Therefore, non-selective and selective inhibitors of PDE could potentially be used in MAS therapy. However, the use of PDE inhibitors can cause cardiovascular side effects. Non-selective PDE inhibitors, such as methylxanthines, increase concentrations of cAMP and cGMP in the cells leading to bronchodilation and vasodilation. Additionally, methylxanthines decreases the concentrations of calcium, acetylcholine and monoamines, this controls the release of various mediators of inflammation and bronchoconstriction, including prostaglandins. Selective PDE inhibitors target one subtype of phosphodiesterase and in MAS the activities of PDE-3, PDE-4, PDE-5 and PDE-7 may become enhanced. For example, Milrinone (a selective PDE3 inhibitor) improved oxygenation and survival of neonates with MAS. Inhibitors of cyclooxygenase
Arachidonic acid is metabolised, via cyclooxygenase (COX) and lipoxygenase, to various substances including prostaglandins and leukotrienes, which exhibit potent pro-inflammatory and vasoactive effects. By inhibiting COX, and more specifically COX-2, (either through selective or non-selective drugs) inflammation and oedema can be reduced. However, COX inhibitors may induce peptic ulcers and cause hyperkalemia and hypernatremia. Additionally, COX inhibitors have not shown any great response in the treatment of MAS. Antibiotics
Meconium is typically sterile however, it can contain various cultures of bacteria so appropriate antibiotics may need to be prescribed. Surfactant treatment
Lung lavage with diluted surfactant is a new treatment with potentially beneficial results depending on how early it is administered in newborns with MAS. This treatment shows promise as it has a significant effect on air leaks, pneumothorax, the need for ECMO and death. Early intervention and using it on newborns with mild MAS is more effective.
The vascular atraumatic forceps (DeBakey)were widely used for grasping vascular tissue and causing minimal damage to the vessels. This invention led to the development of the Dacron aortic graft for the repair of aortic aneurysms. Around the mid 1900s, Alfred Washington Adson, a pioneer in neuroscience at Mayo Clinic, invented Adson forceps that allows the lifting and removal of neural tissue. Hemostat/clamp
Hemostats are forceps that aim to obliterate the lumen of vessels and to obtain adherence to the crushed surfaces and vascular hemostasis. Originally, this notion of crushing did not exist and arterial catch forceps simply clamped vessels temporarily prior to ligature or cautery. In 1867, Eugene Koeberle, who accidentally found arterial forceps with a catch closure came away spontaneously without the need for ligature, and invented “pince hémostatique,” which have pin and hole catches. In 1882, the Kocher clamp was created by Emil Theodor Kocher, who significantly contributed to thyroidectomies (removal of all or a part of the thyroid gland) and decompressive craniotomy. This invention decreases the risk of contamination while cutting dense tissue. Later, Dr. William Henry Welch and William Stewart Halsted contributed to the invention of clamps and Halsted-Mosquito Hemostats, which were used to clamp small blood vessels.