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"Midazolam" AND "Emergency"

James J Brown, James M Gray, Mark G Roback, Usha Sethuraman, Ahmad Farooqi, Nirupama Kannikeswaran
BACKGROUND AND OBJECTIVES: Children with autism spectrum disorder (ASD) present more frequently to the emergency department (ED) than children with normal development, and frequently have injuries requiring procedural sedation. Our objective was to describe sedation practice and outcomes in children with ASD in the ED. METHODS: We performed a retrospective chart review of children with ASD who underwent sedation at two tertiary care EDs between January 2009-December 2016...
October 16, 2018: American Journal of Emergency Medicine
Steven G Schauer, Jason F Naylor, Joseph K Maddry, Denise M Beaumont, Cord W Cunningham, Megan B Blackburn, Michael D April
OBJECTIVES: Airway failures are the second leading cause of potentially preventable death on the battlefield. Improvements in airway management depend on identifying current challenges. We sought to build on previously reported data on prehospital, combat airway management. METHODS: We used a series of emergency department procedure codes to identify patients within the Department of Defense Trauma Registry from January 2007 to August 2016. This is a subanalysis of those with a documented prehospital airway intervention...
December 2018: Southern Medical Journal
David Barbic, Gary Andolfatto, Brian Grunau, Frank X Scheuermeyer, William MacEwan, William G Honer, Hubert Wong, Skye P Barbic
BACKGROUND: The rapid control of patients presenting to the emergency department (ED) with psychomotor agitation and violent behavior is paramount for the safety of patients and ED staff. The use of intramuscular (IM) ketamine in the pre-hospital and ED settings has demonstrated promising preliminary results to provide rapid and safe behavioral control. A prospective, randomized controlled trial is required to measure the potential superiority of IM ketamine compared to current standard care (IM benzodiazepines plus antipsychotics)...
November 26, 2018: Trials
Sylvia Kramer, Martin Krebs, Claudia Spies, Shahab Ghamari, Claudia Höhne, Karin Becke, Christoph Eich, Andreas Hoeft, Julius Wermelt, Richard K Ellerkmann
The upcoming and ongoing debate on neurotoxicity of anesthetics at a young age put a new spotlight on the emergence delirium of children (paedED). The European Society for Anesthesiology published a consensus guideline on prevention and therapy in 2017 which can be a useful guidance in daily clinical practice. Patient data management systems with their clear documentation concerning pain/therapy of pain and paedED will be valuable tools in order to assess the real incidence of paedED. Differentiating between pain/agitation and paedED migth not always be easy...
November 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
G Homfray, A Palmer, H Grimsmo-Powney, A Appelboam, G Lloyd
BACKGROUND: The elderly are perceived as a high-risk group for procedural sedation. Concern exists regarding the safety of sedation of this patient group by emergency physicians, particularly when using propofol. METHODS: We analysed prospectively collected data on patients aged 75 yr or older undergoing sedation between October 2006 and March 2017 in the emergency department of a single centre. We used the World Society of Intravenous Anaesthesia International Sedation Task Force adverse event tool, stratifying identified adverse events according to consensus agreement...
December 2018: British Journal of Anaesthesia
Manal H Saad, Candace L Savonen, Matthew Rumschlag, Sokol V Todi, Carl J Schmidt, Michael J Bannon
Opioid abuse is now the primary cause of accidental deaths in the United States. Studies over several decades established the cyclical nature of abused drugs of choice, with a current resurgence of heroin abuse and, more recently, fentanyl's emergence as a major precipitant of drug-related deaths. To better understand abuse trends and to explore the potential lethality of specific drug-drug interactions, we conducted statistical analyses of forensic toxicological data from the Wayne County Medical Examiner's Office from 2012-2016...
2018: Frontiers in Neuroscience
Itai Shavit, Danielle Shavit, Oren Feldman, Nir Samuel, Anat Ilivitzki, Daniel M Cohen
BACKGROUND: Ileocolic intussusception is a major cause for intestinal obstruction in early childhood. Reduction of intussusception, in the vast majority of institutions, is performed on awake children, without sedation. OBJECTIVE: The aim of this study was to report the course of the first patients who were sedated by emergency physicians for pneumatic reduction of intussusception (PRI). METHODS: We conducted a case series analysis of prospectively collected data on patients undergoing PRI, using a sedation recording tool...
October 30, 2018: Journal of Emergency Medicine
Torgrim Soeyland, Alan Garner, Sam Vidler, Cristian Humberto Gutierrez, Arnold Foster, Jane Kitcher
BACKGROUND: Prehospital medical teams are commonly required to administer a range of medications for urgent stabilisation and treatment. The safe preparation of medications during resuscitation requires attention, time and resources, and can be a source of medication error. In our two road and HEMS (Helicopter Emergency Medical Service) prehospital services, medication errors are mitigated by predrawing commonly used medications to set concentrations daily (Hunter Retrieval Service, HRS) or second-daily (CareFlight Sydney, CFS)...
October 20, 2018: Emergency Medicine Journal: EMJ
Amgad H Hanna, Davinder Ramsingh, Whitney Sullivan-Lewis, Sarah Cano, Patrick Leiter, Desiree Wallace, Gerald Andrews, Briahnna Austin, Richard L Applegate
BACKGROUND: Anxiety associated with pediatric surgery can be stressful. Midazolam is a well-accepted anxiolytic in this setting. However, there are cases in which this medication is not effective. Zolpidem is a short-acting nonbenzodiazepine hypnotic drug that is administered orally and has quick onset of action (~15 minutes), and 2-3 hour duration. AIMS: Based on the theory that impaired perception following oral zolpidem administration would suppress the development of anxiety, we sought to compare zolpidem to midazolam for pediatric preoperative anxiety...
October 17, 2018: Paediatric Anaesthesia
Katharina Marquart, Julia Herbert, Niko Amend, Horst Thiermann, Franz Worek, Timo Wille
BACKGROUND: In a military or terrorist scenario, combination of organophosphorus compounds (OP) poisoning with physical trauma requiring surgical treatment and thus general anaesthesia are possible. Previous in vitro studies showed an altered potency of relevant anaesthetics during cholinergic crisis. Hence, it is not clear, which anaesthetics are suitable to achieve the necessary stage of surgical anaesthesia in OP poisoning. METHODS: In the present study, different anaesthetic regimens (ketamine-midazolam, propofol-fentanyl, thiopental-fentanyl), relevant in military emergency medicine, were examined in soman-poisoned rats...
October 11, 2018: Clinical Toxicology
Nicholas J Pastis, Lonny B Yarmus, Frank Schippers, Randall Ostroff, Alexander Chen, Jason Akulian, Momen Wahidi, Samira Shojaee, Nichole T Tanner, Sean P Callahan, Gregory Feldman, Daniel G Lorch, Ikeadi Ndukwu, Michael A Pritchett, Gerard A Silvestri
BACKGROUND: While the complexity of flexible bronchoscopy has increased, standard options for moderate sedation medications have not changed in three decades. There is need to improve moderate sedation while maintaining safety. Remimazolam was developed to address shortcomings of current sedation strategies. METHODS: A prospective, double-blind, randomized, multi-center, parallel group trial was performed at 30 U.S. sites. The efficacy and safety of remimazolam for sedation during flexible bronchoscopy were compared to placebo and open-label midazolam...
October 4, 2018: Chest
Veena Chatrath, Rajan Kumar, Upasna Sachdeva, Milind Thakur
Background: Surgery is a very stressful experience for patients. Children are the most susceptible to fear, anxiety, and stress due to their limited cognitive capabilities and dependency. In children, pharmacologic agents are frequently used as premedication to relieve the fear of surgery, to make child-parental separation easy, and to carry out a smooth induction of anesthesia. We conducted this study to compare the efficacy of intranasal fentanyl, midazolam, and dexmedetomidine as premedication in pediatric patients...
July 2018: Anesthesia, Essays and Researches
Unnikrishnan Prathapadas, Maya Gomathiamma, Appavoo Arulvelan, Karen Ruby Lionel, Ajay Prasad Hrishi
Background: Propofol has emerged as an induction agent of choice over the past two decades due to its quick, smooth induction and rapid recovery. The main concern for an anesthesiologist is the hemodynamic instability caused by the standard induction dose of propofol (2-3 mg/kg). Aim: We aim to study the efficacy of propofol auto-coinduction technique in comparison to the standard propofol induction technique in terms of the total induction dose requirement of propofol, the incidence of hemodynamic side effects and pain on injection, and the incidence of fentanyl-induced cough (FIC) in the absence of a synergistic agent like midazolam...
July 2018: Anesthesia, Essays and Researches
Alfonsus Adrian Hadikusumo Harsono, Achmadi Achmadi, Muhammad Ilham Aldika Akbar, Hermanto Tri Joewono
BACKGROUND Recurrent seizure in patients with magnesium sulfate-treated eclampsia is very rare and requires meticulous management due to poor prognosis. The development of eclamptic convulsions is considered a preventable obstetric situation. Magnesium sulfate has been the drug of choice in such cases. However, some cases are persistent and need more aggressive treatment. CASE REPORT First case: A 20-year-old, nulliparous woman was referred from a private midwifery practice with history of convulsion, 40 weeks of gestational age (GA), and in the active phase of labor...
September 25, 2018: American Journal of Case Reports
Kazuhiro Sugiyama, Kazuki Miyazaki, Takuto Ishida, Takahiro Tanabe, Yuichi Hamabe
BACKGROUND: Continuous electroencephalography (cEEG), interpreted by an experienced neurologist, has been reported to be useful in predicting neurological outcome in adult patients post cardiac arrest. Amplitude-integrated electroencephalography (aEEG) is a type of quantitative EEG and is easily interpreted by a non-neurologist. A few studies have shown the effectiveness of aEEG in prognostication among adult patients post cardiac arrest. In this study, we hypothesized that the pattern of aEEG after return of spontaneous circulation (ROSC) could successfully categorize patients post cardiac arrest according to their expected neurological outcome...
September 20, 2018: Critical Care: the Official Journal of the Critical Care Forum
Miriam Luginbühl, Timo Junker, Dagmar I Keller
BACKGROUND: Smuggling of illegal drugs by hiding them inside one's own body, also called body packing, is a worldwide phenomenon. Cocaine is the most frequently transported drug. Body packing is a potentially lethal practice. The most serious complications of body packing are gastrointestinal obstruction or perforation and drug toxicity due to packet leakage or rupture. CASE PRESENTATION: A 30-year-old confirmed body packer was brought to our emergency department from jail because of agitation and mydriasis...
September 4, 2018: BMC Emergency Medicine
Kotaro Hatta, Shigemasa Katayama, Fumiyoshi Morikawa, Atsushi Imai, Kiyoshi Fujita, Aiko Fujita, Takuya Ishizuka, Takayuki Abe, Yasuhiko Sudo, Kijiro Hashimoto, Chie Usui, Hiroyuki Nakamura, Yoshio Yamanouchi, Toyoaki Hirata
AIM: To provide information about psychiatric emergency situations in Japan, we examined psychiatrists' preference among parenteral medication since intramuscular (IM)-olanzapine became available and clinical characteristics in patients given IM-olanzapine compared to those given other parenteral medication. METHODS: We conducted a naturalistic study proceeding over a 1-year period in 9 psychiatric emergency departments. RESULTS: Among 197 patients, the distribution of IM-injections (n = 89) was as follows: IM-olanzapine, 66 patients (74...
September 2018: Neuropsychopharmacology reports
Patricia D Maglalang, Davin Rautiola, Ronald A Siegel, Jared M Fine, Leah R Hanson, Lisa D Coles, James C Cloyd
A subgroup of patients with drug-resistant epilepsy have seizure clusters, which are a part of the continuum of seizure emergencies that includes prolonged episodes and status epilepticus. When the patient or caregiver can identify the beginning of a cluster, the condition is amenable to certain treatments, an approach known as rescue therapy. Intravenous drug administration offers the fastest onset of action, but this route is usually not an option because most seizure clusters occur outside of a medical facility...
October 2018: Epilepsia
Patrick M Ryan, Andrew J Kienstra, Peter Cosgrove, Robert Vezzetti, Matthew Wilkinson
OBJECTIVE: To examine the safety and effectiveness of intranasal midazolam and fentanyl used in combination for laceration repair in the pediatric emergency department. METHODS: We performed a retrospective chart review of a random sample of 546 children less than 18 years of age who received both intranasal midazolam and fentanyl for laceration repair in the pediatric emergency department at a large, urban children's hospital. Records were reviewed from April 1, 2012 to June 31, 2015...
May 17, 2018: American Journal of Emergency Medicine
Fabrice Michel, Thomas Vacher, Florence Julien-Marsollier, Christophe Dadure, Jean-Vincent Aubineau, Corinne Lejus, Nada Sabourdin, Eric Woodey, Gilles Orliaguet, Christopher Brasher, Souhayl Dahmani
BACKGROUND: Peri-operative respiratory adverse events (PRAEs) in paediatric patients with upper respiratory tract infections (URTIs) remain inadequately explored in patients allowed to proceed to anaesthesia and surgery. OBJECTIVE: To determine the incidence and risk factors of PRAE in children with URTI allowed to proceed to anaesthesia. DESIGN: Multicentre cohort study performed over 6 months in France. SETTING: Sixteen centres with dedicated paediatric anaesthetists...
December 2018: European Journal of Anaesthesiology
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