Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound

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Query: EC:3.2.1.36 (hyaluronidase)
4,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The purpose of this prospective, randomized, double-blind study was to determine the anesthetic efficacy of a buffered lidocaine with epinephrine solution compared to a combination buffered lidocaine with epinephrine plus hyaluronidase solution in inferior alveolar nerve blocks. Thirty subjects randomly received an inferior alveolar nerve block using 1 of the 2 solutions at 2 separate appointments using a repeated-measures design. Mandibular anterior and posterior teeth were blindly pulp tested at 4-minute cycles for 60 minutes postinjection. No response from the subject to the maximum output (80 reading) of the pulp tester was used as the criterion for pulpal anesthesia. Anesthesia was considered successful when 2 consecutive readings of 80 were obtained. A postoperative survey was used to measure pain and trismus. The results demonstrated 100% of the subjects had profound lip numbness with both solutions for inferior alveolar nerve blocks. The anesthetic success rates for individual teeth ranged from 20 to 80%. There were no significant differences (P > .05) between the 2 solutions. However, the combination lidocaine/hyaluronidase solution resulted in a significant increase in postoperative pain and trismus. It was concluded that adding hyaluronidase to a buffered lidocaine solution with epinephrine did not statistically increase the incidence of pulpal anesthesia in inferior alveolar nerve blocks and, because of its potential tissue damaging effect, it should not be added to local anesthetic solutions for inferior alveolar nerve blocks.
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PMID:Anesthetic efficacy of a combination of hyaluronidase and lidocaine with epinephrine in inferior alveolar nerve blocks. 1149 5

We have compared the efficacy of adding varying concentrations of hyaluronidase to a standard mixture of 2% lidocaine and 1% ropivacaine to provide peribulbar anaesthesia for cataract surgery. We used (i) the time to adequate anaesthesia for surgery and (ii) ocular and eyelid movement scores at 8 min after block as clinical endpoints. Ninety patients were randomly allocated to receive 7-10 ml of equal volumes of 2% lidocaine and 1% ropivacaine without hyaluronidase or with hyaluronidase 15 IU ml(-1) or 150 IU ml(-1). Median time at which the block was adequate for surgery was 6 min in all groups (interquartile range 4-12 min). Median eyelid movement scores were similar in all groups, but the ocular movement scores at 8 min were significantly lower in the group which received hyaluronidase 150 IU ml(-1) than in the group not given hyaluronidase (P<0.03). There were no differences between groups in the incidence of minor complications. A high concentration of hyaluronidase resulted in a statistically significantly lower ocular movement score at 8 min; the clinical relevance of this finding is uncertain.
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PMID:Efficacy of varying concentrations of hyaluronidase in peribulbar anaesthesia. 1157

In a university ophthalmology department, a cluster of postoperative diplopia and ptosis cases occurred in the initial 3 months after hyaluronidase (Wydase) became unavailable for use with injection anesthesia. These cases suggest that hyaluronidase, when used with injection anesthesia, may protect extraocular muscles and nerves from the toxic effects of local anesthetic agents. The spreading action of hyaluronidase facilitates uniform diffusion of anesthetic agents. This prevents elevated extracellular tissue pressure, a cause of ischemic damage to extraocular muscles or nerves. Hyaluronidase may also prevent focal accumulations and concentrations of local anesthetic agents, which at high enough levels may cause myotoxic or neurotoxic damage, fibrosis, and contracture of extraocular muscles or nerves.
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PMID:Diplopia and ptosis following injection of local anesthesia without hyaluronidase. 1170 64

A prospective, randomized blind study was conducted in 40 patients undergoing phacoemulsification and posterior chamber intraocular lens implantation. They received anaesthetic infiltration of 2% lidocaine with 1:200,000 epinephrine and hyaluronidase 150 U ml(-1) in a volume of 2, 3, 4 or 5 ml into the sub-Tenon's fascial space through a Greenbaum cannula after a conjunctival incision. Reduction of ocular movements, anaesthesia, pain on injection and any incidental complications were recorded. Akinesia and anaesthesia occurred within 5 min with 4 and 5 ml of local anaesthetic, and no supplementary injections were required. There were marked reductions in the frequency of forced eyelid movements with these volumes. Chemosis and conjunctival haemorrhage were noted in the majority of patients but caused no intraoperative problems. Approximately 10-15% of patients reported slight discomfort at the time of injection. Four to 5 ml of 2% lidocaine with 1:200,000 epinephrine and 150 U ml(-1) of hyaluronidase is the optimum volume to achieve adequate akinesia, anaesthesia and reduction of lid movements during the Greenbaum sub-Tenon's block.
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PMID:Evaluation of the Greenbaum sub-Tenon's block. 1199 Feb 92

Clonidine added to local anaesthetics prolongs the duration of anaesthesia and analgesia of peripheral, neuraxial and retrobulbar blocks. The present randomized blinded controlled study was conducted to evaluate the effect of the addition of clonidine to local anaesthetic mixture on the quality, onset time, duration of peribulbar block, perioperative analgesia and patients' comfort. The study comprised two groups of 12 patients each. Group A (control) patients received 7 ml of a mixture of 2% lignocaine and hyaluronidase with 1 ml normal saline, while group B (clonidine group) patients had clonidine 1 microg/kg added to the above mixture. Onset and duration of lid akinesia, globe anaesthesia and akinesia, time to first analgesic medication and total analgesic requirement were assessed. Patients were monitored for heart rate, blood pressure, sedation and respiratory depression. Addition of clonidine to local anaesthetic mixture resulted in a significant increase in duration of lid akinesia (85.4+/-25.6 vs 173.3+/-35.3 min, P<0.001), globe anaesthesia (63.2+/-6.9 vs 78.8+/-17.5 min, P=0.012) and globe akinesia (161.3+/-24.3 vs 201.2+/-45.7 min, P=0.016). The onset time and quality of block were similar in both the groups. No significant haemodynamic, respiratory or sedative effects were recorded. The perioperative pain scores and the analgesic requirements were significantly (P<0.01) lower in group B patients. We found that addition of clonidine 1 microg/kg to local anaesthetic mixture significantly increases the duration of anaesthesia and analgesia after peribulbar block.
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PMID:Effect of addition of clonidine to local anaesthetic mixture for peribulbar block. 1218 May 81

Paracervical block anesthesia was used for 54 patients aged 23-63 years undergoing dilatation and curettage for incomplete abortions and various gynecological disorders. carbocaine (mepivacaine) and hyaluronidase were used. Results were considered excellent or good in all but 4 patients. The authors felt that the method was safe and effective and could routinely be used in minor procedures in place of ge neral anesthesia. The technique is described in detail.
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PMID:[Positive experience with paracervical block in minor gynecological surgery]. 1225 30

Whilst local anaesthesia for daycase arthroscopic knee surgery has been well reported, there are few centres in the United Kingdom performing such a technique. Hyaluronidase has been widely used as an adjunct to local anaesthetic infiltration in the fields of ophthalmic and plastic surgery, but it is rarely used in orthopaedic surgery. We report our technique, which the senior author has successfully used in 121 patients having arthroscopic knee surgery over the past year, and discuss the role of added hyaluronidase to the local anaesthetic portal infiltrate.
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PMID:Daycase arthroscopic knee surgery performed under local anaesthesia with hyaluronidase: technical note. 1235 8

Many chondroitin sulfate proteoglycans (CSPGs) have been shown to influence CNS axon growth in vitro and in vivo. These interactions can be mediated through the core protein or through the chondroitin sulfate (CS) glycosaminoglycan (GAG) side chains. We have shown previously that degrading CS GAG side chains using chondroitinase ABC enhances dopaminergic nigrostriatal axon regeneration in vivo. We test the hypothesis that interfering with complete CSPGs also limit axon growth in vivo. Neurocan, versican, aggrecan, and brevican CSPGs may be anchored within extracellular matrix through binding to hyaluronan glycosaminoglycan. We examine whether degradation of hyaluronan using hyaluronidase might release these inhibitory CSPGs from the extracellular matrix and thereby enhance regeneration of cut nigrostriatal axons. Anesthetized adult rats were given knife cut lesions of the right hemisphere nigrostriatal tract and cannulae were secured transcranially thereby allowing repeated perilesional infusion of saline or saline containing hyaluronidase once daily for 10 days post-axotomy. Eleven days post-transection brains from animals under terminal anesthesia were recovered for histological evaluation. Effective delivery of substance was inferred from the observed reduction in perilesional immunoreactivity for neurocan and versican after treatment with hyaluronidase (relative to saline). Immunolabeling using antibodies against tyrosine hydroxylase was used to examine the response of cut dopaminergic nigral neurons. After transection and treatment with saline, dopaminergic nigral neurons sprouted in a region lacking astrocytes, neurocan and versican. Axons did not regenerate into the lesion surround that contained astrocytes and abundant neurocan and versican. After transection and treatment with hyaluronidase, there was a significant increase in the number of cut dopaminergic nigral axons growing up to 800 microm anterior to the site of transection. However, cut dopaminergic nigral axons still did not regenerate into the lesion surround that contained reduced (albeit residual) neurocan and versican immunoreactivity. Thus, partial degradation of hyaluronan and chondroitin sulfate and depletion of hyaluronan-binding CSPGs enhances local sprouting of cut CNS axons, but long-distance regeneration fails in regions containing residual hyaluronan-binding CSPGs. Hyaluronan, chondroitin sulfate and hyaluronan-binding CSPGs therefore likely contribute toward the failure of spontaneous axon regeneration in the injured adult mammalian brain and spinal cord.
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PMID:Limited growth of severed CNS axons after treatment of adult rat brain with hyaluronidase. 1247 11

Regional anesthesia for ophthalmic procedures has changed significantly in the past ten years. Phacoemulsification for cataract surgery through corneal microincisions, soft foldable lenses and topical anesthesia simplify surgery such that most operations can be performed on an outpatient basis. Some anesthetic blocks are performed by either anesthesiologists or ophthalmologists, who should understand the advantages and disadvantages for each patient. This review discusses anatomical aspects of interest to the anesthesiologist, the main techniques used and anesthetic innovations, complications and certain controversies such as management of the patient who is taking medications that alter hemostasis, the withdrawal of hyaluronidase in some countries and the systematic ordering of tests before the procedure.
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PMID:[Locoregional anesthesia in ophthalmology: update]. 1294 Feb 18

Immediate steps in the treatment of ureteral stone, beginning with the often acute onset, are relief of pain, urinalysis (including Gram stain), forcing fluids, examination of urine for the stone and urography at the earliest feasible time. If the stone causes continual pain or appears unlikely to be passed safely, it should be removed-with a cystoscope if possible; if not, by operation which may be done while the patient is still under anesthesia. To combat further stone formation a large fluid intake should be maintained, the extracted stone analyzed, an acid ash diet prescribed, serum calcium and phosphorus measured, urinary stasis corrected and urinary infection and distant foci of infection cured. Vitamin A, aluminum gels and particularly hyaluronidase appear promising as preventives to stone formation.
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PMID:Management of patients with ureteral stone. 1301 10


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