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https://www.readbyqxmd.com/read/28417683/tracheostomy-for-severe-pediatric-obstructive-sleep-apnea-indications-and-outcomes
#1
Christopher J Rizzi, Julian D Amin, Amal Isaiah, Tulio A Valdez, Anita Jeyakumar, Suzanne E Smart, Kevin D Pereira
Objectives (1) To describe characteristics of pediatric patients undergoing tracheostomy for obstructive sleep apnea (OSA). (2) To highlight perioperative events and outcomes of the procedure. Study Design Case series with chart review. Setting Four tertiary care academic children's hospitals. Subjects and Methods Twenty-nine children aged <18 years from January 1, 2010, to December 31, 2015, who underwent tracheostomy for severe OSA, defined as an apnea-hypopnea index (AHI) >10, were included in the study...
April 1, 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/28410262/life-saving-esophageal-intubation-in-neonate-with-undiagnosed-tracheal-agenesis-a-case-report
#2
Christopher Sattler, Franklin Chiao, David Stein, Denise Murphy
A 3-day-old, 2.2-kg former 34-week premature infant with imperforate anus required loop ileostomy surgery. At delivery, the child had respiratory distress. Endotracheal intubation was "confirmed" by detection of exhaled carbon dioxide with a Pedi-Cap (Covidien, Dublin, Ireland) and subsequent chest x-ray. On arrival to the operating room, the pulse oximeter reading was 100% despite a large leak around the endotracheal tube and high-airway pressures. Packing the throat reduced the leak and increased the tidal volume...
April 13, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28400472/novel-selective-%C3%AE-1-adrenoceptor-antagonists-for-concomitant-cardiovascular-and-respiratory-disease
#3
Jillian G Baker, Sheila M Gardiner, Jeanette Woolard, Christophe Fromont, Gopal P Jadhav, Shailesh N Mistry, Kevin S J Thompson, Barrie Kellam, Stephen J Hill, Peter M Fischer
β-Blockers reduce mortality and improve symptoms in people with heart disease; however, current clinically available β-blockers have poor selectivity for the cardiac β1-adrenoceptor (AR) over the lung β2-AR. Unwanted β2-blockade risks causing life-threatening bronchospasm and reduced efficacy of β2-agonist emergency rescue therapy. Thus, current life-prolonging β-blockers are contraindicated in patients with both heart disease and asthma. Here, we describe NDD-713 and -825, novel highly β1-selective neutral antagonists with good pharmaceutical properties that can potentially overcome this limitation...
April 11, 2017: FASEB Journal: Official Publication of the Federation of American Societies for Experimental Biology
https://www.readbyqxmd.com/read/28397992/mucoactive-agents-for-chronic-non-cystic-fibrosis-lung-disease-a-systematic-review-and-meta-analysis
#4
REVIEW
Benjamin J Tarrant, Caitlin Le Maitre, Lorena Romero, Ranjana Steward, Brenda M Button, Bruce R Thompson, Anne E Holland
Inhaled mucoactive agents are used in respiratory disease to improve mucus properties and enhance secretion clearance. The effect of mannitol, recombinant human deoxyribonuclease/dornase alfa (rhDNase) and hypertonic saline (HS) or normal saline (NS) are not well described in chronic lung conditions other than cystic fibrosis (CF). The aim of this review was to determine the benefit and safety of inhaled mucoactive agents outside of CF. We searched Medline, Embase, CINAHL and CENTRAL for randomized controlled trials investigating the effects of mucoactive agents on lung function, adverse events (AEs), health-related quality of life (HRQOL), hospitalization, length of stay, exacerbations, sputum clearance and inflammation...
April 11, 2017: Respirology: Official Journal of the Asian Pacific Society of Respirology
https://www.readbyqxmd.com/read/28391760/use-of-temperature-controlled-laminar-airflow-in-the-management-of-atopic-asthma-clinical-evidence-and-experience
#5
John O Warner
Avoidance of allergens in the treatment of asthma has hitherto not achieved significant benefit despite the strong evidence that allergy both increases severity and contributes to exacerbations of asthma. House dust mite, cat and dog allergens are the most common perennial allergic triggers and most avoidance strategies have focused on reducing exposures in bedrooms. Cochrane reviews have suggested that they neither significantly reduce allergen levels nor improve asthma. While the lack of efficacy may be assumed to be a consequence of exposures occurring outside the bedroom, prolonged sleep is associated with increased susceptibility to bronchospasm and airway inflammation...
April 2017: Therapeutic Advances in Respiratory Disease
https://www.readbyqxmd.com/read/28384964/post-extubation-bronchospasm-in-an-undiagnosed-case-of-ascariasis-anaesthetic-challenges
#6
Ravindra Gehlot, Shekhar Suman Saxena, Indira Kumari, Virendra Verma, Aditya Bidwaikar
One of the most prevalent parasitic infestation is ascariasis which poses a great challenge to both the person being infested with and the treating medical team. We present here a case of round worm (Ascaris lumbricoides) infestation. A 40-year-old male, weighing 60 kg, diagnosed as perforation peritonitis, was scheduled for emergency exploratory laparotomy. The round worm was crawling out from duodenal perforation vent during laparotomy confirming the infestation. Patient later developed bronchospasm in post-extubation period and was managed accordingly...
February 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28377880/paradoxical-bronchospasm-from-benzalkonium-chloride-bac-preservative-in-albuterol-nebulizer-solution-in-a-patient-with-acute-severe-asthma-a-case-report-and-literature-review-of-airway-effects-of-bac
#7
Mathew George, Saumya Vinod Joshi, Emily Concepcion, Haesoon Lee
Nebulized bronchodilator solutions are available in the United States as both nonsterile and sterile-filled products. Sulfites, benzalkonium chloride (BAC), or chlorobutanol are added to nonsterile products to prevent bacterial growth. Bronchoconstriction from inhaled BAC is cumulative, prolonged, and correlates directly with basal airway responsiveness. The multi-dose dropper bottle of albuterol sulfate solution contains 50 μg BAC per/2.5 mg of albuterol, which may be below or at the lower limit of the threshold dose for bronchoconstriction...
2017: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/28367431/a-3-year-old-girl-with-recurrent-infections-and-autoimmunity-due-to-a-stat1-gain-of-function-mutation-the-expanding-clinical-presentation-of-primary-immunodeficiencies
#8
Juan Carlos Aldave Becerra, Enrique Cachay Rojas
We report a 3-year-old Peruvian girl, born to non-consanguineous parents. At the age of 8 months, she had a severe pneumonia complicated with empyema that required thoracic drainage and mechanical ventilation. Although no microorganisms were isolated, the patient recovered with broad-spectrum antibiotics. Since that date, she has presented multiple episodes of pneumonia and recurrent episodes of bronchospasm. At 1 year 5 months of age, the patient began with recurrent episodes of oropharyngeal, vaginal, and skin candidiasis, which improved transiently after using oral azole drugs...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28367177/bronchoscopy-for-foreign-body-aspiration-and-effects-of-nebulized-albuterol-and-budesonide-combination
#9
Bulent Akcora, Mehmet Emin Celikkaya, Cahit Ozer
OBJECTIVE: A foreign body aspiration in the tracheobronchial tree is a dangerous medical condition in the childhood period. Although rigid bronchoscopy is a safe procedure, it may cause complications. The aim of this study was to present our bronchoscopy experience and to evaluate the efficacy of pre-operative administration of nebulized albuterol and budesonide combination for reducing intra-operative complications in foreign body aspirated cases. METHODS: In this retrospective study our pediatric cases in which a foreign body was removed from tracheobronchial tree in last 8 years were analyzed...
January 2017: Pakistan Journal of Medical Sciences Quarterly
https://www.readbyqxmd.com/read/28356076/dexmedetomidine-s-inhibitory-effects-on-acetylcholine-release-from-cholinergic-nerves-in-guinea-pig-trachea-a-mechanism-that-accounts-for-its-clinical-benefit-during-airway-irritation
#10
Maya Mikami, Yi Zhang, Benjamin Kim, Tilla S Worgall, Harald Groeben, Charles W Emala
BACKGROUND: Airway instrumentation can evoke upper airway reflexes including bronchoconstriction and cough which can cause serious complications including airway trauma, laryngospasm or bronchospasm which may in turn lead to difficulty with ventilation and hypoxemia. These airway events are mediated in part by irritant-induced neuronal modulation of airway tone and cough responses. We investigated whether the commonly used anesthetic agents dexmedetomidine, lidocaine or remifentanil attenuated neuronal and airway smooth muscle responses in the upper airways of guinea pigs...
March 29, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28349590/benzalkonium-chloride-a-bronchoconstricting-preservative-in-continuous-albuterol-nebulizer-solutions
#11
Sreekala Prabhakaran, Mutasim Abu-Hasan, Leslie Hendeles
BACKGROUND: For convenience, many pediatric hospitals are preparing solutions for continuous nebulized albuterol (CNA) using the 0.5% 20 mL multi-dose albuterol dropper bottle. This product contains benzalkonium chloride (BAC) which, by itself, produces bronchospasm that is dose-dependent and cumulative. The bronchoconstrictive effects of BA are greater in patients with more severe airway obstruction and increased airway responsiveness. CONCERNS: Use of BAC-containing albuterol during severe acute asthma exacerbations may antagonize the bronchodilator response to albuterol, prolong treatment, and increase the risk of albuterol-related systemic adverse effects...
March 28, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28345177/pharmacogenomics-of-off-target-adrs
#12
REVIEW
Sarah L Garon, Rebecca K Pavlos, Katie D White, Nancy J Brown, Cosby A Stone, Elizabeth J Phillips
Off-target adverse drug reactions (ADRs) are associated with significant morbidity and costs to the healthcare system and their occurrence is not predictable based on the known pharmacological action of the drug's therapeutic effect. Off-target ADRs may or may not be associated with immunological memory although they can manifest with a variety of shared clinical features including maculopapular exanthema, severe cutaneous adverse reactions (SCARs), angioedema, pruritus, and bronchospasm. Discovery of specific genes associated with a particular ADR phenotype is a foundational component of clinical translation into screening programs for their prevention...
March 26, 2017: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28333705/inhaled-remimazolam-potentiates-inhaled-remifentanil-in-rodents
#13
Tatjana Bevans, Cassandra Deering-Rice, Chris Stockmann, Joseph Rower, Derek Sakata, Christopher Reilly
BACKGROUND: Remimazolam is an ester-based short-acting benzodiazepine currently in clinical trials for IV administration. This study explored the feasibility of delivering remimazolam alone and as an adjunct to remifentanil via inhalation in rodent models. METHODS: Mice were exposed to remimazolam via inhalation; sedation was assessed using time to movement outside a set perimeter. Rats were also exposed to remimazolam aerosol alone and in combination with inhaled remifentanil, and analgesia was quantified by using a tail flick meter...
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28328587/bedside-breath-wise-visualization-of-bronchospasm-by-electrical-impedance-tomography-could-improve-perioperative-patient-safety-a-case-report
#14
Pedro de la Oliva, Andreas D Waldmann, Stephan H Böhm, Cristina Verdú-Sánchez, Antonio Pérez-Ferrer, Elena Alvarez-Rojas
Bronchospasm appears in up to 4% of patients with obstructive lung disease or respiratory infection undergoing general anesthesia. Clinical examination alone may miss bronchospasm. As a consequence, subsequent (mis)treatment and ventilator settings could lead to pulmonary hyperinflation, hypoxia, hypercapnia, hypotension, patient-ventilator asynchrony, volutrauma, or barotrauma. Electrical impedance tomography (EIT), a new noninvasive technique, can potentially identify bronchospasms by determining regional expiratory time constants (τ) for each one of the pixels of a functional EIT image...
March 15, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28306629/management-of-acute-asthma-exacerbations
#15
Erin K Stenson, Michael J Tchou, Derek S Wheeler
PURPOSE OF REVIEW: Herein, we review the current guidelines for the management of children with an acute asthma exacerbation. We focus on management in the emergency department, inpatient, and ICU settings. RECENT FINDINGS: The most recent statistics show that the prevalence of asthma during childhood has decreased in certain demographic subgroups and plateaued in other subgroups. However, acute asthma accounts for significant healthcare expenditures. Although there are few, if any, newer therapeutic agents available for management of acute asthma exacerbations, several reports leveraging quality improvement science have shown significant reductions in costs of care as well as improvements in outcome...
March 16, 2017: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/28301407/in-vivo-cysteinyl-leukotriene-release-in-allergic-and-nonallergic-immediate-hypersensitivity-reactions-during-anesthesia
#16
Dominique Laroche, Pierre Léturgie, Delphine Mariotte, Yann Ollivier, Jean-Luc Hanouz, Brigitte Le Mauff, Jean-Jacques Parienti
BACKGROUND: Immediate hypersensitivity reactions occurring during anesthesia are classified as allergic when skin tests and mast cell tryptase are positive and as nonallergic when negative results are obtained. Cysteinyl leukotrienes (cysLTs) are potent mediators synthesized by mast cell and eosinophil that induce bronchial constriction. They could play a role in hypersensitivity reactions. METHODS: cysLT C4, D4, and E4 concentrations were measured by a competition immunoassay in serial plasma samples obtained prospectively from 21 anesthetized controls and retrospectively from 34 patients who reacted at induction of anesthesia (24 with allergic and 10 with nonallergic reactions)...
May 2017: Anesthesiology
https://www.readbyqxmd.com/read/28278518/the-actin-regulator-zyxin-reinforces-airway-smooth-muscle-and-accumulates-in-airways-of-fatal-asthmatics
#17
Sonia R Rosner, Christopher D Pascoe, Elizabeth Blankman, Christopher C Jensen, Ramaswamy Krishnan, Alan L James, John G Elliot, Francis H Green, Jeffrey C Liu, Chun Y Seow, Jin-Ah Park, Mary C Beckerle, Peter D Paré, Jeffrey J Fredberg, Mark A Smith
Bronchospasm induced in non-asthmatic human subjects can be easily reversed by a deep inspiration (DI) whereas bronchospasm that occurs spontaneously in asthmatic subjects cannot. This physiological effect of a DI has been attributed to the manner in which a DI causes airway smooth muscle (ASM) cells to stretch, but underlying molecular mechanisms-and their failure in asthma-remain obscure. Using cells and tissues from wild type and zyxin-/- mice we report responses to a transient stretch of physiologic magnitude and duration...
2017: PloS One
https://www.readbyqxmd.com/read/28216960/pharmacological-evaluation-of-apium-leptophyllum-pers-on-bronchial-asthma
#18
Himanshu Bhusan Sahoo, Rakesh Sagar, Ganesh Patro, Madhulita Panda, Saroj Kumar Sahoo, D Priyadarshini
OBJECTIVE: The present study was to investigate the antiasthmatic potential from the flavonoid fraction of Apium leptophyllum fruit (FFALF) to validate its traditional claim. MATERIALS AND METHODS: The antiasthmatic activity of FFALF was evaluated by histamine or acetylcholine-induced bronchospasm model in guinea pigs, compound 48/80 induced mast cell degranulation in albino rats and histamine-induced tracheal contraction in guinea pig. The preconvulsion dyspnea time at 0(th) and 7(th) day at the dose of 100 and 200 mg/kg in guinea pig's bronchospasm model, the percentage of granulated and degranulated mast cell at the dose of 500, 750, and 1000 μg/ml in rats and tracheal contraction at the dose of 500, 750, and 1000 μg/ml in guinea pig were measured and compared with respective control groups...
October 2016: Journal of Pharmacy & Bioallied Sciences
https://www.readbyqxmd.com/read/28208695/the-role-of-inhaled-loxapine-in-the-treatment-of-acute-agitation-in-patients-with-psychiatric-disorders-a-clinical-review
#19
REVIEW
Domenico de Berardis, Michele Fornaro, Laura Orsolini, Felice Iasevoli, Carmine Tomasetti, Andrea de Bartolomeis, Nicola Serroni, Alessandro Valchera, Alessandro Carano, Federica Vellante, Stefano Marini, Monica Piersanti, Giampaolo Perna, Giovanni Martinotti, Massimo Di Giannantonio
Loxapine is a first generation antipsychotic, belonging to the dibenzoxazepine class. Recently, loxapine has been reformulated at a lower dose, producing an inhaled powder that can be directly administered to the lungs to treat the agitation associated with psychiatric disorders, such as schizophrenia and bipolar disorder. Thus, the aim of this narrative and clinical mini-review was to evaluate the efficacy and tolerability of inhaled loxapine in the treatment of acute agitation in patients with psychiatric disorders...
February 8, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/28207593/delayed-detection-of-esophageal-intubation-in-anesthesia-malpractice-claims-brief-report-of-a-case-series
#20
Marzieh R Honardar, Karen L Posner, Karen B Domino
This retrospective case series analyzed 45 malpractice claims for delayed detection of esophageal intubation from the Anesthesia Closed Claims Project. Inclusion criteria were cases from 1995 to 2013, after adoption of identification of CO2 in expired gas to verify correct endotracheal tube position as a monitoring standard by the American Society of Anesthesiologists. Forty-nine percent (95% confidence interval 34%-64%) occurred in the operating room or other anesthesia location where CO2 detection equipment should have been available...
February 15, 2017: Anesthesia and Analgesia
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