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https://www.readbyqxmd.com/read/29701428/anaesthetic-management-in-a-duchennne-muscle-dystrophy-patient-for-treatment-of-recurrent-pneumothorax
#1
Sara Mota, Liuba Germanova, Joana Cortesão, Teresa Paiva
INTRODUCTION: Duchenne muscular dystrophy (DMD) is an x linked recessive disorder. Long term prognosis is ominous, with development of respiratory distress and cardiomyopathy in advanced stage of the disease and expected death in the teens-to-mid 20s due to respiratory or cardiac failure. Peri-operative management of this patients is challenging due to difficult airway anatomy (macroglossia, limited neck and mandibular mobility). Additionally, they are at risk of developing malignant hyperthermia, rhabdomyolysis and hyperkalemic cardiac arrest when exposed to halogenated inhalational anaesthetics and depolarizing muscle relaxants...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
https://www.readbyqxmd.com/read/29701425/analgesia-management-for-mitral-valve-repair-via-minithoracotomy-a-case-report
#2
Andreia Fernandes, Clara Gaio Lima, Nelson Paulo, Catarina Celestino, Ana Fonte Boa, Fátima Lima, Manuela Vieira
INTRODUCTION: Minimally invasive cardiac surgery (MICS), via minithoracotomy, is thought to be a fast track to extubation and recovery after surgery. Chronic pain, due to intercostal nerve injury, develops in up to 50% of postthoracotomy patients.A number of regional anaesthesia and analgesia techniques may be employed, and the anaesthesiologists play a key role in facilitating optimal outcomes after surgery. METHODS: We report a case of postoperative pain management with a local anesthetic infiltration for MICS...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
https://www.readbyqxmd.com/read/29700664/halving-the-volume-of-anaconda-initial-clinical-experience-with-a-new-small-volume-anaesthetic-reflector-in-critically-ill-patients-a-quality-improvement-project
#3
Hagen Bomberg, Franziska Meiser, Sarah Zimmer, Martin Bellgardt, Thomas Volk, Daniel I Sessler, Heinrich V Groesdonk, Andreas Meiser
AnaConDa-100 ml (ACD-100, Sedana Medical, Uppsala, Sweden) is well established for inhalation sedation in the intensive care unit. But because of its large dead space, the system can retain carbon dioxide (CO2 ) and increase ventilatory demands. We therefore evaluated whether AnaConDa-50 ml (ACD-50), a device with half the internal volume, reduces CO2 retention and ventilatory demands during sedation of invasively ventilated, critically ill patients. Ten patients participated in this cross-over protocol. After sedation with isoflurane via ACD-100 for 24 h, the 5-h observation period started...
April 26, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29505006/clinically-suspected-anaphylaxis-induced-by-sugammadex-in-a-patient-with-weaver-syndrome-undergoing-restrictive-mammoplasty-surgery-a-case-report-with-the-literature-review
#4
REVIEW
Nurdan Bedirli, Berrin Işık, Mehrnoosh Bashiri, Kutluk Pampal, Ömer Kurtipek
RATIONALE: Sugammadex is a cylodextrin derivate that encapsulates steroidal neuromuscular blocker agents and is reported as a safe and well-tolerated drug. In this case report, we present a patient who developed grade 3 anaphylaxis just after sugammadex administration. PATIENT CONCERNS: A 22-year-old woman with diagnosis of Weaver syndrome was scheduled for bilateral mammoplasty and resection of unilateral accessory breast tissue resection. Anesthesia was induced and maintained by propofol, rocuronium, and remifentanil...
January 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29479930/delirium-and-agitation-in-traumatic-brain-injury-patients-an-update-on-pathological-hypotheses-and-treatment-options
#5
Mario Ganau, Andrea Lavinio, Lara Prisco
Traumatic brain injury (TBI) is a global public health epidemic. It represents the principal cause of death and disability in individuals aged under 35 in the USA. In the subacute phase, severe TBI patients who recover consciousness go through a state of agitation and delirium. However, there is only limited research exploring the characteristics of post-traumatic delirium (PTD) although it is likely to be more frequent than in general Intensive Care Unit (ICU) patients. Evidence suggest the incidence of delirium in non-TBI ICU patients is up to 86%...
May 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29434802/an-investigation-of-the-mechanism-of-dexmedetomidine-in-improving-postoperative-cognitive-dysfunction-from-the-perspectives-of-alleviating-neuronal-mitochondrial-membrane-oxidative-stress-and-electrophysiological-dysfunction
#6
Jie Chen, Na Shen, Xiaohui Duan, Yaning Guo
The aim of this study was to investigate the mechanism of dexmedetomidine in improving postoperative cognitive dysfunction from the perspectives of alleviating neuronal mitochondrial membrane oxidative stress and electrophysiological dysfunction. A total of 120 patients undergoing elective surgery under general anesthesia from June 2013 to May, 2016 were selected as the subjects of the study and randomly divided into the propofol + remifentanil and dexmedetomidine groups. The Rey Auditory Verbal Learning Test (AVLT) and Beck Depression Inventory (BDI) were performed at day 1 before operation and at day 1, 3, 5 and 15 after operation...
February 2018: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/29402365/-effect-and-mechanism-of-dexmedetomidine-on-lungs-in-patients-of-sepsis-complicated-with-acute-respiratory-distress-syndrome
#7
Xianfeng Chen, Juntao Hu, Chi Zhang, Yiping Pan, Diansheng Tian, Fafa Kuang, Zhanhong Tang
OBJECTIVE: To investigate the mechanisms of protective effects of dexmedetomidine on lungs in patients of sepsis complicated with acute respiratory distress syndrome (ARDS). METHODS: The adult patients with sepsis complicated with ARDS, the oxygenation index (PaO2 /FiO2 ) was 150-200 mmHg (1 mmHg = 0.133 kPa), acute physiology and chronic health evaluation II (APACHE II) score was 10-20, need mechanical ventilation (MV) treatment > 72 hours, and admitted to intensive care unit (ICU) of the First Affiliated Hospital of Guangxi Medical University from September 2013 to June 2017 were enrolled...
February 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29386974/target-controlled-infusion-propofol-versus-sevoflurane-anaesthesia-for-emergency-traumatic-brain-surgery-comparison-of-the-outcomes
#8
Wan Mohd Nazaruddin Wan Hassan, Yusnizah Mohd Nasir, Rhendra Hardy Mohamad Zaini, Wan Fadzlina Wan Muhd Shukeri
Background: The choice of anaesthetic techniques is important for the outcome of traumatic brain injury (TBI) emergency surgery. The objective of this study was to compare patient outcomes for target-controlled infusion (TCI) of propofol and sevoflurane anaesthesia. Methods: A total of 110 severe TBI patients, aged 18-60, who underwent emergency brain surgery were randomised into Group T (TCI) ( n = 55) and Group S (sevoflurane) ( n = 55). Anaesthesia was maintained in Group T with propofol target plasma concentration of 3-6 μg/mL and in Group S with minimum alveolar concentration (MAC) of sevoflurane 1...
October 2017: Malaysian Journal of Medical Sciences: MJMS
https://www.readbyqxmd.com/read/29315660/precision-and-bias-of-target-controlled-prolonged-propofol-infusion-for-general-anesthesia-and-sedation-in-neurosurgical-patients
#9
Andrea Cortegiani, Alessandra Pavan, Fabio Azzeri, Giuseppe Accurso, Filippo Vitale, Cesare Gregoretti
The aim of this study was to determine the relationship, precision, and bias of a propofol target-controlled infusion (TCI) system during prolonged infusion in neurosurgical patients. We retrospectively included patients undergoing general anesthesia for elective neurosurgical removal of brain tumors and postoperative sedation in the intensive care unit over a period of 3 months. TCI of propofol (Diprifusor - Marsh model) and remifentanil were used for general anesthesia and sedation. We compared propofol blood concentration (Cmeas ) measured by liquid chromatography-mass spectroscopy with predicted concentrations (Cpred ) by the TCI system at 40 minutes (T0), 2 hours (T1), and 4 hours (T2) and every 8 hours after starting the drug infusion and at the time of emergence from sedation...
January 9, 2018: Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29132458/-efficacy-of-analgesic-and-sedative-treatments-in-children-with-mechanical-ventilation-in-the-pediatric-intensive-care-unit
#10
RANDOMIZED CONTROLLED TRIAL
Xiao-Fang Cai, Fu-Rong Zhang, Long Zhang, Ji-Min Sun, Wen-Bin Li
OBJECTIVE: To compare the efficacy and safety of different analgesic and sedative treatments in children with mechanical ventilation in the pediatric intensive care unit (PICU). METHODS: Eighty children with mechanical ventilation in the PICU who needed analgesic and sedative treatments were equally and randomly divided into midazolam group and remifentanil+midazolam group. The sedative and analgesic effects were assessed using the Ramsay Scale and the Face, Legs, Activity, Cry and Consolability (FLACC) Scale...
November 2017: Zhongguo Dang Dai Er Ke za Zhi, Chinese Journal of Contemporary Pediatrics
https://www.readbyqxmd.com/read/28910303/the-influence-of-analgesic-based-sedation-protocols-on-delirium-and-outcomes-in-critically-ill-patients-a-randomized-controlled-trial
#11
RANDOMIZED CONTROLLED TRIAL
Dan Liu, Jie Lyu, Huiying Zhao, Youzhong An
OBJECTIVE: To investigate the influence of analgesic-based midazolam sedation on delirium and outcomes in critically ill patients and to analyze the risk factors of delirium. DESIGN: Single center, prospective randomized controlled trial. SETTING: A surgical intensive care unit (ICU) in a tertiary care hospital in China. PATIENTS: Mechanically ventilated patients requiring sedation. MEASUREMENTS AND MAIN RESULTS: Patients admitted to the surgical intensive care unit who required sedation and were undergoing mechanical ventilation for longer than 24 hours were randomly divided into three groups: 1) the remifentanil group received remifentanil and midazolam, 2) the fentanyl group received fentanyl and midazolam, and 3) the control group received only midazolam...
2017: PloS One
https://www.readbyqxmd.com/read/28774327/could-remifentanil-reduce-duration-of-mechanical-ventilation-in-comparison-with-other-opioids-for-mechanically-ventilated-patients-a-systematic-review-and-meta-analysis
#12
Yibing Zhu, Yinhua Wang, Bin Du, Xiuming Xi
BACKGROUND: Sedation and analgesia are commonly required to relieve anxiety and pain in mechanically ventilated patients. Fentanyl and morphine are the most frequently used opioids. Remifentanil is a selective μ-opioid receptor that is metabolized by unspecific esterases and eliminated independently of liver or renal function. Remifentanil has a rapid onset and offset and a short context-sensitive half-life regardless of the duration of infusion, which may lead to reductions in weaning and extubation...
August 3, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28733841/analgosedation-of-adult-patients-with-elevated-intracranial-pressure-survey-of-current-clinical-practice-in-austria
#13
Guenther Herzer, Claudia Mirth, Udo M Illievich, Wolfgang G Voelckel, Helmut Trimmel
BACKGROUND: Analgesia and sedation are key items in intensive care. Recently published S3 guidelines specifically address treatment of patients with elevated intracranial pressure. METHODS: The Austrian Society of Anesthesiology, Resuscitation and Intensive Care Medicine carried out an online survey of neurointensive care units in Austria in order to evaluate the current state of practice in the areas of analgosedation and delirium management in this high-risk patient group...
July 21, 2017: Wiener Klinische Wochenschrift
https://www.readbyqxmd.com/read/28425334/remifentanil-for-sedation-of-children-with-traumatic-brain-injury
#14
James L Hungerford, Nicole O'Brien, Melissa Moore-Clingenpeel, Eric A Sribnick, Cheryl Sargel, Mark Hall, Jeffrey R Leonard, Joseph D Tobias
OBJECTIVE: To determine whether remifentanil would provide adequate sedation while allowing frequent and reproducible neurologic assessments in children admitted to the pediatric intensive care unit (PICU) with traumatic brain injury (TBI) during mechanical ventilation. DESIGN: Retrospective review. SETTING: Tertiary care PICU. PATIENTS: Thirty-eight patients over a 30-month period. MEASUREMENTS AND MAIN RESULTS: Median age was 9 years (interquartile range [IQR] 2...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28412050/-the-correlation-among-the-ramsay-sedation-scale-richmond-agitation-sedation-scale-and-riker-sedation-agitation-scale-during-midazolam-remifentanil-sedation
#15
Turgut Namigar, Karacalar Serap, Akdaş Tekin Esra, Odacılar Özgül, Öztürk Ali Can, Ak Aysel, Ali Achmet
BACKGROUND AND OBJECTIVES: Sedative and analgesic treatment administered to critically ill patients need to be regularly assessed to ensure that previously stated goals are well achieved as the risk of complications of oversedation is minimized. We revised and prospectively tested the Ramsay Sedation Scale (RSS) for interrater reliability and compared it with the Riker Sedation-Agitation Scale (RSAS) and the Richmond Agitation Sedation Scale (RASS) to test construct validity during midazolam-remifentanil sedation...
July 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28157809/withdrawal-assessment-tool-1-monitoring-in-picu-a-multicenter-study-on-iatrogenic-withdrawal-syndrome
#16
MULTICENTER STUDY
Angela Amigoni, Maria Cristina Mondardini, Ilaria Vittadello, Federico Zaglia, Emanuele Rossetti, Francesca Vitale, Stefania Ferrario, Fabio Savron, Giancarlo Coffaro, Luca Brugnaro, Roberta Amato, Andrea Wolfler, Linda S Franck
OBJECTIVES: Withdrawal syndrome is an adverse reaction of analgesic and sedative therapy, with a reported occurrence rate between 17% and 57% in critically ill children. Although some factors related to the development of withdrawal syndrome have been identified, there is weak evidence for the effectiveness of preventive and therapeutic strategies. The main aim of this study was to evaluate the frequency of withdrawal syndrome in Italian PICUs, using a validated instrument. We also analyzed differences in patient characteristics, analgesic and sedative treatment, and patients' outcome between patients with and without withdrawal syndrome...
February 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28110927/safety-of-remifentanil-in-transsphenoidal-surgery-a-single-center-analysis-of-540-patients
#17
David J Cote, William T Burke, Joseph P Castlen, Chih H King, Hasan A Zaidi, Timothy R Smith, Edward R Laws, Linda S Aglio
Although some studies have examined the efficacy and safety of remifentanil in patients undergoing neurosurgical procedures, none has examined its safety in transsphenoidal operations specifically. In this study, all transsphenoidal operations performed by a single author from 2008 to 2015 were retrospectively reviewed to evaluate the safety of remifentanil in a consecutive series of patients. During the study period, 540 transsphenoidal operations were identified. Of these, 443 (82.0%) patients received remifentanil intra-operatively; 97 (18...
April 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28070654/anesthesia-management-of-cesarean-section-in-parturient-with-anti-n-methyl-d-aspartate-receptor-encephalitis-a-case-report
#18
Zhimin Liao, Xiaoqin Jiang, Juan Ni
A 24-year-old woman at 29 weeks' gestation, and with psychiatric symptoms, was admitted to hospital and diagnosed as having anti-N-methyl-D-aspartate receptor encephalitis. After 4 weeks of immunotherapy with little effect, an emergency cesarean section was performed at 33(+4) weeks gestation under general anesthesia. The parturient was intubated after rapid sequence induction with etomidate, remifentanil and succinylcholine. Anesthesia was maintained with sevoflurane and remifentanil. Except for low weight, the infant was normal at birth...
April 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/27871542/severe-respiratory-depression-and-bradycardia-before-induction-of-anesthesia-and-onset-of-takotsubo-cardiomyopathy-after-cardiopulmonary-resuscitation
#19
Yuko Furuichi, Ayaka Hamada, Keiko Nakazato, Katsuya Kobayashi, Atsuhiro Sakamoto
A 69-year-old woman undergoing treatment for hypertension and epilepsy was scheduled to undergo cataract surgery. All preoperative examination results were within normal limits. Despite being tense, she walked to the operating room. Approximately 2 minutes after an intravenous line was established by an anesthesia resident, severe hypoxia and bradycardia developed, and she lost consciousness. Cardiopulmonary resuscitation was initiated immediately, and after 1 minute, she regained consciousness, and her breathing and circulation recovered...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27867133/fiber-optic-bronchoscopy-and-remifentanil-target-controlled-infusion-in-critically-ill-patients-with-acute-hypoxaemic-respiratory-failure-a-descriptive-study
#20
Saïda Rezaiguia-Delclaux, Florent Laverdure, Talna Kortchinsky, Léa Lemasle, Audrey Imbert, François Stéphan
INTRODUCTION: Sedation optimizes patient comfort and ease of execution during fiber optic bronchoscopy (FOB). Our objective was to describe the safety and efficacy of remifentanil-TCI during FOB in non-intubated, hypoxaemic, thoracic surgery ICU patients. METHODS: Consecutive spontaneously breathing adults requiring FOB after thoracic surgery were included if they had hypoxaemia (PaO2/FiO2<300mmHg or need for non-invasive ventilation [NIV]) and prior FOB failure under topical anaesthesia...
October 2017: Anaesthesia, Critical Care & Pain Medicine
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