Ephedrine Research Articles

P.1.j.007 - Ephedrine HCL, curcumin and turmerone in neurogenesis and inhibition of beta-amyloid plaques in transgenic mice models

P.1.j.007 - Ephedrine HCL, curcumin and turmerone in neurogenesis and inhibition of beta-amyloid plaques in transgenic mice models

Effects of different depths of sedation on serum adiponectin concentrations in elderly patients undergoing general anesthesia

Objective To evaluate the effects of different depths of sedation on serum adiponectin (ADP) concentrations in elderly patients undergoing general anesthesia. Methods A total of 120 elderly patients of both sexes, aged 65-83 yr, weighing 45-75 kg, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, undergoing elective noncardiac surgery under general anesthesia, were divided into Ⅰ and Ⅱ groups (n=60 each) using a random number table.Propofol was given by closed-loop target-controlled infusion, and bispectral index value was maintained at 40-50 in group Ⅰ and at 50-60 in group Ⅱ.The cognitive function was assessed by the Montreal Cognitive Assessment at 1 day before operation ant 1 and 7 days after operation.Blood samples were collected from the internal jugular vein immediately before surgery, at 2 h after the beginning of surgery and at 1 and 7 days after surgery for determination of serum ADP and S-100β protein concentrations. Results Compared with group Ⅰ, Montreal Cognitive Assessment scores were significantly increased at 1 and 7 days after surgery, the serum concentrations of ADP were increased and S-100β protein concentrations in serum were decreased at 1 and 7 days after surgery, and the intraoperative requirement for ephedrine and atropine and incidence of postoperative cognitive dysfunction were decreased during surgery in group Ⅱ (P<0.05). Conclusion Maintaining BIS value at 50-60 can reduce the development of postoperative cognitive dysfunction, which is related to the increased concentration of serum ADP in elderly patients undergoing general anesthesia. Key words: Electroencephalography; Aged; Cognition disorders; Adiponectin

Anesthetic management of patients with active infective endocarditis undergoing cardiac valve surgery under cardiopulmonary bypass

Objective To summarize experience and characteristics of the perioperative anesthetic management of patients with active infective endocarditis(AIE)undergoing cardiac valve surgery under cardiopulmonary bypass (CPB). Methods A total of 117 patients of both sexes, aged 18-70 yr, of American Society of Anesthesiologists physical status Ⅱ-Ⅳ, undergoing cardiac valve surgery under CPB from January 2014 to June 2015 in Peking Union Medical College Hospital, were enrolled in the study and divided into AIE group (n=57) and non-AIE group (n=60). Anesthesia was induced by IV injection of midazolam 1-2 mg, etomidate 0.15-0.30 mg/kg, sufentanil 0.3-0.5 μg/kg and rocuronium 0.6-1.0 mg/kg.After orotracheal intubation, the patients underwent high-frequency volume-controlled ventilation with low tidal volume, and positive end-expiratory pressure was increased appropriately.Esophageal echocardiography was used for evaluation.Anesthesia was maintained by inhalation of 1.0%-1.5% sevoflurane, intermittent IV boluses of sufentanil 0.2-0.3 μg/kg and IV infusion of piperium bromide 2 mg/h, and the bispectral index value was maintained between 40-60 during surgery.Sensitive antibiotics were given during surgery according to the results of preoperative blood culture in AIE group.The following data were collected: baseline patient characteristics, preoperative blood routine, erythrocyte sedimentation rate, concentrations of hypersensitive c-reactive protein and amino-terminal pro-brain natriuretic peptide, operation time, CPB time, intraoperative consumption of vasoactive drugs, fluid intake and output, use of antibiotics, length of postoperative intensive care unit stay, extubation time, new invasive operation (intra-aortic balloon counterpulsation was performed), time for use of vasoactive drugs, postoperative 24 h drainage, length of hosptial stay, serious complications (postoperative bleeding, pericardial tamponade, severe arrhythmia, heart failure, acute lung injury, renal failure and other organ function failure, etc.) and development of death. Results Compared with non-AIE group, age, body mass index and preoperative Hb, Hct, systolic blood pressure and diastolic blood pressure were significantly decreased, the rate of preoperative hypertension, neutrophil count, erythrocyte sedimentation rate, concentrations of hypersensitive c-reactive protein and amino-terminal pro-brain natriuretic peptide, body temperature and heart rate were increased, the intraoperative volume of allogeneic blood transfused and consumption of norepinephrine, phenylephrine and ephedrine after CPB were increased, the time for postoperative use of vasoactive drugs, extubation time and length of postoperative intensive care unit stay were shortened, and the length of hospital stay was prolonged in AIE group (P<0.05). Conclusion For the patients with AIE undergoing cardiac valve surgery under CPB, comprehensive evaluation should be performed and heart failure be corrected actively before surgery; esophageal echocardiography should be used for evaluation, the application of vasoactive drugs could be increased appropriately and anesthetists should pay attention to respiratory management during surgery; cardiotonic and anti-shock therapy should be maintained, arrhythmia prevented and anti-infective therapy strengthened after surgery. Key words: Endocarditis; Cardiac surgical procedures; Cardiopulmonary bypass; Anesthesia

Effects of different analgesia regimens on fast recovery in patients following radical operation for gastric cancer

Objective To investigate the effects of different analgesia regimens on fast recovery in patients following radical operation for gastric cancer. Methods A total of 67 gastric cancer patients subjected to radical operation were randomly divided into three groups, receiving epidural analgesia (EA group, n=20), intravenous analgesia (PCIA group, n=24) and subcostal transverse abdominis plane block(STAP group, n=23), respectively. The consumption of sevoflurane, sufentanil and vasoactive drugs during operation, VAS score at 1, 6, 12, 24, 48, 72 h after operation, and pethidine consumption after operation were recorded. Recovery of gastrointestinal function, first postoperative feeding time, ambulation time, duration of stay in hospital and the occurrence of adverse effects were compared among three groups. Results Compared with PCIA group (3.8±2.0, 4.7±1.8, 6.5±1.7) , EA group and STAP group have less VAS scores in T1[(2.3±1.2), (3.1±2.3)], T2 [(2.3±1.1), (3.4±2.0)], T3 [(2.8±1.1), (3.6±2.0)] respectively and less occurrence of nausea and vomiting, fatigue and dizziness(P<0.05). Compared with EA group, PCIA group and STAP group have more consumption of sufentanil, pethidine and less consumption of ephedrine and less occurrence of hypotension. Recovery time of gastrointestinal function [(37±12), (50±16), (74±13) h], first postoperative feeding time [(47±10), (61±15), (89±11) h], and ambulation time [(41±15), (54±18), (56±22) h] significantly differ among STAP group, EA group and PCIA group (P<0.05). There was no difference in length of hospital stay between three groups. Conclusions General anesthesia combined with epidural analgesia or with subcostal transverse abdominis plane block is beneficial for the fast-recovery of gastric cancer patients subjected to radical operation. General anesthesia combined with intravenous analgesia has less analgesia, more side effects and longer recovery time. Key words: Analgesia; Radical operation for gastric cancer; Subcostal transverse abdominis plane block; Fast recovery

One-Step Derivatization-Extraction Method for Rapid Analysis of Eleven Amphetamines and Cathinones in Oral Fluid by GC-MS.

A simple analytical method was developed for in-matrix derivatization of 11 amphetamine-like molecules. Ethyl chloroformate as the derivatization reagent and ethyl acetate as the extraction solvent were added directly to oral fluid samples at alkaline pH. Samples were analyzed by gas chromatography-mass spectrometry. Ions monitored for quantification were m/z 44, 91 and 116 for amphetamine (AMP); m/z 58, 91 and 130 for methamphetamine (MA); m/z 44, 105 and 116 for 4-methylamphetamine; m/z 44, 116 and 251 for 3,4-methylenedioxyamphetamine; m/z 58, 130 and 265 for 3,4-methylenedioxymethamphetamine (MDMA); m/z 72, 116 and 144 for 3,4-methylenedioxyethylamphetamine; m/z 44, 105 and 116 for cathinone; m/z 58, 105 and 130 for methcathinone; m/z 58, 119 and 130 for mephedrone; m/z 58, 107 and 130 for ephedrine (EPH); m/z 207, 250 and 322 for fenethylline; m/z 48, 92 and 120 for AMP-D5; m/z 62, 92 and 134 for MA-D5; m/z 48, 120 and 256 for MDA-D5; and m/z 62, 134 and 270 for MDMA-D5. The underlined ions were used as quantifier ions. Calibration curves were linear in the concentration range of 2.5-1,000 ng/mL for all analytes except for EPH, which was linear within 5-1,000 ng/mL. Precision and accuracy were less than 12.9% (relative standard deviation) and ±12.8% (bias), respectively, for all analytes. The method was tested in the analysis of oral fluid specimens collected from users.

Distribution Characteristics of Drugs of Abuse and Their Metabolites in Aqueous Environment of Beijing, China

This work investigated the occurrence and distribution of six drugs of abuse and their metabolites, i.e. methamphetamine(METH), amphetamine(AMP), ketamine(KET), ephedrine(EPH), methcathinone(MC) and hydroxylimine(HY) in the surface water and groundwater in Beijing, China. Forty-three samples were collected and analyzed by solid-phase extraction and high performance liquid chromatography coupled to tandem mass spectrometry(SPE-HPLC-MS/MS). The result showed that KET, MC and HY were not detected in any of the analyzed samples. EPH was the most abundant and ubiquitous compound in the surface water, with the detection frequency of 42% and average concentration of 10.1 ng·L-1, followed by METH(25%, average 1.8 ng·L-1). Only trace amount of AMP was detected in some groundwater samples(n.d.-2.2 ng·L-1), with detection frequency of 21%. Spatial variation of target drug concentrations in the aqueous environment was also studied, and the highest levels of METH and EPH were observed in Liangshui River. Risk assessment suggested that the RQ values of target compounds were lower than 0.10. Although no toxic effects could be expected at the current levels, further studies are needed to assess the long-term effect of drugs of abuse and their metabolites on organisms as well as the joint toxic effect.

A new UPLC approach for the quantitation of ephedrine and guaifenesin in a syrup formulation using multivariate optimization strategy

ABSTRACTA new ultraperformance liquid chromatography (UPLC) method with photodiode array detection was developed for the quantitative analysis of a commercial syrup formulation containing ephedrine (EPH) and guaifenesin (GUA). In the development of UPLC method, experimental chromatographic conditions, flow rate, column temperature, and percentage of 0.1 M H3PO4 in mobile phase, were optimized using chemometric multivariate strategy. From the application of a 33 full factorial design, the optimal chromatographic conditions were obtained as the flow rate of 0.29 mL/min, column temperature of 36.4°C, and 56.9% of 0.1 M H3PO4 in the mobile phase. The optimal conditions gave us a good chromatographic separation of the analyzed drugs with short analysis runtime within 3 min. Calibration curves for EPH and GUA in the linear working range of 4–64 and 6–96 µg/mL, respectively, were obtained using peak areas detected at 215 nm. Performance and validity of the optimized UPLC method were estimated by analyzing independent binary mixtures, inter-day and intra-day samples, and standard addition solutions containing EPH and GUA substances. It was concluded that the proposed method was a promising approach for the quantitative determination and routine analysis of a commercial syrup formulation of the titled substances.

Maternal care bundle: The effect of a multimodal approach on the prevention of maternal hypotension following spinal anesthesia in parturients undergoing elective or urgent cesarean section

Background and AimMany techniques to prevent spinal induced hypotension in cesarean section have been advocated; but no one technique proved to be totally effective. The aim of this cohort interventional study was to investigate the efficacy of application of multimodal approach to decrease the incidence of hypotension (defined as mean arterial blood pressure ⩽60 mmHg) following spinal anesthesia in parturients undergoing elective or urgent cesarean section.Patients and MethodsIn this prospective cohort interventional study, 159 American Society of Anesthesiologists (ASA) classification I–II parturients undergoing elective or urgent cesarean section were enrolled. All patients received maternal care bundle which consisted of; fixed low dose of bupivacaine (7.5 mg + fentanyl 25 μg), coloading with 15 ml/kg lactated Ringer’s, placement of the patient in the supine wedged position, administration of 9 mg ephedrine sulphate IV after intrathecal injection and placement of graduated compression stockings (GCS) in the elevated leg position >45° and maintaining leg elevation at 20° following application of GCS. Demographic data, spinal anesthetic technique variables, fluid intake and urine output were documented. Mean arterial blood pressure, heart rate and oxygen saturation were recorded at baseline T0 (before spinal anesthesia administration), T1 (5 min following intrathecal injection of local anesthetics), T2 (15 min), T3 (30 min) and at T4 (end of procedure prior to PACU transfer). Total dose of ephedrine and any complication was documented.ResultsIncidence of hypotension after 5 min (T1) was 17.6%, at 15 min (T2) was 3.8% and at 30 min (T3) was 5%.ConclusionsThe application of a maternal care bundle had significantly decreased the incidence of spinal induced hypotension in parturient undergoing elective or urgent Cesarean delivery.

Distribution Analysis via Mass Spectrometry Imaging of Ephedrine in the Lungs of Rats Orally Administered the Japanese Kampo Medicine Maoto

Maoto, a traditional Japanese Kampo medicine, has been used to treat various respiratory diseases, including respiratory infections and influenza. Ephedrine (EPD), the main ingredient in maoto, is also clinically used to treat respiratory diseases. However, the pharmacokinetics and distribution of EPD in the lungs after the administration of maoto have not been demonstrated. This study aimed to determine the concentrations, distribution, and pharmacokinetics of EPD and its precursor methylephedrine (MEPD) in the lungs of rats orally administered maoto (1 and 4 g/kg). We used liquid chromatography–electrospray ionization-tandem mass spectrometry to measure the ingredient concentrations. Both ingredients were detected in maoto-treated lung homogenates. Next, we examined the distribution of both ingredients in lung sections by using matrix-assisted laser desorption/ionization-mass spectrometry imaging, a powerful tool for the visualization of the distribution of biological molecules. The mass spectrometry imaging analysis detected only EPD and provided the first visual demonstration that EPD is distributed in the alveoli, bronchi, and bronchioles in the lungs of rats orally administered maoto (4 g/kg, three times at 2-h intervals). These results suggest that the pharmacological efficacy of maoto for the amelioration of respiratory symptoms is related to the distribution of EPD in the lung.

Intravenous ephedrine, phenylephrine, and ketamine for attenuation of hypotension associated with induction of general anesthesia with propofol

Background and objective Hypotension and bradycardia remain the major adverse effects of propofol during induction of general anesthesia. Several drugs were studied to prevent these adverse effects. In our study, we compare the effect of mixing ephedrine, phenylephrine, or ketamine with propofol to attenuate its hypotensive effect during induction of general anesthesia. Materials and methods A total of 120 patients of both sexes between 20 and 50 years of age and ASA I–II physical status undergoing elective ambulatory surgeries under general anesthesia were included in our study. Patients were randomly allocated into four groups (30 patients each): group C (the control group), which received plain propofol; group E (the ephedrine group), which received 15 mg of ephedrine premixed with propofol; group Ph (the phenylephrine group), which received 100 μg of phenylephrine premixed with propofol; and group K (the ketamine group), which received 30 mg of ketamine premixed with propofol. In all groups, mean arterial blood pressure (MABP) and heart rate (HR) were recorded at baseline (before induction) and then every 1 min until 6 min after induction. Results Addition of ephedrine, phenylephrine, or ketamine to propofol during general anesthesia induction can significantly attenuate hypotension and bradycardia. In the control group, the MABP dropped from 91.96±3 mmHg just before induction to 75.6±8.7 mmHg at 6 min after induction. HR in the control group dropped from 83.76±7.29/min just before induction to 75.3±12/min at 6 min after induction. The drop in MABP and HR were nonsignificant in the other three groups. Conclusion Mixing propofol with ketamine, ephedrine, or phenylephrine before induction can attenuate its hypotensive and bradycardic effects.

Comparative Pharmacokinetics and Bioavailability of Three Ephedrines in Rat after Oral Administration of Unprocessed and Honey-Fried Ephedra Extract by Response Surface Experimental Design.

Ephedra have been used as a common traditional Chinese medicine for thousands of years. However, the perspiration effect of the unprocessed ephedra was too strong. Clinical trials have shown that processing methods play a critical role in moderating the perspiration property of ephedra according to the needs. A LC-MS/MS method was developed and validated to compare the pharmacokinetic properties of the three ephedrines after oral administration of unprocessed and honey-fried ephedra extract. The contents of honey, frying temperature, and frying time were set at 20%, 116°C, and 7 min by the Box-Behnken response surface method, respectively. In the pharmacokinetics study, the biosamples were pretreated and extracted by protein precipitation method with acetonitrile and separated on an Agilent TC-C18 column (250 mm × 4.6 mm, 5 μm) using a mobile phase consisting of 0.1% formic acid methanol and 5 mM ammonium acetate aqueous solution (5 : 95, v/v). All calibration curves were linear (r > 0.9932) with lower limits of quantitation (LLOQs) < 12 ng/mL. The mean recoveries of the three analytes were higher than 75%. The pharmacokinetics study indicated that the reduced absorption of ephedrine hydrochloride (EH) and pseudoephedrine hydrochloride (PEH) in honey-fried ephedra group might be the main reason for the moderation of the diaphoretic property.

Drugs of abuse and their metabolites in the urban rivers of Beijing, China: Occurrence, distribution, and potential environmental risk.

The occurrence and distribution of five drugs of abuse and their metabolites, namely, methamphetamine (METH), amphetamine (AMP), ketamine (KET), ephedrine (EPH), and hydroxylimine (HY), were investigated in the surface water in urban rivers in Beijing, China. A total of 117 surface water samples were collected from the seven rivers in the Beijing urban areas during four different seasons. Laboratory analyses revealed that EPH and METH were the most predominant drugs, with detection frequency ranging from 94% to 100% and from 65% to 100%, respectively. High levels of METH and KET were observed in the center part of the urban areas, which was likely associated with the drug abuse and the entertainment activities. Seasonal variation of the drug occurrence showed that the highest concentration of drugs of abuse was found during winter, which was likely due to the high consumption, low temperature, and low water flows during the cold weather. By contrast, the concentration and detection frequency of AMP and HY were relatively low. Risk assessment by the risk quotient method indicated that the five drugs of abuse and their metabolites were not likely to exert biological effects on the aquatic ecosystems at current levels in the surface water. However, the potential adverse effect of drugs of abuse and their metabolites on ecosystem functioning and human health should not be neglected.

Influence of combined spinal epidural anesthesia with head-up of 10°on maternal hemodynamics during cesarean section

Objective To explore the anesthesia effect and influence of combined spinal epidural anesthesia(CSEA) with head-up of 10°on maternal hemodynamics during cesarean section. Methods 120 pregnant women undergoing cesarean section were selected, and were randomly divided into group A, B and C, 40 cases in each group.Three groups were all given CSEA, yet pregnant women in group A were taken supine position, group B was taken head-up of 10°, and group C was taken head-up of 20°.Hemodynamic parameters of three groups of the following time points were compared, including before anesthesia(T0), 5min after anesthesia(T1), skin incision(T2), fetal disengagement immediately(T3), and operation at the end(T4), also anesthesia effect was recorded, and usage of ephedrine and local anesthetic was noted, and adverse reactions were compared. Results Compared with T0, group A's hemodynamics in T1 decreased, including systolic blood pressure (SBP), diastolic blood pressure (DBP), and increased in T2 and T3, yet there were no statistical differences on hemodynamics in three groups in T4.Compared with group B and C, there were statistical differences on hemodynamics in T1, T2 and T3 in group A(t=3.63-7.25, P 0.05). Anesthesia block scores in group A, B and C were (2.0±0.3)points, (2.5±0.2) points, (2.6±0.2) points, and scores of B and C were higher than that in group A(t=3.92, 4.01, all P<0.05). Cases and total usage of ephedrine in group A were higher than those of group B and C(χ2=31.43, 50.61, t=16.27, 20.17, all P<0.01). Cases of adjusting surgical position, and addition of local anesthetic in group C were significantly higher than those of group B(χ2=23.85, 28.47, all P<0.01). Conclusion It has better anesthetic effect of taking CSEA by head-up of 10°, and maternal hemodynamics are more stable, can better meet operation's requirements, also with easier operation, so it is superior to supine position and head-up of 20°. Key words: Cesarean section; Hemodynamics; Combined spinal epidural anesthesia; Body position

Efficacy and Safety of Dexmedetomidine for Conscious Sedation During Endoscopic Submucosal Dissection

Introduction: Although diazepam DZP and pentazocine Hydrochloride (PTZ) is widely used for sedation during ESD in Japan, there are frequent cases found where the total amount of DZP usage is quite large due to ineffectiveness of sedation. Recently dexmedetomidine (DEX) has become used for sedation during ESD in Japan. DEX has an advantage over DZP in that it does not cause respiratory depression. Therefore, also in our institution DEX has been introduced for sedation during ESD since 2014. In the present study we aimed to investigate the efficacy and safety of DEX for sedation during ESD. Methods: We checked our electronic medical records and extracted 114 cases of ESD between 19th March 2014 and 7th April 2016. These 114 cases were divided into two groups: Group A DEX DPZ and PTZ used concomitantly; Group B, DPZ and PTZ used (without DEX). As the indicator of sedative effectiveness, we investigated the number of body movement which required additional administration of DPZ or PTZ. And we checked adverse events during sedation, such as bradycardia. Results: There were 80 cases extracted in group A, and 34 cases in group B. In group A, the number of body movement was significantly fewer than in group B (A 1.14/h, B 1.18/h). Moreover, the incidence of nausea or vomiting during or three hours after ESD was significantly lower in group A than in group B (2.5% vs 23%, P< 0.001). Whereas, low blood pressure sBP < 80mmHg or bradycardia < 60bpm occurred more frequently in group A than in group B (35% and 28% vs 2% and 0%, respectively; P < 0.001). In 6 cases of low blood pressure we required ephedrine hydrochloride injection. The rest cases of low blood pressure (23 cases) and all the bradycardia cases recovered spontaneously after the end of DEX injection. Conclusion: We concluded that DEX is effective in that it can reduce the number of body movement compared to a DPZ/PTZ method. Although low blood pressure and bradycardia are important adverse events related to DEX, it can be usually managed safely. DEX should be recommended for a sedative agent for ESD.

Pharmacokinetic Effects of Cinnamic Acid, Amygdalin, Glycyrrhizic Acid and Liquiritin on Ephedra Alkaloids in Rats.

Ephedra alkaloids, including ephedrine (EP), pseudoephedrine (PEP) and methylephedrine (MEP), are sympathomimetic compounds with known toxicities but many Ephedra (Ephedrae herba) preparations, such as Ephedra decoction, have been clinically applied for centuries. In order to explore the possible detoxification mechanism of Ephedra alkaloids, four representative compounds in Ephedra decoction (cinnamic acid, amygdalin, glycyrrhizic acid and liquiritin) were studied for their pharmacokinetic effects on Ephedra alkaloids in Sprague-Dawley rats. Animals were randomly divided into six groups, with six rats in each. Rats were treated orally with EP-PEP-MEP (20mg/kg EP+20mg/kg PEP+20mg/kg MEP) and different combinations of cinnamic acid (3.03mg/kg), amygdalin (56.97mg/kg), glycyrrhizic acid (12.42mg/kg), liquiritin (3.79mg/kg) with EP-PEP-MEP, and 20mg/kg EP+20mg/kg PEP+20mg/kg MEP+3.03mg/kg cinnamic acid+56.97mg/kg amygdalin+12.42mg/kg glycyrrhizic acid+3.79mg/kg liquiritin. Blood samples (0.5mL) were taken from the orbital sinus venous plexus into heparinized tubes at 5, 10, 20, 30, 45, 60, 90, 120, 180, 240, 300 and 360min(6 rats per time point in each group) following single administration. The concentrations of Ephedra alkaloids in rat plasma were determined using a validated high performance liquid chromatography method. Area under the concentration-time curve from 0 to 360min (AUC0-t ) of EP, PEP and MEP were 666.99, 650.76 and 632.37µg·min/mL, respectively. Maximum plasma concentration (C max) of EP, PEP and MEP were 4.15, 4.08 and 3.59μg/mL, respectively. Mean residence time (MRT) of EP, PEP and MEP were 197.00, 173.97 and 183.87min, respectively, when the rats were treated with EP-PEP-MEP. Cinnamic acid increased the AUC0-t of EP while decreased C max of EP, amygdalin and glycyrrhizic acid increased C max and AUC0-t of EP and PEP, while liquiritin decreased AUC0-t of EP and PEP. The four representative compounds reduced MRT of EP, PEP and MEP, four compounds decreased AUC0-t of MEP. The EP-PEP-MEP+cinnamic acid+amygdalin+glycyrrhizic acid+liquiritin group increased AUC0-t of EP while decreased MRT of EP, increased MRT of PEP while decreased AUC0-t of PEP. The EP-PEP-MEP+cinnamic acid+amygdalin+glycyrrhizic acid+liquiritin group decreased MRT, AUC0-t and C max of MEP. Significant changes in pharmacokinetic parameters of EP, PEP and MEP were observed after oral administration with different combinations. The pharmacokinetic results reported here might provide reference for clinical usage of Ephedra alkaloids.

Determination of amphetamines in hair by integrating sample disruption, clean-up and solid phase derivatization

The utility of matrix solid phase dispersion (MSPD) for the direct analysis of amphetamines in hair samples has been evaluated, using liquid chromatography (LC) with fluorescence detection and precolumn derivatization. The proposed approach is based on the employment of MSPD for matrix disruption and clean-up, followed by the derivatization of the analytes onto the dispersant-sample blend. The fluorogenic reagent 9-fluorenylmethyl chloroformate (FMOC) has been used for derivatization. Different conditions for MSPD, analyte purification and solid phase derivatization have been tested, using amphetamine (AMP), methamphetamine (MET), ephedrine (EPE) and 3,4-methylenedioxymethamphetamine (MDMA) as model compounds. The results have been compared with those achieved by using ultrasound-assisted alkaline digestion and by MSPD combined with conventional solution derivatization. On the basis of the results obtained, a methodology is proposed for the analysis of amphetamines in hair which integrates sample disruption, clean-up and derivatization using a C18 phase. Improved sensitivity is achieved with respect to that obtained by the alkaline digestion or by the MSPD followed by solution derivatization methods. The method can be used for the quantification of the tested amphetamines within the 2.0–20.0ng/mg concentration interval, with limits of detection (LODs) of 0.25–0.75ng/mg. The methodology is very simple and rapid (the preparation of the sample takes less than 15min).

Management of Anesthesia during Lung Transplantations in a Single Turkish Center.

The aim of this study is to present our institutional experience during the management of anesthesia in lung transplantation (LT) surgeries as a definitive surgical treatment option in end-stage lung diseases. From a total of 15 patients, lung transplantation was performed as single LT (SLT) in 4 patients (n = 4) and as sequential bilateral LT (BLT) in 11 patients (n = 11). The anesthetic management included; for induction; intravenous ketamine, midazolam at doses of 2 mg/kg, 0.05 mg/kg, respectively or propofol, fentanyl at doses of 1 mg/kg, 3 mcg/kg, respectively. For maintenance, all patients received; 100% O2 and total intravenous infusion of propofol and remifentanil at doses of 0.02 mcg/kg/min and 0.1-0.25 µg/kg/min, respectively. All patients received intravenous rocuronium bromide for induction and maintenance. Hemodynamic stability was maintained with appropriate and adequate administration of vasodilators (intravenous Prostaglandin (PGI2) (0.5-1 ng/kg/min), inhaled nitric oxide (10-40 ppm), dopamine (2 mcg/kg/min) and vasopressors (intravenous dobutamine (5-15 mcg/kg/min), norepinephrine (0.05-1 mcg/kg/min),ephedrine (5 to 10 mg bolus doses ) to keep mean arterial blood pressure above 50 mmHg. Cardiopulmonary bypass (CPB) was performed in five patients who underwent sequential BLT and one SLT case. Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) was used in four cases of sequential BLT and in two cases of SLT. Neither ECMO nor CPB was performed in two BLT and in one SLT patient. One SLT patient who underwent CPB was admitted to the intensive care unit with support of intra-aortic balloon pump (IABP) and ECMO. Intraoperative death did not occur. During SLT or BLT, management of anesthesia with propofol and remifentanil provides a stable hemodynamic and medical support. Although our experience with VA ECMO was limited, our experience shows that this support system is a valuable tool to provide hemodynamic stability for patients undergoing LT.

Charge-transfer complexes of two highly efficient drugs with σ- and π-acceptors: Spectroscopic, thermal, and surface morphology characteristics

Considerable attention has recently been devoted to the formation of stable charge-transfer (CT) complexes that result from the reaction of drugs with acceptors. Intermolecular CT interactions of two drugs, barbituratic acid (Bar) and ephedrine hydrochloride (Eph), with different σ- and π-acceptors have been studied stoichiometrically, structurally (IR, Raman, 1H NMR, and UV-Vis spectroscopy), thermally, and morphologically (SEM).

A randomized comparative study of preloading with Ringers lactate and intravenous Ephedrine for the prevention of hypotension due to propofol during induction of general anesthesia

Background: The ideal method to prevent hypotension due to intravenous propofol for induction of anesthesia is still debatable. The aim of the study was to compare the hemodynamic response of ephedrine and volume loading with ringer lactate in preventing the hypotension caused by propofol as inducing agent in patients scheduled for elective surgeries requiring general anesthesia with endotracheal intubation.Methods: This was prospective randomized study conducted in 40 patients of ASA physical status I, aged 20-50 years, scheduled for elective surgeries requiring general anesthesia with endotracheal intubation. Group I received intravenous ephedrine sulphate (70 mcg/kg) just before induction of anaesthesia, and patients assigned to Group II received preloading with Ringer's lactate (12 ml/kg) over the 10-15 minutes before the administration of propofol. The variables compared were heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure following induction of anesthesia till 10 minutes after intubation of trachea.Results: We found that there were increase in systolic blood pressure, diastolic blood pressure and mean arterial pressure after induction in both the groups but the difference between the groups was not significant. The increase in heart rate was found to be significantly higher in ephedrine group in comparison to volume loading group.Conclusion: Our study showed that both the methods used were equally effective in preventing hypotension induced by propofol in the adult ASA physical status I patients requiring general anesthesia with endotracheal intubation. However, the heart rate was significantly higher in patients receiving ephedrine in comparison to volume loading group.

Application of Carbon Nanotubes Modified Coatings for the Determination of Amphetamines by In-Tube Solid-Phase Microextraction and Capillary Liquid Chromatography

In this study, polydimethylsiloxane (PDMS)-coated capillary columns (TRB-5 and TRB-35), both unmodified and functionalized with single-wall carbon nanotubes (SWCNTs) or multiwall carbon nanotubes (MWCNTs), have been tested and compared for the extraction of amphetamine (AMP), methamphetamine (MET) and ephedrine (EPE) by in-tube solid-phase microextraction (IT-SPME). Prior to their extraction, the analytes were derivatized with the fluorogenic reagent 9-fluorenylmethyl chloroformate (FMOC). For separation and detection capillary chromatography with fluorimetric detection has been used. The presence of carbon nanotubes in the extractive coatings enhanced the extraction efficiencies and also significantly improved the chromatographic profiles, thus resulting in a reliable option for the analysis of these drugs. As an example of application, a new method is proposed for the analysis of the tested amphetamines in oral fluid using a TRB-35 capillary column functionalized with MWCNTs. The proposed conditions provided suitable selectivity and reproducibility (CV ≤ 6%, n = 3) at low µg/mL levels, and limits of detection of 0.5–0.8 µg/mL.