Purpose
Nonopioid analgesics are frequently used for the treatment of acute and chronic pain. Dipyrone is an alternative to NSAIDs and paracetamol, however, data on the frequency of its usage by ...anaesthesiologists in the perioperative and chronic pain setting are lacking and its adverse reactions are a matter of debate.
Methods
The link to a questionnaire on the use of nonopioid analgesics (NSAIDs, COX‐2 inhibitors, paracetamol, dipyrone) and the safety of dipyrone in the perioperative and chronic pain setting was mailed to anaesthesiologists and pain physicians.
Results
A total of 2237 responses were analysed. About 97.4% of the respondents used nonopioid analgesics for the treatment of acute pain, with 93.8% administering dipyrone, 54.0% NSAIDs, 41.8% COX‐2 inhibitors and 49.2% paracetamol. Nonopioid analgesics were administered preoperatively by 22.3%, intraoperatively by 86.1% and postoperatively by 73.0% of the respondents. For chronic pain management, 76.7% of the respondents prescribed oral dipyrone in combination with other nonopioid analgesics; 19.9% used dipyrone as sole nonopioid, whereas 2.9% denied its use. Cases of dipyrone‐associated agranulocytosis were observed by 3.5% of the respondents of the acute and 1.5% of the chronic pain questionnaire, respectively. The majority of respondents (acute pain: 73.0%, chronic pain 59.3%) performed no blood cell counts to monitor dipyrone therapy. Patients were rarely informed about possible adverse drug reactions.
Conclusions
Dipyrone is the preferred nonopioid analgesic in the perioperative and chronic pain setting. Although cases of agranulocytosis occur, benefits apparently outweigh the risks according to anaesthesiologists. Measures like patient information may improve safety.
Significance
A survey of anaesthesiologist in German‐speaking countries revealed dipyrone as preferred nonopioid analgesic for the treatment of acute and chronic pain. Benefits seem to outweigh the risks, specifically the risk of agranulocytosis. Information of medical staff and patients on adverse drug reactions and symptoms of agranulocytosis should be implemented.
The serotonin (5-hydroxtryptamine, 5-HT) system plays a role in analgesia and emesis. The aim of this study was to test whether opioids or ketamine inhibit the human 5-HT transporter and whether this ...increases free plasma 5-HT concentrations. HEK293 cells, stably transfected with the human 5-HT transporter cDNA, were incubated with morphine, hydromorphone, fentanyl, alfentanil, pethidine (meperidine), tramadol, ketamine, and the reference substance citalopram (specific 5-HT transporter inhibitor). The uptake of
3
H5-HT was measured by liquid scintillation counting. In a second series of experiments, study drugs were incubated with plasma of ten healthy blood donors and change of 5-HT plasma-concentrations were measured (ELISA). The end point was the inhibition of the 5-HT transporter by different analgesics either in HEK293 cells or in human platelets ex vivo. Tramadol, pethidine, and ketamine suppressed
3
H5-HT uptake dose-dependently with an IC
50
of 1, 20.9, and 230 μM, respectively. These drugs also prevented 5-HT uptake in platelets with an increase in free plasma 5-HT. Free 5-HT concentrations in human plasma were increased by citalopram 1 μM, tramadol 20 μM, pethidine 30 μM, and ketamine 100 μM to 280 248/312%, 269 188/349%, and 149 122/174%, respectively, compared to controls without any co-incubation (means 95 % CI; all
p
< 0.005). No change in both experimental settings was observed for the other opioids. Tramadol and pethidine inhibited the 5-HT transporter in HEK293 cells and platelets. This inhibition may contribute to serotonergic effects when these opioids are given in combination, e.g., with monoamine oxidase inhibitors or selective serotonin reuptake inhibitors.
•Carbonaceous materials were prepared from exhausted sludge materials.•High surface area and good physicochemical properties were achieved.•Utilization of waste sludge materials and mixed anaerobic ...cultures were used in a continuous anaerobic UPBR system (upflow packed bed biological reactor).•Effective treatment of dye contaminated wastewater in a cheapest and environmental friendly method was demonstrated.
This work presents the preliminary study of new carbonaceous materials (CMs) obtained from exhausted sludge, their use in the heterogeneous anaerobic process of biodecolorization of azo dyes and the comparison of their performance with one commercial active carbon. The preparation of carbonaceous materials was conducted through chemical activation and carbonization. Chemical activation was carried out through impregnation of sludge-exhausted materials with ZnCl2 and the activation by means of carbonization at different temperatures (400, 600 and 800°C). Their physicochemical and surface characteristics were also investigated. Sludge based carbonaceous (SBC) materials SBC400, SBC600 and SBC800 present values of 13.0, 111.3 and 202.0m2/g of surface area. Biodecolorization levels of 76% were achieved for SBC600 and 86% for SBC800 at space time (τ) of 1.0min, similar to that obtained with commercial activated carbons in the continuous anaerobic up-flow packed bed reactor (UPBR). The experimental data fit well to the first order kinetic model and equilibrium data are well represented by the Langmuir isotherm model. Carbonaceous materials show high level of biodecolorization even at very short space times. Results indicate that carbonaceous materials prepared from sludge-exhausted materials have outstanding textural properties and significant degradation capacity for treating textile effluents.
•Activated carbons with different amounts of surface oxygenated groups were prepared.•The presence of acidic oxygenated surface groups is not favorable for the catalytic activity of ZVI.•ZVI ...supported on AC having higher basicity yields the best phenol removal efficiency.
Activated carbons with different amounts of surface oxygenated groups were used as adsorbents or supports for zero-valent iron (ZVI) catalyst and tested in phenol adsorption and catalytic wet peroxide oxidation, respectively. The results revealed that the surface chemistry of the support plays an important role in phenol adsorption and in the catalytic performance of the respective iron-supported catalysts. ZVI is active when the support has only a limited amount of oxygenated groups on the surface. The presence of acidic oxygenated surface groups is not favorable for the catalytic activity of ZVI in phenol oxidation as well as for phenol adsorption. ZVI supported on activated carbon heat-treated at 900°C yields the best phenol removal, reaching over 85% after 3h, under the conditions tested: 150mgL−1 of initial phenol concentration, initial pH set at 3, 30°C, and the stoichiometric amount of hydrogen peroxide for achieving complete mineralization.
Improved gas exchange has been observed during spontaneous breathing with airway pressure release ventilation (APRV) as compared with controlled mechanical ventilation. This study was designed to ...determine whether use of APRV with spontaneous breathing as a primary ventilatory support modality better prevents deterioration of cardiopulmonary function than does initial controlled mechanical ventilation in patients at risk for acute respiratory distress syndrome (ARDS). Thirty patients with multiple trauma were randomly assigned to either breathe spontaneously with APRV (APRV Group) (n = 15) or to receive pressure-controlled, time-cycled mechanical ventilation (PCV) for 72 h followed by weaning with APRV (PCV Group) (n = 15). Patients maintained spontaneous breathing during APRV with continuous infusion of sufentanil and midazolam (Ramsay sedation score RSS of 3). Absence of spontaneous breathing (PCV Group) was induced with sufentanil and midazolam (RSS of 5) and neuromuscular blockade. Primary use of APRV was associated with increases (p < 0.05) in respiratory system compliance (CRS), arterial oxygen tension (PaO2), cardiac index (CI), and oxygen delivery (DO2), and with reductions (p < 0.05) in venous admixture (QVA/QT), and oxygen extraction. In contrast, patients who received 72 h of PCV had lower CRS, PaO2, CI, DO2, and Q VA/Q T values (p < 0.05) and required higher doses of sufentanil (p < 0.05), midazolam (p < 0.05), noradrenalin (p < 0.05), and dobutamine (p < 0.05). CRS, PaO2), CI and DO2 were lowest (p < 0.05) and Q VA/Q T was highest (p < 0.05) during PCV. Primary use of APRV was consistently associated with a shorter duration of ventilatory support (APRV Group: 15 +/- 2 d mean +/- SEM; PCV Group: 21 +/- 2 d) (p < 0.05) and length of intensive care unit (ICU) stay (APRV Group: 23 +/- 2 d; PCV Group: 30 +/- 2 d) (p < 0.05). These findings indicate that maintaining spontaneous breathing during APRV requires less sedation and improves cardiopulmonary function, presumably by recruiting nonventilated lung units, requiring a shorter duration of ventilatory support and ICU stay.
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•A sequential anaerobic–aerobic system for complete azo dye degradation is proposed.•Sludge carbonaceous material and activated carbon were used as support material.•The mixed aerobic ...culture was used to create the biofilm in both units.•High azo dye removal conversions were achieved at very short space time.•Total aromatic amines were successfully degraded in the aerobic stage.
The decolorization of azo dye Acid Orange 7 (AO7) was studied in a sequential anaerobic/aerobic reactor system; the anaerobic stage was carried out in a continuous upflow stirred packed-bed reactor (USPBR) filled with biological sludge carbonaceous material (BSCM) and aerobic stage took place in an aerobic membrane bioreactor (aerobic MBR). In a continuous USPBR-BSCM system, azo dye bioconversion rates were about 99% at very short space times (τ) 1.02–1.6min. In the sequential aerobic stage, hydraulic retention times (HRTs) were determined on removal efficiencies of chemical oxygen demand (COD), resulting about 66% at 48h. Total organic carbon (TOC) assay showed a removal efficiency about 54.37%, suggesting the degradation of the aromatic amines produced in the anaerobic reactor. Total aromatic amine (TAA) values were 45.30 and 8.97mgL−1 in USPBR and aerobic MBR respectively, resulting in about 80.28% removal efficiency. These results indicate that anaerobic sequential USPBR/aerobic MBR reactor system seems to be an effective and promising system for complete azo dye biodegradation.
Bisphenol A (BPA) is a typical Endocrine Disrupting Chemical (EDC), which is potentially harmful during wastewater reclamation. In this study, its degradation during Fenton's process under different ...operational conditions was investigated in combination with subsequent nanofiltration of low concentration remnant BPA and compounds derived from oxidation. The results indicate that BPA could be degraded efficiently in aqueous phase by Fenton, even at very low hydrogen peroxide doses. The treatment of up to 300mg/L solutions of BPA with Fenton liquor at optimal conditions resulted in its complete removal in less than 2min. The optimal conditions were found to be pHr=3, H2O2/BPA=0.20 and Fe2+/BPA=0.012. Five NF polymeric membranes having different properties were used for the nanofiltration of treated and non-treated solutions. The nanofiltration of BPA solutions showed that rejection is related to adsorption ability of BPA on the membrane and size exclusion mechanism. In the nanofiltration of the effluent after Fenton oxidation, high TOC, COD, colour and Fe2+ (>77%) removal were achieved, although significant membrane fouling was also observed. The normalised water flux after membrane flushing with water was lower than 60% in almost all used membranes, which indicates significant non-easily removable fouling.
•Bisphenol A is degraded by Fenton treatment using the stoichiometric molar ratio.•Nanofiltration of the Fenton-treated effluent achieves high TOC, COD and Fe.•Significant membrane fouling was observed in the NF of the Fenton-treated effluent.•Coupling of Fenton treatment and nanofiltration allows iron recycling.
In this study, three different approaches for the covalent immobilisation of the horseradish peroxidase (HRP) onto epoxy-activated acrylic polymers (EupergitC) were explored for the first time, ...direct HRP binding to the polymers via their oxirane groups, HRP binding to the polymers via a spacer made from adipic dihydrazide, and HRP binding to hydrazido polymer surfaces through the enzyme carbohydrate moiety previously modified by periodate oxidation. The periodate-mediated covalent immobilisation of the HRP on hydrazido EupergitC was found to be the most effective method for the preparation of biocatalysts. In this case, a maximum value of the immobilised enzyme activity of 127 U/g(support) was found using an enzyme loading on the support of 35.2mg/g(support). The free and the immobilised HRP were used to study the elimination of phenol in two batch reactors. As expected, the activity of the immobilised enzyme was lower than the activity of the free enzyme. Around 85% of enzyme activity is lost during the immobilisation. However, the reaction using immobilised enzyme showed that it was possible to reach high degrees of phenol removal (around 50%) using about one hundredth of the enzyme used in the soluble form.
In this study, three different approaches for the covalent immobilisation of the horseradish peroxidase (HRP) onto epoxy-activated acrylic polymers (Eupergit
®C) were explored for the first time, ...direct HRP binding to the polymers via their oxirane groups, HRP binding to the polymers via a spacer made from adipic dihydrazide, and HRP binding to hydrazido polymer surfaces through the enzyme carbohydrate moiety previously modified by periodate oxidation. The periodate-mediated covalent immobilisation of the HRP on hydrazido Eupergit
®C was found to be the most effective method for the preparation of biocatalysts. In this case, a maximum value of the immobilised enzyme activity of 127
U/g
support was found using an enzyme loading on the support of 35.2
mg/g
support. The free and the immobilised HRP were used to study the elimination of phenol in two batch reactors. As expected, the activity of the immobilised enzyme was lower than the activity of the free enzyme. Around 85% of enzyme activity is lost during the immobilisation. However, the reaction using immobilised enzyme showed that it was possible to reach high degrees of phenol removal (around 50%) using about one hundredth of the enzyme used in the soluble form.
To investigate the kinetic and reversibility of mechanical ventilation-associated pulmonary and systemic inflammatory response in patients with acute lung injury (ALI).
Prospective observational ...cross-over study.
Intensive care unit of a university hospital.
Twelve mechanically ventilated patients with ALI.
Mechanical ventilation was transiently changed from a lung protective setting with PEEP of 15 cmH(2)O and a V(T) of 5 ml/kg predicted body weight to a more conventional ventilatory setting with PEEP of 5 cmH(2)O and V(T) of 12 ml/kg predicted body weight for a period of 6 h.
We examined the profile of interleukin (IL)-1beta, IL-1 receptor antagonist, IL-6, IL-10, and tumor necrosis factor in the plasma of all patients, and in the bronchoalveolar lavage (mini-BAL) fluid of six of these patients. Measurements were performed at baseline, 1 h, and 6 h after each change of the ventilatory setting. Switching to conventional mechanical ventilation was associated with a higher PaO(2) ( P < 0.05) and a marked increase ( P < 0.05) of measured plasma cytokines in patients with and without mini-BAL with a maximum after 1 h. Similarly, intraalveolar cytokine concentrations increased with conventional mechanical ventilation. While plasma cytokine levels returned to baseline values, intraalveolar cytokine concentrations further increased when lung protective mechanical ventilation was reestablished.
In patients with ALI, initiation of low PEEP and high V(T) mechanical ventilation is associated with cytokine release into circulation which occurred within 1 h. It is independent from BAL procedures and can be reversed by reinstitution of lung protective mechanical ventilation.
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