Psychoactive Plant Database - Neuroactive Phytochemical Collection

1. Cureus. 2024 Oct 2;16(10):e70681. doi: 10.7759/cureus.70681. eCollection 2024 
Oct.

The Problem to a Solution: A Case of Local Anesthetic-Related Acute 
Pancreatitis.

Robles J(1), Rogando D(2), Ranjbar T(2), Mukherjee I(3), Clarke E(2), Mukharjee 
S(3).

Author information:
(1)Surgery, Northwell Health Staten Island University Hospital/City University 
of New York School of Medicine, New York, USA.
(2)General Surgery, Northwell Health Staten Island University Hospital/City 
University of New York School of Medicine, New York, USA.
(3)General Surgery, Northwell Health Staten Island University Hospital, New 
York, USA.

Although rare, local anesthetic use has been associated with adverse central 
nervous system and cardiovascular adverse events. One complication is local 
anesthetic systemic toxicity (LAST), wherein the anesthetic agent inadvertently 
enters systemic circulation resulting in widespread inhibition of fast-gated 
sodium channels. Organs dependent on aerobic metabolism, such as the heart and 
brain, are especially susceptible to toxic injury resulting in cardiovascular 
collapse. Lipid emulsion therapy is a mainstay treatment of LAST; however, it 
may inadvertently cause lipid-induced necrotizing pancreatitis. We present a 
71-year-old female with a non-contributory past medical history who presented 
for elective open reduction and internal fixation (ORIF) of the right wrist 
after a fall onto the right hand one week prior. A supraclavicular brachial 
plexus block was planned to deliver regional analgesia for ORIF of the right 
wrist. Shortly after the introduction of the local anesthetic agent, our patient 
became bradycardic and hypotensive. The patient's heart rate and systolic blood 
pressure remained in the low 45s and 50s, respectively, refractory to multiple 
doses of phenylephrine and ephedrine. Suspicion for LAST syndrome was high and 
lipid emulsion therapy was started. Once stabilized, the patient was transported 
to the ICU requiring manual ventilation, where she later reported flank pain. 
Labs drawn were notable for elevated triglyceride, lipase, and amylase levels of 
over 3000, 600, and 700, respectively. CT imaging confirmed acute necrotizing 
pancreatitis. The patient's ICU stay was uncomplicated with stabilization of 
vitals and discharge 10 days later. A follow-up with gastroenterology (GI) was 
scheduled after two weeks. Since discharge, the patient noted intermittent 
abdominal aches. Magnetic resonance cholangiopancreatography (MRCP) and MRI were 
performed after liver function tests (LFTs) were found to be elevated during her 
follow-up appointment. MRI showed liquefaction necrosis of 80% of the pancreas, 
with a 14-centimeter fluid collection pushing on the distal common bile duct, 
causing extrinsic obstruction. MRCP revealed no stones. Advanced GI performed a 
transgastric cystogastrostomy with lumen apposing metal stent placement in the 
common bile duct, and drained the fluid from the obstructing cyst. Cytopathology 
came back as virtually acellular. Liver enzymes began to downtrend appropriately 
and the patient was discharged soon after. Follow-up at two and four days 
post-discharge confirmed resolution of symptoms.

Copyright © 2024, Robles et al.

DOI: 10.7759/cureus.70681
PMCID: PMC11528620
PMID: 39493173

Conflict of interest statement: Human subjects: Consent was obtained or waived 
by all participants in this study. Conflicts of interest: In compliance with the 
ICMJE uniform disclosure form, all authors declare the following: 
Payment/services info: All authors have declared that no financial support was 
received from any organization for the submitted work. Financial relationships: 
All authors have declared that they have no financial relationships at present 
or within the previous three years with any organizations that might have an 
interest in the submitted work. Other relationships: All authors have declared 
that there are no other relationships or activities that could appear to have 
influenced the submitted work.


2. J Perianesth Nurs. 2024 Nov 1:S1089-9472(24)00391-5. doi: 
10.1016/j.jopan.2024.07.023. Online ahead of print.

Preventing Spinal-induced Hypotension During Elective Cesarean Sections.

Rowe N(1), Calhoun K(2), Oliver K(2), Wofford K(2), Canale M(2).

Author information:
(1)College of Nursing, University of South Florida, Tampa, FL. Electronic 
address: hoyt16@usf.edu.
(2)College of Nursing, University of South Florida, Tampa, FL.

PURPOSE: The purpose of this quality improvement project was to implement an 
evidence-based intraoperative protocol to reduce the incidence of spinal-induced 
hypotension during elective cesarean sections.
DESIGN: A quality improvement project.
METHODS: After receiving education, anesthesia providers implemented the 
intraoperative protocol for 6 weeks on elective cesarean sections. 
Intraoperative anesthesia records were retrospectively reviewed and evaluated 
preimplementation and postimplementation to determine the impact of the project 
on the incidence of spinal-induced hypotension.
FINDINGS: The final sample included 134 patient charts (64 preimplementation and 
72 postimplementation). The incidence of hypotension 10 minutes after spinal 
placement was not significantly different before (n = 9) or after implementation 
(n = 13; χ2 = 0.4, P = .554). After project implementation, the rate of 
hypotension was 22% (n = 13) in patients not treated per the protocol and 0% 
(n = 0, χ2 = 3.5, P = .062) in patients treated per the protocol. There was a 
39.4% (P < .001) reduction in the need for rescue doses of phenylephrine and a 
27.8% (P = .001) reduction in the need for rescue doses of ephedrine after 
protocol implementation.
CONCLUSIONS: Hypotension was not significantly decreased for all patients after 
project implementation but was eliminated for patients in whom the protocol was 
used. Provider utilization of the intraoperative protocol was only 18%. It is 
recommended to pursue additional interventions to increase protocol utilization, 
accessibility of protocol components, and staff training. Future studies can 
investigate the impact of this protocol on maternal nausea and vomiting 
incidence during elective cesarean sections.

Copyright © 2024 The American Society of PeriAnesthesia Nurses. Published by 
Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jopan.2024.07.023
PMID: 39488780

Conflict of interest statement: Declaration of Competing Interest None to 
report.


3. Sci Rep. 2024 Nov 2;14(1):26443. doi: 10.1038/s41598-024-77785-w.

Late pleistocene exploitation of Ephedra in a funerary context in Morocco.

Morales J(1), Carrión Marco Y(2)(3), Cooper JH(4), Turner E(5), Freyne A(6), 
Hogue J(7)(8), Ziani I(2), Barton RNE(7), Bouzouggar A(9)(10), Humphrey LT(2).

Author information:
(1)Research Group Tarha, Department of Historical Sciences, University of Las 
Palmas de Gran Canaria, Pérez del Toro 1, Las Palmas, 35003, Spain. 
jacob.morales@ulpgc.es.
(2)Research Group Tarha, Department of Historical Sciences, University of Las 
Palmas de Gran Canaria, Pérez del Toro 1, Las Palmas, 35003, Spain.
(3)Departamento de Prehistoria, Arqueología e Historia Antigua, PREMEDOC, 
Universidad de Valencia, Valencia, Spain.
(4)Bird Group, The Natural History Museum, Akeman Street, Tring, HP23 6AP, 
Hertfordshire, UK.
(5)Monrepos Archaeological Research Centre and Museum for Human Behavioural 
Evolution, Leibniz- Zentrum für Archäologie, Schloss Monrepos, D-56567, Neuwied, 
Germany.
(6)Centre for Human Evolution Research, Natural History Museum, Cromwell Road, 
London, SW7 5BD, UK.
(7)Institute of Archaeology, Oxford University, Oxford, OX1 2PG, UK.
(8)Allen Archaeology Ltd, Whisby Lodge, Lincoln, LN6 3QL, UK.
(9)Institut National des Sciences de l'Archéologie et du Patrimoine, group 
leader Origin and Evolution of Homo sapiens cultures in Morocco, Av. Allal El 
Fassi angle rues 5 et 7,Madinat Al Irfane, Hay Riad, Rabat, Morocco.
(10)Department of Archaeogenetics, Max Planck Institute for Evolutionary 
Anthropology, Leipzig, Germany.

The active compounds found in many plants have been widely used in traditional 
medicine and ritual activities. However, archaeological evidence for the use of 
such plants, especially in the Palaeolithic period, is limited due to the poor 
preservation and fragility of seed, fruit, and other botanical macro-remains. In 
this study, we investigate the presence and possible uses of Ephedra during the 
Late Pleistocene based on the analysis of exceptionally preserved plant 
macrofossils recovered from c. 15 ka year-old archaeological deposits at Grotte 
des Pigeons in northeastern Morocco. This cave has yielded the earliest 
carbonized plant macrofossils of Ephedra, which were found concentrated in a 
human burial deposit along with other special finds. Ephedra is a plant known to 
produce high amounts of alkaloids, primarily ephedrine and pseudoephedrine, 
which have been utilized in traditional medicine. Direct radiocarbon dates on 
both Ephedra and the human remains indicate that they were contemporaneous. To 
understand the uses of Ephedra by people at the site, we discuss the different 
pathways through which plant remains could have arrived. We suggest that the 
charred cone bracts of Ephedra likely represent residues of the processing and 
consumption of the plant's fleshy cones, which may have been valued for both 
their nutritional and therapeutic properties. Furthermore, we interpret the 
presence of Ephedra and its deposition in the burial area as evidence that this 
plant played a significant role during the funerary activities.

© 2024. The Author(s).

DOI: 10.1038/s41598-024-77785-w
PMCID: PMC11531600
PMID: 39488593 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


4. BMC Anesthesiol. 2024 Oct 30;24(1):394. doi: 10.1186/s12871-024-02779-0.

Efficacy and safety of esketamine combined with propofol for conscious sedation 
in painless colonoscopy: a prospective, randomized, double-blind controlled 
clinical trial.

Xiao L(1), Zhang Z(1), Lu J(1), Liu Z(1), Zhang J(1), Kang L(1), Tang J(2), Zou 
X(3).

Author information:
(1)Department of Anesthesiology, First Affiliated Hospital of Hunan University 
of Medicine, Huaihua City, Hunan Province, China.
(2)Department of Anesthesiology, First Affiliated Hospital of Hunan University 
of Medicine, Huaihua City, Hunan Province, China. tangjiefu@126.com.
(3)Department of Anesthesiology, Affiliated Hospital of Guizhou Medical 
University, Guiyang City, Guizhou Province, China. zouxiaohuazxh@163.com.

BACKGROUND: We explored the efficacy and safety of esketamine combined with 
propofol for conscious sedation in painless colonoscopy.
METHODS: A total of 195 patients who underwent painless colonoscopy surgery were 
randomly divided into three groups: the propofol deep sedation group (group DS), 
the sufentanil combined with propofol for conscious sedation (group CS1) and the 
esketamine combined with propofol for conscious sedation (group CS2). The 
primary outcomes of this study included the incidence of hypoxemia, hypotension, 
hypertension, and bradycardia and excellent and good rates of anaesthesia during 
colonoscopy. The secondary outcomes included perioperative changes in vital 
signs (MAP, HR, and SpO2), anaesthesia induction time, dischargeable time, 
patient and endoscopist satisfaction scores, and incidence of postoperative 
nausea and vomiting (PONV), drowsiness, dizziness, propofol injection pain, 
assisted ventilation and vasoactive medications.
RESULTS: The incidence of intraoperative hypoxemia in the DS group was 
significantly greater than that in the CS1 and CS2 groups (χ2 = 7.081, 
P = 0.029). The incidence of hypotension in the CS2 group was significantly 
lower than that in the DS and CS1 groups (χ2 = 16.278, P < 0.001). The risk of 
hypoxemia was 5.727 times higher in Group DS than in Group CS2 (OR 5.727; 95%CI 
1.203-27.273), and the risk of hypotension was 9.864 times higher in Group DS 
than in Group CS2 (OR 9.864; 95%CI 2.770-35.120). The risk of hypotension in 
Group CS1 was 5.167 times that in Group CS2 (OR 5.167; 95%CI 1.396-19.117). The 
incidence of propofol injection pain, assisted ventilation, ephedrine usage and 
drowsiness in the DS group was significantly greater than that in the CS1 and 
CS2 groups (χ2 = 57.618, P < 0.001; χ2 = 9.544, P = 0.008; χ2 = 14.820, 
P = 0.001; χ2 = 37.257, P < 0.001). The incidence of dizziness during recovery 
in the CS1 group was significantly greater than that in the DS and CS2 groups 
(χ2 = 6.594, P = 0.037). The dischargeable time in the DS group was 
significantly greater than that in the CS1 and CS2 groups (F = 53.039, 
P < 0.001). The satisfaction scores of the endoscopist and patients in the DS 
group were significantly lower than those in the CS1 and CS2 groups (F = 17.390, 
P < 0.001; F = 19.282; P < 0.001).
CONCLUSIONS: In conclusion, esketamine combined with propofol for conscious 
sedation can be safely and effectively used for painless colonoscopy and has 
fewer complications.It is recommended for painless colonoscopy.

© 2024. The Author(s).

DOI: 10.1186/s12871-024-02779-0
PMCID: PMC11523800
PMID: 39478485 [Indexed for MEDLINE]

Conflict of interest statement: The authors declare no competing interests.


5. J Nat Med. 2024 Oct 29. doi: 10.1007/s11418-024-01853-8. Online ahead of
print.

Preventive and therapeutic effects of ephedrine alkaloids-free Ephedra Herb 
extract on paclitaxel-induced neuropathic pain.

Huang X(1), Hyuga S(2), Ito M(3), Goda Y(3), Kobayashi Y(1).

Author information:
(1)Oriental Medicine Research Center, School of Pharmacy, Kitasato University, 
Tokyo, Japan.
(2)Oriental Medicine Research Center, School of Pharmacy, Kitasato University, 
Tokyo, Japan. hyuga-s@insti.kitasato-u.ac.jp.
(3)National Institute of Health Sciences, Kawasaki, Japan.

Currently, there are no effective prophylactic or therapeutic drugs for the 
treatment of paclitaxel (PTX)-induced peripheral neuropathic pain (PTX-PNP), 
highlighting the urgent need for the development of effective prophylactic and 
therapeutic drugs. In this study, we initially compared the efficacy of Ephedra 
Herb extract (EHE) with that of ephedrine alkaloids-free Ephedra Herb extract 
(EFE), which lacked ephedrine alkaloids (EAs)-associated side effects, against 
the onset of PTX-induced mechanical allodynia, thermal hyperalgesia, and cold 
allodynia in mice. EHE and EFE demonstrated comparable preventive effects on the 
PTX-PNP in a dose-dependent manner. These results indicated that the preventive 
properties of EHE were independent of the EAs. Since elderly people are 
overwhelmingly more susceptible to developing cancer, we considered that EFE has 
greater benefits than EHE, so we conducted a study focused on the effects of 
EFE. EFE showed dose-dependent preventive effects on the onset of PTX-PNP. As a 
result of detailed investigation, coadministration of PTX and EFE (Co-EFE) was 
more effective than preadministration of EFE alone (Pre-EFE). And the effects of 
Co-EFE was same with the effect of preadministration of EFE and then 
coadministration of PTX and EFE (P&C-EFE). Additionally, Co-EFE after the onset 
of PTX-PNP improved PTX-induced mechanical allodynia, thermal hyperalgesia, and 
cold allodynia, confirming the therapeutic efficacy of EFE on PTX-PNP. In 
contrast, goshajinkigan, a Kampo medicine, and diclofenac, a non-steroidal 
anti-inflammatory drug, showed minimal therapeutic effects on PTX-PNP. These 
findings demonstrate the significant potential of EFE as a novel, safe 
prophylactic and therapeutic agent against PTX-PNP.

© 2024. The Author(s) under exclusive licence to The Japanese Society of 
Pharmacognosy.

DOI: 10.1007/s11418-024-01853-8
PMID: 39470960