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https://www.readbyqxmd.com/read/28433581/therapeutic-burst-suppression-coma-in-pediatric-febrile-refractory-status-epilepticus
#1
Jainn-Jim Lin, Cheng-Che Chou, Shih-Yun Lan, Hsiang-Ju Hsiao, Yu Wang, Oi-Wa Chan, Shao-Hsuan Hsia, Huei-Shyong Wang, Kuang-Lin Lin
BACKGROUND: Evidence for the beneficial effect of therapeutic burst-suppression coma in pediatric patients with febrile refractory status epilepticus is limited, and the clinical outcomes of this treatment strategy are largely unknown. Therefore, the aim of this study was to explore the outcomes of therapeutic burst-suppression coma in a series of children with febrile refractory status epilepticus. METHODS: We retrospectively reviewed consecutive pediatric patients with febrile refractory status epilepticus admitted to our pediatric intensive care unit between January 2000 and December 2013...
April 19, 2017: Brain & Development
https://www.readbyqxmd.com/read/28433385/perioperative-risks-of-narcolepsy-in-patients-undergoing-general-anesthesia-a-case-control-study
#2
Alexandre N Cavalcante, Ryan E Hofer, Maja Tippmann-Peikert, Juraj Sprung, Toby N Weingarten
STUDY OBJECTIVE: To compare the perioperative outcomes between patients with narcolepsy and matched controls undergoing anesthetic management. DESIGN: Retrospective 2:1 matched study design. SETTING: Large tertiary medical center. PATIENTS: Narcoleptic patients who underwent general anesthesia from January 1, 2011, through September 30, 2015, were matched with controls by age, sex, and type and year of surgery. MEASUREMENTS: Medical records were reviewed for episodes of respiratory depression during phase I recovery and for other meaningful perioperative outcomes...
April 19, 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28433337/increased-resource-utilization-and-overall-morbidity-are-associated-with-general-versus-regional-anesthesia-for-carotid-endarterectomy-in-data-collected-by-the-michigan-surgical-quality-collaborative
#3
Ahmad S Hussain, Andrew Mullard, William F Oppat, Kevin D Nolan
OBJECTIVE: Advocates for performing carotid endarterectomy (CEA) under regional anesthesia (RA) cite reduction in hemodynamic instability and the ability for neurologic monitoring, but many still prefer general anesthesia (GA) as benefits of RA have not been clearly demonstrated, reliable RA may not be available in all centers, and a certain amount of movement by the patient during the procedure may not be uniformly tolerated. We evaluated the association of anesthesia type and perioperative morbidity and mortality as well as resource utilization in patients undergoing CEA using the Michigan Surgical Quality Collaborative (MSQC) database...
April 19, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28428527/-treatment-strategy-for-complicated-acute-type-b-aortic-dissection-in-the-thoracic-endovascular-aortic-repair-era
#4
Norihisa Karube, Keiji Uchida, Shinichi Suzuki, Munetaka Masuda
Our treatment strategy for acute type B aortic dissection (ABAD) included complicated type is as follows. Indications of thoracic endovascular aortic repair (TEVAR) for ABAD are rupture and organ ischemia, and TEVAR has been the 1st line central repair therapy since January 2009 in our institution. At the time of TEVAR for ruptured communicating type ABAD, we usually seal the proximal entry tear and cover the existing range of hematoma at descending aorta. Procedures for ABAD with malperfusion should be changed according to the patient's condition such as branch vessel obstructions either dynamic type or static type...
April 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28427379/novel-mutation-identified-in-severe-early-onset-tumor-necrosis-factor-receptor-associated-periodic-syndrome-a-case-report
#5
Suhas M Radhakrishna, Amy Grimm, Lori Broderick
BACKGROUND: Tumor Necrosis Factor Receptor-Associated Periodic Syndrome (TRAPS) is the second most common heritable autoinflammatory disease, typically presenting in pre-school aged children with fever episodes lasting 1-3 weeks. Systemic symptoms can include rash, myalgia, ocular inflammation, and serositis. CASE PRESENTATION: Here we report an unusual presentation of TRAPS in a 7 month old girl who presented with only persistent fever. She was initially diagnosed with incomplete Kawasaki Disease and received IVIG and infliximab; however, her fevers quickly recurred...
April 20, 2017: BMC Pediatrics
https://www.readbyqxmd.com/read/28427001/emergency-room-thoracotomy-for-acute-traumatic-cardiac-tamponade-caused-by-a-blunt-cardiac-injury-a-case-report
#6
Kenichiro Ishida, Yoshihiro Kinoshita, Nobutaka Iwasa, Masaro Nakae, Masayuki Sakaki, Yohei Ieki, Kyosuke Takahashi, Yumiko Shimahara, Taku Sogabe, Keiichiro Shimono, Mitsuhiro Noborio, Daikai Sadamitsu
INTRODUCTION: Traumatic blunt cardiac injuries have a high mortality rate, and prompt diagnosis and treatment can be lifesaving in cardiac tamponade. PRESENTATION OF CASE: A 62-year-old man was transferred to the emergency department after a motor vehicle accident. He was hemodynamically unstable. A focused assessment with sonography in trauma (FAST) showed pericardial fluid with right ventricular collapse consistent with cardiac tamponade in the subxiphoid view...
April 5, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28425335/the-incidence-of-and-risk-factors-for-postintubation-hypotension-in-the-immunocompromised-critically-ill-adult
#7
Nathan J Smischney, Mohamed O Seisa, John Cambest, Robert A Wiegand, Kyle D Busack, Theodore O Loftsgard, Darrell R Schroeder, Daniel A Diedrich
OBJECTIVES: Our primary aim was to ascertain the frequency of postintubation hypotension in immunocompromised critically ill adults with secondary aims of arriving at potential risk factors for the development of postintubation hypotension and its impact on patient-related outcomes. METHODS: Critically ill adult patients (≥18 years) were included from January 1, 2010, to December 31, 2014. We defined immunocompromised as patients with any solid organ or nonsolid organ malignancy or transplant, whether solid organ or not, requiring current chemotherapy...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28422910/incremental-balloon-deflation-following-complete-reboa-results-in-steep-inflection-of-flow-and-rapid-reperfusion-in-a-large-animal-model-of-hemorrhagic-shock
#8
Anders J Davidson, Rachel M Russo, Sarah-Ashley E Ferencz, Jeremy W Cannon, Todd E Rasmussen, Lucas P Neff, M Austin Johnson, Timothy K Williams
INTRODUCTION: To avoid potential cardiovascular collapse after Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), current guidelines recommend methodically deflating the balloon over 5 minutes to gradually reperfuse distal tissue beds. However, anecdotal evidence suggests that this approach may still result in unpredictable aortic flow rates and hemodynamic instability. We sought to characterize aortic flow dynamics following REBOA as the balloon is deflated in accordance with current practice guidelines...
April 18, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28410631/comparison-of-three-caval-reconstruction-techniques-in-orthotopic-liver-transplantation-a-retrospective-review
#9
Tiffany Chan, Kristin DeGirolamo, Stephanie Chartier-Plante, Andrzej K Buczkowski
BACKGROUND: Classic caval reconstruction during liver transplantation involves complete cross-clamping and resection of the recipient inferior vena cava (IVC) followed by donor IVC interposition. Other techniques preserve the IVC, with piggyback (PB) to the hepatic veins or side-to-side (SS) caval anastomosis. Avoidance of cross-clamping may be beneficial for minimizing hemodynamic instability and transfusion requirements. METHODS: Retrospective review of a provincial transplant database (2007-2011)...
April 6, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28408853/tumescent-mastectomy-the-current-indications-and-operative-tips-and-tricks
#10
Ashraf Khater, Alaa Mazy, Mona Gad, Ola Taha Abd Eldayem, Mohamed Hegazy
BACKGROUND: Tumescent mastectomy refers to usage of a mixture of lidocaine and epinephrine in a diluting saline solution that makes flaps firm and tense, thus minimizing systemic drugs toxicity and making surgery possible with minimal bleeding. This technique is very useful in elder women and those with American Society of Anesthesiologists; score III and IV. The objective was to establish an alternative safe technique to general anesthesia in some selected mastectomy patients. PATIENTS AND METHODS: Twenty candidate women for total mastectomy and axillary dissection were enrolled and consented to participate...
2017: Breast Cancer: Targets and Therapy
https://www.readbyqxmd.com/read/28406853/the-role-of-computed-tomography-in-the-classification-of-pediatric-pelvic-fractures-revisited
#11
Bent Ma, Hennrikus Wl, Latorre Je, Armstrong Dg, Shaw B, Jones Kc, Segal Ls
OBJECTIVES: To determine the need of CT scans in the assessment of pediatric pelvic fractures DESIGN:: Retrospective Chart Review SETTING:: Level-1 Pediatric Trauma CenterPatients/Participants: 30 pediatric trauma patients with pelvic fractures who have obtained both a radiograph and CT Scan MAIN OUTCOME MEASUREMENTS:: Fleiss Kappa coefficient to compare inter-reliability. RESULTS: The average age of the patients was 7 years (range 1-13 years). 17 were male and 13 were female...
April 10, 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28392116/carotid-dissection-complicated-by-polymorphic-ventricular-tachycardia
#12
Bria D Giacomino, Michael C Giudici
In this case report, we describe a patient with fibromuscular dysplasia who suffered spontaneous bilateral carotid artery dissections. This was followed by significant variations in blood pressure and heart rates during her admission. Unfortunately, during an episode of bradycardia, a premature ventricular contraction occurred during the T wave which resulted in polymorphic ventricular tachycardia. As described in the case and in graphic depiction, this hemodynamic instability resolved after stenting of the carotid artery...
April 5, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28387070/-how-i-treat-%C3%A2-a-poisoning-with-tricyclic-antidepressants-potential-role-of-a-treatment-with-lipid-emulsion
#13
G Berthe, M Tonglet, X Bertrand, S Degesves
Poisoning with tricyclic antidepressants is common and can be life-threatening. The classic management is well known (chelating gastrointestinal, sodium bicarbonate, benzodiazepine, norepinephrine). A few years ago, a treatment with lipid emulsion, previously used in local anesthetics poisoning, has been successfully tested in tricyclic poisoning with cardiac arrest. We are currently unable to explain the exact mechanism of this treatment but it could have a place in the treatment of severe tricyclic poisoning with hemodynamic instability in addition to the conventional treatment...
January 2017: Revue Médicale de Liège
https://www.readbyqxmd.com/read/28382424/plasma-exchange-for-the-patients-with-dilated-cardiomyopathy-in-children-is-safe-and-effective-in-improving-both-cardiac-function-and-daily-activities
#14
Takeshi Moriguchi, Keiichi Koizumi, Kenichi Matsuda, Norikazu Harii, Junko Goto, Daiki Harada, Hisanori Sugawara, Minako Hoshiai, Hiroaki Kise, Akiyasu Baba
Autoantibodies against cardiac proteins play an important role in the development of dilated cardiomyopathy (DCM). The efficacy and safety of apheresis such as immunoadsorption (IA) or plasma exchange (PE) to remove such antibodies have been reported in adult DCM patients. However, apheresis for pediatric DCM has not been performed because of technical difficulty due to relatively low blood volume and instability of hemodynamics. As we have experiences of preforming apheresis on hemodynamically unstable children, we have preformed ten courses of PE on seven child DCM patients including both patients in chronic and acute phase to assess the safety and efficacy to PE...
April 5, 2017: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
https://www.readbyqxmd.com/read/28377246/awake-surgery-for-brain-vascular-malformations-and-moyamoya-disease
#15
Rami James N Aoun, Mithun G Sattur, Chandan Krishna, Amen Gupta, Matthew E Welz, Allan D Nanney, Antoun H Koht, Matthew C Tate, Katherine H Noe, Joseph I Sirven, Barrett J Anderies, Patrick B Bolton, Terry L Trentman, Richard S Zimmerman, Kristin R Swanson, Bernard R Bendok
OBJECTIVE: While a significant amount of experience has accumulated for awake procedures for brain tumor, epilepsy and carotid surgery, its utility for intracranial neurovascular indications remains largely undefined. Awake surgery, for select neurovascular cases, offers the advantage of precise brain mapping and robust neurological monitoring during surgery for lesions in eloquent areas, avoidance of potential hemodynamic instability, and possible faster recovery. Additionally, it opens the window for perilesional epileptogenic tissue resection with potentially less risk for iatrogenic injury...
April 1, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28371158/the-effect-of-gabapentin-on-delayed-discharge-from-the-postanesthesia-care-unit-a-retrospective-analysis
#16
Naveed T Siddiqui, Amir Yousefzadeh, Maaz Yousuf, Dileep Kumar, Farah K Choudhry, Zeev Friedman
BACKGROUND: Enhanced recovery after surgery programs have incorporated gabapentin as part of a multimodal analgesia protocol. The preemptive use of gabapentin was found to be beneficial due to its opioid-sparing effect. However, excessive sedation and delayed discharge from postanesthesia recovery units are of concern. The aim of this study was to investigate whether preoperative gabapentin increased the length of stay in the recovery unit. METHODS: This retrospective cross-sectional study was carried out over a period of 2 months in the postanesthesia care unit (PACU) of a tertiary care hospital in Canada...
March 30, 2017: Pain Practice: the Official Journal of World Institute of Pain
https://www.readbyqxmd.com/read/28367346/gland-new-psychosis-new-onset-adult-psychosis-with-suicidal-ideation-and-attempt-in-the-setting-of-thyroid-storm
#17
Esteban Cota, Jacob Lentz
We present a case of new onset psychosis in the setting of thyroid storm in a woman with no previous psychiatric history. The patient presented with ongoing suicidal ideation, a suicide attempt that was interrupted by her husband, and audio and visual hallucinations. The patient was placed on a psychiatric hold and treated for thyrotoxicosis as well as psychosis. Treatment of the thyroid hormone overload resulted in a rapid resolution of her symptoms; she was discharged in excellent condition, and she has had no repeat hallucinations or self-injury ideation or attempts since...
2017: Case Reports in Psychiatry
https://www.readbyqxmd.com/read/28367281/intraoperative-management-of-critical-arrhythmia
#18
REVIEW
Chang Hee Kwon, Seong-Hyop Kim
The incidence of intraoperative arrhythmia is extremely high, and some arrhythmias require clinical attention. Therefore, it is essential for the anesthesiologist to evaluate risk factors for arrhythmia and understand their etiology, electrophysiology, diagnosis, and treatment. Anesthetic agents reportedly affect normal cardiac electrical activity. In the normal cardiac cycle, the sinoatrial node initiates cardiac electrical activity through intrinsic autonomous pacemaker activity. Sequential atrial and ventricular contractions result in an effective cardiac pumping mechanism...
April 2017: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/28344147/evaluation-of-deprescribing-amiodarone-after-new-onset-atrial-fibrillation-in-critical-illness
#19
Areerut Leelathanalerk, Wannisa Dongtai, Yvonne Huckleberry, Brian Kopp, John Bloom, Joseph Alpert
BACKGROUND: Recent studies have shed light on the continued prescription of inpatient medications upon hospital discharge despite the original intent of short-term inpatient therapy. Amiodarone, an antiarrhythmic associated with significant adverse effects with long-term use, is commonly used for new-onset atrial fibrillation in critical illness (NAFCI). While it is often preferred in this setting of hemodynamic instability, a prescription for long-term use should be carefully considered, preferably by a cardiologist...
March 23, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28338590/small-changes-big-effects-the-hemodynamics-of-partial-and-complete-aortic-occlusion-to-inform-next-generation-resuscitation-techniques-and-technologies
#20
M Austin Johnson, Anders J Davidson, Rachel M Russo, Sarah-Ashley E Ferencz, Oren Gotlib, Todd E Rasmussen, Lucas P Neff, Timothy K Williams
BACKGROUND: The transition from complete aortic occlusion during Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) can be associated with hemodynamic instability. Technique refinements and new technologies have been proposed to minimize this effect. In order to inform new techniques and technology, we examined the relationship between blood pressure and aortic flow during the restoration of systemic circulation following aortic occlusion at progressive levels of hemorrhage...
March 23, 2017: Journal of Trauma and Acute Care Surgery
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