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Olumuyiwa A Bamgbade
Obstructive sleep apnea (OSA) is prevalent and presents perioperative challenges. There are guidelines regarding perioperative care of OSA, but analgesia management of OSA patients is inconsistent or inadequate. This is a study of the United Kingdom anesthesiologists' postoperative analgesia preferences for OSA patients. Overall, the 1st choice of main analgesia was continuous epidural local anesthetic (LA) without opioid, at 30% rate; P = 0.001. The 2nd choice was continuous epidural LA plus fentanyl, at 21% rate; P = 0...
July 2018: Saudi Journal of Anaesthesia
Alaa Eldin Adel Elmaddawy, Alaa Eldin Mazy
Background: The thyroid gland surgery is a common and painful procedure demanding analgesia. Many regional techniques are applied for anterior neck surgeries mostly assigned in relation to the involved cervical fascia. Dexmedetomidine (Precedex) is a selective alpha 2 adrenoceptor agonist which prolongs the sensory blockade duration of local anesthetics. Our study hypothesis is that ultrasound (US)-guided bilateral superficial cervical plexus block (BSCPB) may provide longer analgesia when adding dexmedetomidine to bupivacaine-epinephrine...
July 2018: Saudi Journal of Anaesthesia
Amy Castilano, Britni Sternard, Earl D Cummings, Runhua Shi, Thomas Arnold, Sami L Bahna
BACKGROUND: Some previous reports revealed suboptimal management of anaphylaxis (ANX) in the emergency department (ED). OBJECTIVE: To evaluate the recorded diagnosis and management of patients who presented with ANX at our university hospital ED and to assess how the management correlated with the severity of the case and the training level of the ED staff. METHODS: A descriptive study that involved reviewing the electronic medical records of patients who presented with ANX at the ED during a period of 4 years...
July 1, 2018: Allergy and Asthma Proceedings:
Ayobami T Akenroye, Abayomi Ajala, Elham Azimi-Nekoo, Gabriele S de Vos
BACKGROUND: In asthmatics, making a diagnosis of anaphylaxis could be challenging as respiratory symptoms are a common feature of both conditions. Identifying anaphylaxis is important to providing appropriate care. A prior study showed that anaphylaxis is sometimes misdiagnosed as acute asthma in children. We sought to identify the percentage of adults admitted to the intensive care unit (ICU) with asthma exacerbations who met criteria for anaphylaxis. METHODS: Retrospective chart review of adults admitted with acute asthma to the ICU at Jacobi Medical Center, a Level 1 trauma centre in Bronx, New York...
August 9, 2018: Emergency Medicine Journal: EMJ
Arsenio P Vasconcelos Neto, Daniel Francisco Scalabrini Machado, Thiago O Lopes, Ademir J Camargo, Heibbe Cristhian Benedito de Oliveira
The electronic absorption spectrum of the neurotransmitter epinephrine (EPN) in water solution is studied, combining ab initio Car-Parrinello molecular dynamics with a quantum mechanical approach within the framework of a time-dependent-density functional theory (TDDFT) scheme. By selecting 52 uncorrelated snapshots, the excitation modes were calculated at the LC-ωPBE/6-31+G(d) level of theory, using an optimal range separation parameter ω, determined by means of the gap-tuning scheme in the presence of the solvent molecules...
August 9, 2018: Journal of Physical Chemistry. B
Lindsey J Noble, Rimenez R Souza, Christa K McIntyre
RATIONALE: Emotionally traumatic experiences can lead to maladaptive memories that are enduring and intrusive. The goal of exposure-based therapies is to extinguish conditioned fears through repeated, unreinforced exposures to reminders of traumatic events. The extinction of conditioned fear depends upon the consolidation of new memories made during exposure to reminders. An impairment in extinction recall, observed in certain patient populations, can interfere with progress in exposure-based therapies, and the drive to avoid thoughts and reminders of the trauma can undermine compliance and increase dropout rate...
August 8, 2018: Psychopharmacology
Farah Syed, Kumud K Awasthi, Lalit P Chandravanshi, Rajbala Verma, Neelu K Rajawat, Vinay K Khanna, P J John, Inderpal Soni
Extensive use of synthetic pyrethroids has resulted in serious human health issues. Induction of oxidative stress is an important mechanism of action of most pesticides including pyrethroids. In the present study, we have elucidated the possible role of oxidative stress in bifenthrin-induced neurotoxicity. Adult male Wistar rats were administered bifenthrin (3.5 and 7 mg per kg body weight p.o.) for 30 days. Behavioral studies were conducted on a set of randomly selected rats from each treatment group after completion of treatment...
January 1, 2018: Toxicology Research
Debesh Bhoi, Purnima Narasimhan, Ranjitha Nethaji, Praveen Talawar
To avoid the safety issues related to thoracic paravertebral blocks, we performed midpoint transverse process to pleura blocks in 3 patients before general anesthesia for modified radical mastectomies. The midpoint transverse process to pleura blocks served as the major component of multimodal analgesia. With ultrasound guidance, 7 mL of a mixture of 0.75% ropivacaine and 2% lidocaine with epinephrine were deposited at T2, T4, and T6 levels. We noted decreased sensation to cold and pinprick from T2 to T8 dermatome level with sparing of axilla and infraclavicular areas...
August 6, 2018: A&A practice
Spyros D Mentzelopoulos, Iosifina Koliantzaki, Marios Karvouniaris, Charikleia Vrettou, Nicolas Mongardon, George Karlis, Demosthenes Makris, Epaminondas Zakynthinos, Sotirios Sourlas, Stavros Aloizos, Theodoros Xanthos, Spyros G Zakynthinos
PURPOSE: Low-dose steroids may reduce the mortality of severely ill patients with septic shock. We sought to determine whether exposure to stress-dose steroids during and/or after cardiopulmonary resuscitation is associated with reduced risk of death due to postresuscitation septic shock. METHODS: We analyzed pooled, individual patient data from two prior, randomized clinical trials (RCTs). RCTs evaluated vasopressin, steroids, and epinephrine (VSE) during resuscitation and stress-dose steroids after resuscitation in vasopressor-requiring, in-hospital cardiac arrest...
August 7, 2018: Cardiovascular Drugs and Therapy
Binav Shrestha, Paritosh Kafle, Shivani Thapa, Suyash Dahal, Vijay Gayam, Alix Dufresne
Introduction. Myocardial infarction in the setting of anaphylaxis may result from the anaphylaxis itself or from the epinephrine used to treat the anaphylaxis. While cases of myocardial infarction due to large doses of intravenous epinephrine have previously been reported, myocardial infarction after therapeutic doses of intramuscular epinephrine is rarely reported. Case Report. A 23-year-old male presented with sudden onset of difficulty in swallowing and speech after eating takeout food. He was treated with intramuscular epinephrine for presumed angioedema following which he immediately developed chest tightness associated with ST elevation on electrocardiogram and elevated serum troponin...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Franco Bassetto, Vincenzo Vindigni, G Tanzillo
In the last years, number of rhinoplasty operations is ever increasing, but what can be done when there is a contraindication to use a vasoconstrictor?2 In our case, we presented our perioperative management of a female patient, epinephrine intolerant, who was arranged for rhinoplasty.
May 2018: World Journal of Plastic Surgery
Yunbing Ma, Qian Wang, Debria Joe, Manqi Wang, Matthew D Whim
Hypoglycemia activates the counterregulatory response (CRR), a neural-endocrine reflex that restores euglycemia. Although effective if occasionally activated, repeated induction of the CRR leads to a decline in responsiveness and prolonged exposure to hypoglycemia. The mechanism underlying this impairment is not known. We found that the reduction in epinephrine release that characterizes a suppressed CRR involves a long-lasting form of sympatho-adrenal synaptic plasticity. Using optogenetically evoked catecholamine release, we show that recurrent hypoglycemia reduced the secretory capacity of mouse adrenal chromaffin cells...
August 6, 2018: Journal of Clinical Investigation
Elizabeth R Seaquist
The mechanisms responsible for the development of the impaired awareness of hypoglycemia often seen in insulin-treated patients with diabetes remain uncertain, but cerebral adaptations to recurrent hypoglycemia are frequently hypothesized. In this issue of the JCI, Ma et al. demonstrate that neuropeptide Y (NPY) secretion from adrenal chromaffin cells persists during exposure to recurrent hypoglycemia and activation of the sympathetic nerves at the same time that epinephrine secretion is reduced. This results in the inhibition of tyrosine hydroxylase, the rate-limiting enzyme for catecholamine synthesis...
August 6, 2018: Journal of Clinical Investigation
Semra Demir, Derya Unal, Muge Olgac, Nilgun Akdeniz, Esin Aktas-Cetin, Asli Gelincik, Bahauddin Colakoglu, Suna Buyukozturk
Both immediate and nonimmediate type hypersensitivity reactions (HRs) with a single dose of quinolone in the same patient have not been previously reported. A 47-year-old female patient referred to us because of the history of a nonimmediate type HR to radio contrast agent and immediate type HR to clarithromycin. She experienced anaphylaxis in minutes after the second dose of 50 mg when she was provocated with moxifloxacin. She was treated immediately with epinephrine, fluid replacement and methylprednisole and pheniramine...
July 2018: Asia Pacific Allergy
Susan Waserman, Ernie Avilla, Laurie Harada, Wanrudee Isaranuwatchai, Johnna Perdrizet, Monika Kastner
No abstract text is available yet for this article.
August 2, 2018: Journal of Allergy and Clinical Immunology in Practice
Jone Jackeviciute, Vidas Pilvinis, Rugile Pilviniene
RATIONALE: Angiotensin-converting enzyme (ACE) inhibitors are one of the most used medication among patients with arterial hypertension. In most cases, ACE inhibitors caused side effects are mild; however, from 0.1% to 0.7% of patients can develop life threatening adverse effect, angioedema. Unlike histamine mediated, ACE inhibitor-related angioedema can develop at any time during the treatment course. PATIENT CONCERNS: An 89-year-old woman with a medical history for arterial hypertension, ischemic heart disease, heart failure, chronic atrial fibrillation developed ACE inhibitor-induced angioedema after 5 years of daily ramipril administration...
August 2018: Medicine (Baltimore)
Jong Hwa Jun, Seung Pil Bang, Young-Sik Yoo, Choun-Ki Joo
Despite the various advantages of femtosecond laser-assisted cataract surgery (FLACS), pupillary constriction during laser photodisruption is considered one of the most unfavorable events. This study aimed to investigate the efficacy of intracameral 0.015% epinephrine injection for miosis after laser pretreatment during FLACS.A total of 82 patients who underwent FLACS for age-related cataracts were investigated in this retrospective study. The epinephrine group included patients who received intracameral epinephrine injection for miosis after femtosecond laser pretreatment, while the no-epinephrine group included the patients who underwent FLACS without intracameral epinephrine due to minimal miosis...
August 2018: Medicine (Baltimore)
Dino F Druda, Santosh Gone, Andis Graudins
INTRODUCTION: Pentobarbital (PB) is a euthanasia drug in doses of 2 to 10 grams, causing death within 15-30 minutes. We report a case of recovery from lethal pentobarbital deliberate self-poisoning with confirmatory serum drug concentrations. CASE REPORT: A 45-year-old male purchased 20 grams of PB powder over the Internet. He ingested this powder and then alerted his mother 10 minutes later. She found him unresponsive and commenced cardiopulmonary resuscitation (CPR)...
August 2, 2018: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
Spencer B Lewis, Mamdouh Khayat, Rajiv Srinivasa, Jeffrey F B Chick, Joseph J Gemmete, Ravi N Srinivasa
Hematochezia may be a result of anatomic, vascular, inflammatory, infectious, or neoplastic diseases. Colonoscopic evaluation and therapy may be limited because of intermittent bleeding in the setting of numerous diverticula. This report describes a patient with diverticulosis who presented with hematochezia and hemodynamic instability with failed colonoscopic and arteriographic evaluations, and was treated with percutaneous transcolonic diverticular cyanoacrylate and epinephrine injection.
June 2018: Radiology Case Reports
Shu Guo Xing, Tian Mao
No abstract text is available yet for this article.
August 2, 2018: Journal of Hand Surgery, European Volume
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