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  1. Article ; Online: Characterization of seizures induced by acute and repeated exposure to tetramethylenedisulfotetramine.

    Zolkowska, Dorota / Banks, Christopher N / Dhir, Ashish / Inceoglu, Bora / Sanborn, James R / McCoy, Mark R / Bruun, Donald A / Hammock, Bruce D / Lein, Pamela J / Rogawski, Michael A

    The Journal of pharmacology and experimental therapeutics

    2012  Volume 341, Issue 2, Page(s) 435–446

    Abstract: Tetramethylenedisulfotetramine (tetramine; TETS) is a potent convulsant poison that is considered to be a chemical threat agent. To provide a basis for the investigation of antidotes for TETS-induced seizures, we characterized the convulsant activity of ... ...

    Abstract Tetramethylenedisulfotetramine (tetramine; TETS) is a potent convulsant poison that is considered to be a chemical threat agent. To provide a basis for the investigation of antidotes for TETS-induced seizures, we characterized the convulsant activity of TETS in mice and rats when administered by the intraperitoneal, intravenous, oral, and intraventricular routes as a single acute dose and with repeated sublethal doses. In mice, parenteral and oral TETS caused immobility, myoclonic body jerks, clonic seizures of the forelimbs and/or hindlimbs, tonic seizures, and death. The CD₅₀ values for clonic and tonic seizures after oral administration were 0.11 and 0.22 mg/kg, respectively. Intraventricular administration of TETS (5-100 μg) in rats also caused clonic-tonic seizures and death. In mice, repeated sublethal doses of TETS at intervals of 2, 24, and 48 h failed to result in the development of persistent enhanced seizure responsivity ("kindling") as was observed with repeated pentylenetetrazol treatment. In mice, sublethal doses of TETS that produced clonic seizures did not cause observable structural brain damage as assessed with routine histology and Fluoro-Jade B staining 7 days after treatment. However, 1 to 3 days after a single convulsant dose of TETS the expression of glial fibrillary acidic protein, an astrocyte marker, and ionized calcium binding adaptor molecule 1, a microglia marker, were markedly increased in cortex and hippocampus. Although TETS doses that are compatible with survival are not associated with overt evidence of cellular injury or neurodegeneration, there is transient reactive astrocytosis and microglial activation, indicating that brain inflammatory responses are provoked.
    MeSH term(s) Animals ; Astrocytes/drug effects ; Astrocytes/metabolism ; Bridged-Ring Compounds/toxicity ; Calcium-Binding Proteins/metabolism ; Cerebral Cortex/drug effects ; Cerebral Cortex/metabolism ; Convulsants/toxicity ; Extremities ; Glial Fibrillary Acidic Protein/metabolism ; Gliosis/chemically induced ; Gliosis/metabolism ; Hippocampus/drug effects ; Hippocampus/metabolism ; Male ; Mice ; Microfilament Proteins/metabolism ; Microglia/drug effects ; Microglia/metabolism ; Pentylenetetrazole/pharmacology ; Picrotoxin/adverse effects ; Rats ; Rats, Sprague-Dawley ; Seizures/chemically induced ; Seizures/metabolism
    Chemical Substances Aif1 protein, mouse ; Bridged-Ring Compounds ; Calcium-Binding Proteins ; Convulsants ; Glial Fibrillary Acidic Protein ; Microfilament Proteins ; Picrotoxin (124-87-8) ; tetramethylenedisulfotetramine (F6TS3WME05) ; Pentylenetetrazole (WM5Z385K7T)
    Language English
    Publishing date 2012-02-10
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 3106-9
    ISSN 1521-0103 ; 0022-3565
    ISSN (online) 1521-0103
    ISSN 0022-3565
    DOI 10.1124/jpet.111.190579
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Adverse cardiovascular and respiratory events during sedation of pediatric patients for imaging examinations.

    Sanborn, Pamela A / Michna, Edward / Zurakowski, David / Burrows, Patricia E / Fontaine, Paulette J / Connor, Linda / Mason, Keira P

    Radiology

    2005  Volume 237, Issue 1, Page(s) 288–294

    Abstract: Purpose: To retrospectively identify factors associated with an increased risk of adverse cardiovascular or respiratory events during sedation of pediatric patients for imaging examinations.: Materials and methods: This HIPAA-compliant study was ... ...

    Abstract Purpose: To retrospectively identify factors associated with an increased risk of adverse cardiovascular or respiratory events during sedation of pediatric patients for imaging examinations.
    Materials and methods: This HIPAA-compliant study was institutional review board approved; the requirement for informed consent was waived. All sedation information--including patient demographics, medications (doses and routes of administration), time required to sedate and before discharge, American Society of Anesthesiologists physical status classification, adverse events, and failed sedations--was maintained in a computerized database. A review of the data on all patients sedated between 1997 and 2003 for magnetic resonance imaging, computed tomography, and interventional radiology revealed associated adverse respiratory events in 70 patients. Adverse respiratory event was defined as oxygen desaturation of at least 5%, pulmonary aspiration, and need for airway resuscitation. Adverse cardiovascular events were defined as cardiac arrest and hemodynamic changes requiring medical therapy. Adverse events were compared between sedation regimens--which included fentanyl, chloral hydrate, pentobarbital, and midazolam hydrochloride--by using the Fisher exact test. Multiple logistic regression analysis was applied to identify potential predictors of adverse events.
    Results: Among 16,467 sedations performed, 70 (0.4%) were associated with adverse respiratory events: 58 cases of oxygen desaturation, two pulmonary aspirations, 10 cases of airway resuscitation, and no cardiovascular events. Nearly 30% (n = 20) of the 70 patients who had an adverse event had a history of serious respiratory illness. Logistic regression analysis revealed that neither patient age, weight, or sex nor type of imaging procedure was associated with an increased risk of an adverse event. Use of a single sedation agent was associated with lower adverse event risk than was use of multiple agents (P < .001).
    Conclusion: Consideration should be given to using single agents, avoiding the use of multidrug sedation regimens, and recognizing that a history of pulmonary disease could be associated with an increased risk of adverse respiratory events despite a currently stable respiratory state.
    MeSH term(s) Cardiovascular System/drug effects ; Child, Preschool ; Chloral Hydrate/adverse effects ; Conscious Sedation/adverse effects ; Diagnostic Imaging/methods ; Female ; Fentanyl/adverse effects ; Humans ; Hypoxia/etiology ; Logistic Models ; Lung Diseases/complications ; Magnetic Resonance Imaging/methods ; Male ; Midazolam/adverse effects ; Pentobarbital/adverse effects ; Radiography, Interventional/methods ; Respiration/drug effects ; Retrospective Studies ; Tomography, X-Ray Computed/methods
    Chemical Substances Chloral Hydrate (418M5916WG) ; Pentobarbital (I4744080IR) ; Midazolam (R60L0SM5BC) ; Fentanyl (UF599785JZ)
    Language English
    Publishing date 2005-10
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 80324-8
    ISSN 1527-1315 ; 0033-8419
    ISSN (online) 1527-1315
    ISSN 0033-8419
    DOI 10.1148/radiol.2371041415
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Infant sedation for MR imaging and CT: oral versus intravenous pentobarbital.

    Mason, Keira P / Zurakowski, David / Connor, Linda / Karian, Victoria E / Fontaine, Paulette J / Sanborn, Pamela A / Burrows, Patricia E

    Radiology

    2004  Volume 233, Issue 3, Page(s) 723–728

    Abstract: Purpose: To compare the effectiveness and safety of oral (PO) versus intravenous (IV) pentobarbital sedation for magnetic resonance (MR) imaging and computed tomography (CT) in infants younger than 12 months.: Materials and methods: The institutional ...

    Abstract Purpose: To compare the effectiveness and safety of oral (PO) versus intravenous (IV) pentobarbital sedation for magnetic resonance (MR) imaging and computed tomography (CT) in infants younger than 12 months.
    Materials and methods: The institutional review board approved the review of medical records and determined informed consent to be unnecessary. All parents gave informed consent for patient sedation. Prior to MR imaging or CT, infants younger than 12 months were sedated with PO pentobarbital (4-8 mg per kilogram body weight) or IV pentobarbital (2-6 mg/kg), depending on the presence of an IV catheter or need for IV contrast medium. A computer database used to record sedation data was reviewed for data from January 1997 to September 2003. PO and IV sedation groups were compared for mean age, weight, dose, time to sedation, time to discharge, and duration of sedation with a two-sample Student t test. Multivariate analysis of covariance was used to determine whether differences in sedation time, time to discharge, and duration of sedation between groups were independent of age, weight, sex, American Society of Anesthesiologists physical status classification, dose, and type of procedure. Sedation effectiveness (outcome) was determined as the percentage of sedation failures in each group. Safety was determined separately for other adverse events as a total and for respiratory adverse events.
    Results: A total of 2164 infants received 2419 (1264 PO, 1155 IV) doses of pentobarbital for sedation. Weight and sex were comparable between groups. Time to sedation was significantly longer with PO than with IV pentobarbital (18 minutes +/- 11 vs 7 minutes +/- 7; P < .01), but time to discharge was similar, at approximately 108 minutes +/- 35. Total adverse events rate during sedation was not significantly different (0.8% [PO] vs 1.3% [IV]), but incidence of abnormal oxygen saturation (5% decrease from baseline, >1 minute duration) differed significantly (0.2% [PO] vs 0.9% [IV]; P = .02). Sedation effectiveness was comparable (failure rate, 0.5% [PO] vs 0.3% [IV]; P = .76).
    Conclusion: PO pentobarbital has comparable effectiveness and a lower rate of respiratory complications compared with IV pentobarbital in infants younger than 12 months; its use should be considered, regardless of presence of an IV catheter.
    MeSH term(s) Administration, Oral ; Age Factors ; Anesthesia Recovery Period ; Body Weight ; Catheterization, Peripheral ; Conscious Sedation/methods ; Contrast Media ; Female ; Humans ; Hypnotics and Sedatives/administration & dosage ; Hypnotics and Sedatives/adverse effects ; Infant ; Injections, Intravenous ; Magnetic Resonance Imaging ; Male ; Outcome Assessment (Health Care) ; Patient Discharge ; Pentobarbital/administration & dosage ; Pentobarbital/adverse effects ; Retrospective Studies ; Safety ; Sex Factors ; Time Factors ; Tomography, X-Ray Computed
    Chemical Substances Contrast Media ; Hypnotics and Sedatives ; Pentobarbital (I4744080IR)
    Language English
    Publishing date 2004-12
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 80324-8
    ISSN 1527-1315 ; 0033-8419
    ISSN (online) 1527-1315
    ISSN 0033-8419
    DOI 10.1148/radiol.2333031872
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Superiority of pentobarbital versus chloral hydrate for sedation in infants during imaging.

    Mason, Keira P / Sanborn, Pamela / Zurakowski, David / Karian, Victoria E / Connor, Linda / Fontaine, Paulette J / Burrows, Patricia E

    Radiology

    2004  Volume 230, Issue 2, Page(s) 537–542

    Abstract: Purpose: To compare the effectiveness and safety of oral pentobarbital and oral chloral hydrate for sedation in infants younger than 1 year during magnetic resonance (MR) imaging and computed tomography (CT).: Materials and methods: A computerized ... ...

    Abstract Purpose: To compare the effectiveness and safety of oral pentobarbital and oral chloral hydrate for sedation in infants younger than 1 year during magnetic resonance (MR) imaging and computed tomography (CT).
    Materials and methods: A computerized database was used to collect information about all cases in which sedation was used. Outcomes of all infants who received oral pentobarbital or oral chloral hydrate for sedation between 1997 and 2002 were reviewed. Two study groups were compared for sedation and discharge times by using Student t test and for adverse events by using Fisher exact test and multiple logistic regression analysis.
    Results: Infants (n = 1,316) received an oral medication for sedation. Mean doses were 50 mg/kg chloral hydrate and 4 mg/kg pentobarbital. Student t test demonstrated no difference in mean time to sedation and in time to discharge between groups. Overall adverse event rate during sedation was lower with pentobarbital (0.5%) than with chloral hydrate (2.7%) (P <.001). There were fewer episodes of oxygen desaturation with pentobarbital (0.2%) than with chloral hydrate (1.6%) (P <.01). Both medications were equally effective in providing successful sedation.
    Conclusion: Although oral pentobarbital and oral chloral hydrate are equally effective, the incidence of adverse events with pentobarbital was significantly reduced.
    MeSH term(s) Administration, Oral ; Adverse Drug Reaction Reporting Systems ; Boston ; Chloral Hydrate/adverse effects ; Conscious Sedation ; Female ; Hospitals, Pediatric ; Humans ; Hypnotics and Sedatives/adverse effects ; Infant ; Infant, Newborn ; Magnetic Resonance Imaging ; Male ; Oxygen/blood ; Pentobarbital/adverse effects ; Tomography, X-Ray Computed
    Chemical Substances Hypnotics and Sedatives ; Chloral Hydrate (418M5916WG) ; Pentobarbital (I4744080IR) ; Oxygen (S88TT14065)
    Language English
    Publishing date 2004-02
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 80324-8
    ISSN 1527-1315 ; 0033-8419
    ISSN (online) 1527-1315
    ISSN 0033-8419
    DOI 10.1148/radiol.2302030107
    Database MEDical Literature Analysis and Retrieval System OnLINE

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