Effects of ephedrine on expression of Nogo-A and synaptophysin in neonatal rats following hypoxic-ischemic brain damage

BACKGROUND: Central nervous system axons regenerate poorly following neonatal hypoxic-ischemic brain damage (HIBD), partly due to inhibitors, such as Nogo-A. Very few studies have addressed the regulation of Nogo-A in neonatal rats following HIBD. However, numerous studies have shown that ephedrine accelerates neuronal remodeling and promotes recovery of neural function in neonatal rats following HIBD. OBJECTIVE: To investigate the effects of ephedrine on expression of Nogo-A and synaptophysin in brain tissues of neonatal rats following HIBD. DESIGN, TIME AND SETTING: A completely randomized, controlled study was performed at the Immunohistochemistry Laboratory of the Research Institute of Pediatrics, Children's Hospital of Chongqing Medical University from August 2008 to March 2009. MATERIALS: Ephedrine hydrochloride (Chifeng Pharmaceutical Group, China), rabbit anti-Nogo-A polyclonal antibody (Abcam, UK), and rabbit antisynaptophysin polyclonal antibody (Lab Vision, USA) were used in this study. METHODS: A total of 96 healthy, neonatal, Sprague Dawley rats were randomly assigned to three groups (n = 32): sham operation, HIBD, and ephedrine. The HIBD model was established by permanent occlusion of the left common carotid artery, followed by 2 hours of hypoxia (8% oxygen and 92% nitrogen). In the sham operation group, the left common carotid artery was exposed, but was not ligated or subjected to hypoxia. Rats in the ephedrine group were intraperitoneally injected with ephedrine immediately following HIBD, with 1.5 mg/kg each time. Rats in the sham operation and HIBD groups were injected with an equal volume of saline. All neonatal rats were treated once daily for 7 days. MAIN OUTCOME MEASURES: Histopathological damage to the cortex and hippocampus was determined by hematoxylin-eosin staining. Expression of Nogo-A and synaptophysin was detected using immunohistochemical staining. RESULTS: Neuronal degeneration and edema were observed in the hypoxic-ischemic cortex and hippocampus by hematoxylin-eosin staining. Compared with the sham operation group, the levels of Nogo-A significantly increased in the HIBD group at various time points (P < 0.01). Nogo-A expression was significantly reduced in the ephedrine group compared with the HIBD group (P < 0.01). Synaptophysin expression was significantly decreased in the hypoxic-ischemic cortex, compared with the sham operation group (P < 0.01). Synaptophysin levels were significantly increased in the ephedrine group, compared with the HIBD group (P < 0.01). CONCLUSION: Altered Nogo-A expression was associated with inversely altered synaptophysin expression. The use of ephedrine normalized expression levels of Nogo-A and synaptophysin following HIBD.

Comparison the effect of ephedrine and phenylephrine in treatment of hypotension after spinal anesthesia during cesarean section

Background and Objective: The effectiveness of ephedrine and/or phenylephrine, in treatment of hypotension secondary to spinal anesthesia for cesarean section and their effects on fetal/neonatal outcome were studied. Methods and Materials: Sixty healthy parturients were randomly assigned to two groups;group E (n = 33) received boluses 5 mg/ml increments ephedrine and group P (n = 27) received a boluses of phnylephrine 100 μg/ml increments for treatment of hypotension after spinal block during cesarean section. Changes in maternal blood pressure and heart rate, and incidence of nausea-vomiting, neonatal Apgar score at 1 and 5 minutes of delivery, and umbilical arterial blood gas values were recorded. Results: There were no differences in treatment of hypotension following sympathectomy after spinal block with two drugs. Neonatal outcome was similar in two groups. There were not significant differences in umbilical arterial values in two groups. Conclusion: Ephedrine and phenylephrine are both effective vasopressores for treatment of hypotension associated to spinal block during cesarean section without adverse effects on infants/neonates.

Volume Preload versus Ephedrine Infusion for Prevention of Hypotension Due to Spinal Anesthesia for Cesarean Section

Background: Spinal anesthesia is used for 95% of planned cesarean sections in the United States. It provides a fast and profound sensory and motor block. However, hypotension is a very common complication of spinal anesthesia during cesarean section, causing significant morbidity and mortality. It could be associated with severe nausea, vomiting and even unconsciousness and pulmonary aspiration in the mother and for the baby, hypoxia, acidosis, and neurological injuries may result. Methodology: Fifty patients were randomly allocated into two groups. Group I (F group) patients received preloading with 15 ml/kg Ringer lactate before induction of spinal anesthesia, and group II (E group) patients received IV ephedrine (5 mg in 1st minute after spinal anesthesia and 5 mg in the 2nd minute and 1 mg every minute after that for 15 minutes). Results: A statistically significant difference in the incidence of hypotension between group F (48%) and group E (24%) was seen, (p-value 0.03). Regarding side effects, the incidence of nausea and vomiting was higher in the group F (20%) when compared to group E (12%), (p-value 0.23). Conclusions: We concluded that IV infusion of ephedrine after induction of spinal anesthesia was more effective than crystalloid preloading in a prevention of hypotension in parturient undergoing cesarean section and did so without causing significant tachycardia.

Effect of ephedrine hydrochloride on regulation of body fluid metabolism and AQP1 and AQP2 in a rabbit model of mechanical ventilation

Objective:Ephedrine hydrochloride(EH)is a major component from Ephedra sinica STAPF,which is used as a traditional Chinese herbal medicine.This study was designed to investigate the effect of EH on water metabolism and further explore the relevant signaling pathway of body fluid regulation in“lung governing regulation of water passage”using a rabbit model of mechanical ventilation.The molecular mechanism of the EH effect in the kidney was also investigated.Methods:Rabbits were randomly divided into a control group,model group,EH group,and dexmedetomidine hydrochloride(DH)group.Urine volume was measured by the intubation method and pathologic changes in lung and renal tissue were measured by hematoxylin and eosin staining.Nitric oxide(NO)production in lung,serum,and kidney were analyzed using chemical methods.An ELISA was used to analyze angiotensin II(Ang II),antidiuretic hormone(ADH),prostaglandin E2(PGE2),atrial natriuretic peptide(ANP),and endothelin-1(ET-1)levels in the lung,serum,and kidney.Aquaporin-1(AQP1)and aquaporin-2(AQP2)mRNA and protein expression in the kidney was determined using qRT-PCR and immunohistochemistry.Results:EH significantly inhibited the decrease in the total urine volume in the third and fourth stages,and displayed significant regulatory effects on NO,Ang II,ADH,PGE2,ANP,and ET-1 in serum,lung,and renal tissues compared with the model group.In the kidney,AQP1 and AQP2 mRNA and protein expression in the EH group were remarkably downregulated compared with the model group.Conclusion:EH exerted a regulatory effect on water metabolism by diffusing the lung and increased urine volume in the rabbit model,which was consistent with the decrease in kidney AQP1 and AQP2 expression levels that led to an increase in urine volume.EH could assist with DH to exert a protective effect on the clinical application of mechanical ventilation.

A Comparative Study of Uses of Ephedrine by Different Doses on Prevention of Hemodynamic Changes Accompanied with Induction of General Anesthesia through Propofol and Fentanyl without Adverse Effects

Background: Propofol and fentanyl combination are common with general anesthesia. However, hypotension and bradycardia are common during induction of anesthetic. This study aimed to compare the response of different doses of ephedrine for attenuation of the hemodynamic changes after anesthetic induction without adverse effects. Materials and Methods: This was a randomized, double-blinded, case-controlled clinical trial. One hundred and twenty adult patients were allocated into one of the four groups: receiving IV saline, ephedrine 0.05 mg/kg, 0.1 mg/kg, or 0.2 mg/kg respectively. Induction of anesthesia was done with propofol 3 mg/kg and fentanyl 1 mg/kg. Alterations in systolic and diastolic blood pressures (SBP, DBP), mean arterial pressure (MAP), and heart rate (HR) were calculated every 1 min after induction, and 2, 3, 4 and 5 min. Then, intubation was made. Results: Baseline hemodynamic variables were comparable between groups. Patients received 0.1 mg/kg, and 0.2 mg/kg had less drop in blood pressure both systolic and diastolic, MAP, and HR with no significant rise in side effects. The numbers of patients with hypotension were significantly lower in the group receiving ephedrine 0.2 mg/kg compared to other groups (P-value 0.05). Use of IV ephedrine at a dose of 0.1 mg/kg was shown to be useful for reduction of hemodynamic changes but did not eliminate the risk of blood pressure drop. Ephedrine 0.2 mg/kg was better without causing any adverse effects. We can conclude that ephedrine 0.1 mg/kg was suitable for minimizing or decreasing changes in hemodynamic at propofol-fentanyl induction but ephedrine 0.2 mg/kg was better without causing more adverse effects.

Effects of ephedrine, phenylephrine and norepinephrine prevent hypotension after spinal anesthesia in cesarean section and comparison of effects on newborns

Objective: To compare the preventive effect of ephedrine, phenylephrine and norepinephrine on hypotension after lumbar anesthesia in cesarean section and their effects on newborns. Methods: 25 cesarean section women in our hospital from December 2016 to January 2018 were selected and divided into three groups according to different surgical medication, namely, ephedrine group (n=40), phenylephrine group (n=45) and norepinephrine group (n=40). Then the vital signs, neonatal blood gas analysis, neonatal Apgar score, adverse reactions of the three groups were compared. Results: The HR at T0~T3, and SBP and DBP at T0 and T1 had no difference among three groups (P>0.05). The HR, SBP and DBP at T3 ranking in a descending order was norepinephrine group, ephedrine group and phenylephrine group (P<0.05). The PCO2 and PO2 had no difference among three groups (P>0.05). The pH ranking in a descending order was norepinephrine group, ephedrine group and phenylephrine group (P<0.05). The SpO2 ranking in a descending order was phenylephrine group, ephedrine group and norepinephrine group (P<0.05). The Apgar score at birth in ephedrine group and norepinephrine group was significantly lower than that in phenylephrine group (P<0.05), while the Apgar score at post-birth 5 min and 10 min had no difference among three groups (P>0.05). The incidence of hypertension, gastrointestinal reaction, hyperhidrosis and palpitation in the phenylephrine group was significantly lower than that in the norepinephrine group (P<0.05). Conclusion: The phenylephrine and norepinephrine have no difference on the preventive effect of hypotension after spinal anesthesia in cesarean section, while safety of norepinephrine for puerpera and neonates is higher.

Management of Arterial Hypotension Induced by Spinal Anesthesia during Cesarean Section at the Parakou University Hospital in Benin in 2020: Ephedrine versus Noradrenaline

Background: Spinal anesthesia (SA) is a preferred anesthetic technique for childbirth through caesarean section. It causes a sympathetic block responsible for low blood pressure which can be prevented or treated with vasopressors. Aim: This research aims to compare the effect of Noradrenaline with that of Ephedrine in the management of arterial hypotension caused by SA during Caesarean act. Study method: It was a cross-sectional study with two comparative settings which took place at the Teaching hospital of Parakou from April 15th to August 15th 2020. It included all parturients who underwent a caesarian act and received spinal anesthesia. To prevent hypotension two groups were formed. The first group parturient received Noradrenaline (10 γ) as prophylactic and the second group received Ephedrine (10 mg) before anesthesia. The main evaluation criteria were the time before the hypotension occurs and, the secondary endpoint was the number of hypotension episode. The two groups were compared using the usual statistical tests. The study received the approval of the Local Ethical committee of University of Parakou. Results: Two hundred and four parturients were compiled with 102 in each group. The mean age was 28.37 ± 6.15 years with extremes of 16 and 45 years. The main indications for Caesarean section were respectively iterative Caesarean section (46.57%) for scheduled Caesarean section and acute fetal distress (15.69%) for emergency Caesarean section. The incidence of hypotension was 38.24%. The mean delay of occurrence of hypotension was significantly longer in adrenaline group (19.90 min) than ephedrine group (12.53 min) with P = 0.001. According to the secondary endpoint the number of episodes of hypotension, number of tachycardia, and the total doses of each vasopressor were significantly lower in adrenaline group than in the ephedrine group. Conclusion: The use of Noradrenaline according to the established protocol demonstrated its efficiency compared with Ephedrine in the management of hypotension after spinal anesthesia.

芳酸偶氮吡唑啉酮及其麻黄碱盐的合成

近期报道了吡唑啉酮衍生物与稀土金属的络合作用。关于4-芳基偶氮吡唑啉酮与过渡金属络合的作用已有报道,但与稀土金属络合的文献不多。根据英国药典,麻黄碱与铜离子络合呈色而作为其鉴定方法,本文制备了麻黄碱类与芳酸偶氮吡唑啉酮形成的盐,以备研究它们的络合作用。在合成的5种吡唑啉酮衍生物中。

运动后鼻腔检查在招飞体检中的应用

招收飞行学员医学选拔中鼻科检查要求必须看清楚鼻腔结构,以明确在飞行环境中鼻腔结构是否影响鼻腔、鼻窦及咽鼓管的功能,做出受检对象是否适合飞行的结论.招飞体检中受时间的限制,需要短时间内做出结论,而自然状态下用前鼻镜检查方法多不能完全看清楚鼻腔完整结构,传统方法使用麻黄素收缩鼻腔黏膜进行检查.而麻黄素应用也存在一系列问题[1].

Comparison of two vasopressor protocols for preventing hypotension post-spinal anesthesia during cesarean section: a randomized controlled trial

Background:Norepinephrine infusion decreases hypotension after spinal anesthesia during cesarean section.This study aimed to compare the efficacy of norepinephrine infusion and ephedrine bolus against post-spinal hypotension in parturients.Methods:In this double-blinded,randomized controlled clinical trial,parturients scheduled for elective cesarean section were randomly allocated to receive norepinephrine infusion(0.05μg·kg^(-1)·min^(-1))just before spinal anesthesia continuing for 30 min or ephedrine bolus(0.15 mg/kg)just before spinal anesthesia.A rescue bolus(5μg norepinephrine for the norepinephrine group,and 5 mg ephedrine for the ephedrine group)was administered whenever hypotension occurred.Our primary outcome was the incidence of hypotension within 30 min of spinal anesthesia administration.Secondary outcomes included maternal and neonatal outcomes 30 min after spinal block,and neonatal cerebral oxygenation 10 min after birth.Results:In total,190 patients were enrolled;of these patients,177 were included in the final analysis.Fewer patients suffered hypotension in the norepinephrine group than in the ephedrine group(29.5%vs.44.9%,odds ratio[OR]:0.51,95%confidence interval[CI]:0.28-0.95,P=0.034).Moreover,the tachycardia frequency was lower in the norepinephrine group than in the ephedrine group(OR:0.22,95%CI:0.11-0.44,P<0.001),and patients suffered less nausea and vomiting(OR:0.28,95%CI:0.11-0.70,P=0.004).There was no difference in Apgar scores and umbilical arterial blood gas analysis between the two groups.However,neonatal cerebral regional saturations were significantly higher after birth in the norepinephrine group than in the ephedrine group(mean difference:2.0%,95%CI:0.55%-3.45%,P=0.008).Conclusion:In patients undergoing elective cesarean section with spinal anesthesia,norepinephrine infusion compared to ephedrine bolus resulted in less hypotension and tachycardia,and exhibited potential neonatal benefits.