RESUMO
BACKGROUND: Myasthenia gravis (MG) is a challenge for anesthesia management. This report shows that the use of rocuronium-sugammadex is not free from flaws and highlights the importance of cholinesterase inhibitors management and neuromuscular block monitoring in the perioperative period of myasthenic patients. CASE PRESENTATION: Myasthenic female patient submitted to general balanced anesthesia using 25 mg of rocuronium. Under train-of-four (TOF) monitoring, repeated doses of sugammadex was used in a total of 800 mg without recovery of neuromuscular blockade, but TOF ratio (TOFR) was stabilized at 60%. Neostigmine administration led to the improvement of TOFR. CONCLUSIONS: Although the use of rocuronium-sugammadex seems safe, we should consider their unpredictability in myasthenic patients. This report supports the monitoring of neuromuscular blockade as mandatory in every patient, especially the myasthenic ones.
Assuntos
Bloqueio Neuromuscular/métodos , Monitoração Neuromuscular , Rocurônio/uso terapêutico , Sugammadex/uso terapêutico , Adulto , Inibidores da Colinesterase/uso terapêutico , Feminino , Humanos , Miastenia Gravis , Neostigmina/uso terapêutico , Fármacos Neuromusculares não Despolarizantes , gama-Ciclodextrinas/uso terapêuticoRESUMO
Propolis, a resinous substance collected by honeybees by mixing their saliva with plant sources, including tree bark and leaves and then mixed with secreted beeswax, possesses a variety of bioactivities. Whereas caffeic acid phenethyl ester (CAPE) has been recognized as a major bioactive ingredient in New Zealand propolis, Brazilian green propolis, on the other hand, possesses artepillin C (ARC). In this study, we report that, similar to CAPE, ARC docks into and abrogates mortalin-p53 complexes, causing the activation of p53 and the growth arrest of cancer cells. Cell viability assays using ARC and green propolis-supercritical extract (GPSE) revealed higher cytotoxicity in the latter, supported by nuclear translocation and the activation of p53. Furthermore, in vivo tumor suppression assays using nude mice, we found that GPSE and its conjugate with γ cyclodextrin (γCD) possessed more potent anticancer activity than purified ARC. GPSEγCD may thus be recommended as a natural, effective and economic anticancer amalgam.
Assuntos
Antineoplásicos/farmacologia , Sobrevivência Celular/efeitos dos fármacos , Neoplasias/tratamento farmacológico , Fenilpropionatos/farmacologia , Própole/farmacologia , Animais , Antineoplásicos/química , Antineoplásicos/uso terapêutico , Brasil , Linhagem Celular Tumoral , Movimento Celular/efeitos dos fármacos , Cromatografia com Fluido Supercrítico , Biologia Computacional , Feminino , Proteínas de Choque Térmico HSP70/metabolismo , Humanos , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , Proteínas Mitocondriais/metabolismo , Simulação de Acoplamento Molecular , Fenilpropionatos/química , Fenilpropionatos/uso terapêutico , Própole/química , Própole/uso terapêutico , Proteína Supressora de Tumor p53/metabolismo , Ensaios Antitumorais Modelo de Xenoenxerto , gama-Ciclodextrinas/química , gama-Ciclodextrinas/farmacologia , gama-Ciclodextrinas/uso terapêuticoAssuntos
Aprovação de Drogas , United States Food and Drug Administration , Amidas , Anticorpos Monoclonais Humanizados/uso terapêutico , Benzofuranos/uso terapêutico , Carbamatos/uso terapêutico , Ciclopropanos , Tratamento Farmacológico/enfermagem , Compostos Heterocíclicos de 4 ou mais Anéis/uso terapêutico , Humanos , Imidazóis/uso terapêutico , Peptídeos/uso terapêutico , Fenilalanina/análogos & derivados , Fenilalanina/uso terapêutico , Quinoxalinas/uso terapêutico , Sofosbuvir/uso terapêutico , Sugammadex , Sulfonamidas , Sulfonas/uso terapêutico , Tioglicolatos/uso terapêutico , Triazóis/uso terapêutico , Estados Unidos , gama-Ciclodextrinas/uso terapêuticoRESUMO
Abstract A case is reported in which a 3-days old neonate with a giant ovarian cyst was scheduled for surgery. The patient received a dose of sugammadex to reverse a rocuronium-induced neuromuscular block. A fast and efficient recovery from neuromuscular block was achieved within 90 s. No adverse events or other safety concerns were observed. Furthermore, a review of the literature on the use of sugammadex in neonates was performed.
Resumo Relato do caso de uma criança recém-nascida de três dias de idade com um cisto ovariano gigante programada para a cirurgia. A paciente recebeu uma dose de sugamadex para reverter o bloqueio neuromuscular induzido por rocurônio. Uma recuperação rápida e eficiente do bloqueio neuromuscular foi obtida dentro de 90 segundos. Não foram observados efeitos adversos ou outros problemas de segurança. Além disso, uma revisão da literatura sobre o uso de sugamadex em recém-nascidos foi feita.
Assuntos
Humanos , Feminino , Recém-Nascido , Cistos Ovarianos/cirurgia , Fármacos Neuromusculares não Despolarizantes/uso terapêutico , Bloqueio Neuromuscular/métodos , gama-Ciclodextrinas/uso terapêutico , Androstanóis/uso terapêutico , Ovário/cirurgia , Drenagem/métodos , Resultado do Tratamento , Sugammadex , RocurônioRESUMO
A case is reported in which a 3-days old neonate with a giant ovarian cyst was scheduled for surgery. The patient received a dose of sugammadex to reverse a rocuronium-induced neuromuscular block. A fast and efficient recovery from neuromuscular block was achieved within 90s. No adverse events or other safety concerns were observed. Furthermore, a review of the literature on the use of sugammadex in neonates was performed.
Assuntos
Androstanóis/uso terapêutico , Bloqueio Neuromuscular/métodos , Fármacos Neuromusculares não Despolarizantes/uso terapêutico , Cistos Ovarianos/cirurgia , gama-Ciclodextrinas/uso terapêutico , Drenagem/métodos , Feminino , Humanos , Recém-Nascido , Ovário/cirurgia , Rocurônio , Sugammadex , Resultado do TratamentoRESUMO
The impact of cyclodextrins (CDs) on postprandial glycemic response employing the real-time continuous glucose monitoring system (RT-CGMS) was investigated. For this purpose, α-CD, ß-CD, γ-CD, HP-ß-CD, curdlan, and dextrin at doses of 10 and 100 mg/kg were orally administered in rats. The RT-CGMS was efficient to evaluate the impact of CDs on postprandial glycemia. The results showed that α-CD, ß-CD, dextrin, and curdlan did not reduce the glycemic response after the administration of starch. In contrast, the HP-ß-CD (100 mg/kg) attenuated the rise in glycemia. Moreover, the γ-CD blunts the postprandial glycemic excursion at doses of 10 and 100 mg/kg. Therefore, γ-CD could attenuate the rise in glycemia promoted by oral administration of starch. Considering that the treatment of postprandial hyperglycemia is necessary to prevent type 2 diabetes, this study opens the perspective of better control of postprandial glycemia by the addition of γ-CD in food.
Assuntos
Glicemia/metabolismo , Ciclodextrinas/uso terapêutico , Hiperglicemia/prevenção & controle , Hipoglicemiantes/uso terapêutico , Período Pós-Prandial , 2-Hidroxipropil-beta-Ciclodextrina , Animais , Ciclodextrinas/farmacologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/prevenção & controle , Hiperglicemia/sangue , Hipoglicemiantes/farmacologia , Masculino , Modelos Animais , Monitorização Fisiológica/métodos , Ratos Wistar , Amido/sangue , beta-Ciclodextrinas/farmacologia , beta-Ciclodextrinas/uso terapêutico , gama-Ciclodextrinas/farmacologia , gama-Ciclodextrinas/uso terapêuticoRESUMO
CONTENT: Strumpell-Lorrain disease - or familial spastic paraplegia (FSP) - is a rare hereditary neurological disorder, mainly characterized by variable degrees of stiffness and weakening of the muscles, with cognitive impairment, deafness, and ataxia in the more severe cases. We describe two female siblings with FSP programmed for cholecystectomy and subtotal colectomy, respectively, and also how we dealt with the anesthetic management in both cases and review the literature on this disease in relation to anesthesia.
Assuntos
Paraplegia Espástica Hereditária/tratamento farmacológico , gama-Ciclodextrinas/uso terapêutico , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Paraplegia Espástica Hereditária/genética , SugammadexRESUMO
CONTEÚDO: A doença de Strumpell-Lorrain, ou paraparesia espástica familiar (PEF), é uma doença hereditária neurológica rara, caracterizada principalmente por graus variáveis de rigidez e enfraquecimento dos músculos, com comprometimento cognitivo, surdez e ataxia nos casos mais graves. Descrevemos os casos de duas irmãs com PEF, agendadas para colecistectomia e colectomia subtotal, respectivamente. Também descrevemos o manejo anestésico em ambos os casos e revisamos a literatura sobre essa doença em relação à anestesia.
CONTENT: Strumpell-Lorrain disease - or familial spastic paraplegia (FSP) - is a rare hereditary neurological disorder, mainly characterized by variable degrees of stiffness and weakening of the muscles, with cognitive impairment, deafness, and ataxia in the more severe cases. We describe two female siblings with FSP programmed for cholecystectomy and subtotal colectomy, respectively, and also how we dealt with the anesthetic management in both cases and review the literature on this disease in relation to anesthesia.
CONTENIDO: La enfermedad de Strumpell-Lorrain, o paraparesia espástica familiar (PEF), es una enfermedad hereditaria neurológica rara, caracterizada principalmente por grados variables de rigidez y debilitamiento de los músculos, con el compromiso cognitivo, la sordera y la ataxia en los casos más graves. Describimos aquí dos casos de dos hermanas con PEF, citadas para colecistectomía y colectomía subtotal respectivamente. Describimos también el manejo anestésico en ambos casos y revisamos la literatura sobre esa enfermedad con relación a la anestesia.