The Experts below are selected from a list of 6 Experts worldwide ranked by ideXlab platform

Santangelo Bruna - One of the best experts on this subject based on the ideXlab platform.

  • ANALGOSEDATION IN HUMANS: WHAT TO CHOOSE?
    2015
    Co-Authors: Giacomelli A, Santangelo Ermenegildo, Vesce Giovanni, Santangelo Bruna
    Abstract:

    Analgo-sedation implies the use of intravenous drugs for analgesia and sedation in patients undergoing outpatient operations or one-day surgery, in which vital signs (SpO2, NIBP, HR, RR, EtCO2) are steadily supervised (1,2). Sedation and analgesia are different conditions: some patients may only need sedation, others only analgesia or both. Analgo-sedation allows the operator to work in the most favorable conditions, given that the patient becomes collaborative, extremely quiet and compliant with the procedure, even in cases of hours long procedures, all carried in absolute safety. Milestones in analgo-sedation: Between the 1920’s and the mid 1950’s the only drugs used as sedatives and hypnotics were barbiturates (Somnifen®, Pernocton®, Pentothal®, Evipal®, etc.). The use of barbiturates declined in the 1950’s after the development of the benzodiazepine derivatives. In 1959, De Castro and Mundeleer introduced the concept of neuroleptoanalgesia followed by the release of "Innovar®", a 50:1 combination of droperidol and fentanyl, both originally synthesized by Janssen pharmaceuticals, which was followed on the Italian market by “Leptofen®” (Famitalia). The next advance in analgosedation at the end of 70s, was the release of the steroid anesthetic "Althesin®", a surprising combination of the two steroidal compounds, alfaxalone and Alfadolone. In spite of its deplorable histamine release, althesin safety profile due to its highest (30/1) therapeutic index among all anesthetic molecules, bestowed to it a long-lasting popularity. The advent of noncumulative anesthetic molecules brought the new concept of TIVA (Total Intravenous Anesthesia) in the field of analgosedation. Most of this unexpected innovation was due to the hypnotic alkylphenol derivative Propofol® and to the opioid agonist remifentanil hydrochloride, both characterized by fast and alternative metabolic pathways. In virtue of their pharmacodynamics and pharmacokinetics peculiarities, propofol and remifentanil, administered by TCI (Target Controlled Infusion), are nowadays the ideal drugs for analgosedation (3). Administered by TCI, such hypnotic/opioid combination warrants extreme precision in dose titration, fast and predictable variations in analgo-sedation depth, reduction of total administered dose, very fast recovery of consciousness and reduction of hospitalization times. Currently, Remimazolam, a new benzodiazepine now in phase III of clinical experimentation, seems to promise further development and enhancement to the current analgo-sedation techniques (4). It is worth to note that parallel advancement in veterinary analgosedation was provided in the same years by parallel anesthetic formulations named pentothal vet®, Innovar vet®, Saffan® (alfaxalone and Alfadolone), Rapinovet® (propofol), and by the off label use of most of the formulations of the anesthetic molecules approved for use in humans

Giacomelli A - One of the best experts on this subject based on the ideXlab platform.

  • ANALGOSEDATION IN HUMANS: WHAT TO CHOOSE?
    2015
    Co-Authors: Giacomelli A, Santangelo Ermenegildo, Vesce Giovanni, Santangelo Bruna
    Abstract:

    Analgo-sedation implies the use of intravenous drugs for analgesia and sedation in patients undergoing outpatient operations or one-day surgery, in which vital signs (SpO2, NIBP, HR, RR, EtCO2) are steadily supervised (1,2). Sedation and analgesia are different conditions: some patients may only need sedation, others only analgesia or both. Analgo-sedation allows the operator to work in the most favorable conditions, given that the patient becomes collaborative, extremely quiet and compliant with the procedure, even in cases of hours long procedures, all carried in absolute safety. Milestones in analgo-sedation: Between the 1920’s and the mid 1950’s the only drugs used as sedatives and hypnotics were barbiturates (Somnifen®, Pernocton®, Pentothal®, Evipal®, etc.). The use of barbiturates declined in the 1950’s after the development of the benzodiazepine derivatives. In 1959, De Castro and Mundeleer introduced the concept of neuroleptoanalgesia followed by the release of "Innovar®", a 50:1 combination of droperidol and fentanyl, both originally synthesized by Janssen pharmaceuticals, which was followed on the Italian market by “Leptofen®” (Famitalia). The next advance in analgosedation at the end of 70s, was the release of the steroid anesthetic "Althesin®", a surprising combination of the two steroidal compounds, alfaxalone and Alfadolone. In spite of its deplorable histamine release, althesin safety profile due to its highest (30/1) therapeutic index among all anesthetic molecules, bestowed to it a long-lasting popularity. The advent of noncumulative anesthetic molecules brought the new concept of TIVA (Total Intravenous Anesthesia) in the field of analgosedation. Most of this unexpected innovation was due to the hypnotic alkylphenol derivative Propofol® and to the opioid agonist remifentanil hydrochloride, both characterized by fast and alternative metabolic pathways. In virtue of their pharmacodynamics and pharmacokinetics peculiarities, propofol and remifentanil, administered by TCI (Target Controlled Infusion), are nowadays the ideal drugs for analgosedation (3). Administered by TCI, such hypnotic/opioid combination warrants extreme precision in dose titration, fast and predictable variations in analgo-sedation depth, reduction of total administered dose, very fast recovery of consciousness and reduction of hospitalization times. Currently, Remimazolam, a new benzodiazepine now in phase III of clinical experimentation, seems to promise further development and enhancement to the current analgo-sedation techniques (4). It is worth to note that parallel advancement in veterinary analgosedation was provided in the same years by parallel anesthetic formulations named pentothal vet®, Innovar vet®, Saffan® (alfaxalone and Alfadolone), Rapinovet® (propofol), and by the off label use of most of the formulations of the anesthetic molecules approved for use in humans

Santangelo Ermenegildo - One of the best experts on this subject based on the ideXlab platform.

  • ANALGOSEDATION IN HUMANS: WHAT TO CHOOSE?
    2015
    Co-Authors: Giacomelli A, Santangelo Ermenegildo, Vesce Giovanni, Santangelo Bruna
    Abstract:

    Analgo-sedation implies the use of intravenous drugs for analgesia and sedation in patients undergoing outpatient operations or one-day surgery, in which vital signs (SpO2, NIBP, HR, RR, EtCO2) are steadily supervised (1,2). Sedation and analgesia are different conditions: some patients may only need sedation, others only analgesia or both. Analgo-sedation allows the operator to work in the most favorable conditions, given that the patient becomes collaborative, extremely quiet and compliant with the procedure, even in cases of hours long procedures, all carried in absolute safety. Milestones in analgo-sedation: Between the 1920’s and the mid 1950’s the only drugs used as sedatives and hypnotics were barbiturates (Somnifen®, Pernocton®, Pentothal®, Evipal®, etc.). The use of barbiturates declined in the 1950’s after the development of the benzodiazepine derivatives. In 1959, De Castro and Mundeleer introduced the concept of neuroleptoanalgesia followed by the release of "Innovar®", a 50:1 combination of droperidol and fentanyl, both originally synthesized by Janssen pharmaceuticals, which was followed on the Italian market by “Leptofen®” (Famitalia). The next advance in analgosedation at the end of 70s, was the release of the steroid anesthetic "Althesin®", a surprising combination of the two steroidal compounds, alfaxalone and Alfadolone. In spite of its deplorable histamine release, althesin safety profile due to its highest (30/1) therapeutic index among all anesthetic molecules, bestowed to it a long-lasting popularity. The advent of noncumulative anesthetic molecules brought the new concept of TIVA (Total Intravenous Anesthesia) in the field of analgosedation. Most of this unexpected innovation was due to the hypnotic alkylphenol derivative Propofol® and to the opioid agonist remifentanil hydrochloride, both characterized by fast and alternative metabolic pathways. In virtue of their pharmacodynamics and pharmacokinetics peculiarities, propofol and remifentanil, administered by TCI (Target Controlled Infusion), are nowadays the ideal drugs for analgosedation (3). Administered by TCI, such hypnotic/opioid combination warrants extreme precision in dose titration, fast and predictable variations in analgo-sedation depth, reduction of total administered dose, very fast recovery of consciousness and reduction of hospitalization times. Currently, Remimazolam, a new benzodiazepine now in phase III of clinical experimentation, seems to promise further development and enhancement to the current analgo-sedation techniques (4). It is worth to note that parallel advancement in veterinary analgosedation was provided in the same years by parallel anesthetic formulations named pentothal vet®, Innovar vet®, Saffan® (alfaxalone and Alfadolone), Rapinovet® (propofol), and by the off label use of most of the formulations of the anesthetic molecules approved for use in humans

Vesce Giovanni - One of the best experts on this subject based on the ideXlab platform.

  • ANALGOSEDATION IN HUMANS: WHAT TO CHOOSE?
    2015
    Co-Authors: Giacomelli A, Santangelo Ermenegildo, Vesce Giovanni, Santangelo Bruna
    Abstract:

    Analgo-sedation implies the use of intravenous drugs for analgesia and sedation in patients undergoing outpatient operations or one-day surgery, in which vital signs (SpO2, NIBP, HR, RR, EtCO2) are steadily supervised (1,2). Sedation and analgesia are different conditions: some patients may only need sedation, others only analgesia or both. Analgo-sedation allows the operator to work in the most favorable conditions, given that the patient becomes collaborative, extremely quiet and compliant with the procedure, even in cases of hours long procedures, all carried in absolute safety. Milestones in analgo-sedation: Between the 1920’s and the mid 1950’s the only drugs used as sedatives and hypnotics were barbiturates (Somnifen®, Pernocton®, Pentothal®, Evipal®, etc.). The use of barbiturates declined in the 1950’s after the development of the benzodiazepine derivatives. In 1959, De Castro and Mundeleer introduced the concept of neuroleptoanalgesia followed by the release of "Innovar®", a 50:1 combination of droperidol and fentanyl, both originally synthesized by Janssen pharmaceuticals, which was followed on the Italian market by “Leptofen®” (Famitalia). The next advance in analgosedation at the end of 70s, was the release of the steroid anesthetic "Althesin®", a surprising combination of the two steroidal compounds, alfaxalone and Alfadolone. In spite of its deplorable histamine release, althesin safety profile due to its highest (30/1) therapeutic index among all anesthetic molecules, bestowed to it a long-lasting popularity. The advent of noncumulative anesthetic molecules brought the new concept of TIVA (Total Intravenous Anesthesia) in the field of analgosedation. Most of this unexpected innovation was due to the hypnotic alkylphenol derivative Propofol® and to the opioid agonist remifentanil hydrochloride, both characterized by fast and alternative metabolic pathways. In virtue of their pharmacodynamics and pharmacokinetics peculiarities, propofol and remifentanil, administered by TCI (Target Controlled Infusion), are nowadays the ideal drugs for analgosedation (3). Administered by TCI, such hypnotic/opioid combination warrants extreme precision in dose titration, fast and predictable variations in analgo-sedation depth, reduction of total administered dose, very fast recovery of consciousness and reduction of hospitalization times. Currently, Remimazolam, a new benzodiazepine now in phase III of clinical experimentation, seems to promise further development and enhancement to the current analgo-sedation techniques (4). It is worth to note that parallel advancement in veterinary analgosedation was provided in the same years by parallel anesthetic formulations named pentothal vet®, Innovar vet®, Saffan® (alfaxalone and Alfadolone), Rapinovet® (propofol), and by the off label use of most of the formulations of the anesthetic molecules approved for use in humans

Yawno T - One of the best experts on this subject based on the ideXlab platform.

  • The effects of betamethasone on allopregnanolone concentrations and brain development in preterm fetal sheep
    Pergamon Press (United Kingdom), 2014
    Co-Authors: Yawno T, Mortale M, Sutherland A, Jenkin G, Wallace E, Walker D, Miller S
    Abstract:

    The risk of preterm delivery often means that the fetus will be exposed to exogenous synthetic glucocorticoids to accelerate fetal lung maturation, but effects on other organs, particularly the brain, are not understood. The neurosteroid allopregnanolone (AP) is a GABAA receptor agonist that influences fetal brain development and has neuroprotective properties. In this study we determined the impact of maternal glucocorticoid (betamethasone) administration on brain development and AP synthesis in preterm fetal sheep. Pregnant ewes underwent surgery at 105 days gestation for implantation of fetal catheters. Ewes received either betamethasone (BM; 11.4 mg; n = 10) or vehicle (saline; n = 5) by i.m injection on days five (BM1) and six (BM2) following surgery. Five fetuses of the BM treated ewes received an infusion of alfaxalone (20 mg) over 48 h commencing 30 min prior to BM1. All animals were euthanased on day 7, and the fetal brains collected to determine AP concentrations and histopathology. BM significantly reduced AP levels in the fetal brain and placental cotyledons, and also in fetal plasma without altering progesterone concentrations. There was a significant decrease in the number of myelinating cells in subcortical white matter, but no change to total oligodendrocyte number. Co-administration of the AP analogue analog alfaxalone with BM prevented this change in MBP expression. BM, given at a dose clinically prescribed to accelerate lung maturation, adversely affects neurosteroid levels in the preterm fetal brain, and affects the maturational profile of white matter development; these effects were mitigated by the co-administration of alfaxolone