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"Midazolam" AND "Emergency"

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...
August 16, 2018: European Journal of Anaesthesiology
Alejandra Vasquez, Marina Gaínza-Lein, Iván Sánchez Fernández, Nicholas S Abend, Anne Anderson, J Nicholas Brenton, Jessica L Carpenter, Kevin Chapman, Justice Clark, William D Gaillard, Tracy Glauser, Joshua Goldstein, Howard P Goodkin, Yi-Chen Lai, Tobias Loddenkemper, Tiffani L McDonough, Mohamad A Mikati, Anuranjita Nayak, Eric Payne, James Riviello, Dmitry Tchapyjnikov, Alexis A Topjian, Mark S Wainwright, Robert C Tasker
OBJECTIVE: We aimed to evaluate and compare the status epilepticus treatment pathways used by pediatric status epilepticus research group (pSERG) hospitals in the United States and the American Epilepsy Society (AES) status epilepticus guideline. METHODS: We undertook a descriptive analysis of recommended timing, dosing, and medication choices in 10 pSERG hospitals' status epilepticus treatment pathways. RESULTS: One pathway matched the timeline in the AES guideline; nine pathways described more rapid timings...
July 11, 2018: Pediatric Neurology
Arezou Soroushnai, Fariba Ganji, Ebrahim Vasheghani-Farahani, Hamid Mobedi
The main objective of this novel study was to develop midazolam hydrochloride Fast dissolving oral films (FDFs) using solvent casting method and to evaluate the characteristics of the optimum formulation through in vitro and in vivo analysis. The FDFs are new favorable solid dosage forms that deliver drugs rapidly to the blood circulation system and have great advantages in the emergent control of severe neuropathic attacks in children.Methods and Midazolam nanosuspensions were prepared using the ultrasonic method and then incorporated in the hydroxypropyl methyl cellulose (HPMC)/pullulan polymeric matrix with other excipients like glycerol and cellulose nanofiber as a softener and a compatibilizer, respectively...
July 22, 2018: Current Drug Delivery
H S Abdel-Ghaffar, S M Kamal, F A El Sherif, S A Mohamed
BACKGROUND: The aim of our study was to compare the efficacy of dexmedetomidine, ketamine, and midazolam for sedative premedication administered by nebuliser 30 min before general anaesthesia in preschool children undergoing bone marrow biopsy and aspiration. METHODS: Ninety children aged 3-7 yr were randomly allocated into three equal groups to be premedicated with either nebulised ketamine 2 mg kg-1 (Group K), dexmedetomidine 2 μg kg-1 (Group D), or midazolam 0...
August 2018: British Journal of Anaesthesia
Benjamin Moeller, Brenna Espelien, Waylon Weber, Philip Kuehl, Melanie Doyle-Eisele, C Edwin Garner, Jacob D McDonald, Efrain Garcia, Robert Raulli, Judith Laney
Ketamine is a glutamate N-methyl-D-aspartate receptor antagonist that is a rapid-acting dissociative anesthetic. It has been proposed as an adjuvant treatment along with other drugs (atropine, midazolam, pralidoxime) used in the current standard of care (SOC) for organophosphate and nerve agent exposures. Ketamine is a pharmaceutical agent that is readily available to most clinicians in emergency departments and possesses a broad therapeutic index with well-characterized effects in humans. The objective of this study was to determine the pharmacokinetic profile of ketamine and its active metabolite, norketamine, in F344 rats following single or repeated intramuscular administrations of subanesthetic levels (7...
July 20, 2018: Drug Testing and Analysis
Jeannette Kadel, Sebastian Bauer, Anke M Hermsen, Ilka Immisch, Lara Kay, Karl Martin Klein, Susanne Knake, Katja Menzler, Philipp S Reif, Felix Rosenow, Adam Strzelczyk
BACKGROUND: Emergency treatment with benzodiazepines is indicated in prolonged seizures, seizure clusters and status epilepticus. OBJECTIVE: The aim of this study was to evaluate the use of emergency medication in adult patients with epilepsy. PATIENTS AND METHODS: All adult epilepsy patients attending the epilepsy outpatient clinics of the university hospitals in Frankfurt and Marburg in 2015 were asked to participate in this questionnaire-based, retrospective survey...
August 2018: CNS Drugs
Ali Arhami Dolatabadi, Aida Mohammadian, Hamid Kariman
Introduction: Finding a fast-acting compound with minimal side-effects to induce a safe and efficient analgesia with short or medium duration of action is of great interest in the emergency department. The present study has been designed with the aim of comparing the effect of midazolam + fentanyl + lidocaine combination with midazolam + fentanyl + placebo in pain management of anterior shoulder dislocation reduction. Methods: The present two-arm parallel double-blind randomized controlled trial was performed on patients who presented to emergency department with anterior shoulder dislocation...
2018: Emergency (Tehran, Iran)
Nathan J Smischney, Emily M Pollard, Asha U Nookala, Oludare O Olatoye
BACKGROUND Serotonin syndrome is a life-threatening condition that can lead to neurologic complications and is associated with the use of serotonergic medications. As the use of antidepressant medications has increased, the incidence of perioperative serotonin syndrome has transitioned from a rare diagnosis to one that should be considered as a differential diagnosis for any patient displaying signs of neuroexcitation. CASE REPORT A 70-year-old man (ASA 2) with a history of vestibular migraines (treated with venlafaxine), gastroesophageal reflux disease, and benign prostatic hyperplasia presented to our institution for photoselective vaporization of the prostate...
July 16, 2018: American Journal of Case Reports
Benedikt Büttner, Ashham Mansur, Matthias Kalmbach, José Hinz, Thomas Volk, Karoly Szalai, Markus Roessler, Ingo Bergmann
BACKGROUND: Out-of-hospital analgosedation in trauma patients is challenging for emergency physicians due to associated complications. We compared peripheral nerve block (PNB) with analgosedation (AS) as an analgetic approach for patients with isolated extremity injury, assuming that prehospital required medical interventions (e.g. reduction, splinting of dislocation injury) using PNB are less painful and more feasible compared to AS. METHODS: Thirty patients (aged 18 or older) were randomized to receive either ultrasound-guided PNB (10 mL prilocaine 1%, 10 mL ropivacaine 0...
2018: PloS One
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