrine; Female; Humans; Hyperhidrosis; Hypoxia; Norepinephrine; Postoperative Complications; Posture; Respiratory System Agents; Sympathectomy; Thoracic Nerves; Vasoconstrictor Agents
PubMed: 14601286
DOI: 10.1177/0310057X0303100516