Optimization of reproductive efficiency of both beef and dairy herds is critical for sustainability and profitability. Two separate experiments were performed to test the reproductive outcomes following early weaning of beef heifers and intrafollicular insemination in dairy cows. Early weaning is a proven way to induce precocious puberty in heifers. Heifers will experience more estrous cycles before breeding, which is associated with increased fertility. In this experiment, heifers were either subjected to early weaning and a high concentrate diet (EW; 106.5±3.4 days of age) or normal weaning (NW; 231.7±3.33 days of age) treatments. Despite no effect (P>0.15) of weaning treatment on age at puberty, EW heifers tended to have higher pregnancy rates than NW heifers. A progesterone clearance analysis revealed that EW heifers also have greater ability to metabolize progesterone. This altered progesterone metabolism could be a direct result of changes in metabolism caused by feeding a high concentrate diet after early weaning. Pregnancy rates in cattle are often lower than desired. New reproductive advances are constantly developed to improve reproductive function. A recently described possible technique is intrafollicular insemination (IFI). The objective of the second experiment was to investigate whether IFI can cause fertilization. Abattoir ovaries with dominant follicles injected with semen and incubated overnight displayed sperm in close association with granulosa cells. When synchronized cows were subjected to IFI, no pregnancies resulted. While other studies have demonstrated success with IFI, it is still unknown if fertilization is possible within the follicle of the ovary. / Master of Science

Le but de notre travail était d'étudier des nouveaux aspects de la physiopathologie et de la thérapeutique du choc anaphylactique chez le rat Brown Norway. La première partie de notre thèse étudie la physiopathologie systémique et régionale du choc anaphylactique. Le choc anaphylactique s'accompagne d'une diminution rapide du débit cardiaque, d'une altération brutale de l'autorégulation du débit sanguin cérébral et d'une atteinte respiratoire associant un oedème des voies respiratoires et un bronchospasme. La deuxième partie de notre travail s'intéresse à la prise en charge thérapeutique du choc anaphylactique. L'adrénaline s'avère supérieure à la vasopressine, pour inhiber le bronchospasme et diminuer la perméabilité microvasculaire, permettant une meilleure préservation de l'oxygénation cérébrale, en particulier dans la région de l'hippocampe, mais aussi une correction du bronchospsme et une diminution de l'hyperperméabilté bronchique à la phase précoce du choc anaphylactique. Nous avons également comparé les effets de trois types de solutés de remplissage administrés en association avec l'adrénaline au cours du choc anaphylactique, démontrant la supériorité de l'administration de soluté macromoléculaires tels que l'HES et l'échec des solutés salés hypertoniques. Enfin nous avons pu mettre en évidence l'intérêt de l'administration de bleu de méthylène (3mg/kg) en démontrant l'existence d'un effet synergique avec l'adrénaline au cours du choc anaphylactique / The aim of our work was to study new aspects of the pathophysiology and treatment of anaphylactic shock in the Brown Norway rat. The first part of this thesis focuses on the systemic and regional pathophysiology of anaphylactic shock which is accompanied by a rapid decrease in cardiac output, a sudden alteration of autoregulation of cerebral blood flow and a respiratory dysfunction involving swelling of the airways and bronchospasm. The second part of our work focuses on the therapeutic management of anaphylactic shock. Epinephrine was found to be superior to vasopressin, to inhibit bronchospasm and decrease microvascular permeability, allowing a better preservation of the cerebral oxygenation, in particular in the region of the hippocampus. Furthermore, it provided also an alleviation of bronchospasm and of bronchial hyperperméabilté in the early phase of anaphylactic shock. We also compared the effects of three types of fluid therapy administered in combination with adrenaline during anaphylactic shock, demonstrating the superiority of the administration of a macromolecular solution such as HES compared to hypertonic saline fluids. Finally we were able to highlight the usefulness of the administration of methylene blue (3mg/kg) demonstrating the existence of a synergistic effect with adrenaline during anaphylactic shock

INTRODUÇÃO E HIPÓTESE: A epinefrina é um potente vasoconstritor com efeitos inotrópico e arritmogênico, é utilizada em protocolos de reanimação cardiopulmonar e como fármaco de primeira escolha em alguns casos de choque. Contudo, o seu uso pode ser seguido por lesões do miocárdio e disfunção cardíaca. Modelos experimentais têm mostrado efeitos cardioprotetores do fentanil por meio de mecanismos antiarrítmicos e anti-isquêmicos. O objetivo deste estudo foi avaliar o efeito cardioprotetor do fentanil em suínos expostos a altas doses de epinefrina. MÉTODOS: Após aprovação do comitê de ética institucional, 26 porcos Large White e Landrace foram alocados aleatoriamente em três grupos: grupo fentanil (n = 10), no qual os porcos receberam 20 ug/kg de fentanil 5 minutos antes de 5 doses de 20 ug/kg de epinefrina, as quais foram intercaladas por intervalos de 5 minutos entre cada dose; grupo salina (n = 10), no qual os porcos receberam solução salina volume-equivalente ao fentanil 5 minutos antes das 5 doses de epinefrina e grupo Sham (n = 6), que não recebeu fentanil ou epinefrina. Foram coletadas variáveis hemodinâmicas, ecocardiográficas, gasométricas e marcadores cardíacos durante as 6 horas de experimento. Ao final do estudo, o coração e os pulmões dos porcos foram removidos para análise por microscopia óptica, microscopia eletrônica e imuno-histoquímica (caspase-3). Os dados foram analisados usando equações de estimação generalizadas (GEE) e a significância estatística foi estabelecida em p < 0,05. RESULTADOS: Os níveis de troponina-I entre os grupos foram inicialmente equivalentes. Ao final do experimento, foi observado menor nível de troponina-I no grupo fentanil, em comparação com o grupo salina (1,91 ± 1,47 versus 5,44 ± 5,35 ng.ml-1, p = 0,019). Adicionalmente, a microscopia eletrônica e a imunohistoquímica demonstraram menor lesão miocárdica no grupo fentanil. Não houve diferença significativa entre o grupo fentanil e o salina para as variáveis hemodinâmicas, ecocardiográficas e gasométricas. CONCLUSÃO: O fentanil promove cardioproteção aos efeitos de altas doses de epinefrina sem prejudicar o efeito hemodinâmico da mesma / INTRODUCTION AND HYPOTHESIS: Epinephrine is a powerful vasopressor with inotropic and arrhythmogenic effects that is used in cardiopulmonary resuscitation protocols and as first choice drug in some cases of shock. However, its use could be followed by myocardial injury and dysfunction. Experimental models have shown cardioprotective effects of fentanyl through antiarrhythmic and anti-ischaemic mechanisms. The objective of this study was to evaluate the cardioprotective effect of fentanyl on myocardial function in swine exposed to high doses of epinephrine. METHODS: After institutional ethics committee approval, twenty-six Large White and Landrace pigs were allocated randomly into three groups: Fentanyl group (n=10), which received 20ug/kg of fentanyl five minutes before five doses of 20ug/kg of epinephrine interspersed with 5 minute intervals between each dose; Saline group (n=10), which received saline in a volume-equivalent manner of fentanyl five minutes before 20ug/kg of epinephrine doses; and Sham group (n=6), which did not receive fentanyl nor epinephrine. We assessed hemodynamics, transesophageal echocardiography, cardiac markers, and gasometry for 6 h. At the end of the experiment, the heart and lungs were removed for analysis by optical and electron microscopy and immunohistochemical (Caspase-3) assay. Data was analyzed using generalized estimating equations (GEE) and statistical significance was assumed at p < 0.05. RESULTS: Troponin levels among the groups were initially equivalent. Fentanyl group showed lower levels of troponin at the end of the sixth hour compared to the saline group (1.91 ± 1.47 vs. 5.44 ± 5.35 ng.mL-1, p=0.019). There were no significantly difference between fentanyl and saline group for hemodynamic, echocardiographic and gasometrical data. Transmission electron microscopy and immunohistochemistry also showed less myocardial injury in the fentanyl group. CONCLUSION: We concluded that fentanyl promotes effective cardioprotection to high-dose epinephrine without blunting the hemodynamic effect of epinephrine

<p>Ischemic neuronal injury continues to be a major delimiting factor in achieving successful clinical outcomesafter resuscitation from cardiac arrest. In this thesis, a pig model of cardiopulmonary resuscitation (CPR) wasused to address the effects of different interventions on cerebral blood flow and oxygenation during CPR and theinitial postresuscitation period. A novel technique is presented to quantify the reperfusion oxidative injury.</p><p>Maximization of cerebral blood flow during CPR by open-chest cardiac compression, continuous aortic balloon occlusion, and intra-aortic administration of hypertonic saline-dextran (HSD) did not ameliorate thepostresuscitation hypoperfusion or improve the cerebral oxygen extraction ratio or tissue pH. These findings disaffirm earlier studies suggesting that conserving brain viability after global ischemia is mostly a question ofmaintaining high perfusion pressure.</p><p>Despite an increased cerebral perfusion pressure during CPR, intra-aortic administered epinephrineabove the aortic balloon occlusion did not further improve cerebral blood flow and oxygenation. This findingmay indicate adverse effects of epinephrine on cerebral vascular beds, possibly induced by a relatively highconcentration of epinephrine when administered above the site for aortic balloon occlusion.</p><p>The IV administration of equipotent doses of epinephrine or vasopressin during CPR resulted incomparable hemodynamic changes. The peak increase in cerebral cortical blood flow, however, was reachedapproximately 30 sec later by vasopressin. Furthermore, the second bolus of vasopressin during CPR did notaugment cerebral perfusion, whereas epinephrine did. Consequently, reports suggesting that vasopressin issuperior to epinephrine with respect to its effects on central hemodynamics and vital organ blood flow may bebiased by the pharmacodynamic differences between the drugs, depending on the time point at which blood flowmeasurements are performed.</p><p>In comparison with IV vasopressin, vasopressin administered above the aortic balloon occlusion resulted in a significant increase in cerebral perfusion pressure during CPR, but not after restoration of spontaneous circulation (ROSC). Cerebral cortical blood flow was, however, not improved <i>during</i> CPR, whereas a significant increase was recorded <i>after</i> ROSC. Relatively higher concentrations of vasopressin above the sitefor intra-aortic balloon occlusion may, therefore, predominantly induce cerebral cortical vasoconstriction duringCPR but induce vasodilatation after ROSC.</p><p>Assessment of oxidative stress or inflammation have been extremely difficult to attain. In our pig model of resuscitation, an association wasobserved between the duration of cardiac arrest and jugular bulb levels of 8-iso-PGF_2α, a major isoprostane and a novel index of oxidative injury. 8-iso-PGF_2α, and the prostaglandin 15-K-DH-PGF_2α, increased within 5 min after ROSC and remained so up to 2 h, indicating the interval of time during which cerebral reperfusion oxidative injury and inflammatory response may occur and are potentially preventable.</p>

Lipids havepreviously been considered primarily as building blocks of the cell membrane, but are now also recognized as important cell signaling molecules. Lysophosphatidic acid (LPA) is a glycerophospholipid consisting of a phosphate head group, a linker region, and a lipophilic tail. LPA has earlier been shown to exert a diversity of cellular effects such as aggregation, apoptosis, contraction, migration, and proliferation. The effects of LPA are elicited by activation of its cognate G protein-coupled receptors LPA1, LPA2, and LPA3. In the present study we have used cultures of human smooth muscle cells (SMCs) and erythroleukemia cells (HEL), and isolated human platelets to characterize physiological effects of LPA compared with adrenaline and noradrenaline as well as structure-activity relationships of LPA. SMCs were isolated from biopsies of human myometrium obtained at cesarean sections. We show that cultured myometrial SMCs express multiple LPA and α2-adrenergic receptor subtypes. Treatment of SMCs with LPA and noradrenaline resulted in increases in proliferation. However, LPA elicits a much more pronounced stimulatory effect than noradrenaline. The ability to increase calcium might be one explanation why LPA is more effective. Further studies indicated that several pathways mediate the growth stimulatory effect of LPA where transactivation of epidermal growth factor receptors through matrix metalloproteinases as well as calcium/calmodulin-dependent protein kinases appears to be important. LPA enantiomers and LPA analogues were synthesized and characterized due to their capacity to increase calcium in HEL cells. Our study is the first to show that both natural (R) and unnatural (S) LPA enantiomers are capable of stimulating cells, suggesting LPA receptors are not stereoselective. Moreover, we have synthesized a LPA analogue with higher maximal effect than LPA by reducing the hydrocarbon chain length. In platelets we demonstrated that LPA is a weak calciumelevating compound which failed to stimulate aggregation. However, in combination with adrenaline, another weak platelet agonist, a complete aggregatory response was obtained in blood from some healthy individuals. These results are important since platelet activation is a key step in distinguishing normal from pathological hemostasis. Since LPA is present at high concentrations in atherosclerotic lesions, the synergistic effect of LPA and adrenaline might be a new risk factor for arterial thrombosis. / On the day of the public defence the status of the article IV was: Submitted for publication.

Ischemic neuronal injury continues to be a major delimiting factor in achieving successful clinical outcomesafter resuscitation from cardiac arrest. In this thesis, a pig model of cardiopulmonary resuscitation (CPR) wasused to address the effects of different interventions on cerebral blood flow and oxygenation during CPR and theinitial postresuscitation period. A novel technique is presented to quantify the reperfusion oxidative injury. Maximization of cerebral blood flow during CPR by open-chest cardiac compression, continuous aortic balloon occlusion, and intra-aortic administration of hypertonic saline-dextran (HSD) did not ameliorate thepostresuscitation hypoperfusion or improve the cerebral oxygen extraction ratio or tissue pH. These findings disaffirm earlier studies suggesting that conserving brain viability after global ischemia is mostly a question ofmaintaining high perfusion pressure. Despite an increased cerebral perfusion pressure during CPR, intra-aortic administered epinephrineabove the aortic balloon occlusion did not further improve cerebral blood flow and oxygenation. This findingmay indicate adverse effects of epinephrine on cerebral vascular beds, possibly induced by a relatively highconcentration of epinephrine when administered above the site for aortic balloon occlusion. The IV administration of equipotent doses of epinephrine or vasopressin during CPR resulted incomparable hemodynamic changes. The peak increase in cerebral cortical blood flow, however, was reachedapproximately 30 sec later by vasopressin. Furthermore, the second bolus of vasopressin during CPR did notaugment cerebral perfusion, whereas epinephrine did. Consequently, reports suggesting that vasopressin issuperior to epinephrine with respect to its effects on central hemodynamics and vital organ blood flow may bebiased by the pharmacodynamic differences between the drugs, depending on the time point at which blood flowmeasurements are performed. In comparison with IV vasopressin, vasopressin administered above the aortic balloon occlusion resulted in a significant increase in cerebral perfusion pressure during CPR, but not after restoration of spontaneous circulation (ROSC). Cerebral cortical blood flow was, however, not improved during CPR, whereas a significant increase was recorded after ROSC. Relatively higher concentrations of vasopressin above the sitefor intra-aortic balloon occlusion may, therefore, predominantly induce cerebral cortical vasoconstriction duringCPR but induce vasodilatation after ROSC. Assessment of oxidative stress or inflammation have been extremely difficult to attain. In our pig model of resuscitation, an association wasobserved between the duration of cardiac arrest and jugular bulb levels of 8-iso-PGF2α, a major isoprostane and a novel index of oxidative injury. 8-iso-PGF2α, and the prostaglandin 15-K-DH-PGF2α, increased within 5 min after ROSC and remained so up to 2 h, indicating the interval of time during which cerebral reperfusion oxidative injury and inflammatory response may occur and are potentially preventable.

INTRODUÇÃO E HIPÓTESE: A epinefrina é um potente vasoconstritor com efeitos inotrópico e arritmogênico, é utilizada em protocolos de reanimação cardiopulmonar e como fármaco de primeira escolha em alguns casos de choque. Contudo, o seu uso pode ser seguido por lesões do miocárdio e disfunção cardíaca. Modelos experimentais têm mostrado efeitos cardioprotetores do fentanil por meio de mecanismos antiarrítmicos e anti-isquêmicos. O objetivo deste estudo foi avaliar o efeito cardioprotetor do fentanil em suínos expostos a altas doses de epinefrina. MÉTODOS: Após aprovação do comitê de ética institucional, 26 porcos Large White e Landrace foram alocados aleatoriamente em três grupos: grupo fentanil (n = 10), no qual os porcos receberam 20 ug/kg de fentanil 5 minutos antes de 5 doses de 20 ug/kg de epinefrina, as quais foram intercaladas por intervalos de 5 minutos entre cada dose; grupo salina (n = 10), no qual os porcos receberam solução salina volume-equivalente ao fentanil 5 minutos antes das 5 doses de epinefrina e grupo Sham (n = 6), que não recebeu fentanil ou epinefrina. Foram coletadas variáveis hemodinâmicas, ecocardiográficas, gasométricas e marcadores cardíacos durante as 6 horas de experimento. Ao final do estudo, o coração e os pulmões dos porcos foram removidos para análise por microscopia óptica, microscopia eletrônica e imuno-histoquímica (caspase-3). Os dados foram analisados usando equações de estimação generalizadas (GEE) e a significância estatística foi estabelecida em p < 0,05. RESULTADOS: Os níveis de troponina-I entre os grupos foram inicialmente equivalentes. Ao final do experimento, foi observado menor nível de troponina-I no grupo fentanil, em comparação com o grupo salina (1,91 ± 1,47 versus 5,44 ± 5,35 ng.ml-1, p = 0,019). Adicionalmente, a microscopia eletrônica e a imunohistoquímica demonstraram menor lesão miocárdica no grupo fentanil. Não houve diferença significativa entre o grupo fentanil e o salina para as variáveis hemodinâmicas, ecocardiográficas e gasométricas. CONCLUSÃO: O fentanil promove cardioproteção aos efeitos de altas doses de epinefrina sem prejudicar o efeito hemodinâmico da mesma / INTRODUCTION AND HYPOTHESIS: Epinephrine is a powerful vasopressor with inotropic and arrhythmogenic effects that is used in cardiopulmonary resuscitation protocols and as first choice drug in some cases of shock. However, its use could be followed by myocardial injury and dysfunction. Experimental models have shown cardioprotective effects of fentanyl through antiarrhythmic and anti-ischaemic mechanisms. The objective of this study was to evaluate the cardioprotective effect of fentanyl on myocardial function in swine exposed to high doses of epinephrine. METHODS: After institutional ethics committee approval, twenty-six Large White and Landrace pigs were allocated randomly into three groups: Fentanyl group (n=10), which received 20ug/kg of fentanyl five minutes before five doses of 20ug/kg of epinephrine interspersed with 5 minute intervals between each dose; Saline group (n=10), which received saline in a volume-equivalent manner of fentanyl five minutes before 20ug/kg of epinephrine doses; and Sham group (n=6), which did not receive fentanyl nor epinephrine. We assessed hemodynamics, transesophageal echocardiography, cardiac markers, and gasometry for 6 h. At the end of the experiment, the heart and lungs were removed for analysis by optical and electron microscopy and immunohistochemical (Caspase-3) assay. Data was analyzed using generalized estimating equations (GEE) and statistical significance was assumed at p < 0.05. RESULTS: Troponin levels among the groups were initially equivalent. Fentanyl group showed lower levels of troponin at the end of the sixth hour compared to the saline group (1.91 ± 1.47 vs. 5.44 ± 5.35 ng.mL-1, p=0.019). There were no significantly difference between fentanyl and saline group for hemodynamic, echocardiographic and gasometrical data. Transmission electron microscopy and immunohistochemistry also showed less myocardial injury in the fentanyl group. CONCLUSION: We concluded that fentanyl promotes effective cardioprotection to high-dose epinephrine without blunting the hemodynamic effect of epinephrine

Made available in DSpace on 2014-08-20T13:32:45Z (GMT). No. of bitstreams: 1 tese_rita_de_cassia_dos_santos_da_conceicao.pdf: 1008237 bytes, checksum: 314712b961ce0f1c183271a96a57f4ea (MD5) Previous issue date: 2012-12-21 / Salmonella spp. is the most commonly bacterium transmitted through contamined food. The foods of animal are the most responsible for the worldwide distribution of this bacterium. Salmonella spp. is able to induce a variety of diseases, ranging from an enteric fever, septicemia, gastroenteritis and infections focused. This is due to the bacteria produce different pathogenicity factors and these factors, the flagellum was the target of our study and it is one of the pathogenicity factors induced by Quorum Sensing. Quorum Sensing is a bacterial signaling system that operates through the so-called autoinducer (AI). Gram-negative bacteria produce three auto-inducers. Studies find that catecholamines are able to use the same pathway the autoinducer 3 (AI-3) to active certain genes. Epinephrine and norepinephrine are catecholamines that are present in the mammalian gastrointestinal tract can modulate bacterial gene expression. This work had as objectives to evaluate the Quorum Sensing signaling system on motility, on the growth and flagellar assembly gene expression of Salmonella enterica serovar Typhimurium (ST) and do a review about pathogenicity factors of Salmonella spp. induced by Quorum Sensing. ST was exposed to different concentrations of epinephrine and conditioned medium and its association. The combination of 500 μM epinephrine with 50 % conditioned medium increased ST bacterial motility, growth and increased the expression of the fliC, motA, motB and fliA genes. These results suggest that epinephrine in association with conditioned medium increases ST growth and motility, by modulating the expression of genes involved in flagellum assembly. These observations provide valuable insight into the association between catecholamine and autoinducer and their role in the outcome of Salmonella spp. infection. / Salmonella spp. é um dos principais patógenos transmitidos por alimentos. Os produtos de origem animal são os maiores responsáveis pela distribuição mundial desta bactéria. Salmonella spp. é capaz de induzir uma série de doenças, que vão desde uma febre entérica, septicemia, gastroenterite e infecções focalizadas. Isto é decorrente da bactéria produzir diferentes fatores de patogenicidade e dentre estes fatores, o flagelo foi o alvo no nosso estudo e é um dos fatores de patogenicidade induzidos por Quorum Sensing. Este é um de sistema de sinalização entre as bactérias, através de substâncias denominadas de auto-indutores (AI). As bactérias Gram-negativas produzem três auto-indutores. Estudos verificaram que catecolaminas são capazes de usar a mesma via de sinalização do auto-indutor 3 (AI-3) para ativar determinados genes. Adrenalina e noradrenalina são catecolaminas presentes no trato gastrointestinal de humanos e animais que são capazes de modular a expressão de gênica de bactérias. O presente trabalho teve por objetivos avaliar o sistema de sinalização Quorum Sensing (AI-3) na motilidade, no crescimento celular e na expressão de genes envolvidos na montagem do flagelo de Salmonella enterica sorovar Typhimurium (ST) e fazer uma revisão bibliográfica de fatores de patogenicidade de Salmonella spp. induzidos por Quorum Sensing. ST foi exposta a diferentes concentrações de adrenalina e esta associada ao meio condicionado. A combinação de 500 μM de adrenalina + 50% de meio condicionado aumentou a motilidade de ST, o crescimento celular e induziu a expressão dos genes motA, motB, fliA e fliC. Estes resultados sugerem que a maior motilidade de ST foi decorrente de uma maior expressão de genes envolvidos com a montagem do flagelo. Estas observações fornecem dados valiosos sobre a associação da adrenalina com os auto-indutores e seu papel na infecção causada por Salmonella spp..

Hjärtstillestånd är ett tillstånd då hjärtat förlorat förmågan att pumpa ut blod i kroppen vilket leder till cerebral och koronar ischemi. Hjärtstillestånd definieras som plötslig och ihållande medvetslöshet med pulslöshet och andningsstillestånd eller agonal andning. Vanliga symtom som kan uppstå en timme före hjärtstilleståndet är yrsel, trötthet, bröstsmärtor och andningssvårigheter. Behandlingen vid hjärtstillestånd i Sverige utgörs av ”basic” och ”advanced cardiac life support”. De viktigaste åtgärderna innefattar hjärt-lung-räddning, defibillering och läkemedelsadministrering. Förstahandsläkemedlet är standarddos adrenalin baserat på den vasokontraherande och därmed blodtryckshöjande effekten. Syftet med arbetet är att utvärdera effekten av standarddos vasopressin alternativt högdos adrenalin jämfört med standarddos adrenalin på vuxna med hjärtstillestånd. Arbetet är en litteraturstudie där sju studier om effekten av standarddos adrenalin jämfört med standarddos vasopressin alternativt högdos adrenalin vid hjärtstillestånd hos vuxna har analyserats. Studierna hämtades från databasen Pubmed. De patienter som behandlades med standarddos vasopressin istället för den första eller andra standarddosen adrenalin hade bättre överlevnad till sjukhusinläggning (31,6% jämfört med 26,0%, p &lt;0,01). De patienter som behandlades med högdos adrenalin istället för standarddos adrenalin hade bättre överlevnad till sjukhusinläggning (26,1% jämfört med 23,1%, p &lt;0,05). Ingen överlevnadsfördel till sjukhusutskrivning fanns för varken standarddos vasopressin eller högdos adrenalin. Dock behövs fler studier med fler patienter för att verifiera resultaten i denna litteraturstudie. Det vore även intressant med studier som fokuserar på de enskilda hjärtstilleståndsrytmerna. Dessutom behövs mer forskning om de potentiellt negativa effekterna på hjärtat och hjärnan som högdos adrenalin kan ha. Orsaken till den dåliga överlevnaden till sjukhusutskrivning oavsett vasopressorisk behandling behöver utredas. / Cardiac arrest is a state when the heart has lost the ability to pump blood to the body which causes cerebral and coronary ischemia. Cardiac arrest is defined as sudden and sustained unconsciousness with pulselessness and suspension of breathing or agonal breathing. Common symptoms that can arise one hour before a cardiac arrest includes dizziness, tiredness, chest pain and breathing difficulties. The treatment for cardiac arrest in Sweden includes basic and advanced cardiac life support. The most important measures are cardiopulmonary resuscitation, defibrillation and drug administration. The drug of choice is standard dose adrenaline based on its vasoconstricting and thus blood pressure raising effect. The aim of this study was to evaluate the effect of standard dose vasopressin alternatively high dose adrenaline compared to standard dose adrenaline in adults with cardiac arrest. This study is a literature review where seven studies on the effect of standard dose adrenaline compared to standard dose vasopressin alternatively high dose adrenaline on cardiac arrest in adults have been analyzed. The studies were found in the database Pubmed. Four studies evaluate the effect on survival by standard dose vasopressin compared to standard dose adrenaline. Three studies evaluate the effect on survival by high dose adrenaline compared to standard dose adrenaline. Patients that were treated with standard dose vasopressin instead of the first or second standard dose adrenaline had better survival to hospital admission (31,6% compared to 26,0%, p &lt;0,01). Patients that were treated with high dose adrenaline instead of standard dose adrenaline had better survival to hospital admission (26,1% compared to 23,1%, p &lt;0,05). There were no effects on survival to hospital discharge for either standard dose vasopressin or high dose adrenaline. More studies are needed though with more patients to verify the results of this literature review. It would also be interesting with studies that focus on the different cardiac arrest rhytms. More research is needed about the potential negative effects on the heart and brain caused by high dose adrenaline. The reason for the bad results regarding survival to hospital discharge regardless of vasopressive treatment needs to be evaluated.

Magister Scientiae - MSc / The purpose of this research project was to assess the safety and efficacy of a combination of drugs for conscious sedation in patients undergoing office-based plastic and reconstructive surgery. A pilot study was done to determine the safety of the co-administration of the drugs used in the sedation technique. / South Africa