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Biomedical subjects

D J Rowbotham

Publications and source records attributed to D J Rowbotham.

At least 73 records · Page 4Linked to original sources

Effects of morphine and its metabolites on opiate receptor binding, cAMP formation and [3H]noradrenaline release from SH-SY5Y cells.

Opiate receptor occupation leads to a variety of intracellular events including inhibition of adenylyl cyclase and cAMP formation. We have examined the opiate binding characteristics, effects on cAMP formation and [3H]noradrenaline release of morphine, morphine-6 (M6G) and -3 (M3G)-glucuronides, and fentanyl in SH-SY5Y human neuroblastoma cells. M6G and M3G are the major metabolites of morphine formed in vivo whose cellular action remains to be fully elucidated. In binding experiments morphine (affinity, K50 = 96 nM) and fentanyl (K50 = 99 nM) were more potent than M6G (K50 = 393 nM), while M3G was inactive. However, for cAMP inhibition morphine (half maximum inhibition, IC50 = 193 nM) and M6G (IC50 = 113 nM) were roughly equipotent, with fentanyl (IC50 = 27 nM) being more potent and producing a greater maximum inhibition (56%). M3G was inactive. These in vitro data are in general agreement with the in vivo effects of these glucuronides. Moreover, all of the opiates tested failed to inhibit K(+)-evoked release of [3H]noradrenaline. Whilst these data do not support a role for cAMP in neurotransmitter release, alterations in cAMP formation may still have a role to play in the mechanism of analgesia.

Cell Line↗

Fentanyl inhibits the uptake of [3H]noradrenaline in cultured neuronal cells.

We have examined how fentanyl modulates [3H]noradrenaline uptake in two cultured neuronal cell preparations, the human neuroblastoma SH-SY5Y and the rat phaeochromocytoma PC12. Fentanyl produced a significant, dose-dependent inhibition of [3H]noradrenaline uptake at concentrations in excess of 0.1 mumol litre-1 (P < 0.05) and 0.3 mumol litre-1 (P < 0.05) for PC12 and SH-SY5Y cells, respectively. However, these values exceed the serum concentration of fentanyl required to produce analgesia. At the maximum concentration examined (100 mumol litre-1), fentanyl produced 85-95% inhibition of uptake. This effect was not antagonized by naloxone, implying a nonopioid mechanism of action. Imipramine 1 mumol litre-1 reduced [3H]noradrenaline uptake by 65-70% but morphine, in contrast to fentanyl, had no effect (P > 0.1).

Adrenal Gland Neoplasms↗

Effect of alcohol on gastric emptying in volunteers.

We have examined the effect of alcohol on the gastric emptying rate of a liquid meal in 10 volunteers. Each volunteer was allocated randomly to receive, on three occasions, no alcohol, 3 units or 6 units of alcohol. Gastric emptying was measured using applied potential tomography. The rate of gastric emptying as measured by the time to 50% emptying (T50) was delayed significantly (P < 0.01) after alcohol 6 units (median 45.0 min (range 19-90 min)) compared with control (23.0 min (13-36 min)) and there was little change after alcohol 3 units (25.5 min (10-65 min)) [corrected].

Adult↗

No effect of cisapride on paracetamol absorption after oral simultaneous administration.

We have measured the effect of oral cisapride on paracetamol absorption in 12 healthy volunteers in a double-blind placebo-controlled study. Volunteers received paracetamol plus placebo, paracetamol plus cisapride 10 mg and paracetamol plus cisapride 20 mg. Mean plasma paracetamol AUC at 60 min were 1070, 1051 and 1031 micrograms.min.ml-1 and maximum paracetamol concentrations were 31.5, 29.3 and 27.4 micrograms.ml-1 respectively (no significant differences). There was no difference also in time to maximum paracetamol concentration [median (range) 30 (15-120), 30 (15-90) and 30 (15-60) min, respectively]. .

Acetaminophen↗

Efficacy of orally administered ondansetron in the prevention of postoperative nausea and vomiting: a dose ranging study.

In a placebo-controlled, double-blind study, we have compared the efficacy of ondansetron 16 mg, 8 mg and 1 mg administered 8-hourly for prevention of postoperative nausea and vomiting. We studied 995 patients undergoing major gynaecological surgery; 982 were included in the analysis. Study medication was administered 1 h before induction of anaesthesia and second and third doses were given 8 and 16 h after the first. The treatment groups were similar for patient characteristics, surgical procedures, anaesthetics administered and opioids given. The frequency of nausea was 75%, 70%, 56% and 55% after placebo and ondansetron 1 mg, 8 mg and 16 mg, respectively; the corresponding frequencies of vomiting were 60%, 55%, 37% and 37%. Ondansetron 8 mg was as effective as 16 mg and both resulted in significant reductions in nausea and vomiting compared with placebo and ondansetron 1 mg (P less than 0.001).

Administration, Oral↗

Regurgitation of gastric contents during general anaesthesia using the laryngeal mask airway.

We have investigated the incidence of regurgitation of gastric contents during general anaesthesia administered via a laryngeal mask airway (LMA) or face mask and Guedel airway in 56 patients with no risk factors for regurgitation. Patients swallowed a gelatin capsule containing methylene blue 10 min before induction of anaesthesia. Fibreoptic laryngoscopy in the LMA group or conventional laryngoscopy in the face mask group was performed at the end of surgery. Dye was observed within the laryngeal mask in seven of 28 patients (25%). No patients in the face mask-Guedel airway group regurgitated dye (P = 0.005). There was no evidence of aspiration of dye.

Adult↗

Effect of the laryngeal mask airway on lower oesophageal sphincter pressure in patients during general anaesthesia.

We have studied the tone of the lower oesophageal sphincter (LOS) in 40 adults undergoing routine body surface surgery and allocated randomly to receive anaesthesia either by face mask and Guedel airway or by laryngeal mask airway. In the laryngeal mask group there was a mean (SEM) decrease in barrier pressure (LOS minus gastric pressure) of 3.6 (1.4) cm H2O, compared with a mean increase of 2.2 (1.2) cm H2O in the face mask group (P < 0.005).

Adult↗

Electronic and disposable patient-controlled analgesia systems. A comparison of the Graseby and Baxter systems after major gynaecological surgery.

We have compared the performance of the Baxter disposable with the Graseby electronic patient-controlled analgesia system in 30 patients following major gynaecological surgery. Patients were allocated randomly to receive analgesia via the Baxter or Graseby device for postoperative pain relief. There were no significant differences between the two groups with regard to postoperative pain relief or sedation as measured by visual analogue scale. Requirements for antiemetic drugs and patient acceptability were similar. Mean (SEM) morphine demanded over 30 h was 35.7 (6.6) in the Graseby group and 35.1 (8.5) in the Baxter group.

Adult↗

Peripartum changes in gastric emptying.

Applied potential tomography was used to measure changes in gastric emptying during the peripartum period. Gastric emptying was measured sequentially in each of 10 healthy patients at 37-40 weeks gestation, 2-3 days postpartum and after the 6-week postnatal assessment (control). Mean (SD) times to 50% emptying were 15 (6.05), 11 (5.9) and 15 (5.5) min, respectively. There was no statistically significant change in gastric emptying as a result of pregnancy in this group of women. Retrospective power analysis (assuming alpha = 0.05 and beta = 0.20) shows the study design was adequate to detect a difference of 8 min.

Adult↗

Gastric emptying after minor gynaecological surgery. The effect of anaesthetic technique.

Gastric emptying was measured using the paracetamol absorption method in 30 patients immediately after a general anaesthetic for minor gynaecological surgery and in 10 female controls. Anaesthesia was induced with either propofol alone, propofol and alfentanil (4.5 micrograms.kg-1) or propofol and fentanyl (1.4 micrograms.kg-1) and maintained with intermittent propofol and 66% nitrous oxide in oxygen. Gastric emptying was delayed significantly in all patient groups when compared with volunteers. However, the delay in gastric emptying was similar in the three patient groups.

Acetaminophen↗

A comparison of gastric emptying rate after cimetidine and ranitidine measured by applied potential tomography.

Gastric emptying was measured using applied potential tomography (APT) after crossover administration of 800 mg cimetidine and 300 mg ranitidine orally. Ten volunteers were studied, each on two occasions. Two hours after taking ranitidine or cimetidine, the volunteer was given a liquid and gastric emptying was measured over 60 min. There was a small but statistically significant delay in gastric emptying following ranitidine compared with cimetidine (P less than 0.04). The median (range) time to 50% emptying (t50) was 24 (15-60) min after ranitidine compared with 22 (15-46) min after cimetidine.

Administration, Oral↗

Effect of single doses of cisapride and ranitidine administered simultaneously on plasma concentrations of cisapride and ranitidine.

We have studied in 12 volunteers the effect of single doses of cisapride and ranitidine, administered simultaneously, on plasma concentrations of cisapride and ranitidine. Median maximum plasma concentration of ranitidine was achieved 1 h earlier when ranitidine was taken with cisapride compared with ranitidine alone (P = 0.012). There was a 24% decrease in plasma ranitidine AUC8h when ranitidine was taken with cisapride compared with ranitidine alone (P less than 0.005). Ranitidine had no effect on absorption of cisapride.

Adult↗

Effect of cisapride on morphine absorption after oral administration of sustained-release morphine.

We investigated the effect of cisapride 20 mg given orally with MST 20 mg on the absorption of morphine in a double-blind, placebo-controlled study. Cisapride increased significantly both plasma concentrations of morphine after 1 h and peak concentrations. There was no significant change in time to peak concentrations, sedation scores or percentage decrease in pupil diameters. Plasma concentrations of amylase were increased in three patients in the MST-placebo group and three in the MST-cisapride group. One patient in the MST-cisapride group developed acute pancreatitis.

Absorption↗

Morphine compared with diamorphine. A comparison of dose requirements and side-effects after hip surgery.

The dose requirements and side effects of morphine were compared with those of diamorphine administered by patient-controlled analgesia in 40 patients following elective total hip replacement. Patients were allocated randomly to receive in a double-blind manner either morphine or diamorphine for postoperative pain relief. There were no significant differences between the two groups with regard to postoperative sedation, nausea, well-being, pain relief and requirements for antiemetic drugs. The dose requirement for diamorphine was approximately 50% of that for morphine.

Adult↗