Navegando por Palavras-chave "Midazolam"
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- ItemSomente MetadadadosEfeitos do midazolam no musculo liso e transmissao simpatica em ducto deferente de rato(Universidade Federal de São Paulo (UNIFESP), 2003) Stefani, Fabio [UNIFESP]Nosso objetivo foi estudar a acao do benzodiazepinico Midazolam sobre a contratilidade e a neurotransmissao do ducto deferente de rato. Verificamos que: A curva dose-efeito do Midazolam apresentou a forma conhecida como curva em sino , caracterizada por um efeito contratil com doses iniciais, seguido de um efeito menor a medida que se aumentaram as doses do benzodiazepinico. Esta e a primeira vez em que se descreve esse tipo de curva para o Midazolam nesta preparacao. O efeito inicial do Midazolam parece ser devido a interacoes com alfa adrenoceptores, pois foi inibido pelos antagonistas competitivos Prazosin e WB4101. Alem disso, o Midazolam pode ser classificado com agonista parcial, com base em duas evidencias experimentais: (a) seu efeito maximo foi menor que o de um agonista total, como a Noradrenalina e (b) quando combinado com este ultimo agonista, o Midazolam comportou-se como sinergista ou antagonista, segundo a dose de Noradrenalina usada. O pD2 do Midazolam foi de 4.4 ± 0.1 e a atividade intrinseca (a) de 0.36 ± 0.02. Verificamos que as doses maiores de Midazolam, ou seja, as que produzem a parte descendente da curva dose - efeito, produziram uma inibicao nao-especifica no ducto deferente, com base nos seguintes resultados: (a) houve um bloqueio do tipo nao competitivo nas contracoes de BaC12 e KCI ; (b) houve um bloqueio das curvas de calcio no orgao despolarizado por KCI; (c) houve um bloqueio da contracao por estimulo eletrico transmural. (d) o deslocamento das curvas de Midazolam por Prazosin e WB 4101 apresentou um componente nao competitivo, que poderia estar relacionado ao efeito inespecifico das doses maiores do benzodiazepinico. O emprego de Midazolam oin vivoo na dose de 1omg/kg, 2 horas antes do experimento nao produziu modificacoes nas curvas dose-efeito de varios agonistas e das contracoes induzidas por calcio ou por estimulo eletrico transmural. Os nossos resultados sugerem que o Midazolam, alem de ser um agonista parcial em receptores alfa adrenergicos, apresentam tambem um componente inibitorio, possivelmente associado a sitios de ligacao perifericos de benzodiazepinicos e a translocacao de calcio
- ItemAcesso aberto (Open Access)Prevenção da síndrome de abstinência associada a interrupção da infusão de fentanil e midazolam em unidades de cuidados intensivos pediátricos(Universidade Federal de São Paulo (UNIFESP), 2006) Souza, Nivaldo de [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]Ainda não existe consenso, quanto à melhor estratégia para retirada gradual de opiáceos e benzodiazepínicos em crianças. O assunto continua motivo de muita controvérsia na literatura médica. Objetivos: 1 - Analisar o impacto, na frequência de síndrome de abstinência, após a implantação de um protocolo, para retirada de fentanil e midazolam, em uma unidade de cuidados intensivos pediátricos; 2 - Comparar duas doses distintas de metadona, utilizadas na prevenção da síndrome de abstinência, durante a retirada do fentanil;3 - Identificar possíveis fatores de risco, para a ocorrência da síndrome de abstinência nesses pacientes. Casuística e Métodos: Foi feita a comparação entre os grupos de pacientes, de até dois anos de idade, internados na unidade de cuidados intensivos padiátricos, nos quais foram administrados fentanil e midazolam cntínuo por mais de 24 horas. Em um grupo de 36 crianças, a retirada dos medicamentos foi feita sem o uso de um protocolo (grupo SP), no outro grupo de 76 crianças, retirou-se o fentanil e o midazolam, utilizando-se um protocolo específico (grupo CP). No grupo de 76 crianças, 50 usaram fentanil e midazolam por mais de sete dias. Estes pacientes foram subdivididos em dois grupos, de forma aleatória, por meio de sorteio, a fim de compararduas doses iniciais de metadona. As doses foram calculadas, empregando-se dois fatores de conversão distintos (3,3 e 1), que multiplicados pela dose diária de fentanil, indicaram a dose diária inicial da metadona...(au).
- ItemAcesso aberto (Open Access)Propofol e fentanil versus midazolam e fentanil para sedação em pacientes cirróticos durante a realização de endoscopia digestiva alta(Universidade Federal de São Paulo (UNIFESP), 2012-02-22) Correia, Lucianna Motta [UNIFESP]; Libera Junior, Ermelindo Della [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: Cirrhotic patients often undergo diagnostic or therapeutic upper gastrointestinal endoscopy. The liver cirrhosis might impair the metabolism of drugs used to sedation due to changes in liver function, with possible consequences for the efficacy and safety during procedures. We designed a study to compare two regimens for sedation during endoscopy in this group of patients: propofol with fentanyl and midazolam with fentanyl. Objectives: To compare the two schemes proposed regarding the sedation efficacy (proportion of complete procedures using the initial proposed scheme), safety (occurrence of sedation-related complications) and recovery time (defined as time between the end of the procedure and ambulatory discharge). Patients and methods: We performed a prospective randomized controlled trial conducted between February 2008 to February 2009. Two hundred and ten cirrhotic outpatients were included and randomized in two groups: Midazolam Group (110 patients, 0.05 mg / kg associated with fentanyl, 50 mg intravenously) and Propofol Group (100 patients, 0.5 mg / kg combined with fentanyl, 50 mg intravenously). Results: There were no differences between groups regarding age, sex, weight, etiology of cirrhosis, classification Child-Pugh or ASA classification, as well as to the type of procedure exam was performed (diagnostic test, band ligation or sclerotherapy for esophageal varices). Sedation with propofol and fentanyl was more efficacious (100% vs. 88.2% - p <0.001) and had a shorter recovery time than sedation with midazolam to fentanyl (16.23 ± 6.84min vs. 27.40 ± 17.19 min, respectively - p <0.001). Complications rate were similar in both groups (14% vs. 7.3% - p = 0.172). Conclusion: Both sedation regimens were safe in this setting. Sedation with propofol and fentanyl was more efficacious and had shorter recovery time when compared to midazolam plus fentanyl. Propofol should be considered as an alternative to sedation during upper GI endoscopy in cirrhotic outpatients.
- ItemSomente MetadadadosRole of state-dependency in memory impairment induced by acute administration of midazolam in mice(Elsevier B.V., 2012-04-27) Sanday, Leandro [UNIFESP]; Zanin, Karina A. [UNIFESP]; Patti, Camilla L. [UNIFESP]; Tufik, Sergio [UNIFESP]; Frussa-Filho, Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Although the memory deficits produced by pre-training benzodiazepines administration have been extensively demonstrated both in humans and in animal studies, there is considerable controversy about the involvement of the state-dependency phenomenon on benzodiazepines-induced anterograde amnesia. the present study aimed to characterize the role of state-dependency on memory deficits induced by the benzodiazepine midazolam (MID) in mice submitted to the plus-maze discriminative avoidance task (PM-DAT). This animal model concomitantly evaluates learning and retention of discriminative avoidance task, exploratory habituation as well as anxiety-like behavior and motor activity. Mice received 2 mg/kg MID before training and/or before testing in the PM-DAT. Pre-training (but not pre-test) MID administration impaired the retention of the discriminative avoidance task, which was not counteracted by a subsequent pre-test administration of this drug, thus refuting the role of state-dependency. Conversely, the pre-training administration of MID also led to an impairment of the habituation of exploration in the PM-DAT (an animal model of non-associative memory). This habituation deficit was state-dependent since it was absent in pre-training plus pretest MID treated mice. Concomitantly, MID pre-training administration induced anxiolytic effects and diminished the aversive effectiveness of the aversive stimuli of the task, leading to an impairment of the acquisition of the discriminative avoidance task. Our findings suggest that pre-training benzodiazepine administration can impair the retention of different types of memory by producing specific deleterious effects on learning or by inducing state-dependent memory deficits. (c) 2012 Published by Elsevier Inc.
- ItemAcesso aberto (Open Access)Síndrome de abstinência associada à interrupção da infusão de fentanil e midazolam em pediatria(Associação Médica Brasileira, 1999-03-01) Bicudo, J.n. [UNIFESP]; Souza, N. de [UNIFESP]; Mângia, C.m.f. [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To determine the incidence of abstinence syndrome in children interned in the Pediatric Intensive Care Unit (PICU) in fentanyl use and midazolam METHODS: Evaluation of 36 children interned in PICU of the Hospital São Paulo - Federal University of São Paulo, in the period from March to September 1997, with age varying from 5 days to 22 months (22 masc: 14 fem) who used fentanyl use and midazolam for more than 24 hours. Used the Escore Neonatal of Abstinence adapted by Finnegan determines the occurrence of abstinence syndrome in was used to children 2 years old or less. Sustain larger or equal for 8 is considered as abstinence syndrome. Correlated the abstinence syndrome with the accumulated total dose, infusion velocity, daily dose and time of use of the fentanyl and midazolam. RESULTS: Certain abstinence syndrome in 18 (50%) of the 36 children. Applied Mann Whitney's statistical test to compare the groups with and without abstinence syndrome. Dose accumulated of fentanyl total (5732.7 ± 5114.91 vs 624.2 ± 591.2 mcg, p < 0.005), dose daily of fentanyl (98.54 ± 6.12 vs 36.23 ± 23.42 mcg/Kg/dia, p < 0.005), velocity of infusion of the fentayl (4.09 ± 2.75 vs 1.5 ± 0.95 mcg/Kg/hora, p < 0.005), time of use of the fentanyl (10.2 ± 5.1 vs 3.16 ± 1.09 days, p < 0.005), dose accumulated of midazolam total (118.8 ± 86.97 vs 20.03 ± 14.79 mg, p < 0.005), dose daily of midazolam (2.32 ± 0.86 vs 1.21 ± 0.68 mg/Kg/dia, p < 0.005), velocity of midazolam infusion (0.13 ± 0.16 vs 0.05 ± 0.02 mg/Kg/hora, p < 0.005) and time of use of the midazolam (9.20 ± 4.67 vs 2.55 ± 1.54 days, p < 0.005) they were considered significant. CONCLUSION: The abstinence syndrome presents an elevated incidence in children interned in PICU owing to the interruption of the fentanyl infusion and midazolam and in these patients it was related with the dose and the time of use.
- ItemSomente MetadadadosUse of fentanyl and midazolam in mechanically ventilated children-Does the method of infusion matter?(W B Saunders Co-Elsevier Inc, 2016) Lucas da Silva, Paulo Sergio; Reis, Maria Eunice; de Aguiar, Vania Euzebio; Machado Fonseca, Marcelo Cunio [UNIFESP]Background and objective: Benzodiazepines and opioids are commonly used in pediatric intensive care unit. However, there is no previous study assessing the use of administering these drugs combined (single solution) or separately. We sought to evaluate the impact of these 2 different methods of providing sedation/analgesia in pediatric intensive care unit. Methods: One hundred twelve patients mechanically ventilated for more than 48 hours were randomized to receive a protocolized sedation regimecomprising midazolamand fentanyl either separately (group 1, 57 patients) or combined as a single solution (group 2, 55 patients). Primary end point variable was the cumulated dose of midazolam and fentanyl. Results: The median cumulated doses of both fentanyl (0.19 vs 0.37 mg/kg, P < .05) and midazolam (28.8 vs 45.6 mg/kg, P < .05) required in group 2 were higher when compared with those of group 1. Moreover, group 2 patients had a significantly longer time of vasopressor drugs requirement and a higher number of patients developing tolerance. Conclusion: Patients who received a single solution of midazolam and fentanyl had a higher cumulated dose of compared with those patients who did not. The potential risk for long-term neurologic effects on developing brains associated with this finding should be considered. (C) 2015 Elsevier Inc. All rights reserved.