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https://www.readbyqxmd.com/read/28100520/evidence-basis-for-using-perineural-dexmedetomidine-to-enhance-the-quality-of-brachial-plexus-nerve-blocks-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#1
L Vorobeichik, R Brull, F W Abdallah
BACKGROUND: Dexmedetomidine has been proposed as a perineural local anaesthetic (LA) adjunct to prolong peripheral nerve block duration; however, results from our previous meta-analysis in the setting of brachial plexus block (BPB) did not support its use. Many additional randomized trials have since been published. We thus conducted an updated meta-analysis. METHODS: Randomized trials investigating the addition of dexmedetomidine to LA compared with LA alone (Control) in BPB for upper extremity surgery were sought...
February 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28093621/outcome-of-elderly-undergoing-extracorporeal-life-support-in-refractory-cardiogenic-shock
#2
Suzanne de Waha, Tobias Graf, Steffen Desch, Georg Fuernau, Ingo Eitel, Janine Pöss, Alexander Jobs, Thomas Stiermaier, Jakob Ledwoch, Ariane Wiedau, Philipp Lurz, Gerhard Schuler, Holger Thiele
BACKGROUND: The current study presents data from a real-world cohort of patients with refractory cardiogenic shock (CS) undergoing extracorporeal life support (ECLS) focusing on the comparison of elderly versus younger patients. METHODS AND RESULTS: One hundred consecutive patients with refractory CS underwent percutaneous ECLS implantation performed by interventional cardiologists. Follow-up was performed at hospital discharge as well as at a median of 18 months [interquartile range 15-36]...
January 16, 2017: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/28079557/dobutamine-aggravates-haemodynamic-deterioration-induced-by-pleural-effusion-a-randomised-controlled-porcine-study
#3
Kristian B Wemmelund, Anders H Sørensen, Viktor K Ringgård, Erik Sloth, Peter Juhl-Olsen
BACKGROUND: Pleural effusion is a common finding in critically ill patients and may contribute to circulatory instability and the need for inotropic support. OBJECTIVE: We hypothesised that dobutamine would affect the physiological determinants preload, afterload, contractility and changes of inferior vena cava characteristics during experimental pleural effusion. DESIGN: A randomised, controlled laboratory study. SETTING: Animal laboratory, conducted from March 2013 to May 2013...
January 11, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/28075423/effects-of-device-guided-slow-breathing-training-on-exercise-capacity-cardiac-function-and-respiratory-patterns-during-sleep-in-male-and-female-patients-with-chronic-heart-failure
#4
Kalina Kawecka-Jaszcz, Grzegorz Bilo, Tomasz Drożdż, Dorota Dębicka-Dąbrowska, Grzegorz Kiełbasa, Gabriella Malfatto, Katarzyna Styczkiewicz, Carolina Lombardi, Agnieszka Bednarek, Sabrina Salerno, Danuta Czarnecka, Gianfranco Parati
INTRODUCTION    Slow breathing training (SBT) has been proposed as new non-pharmacological treatment in chronic heart failure (CHF) patients.  OBJECTIVES    The aim of this study was to assess the effects of SBT on exercise capacity, haemodynamic parameters and sleep respiratory patterns in a relatively large sample of CHF patients. PATIENTS ABD METHODS    A cross-over open study was conducted. The patients completed, in random order, 10-12 week periods of SBT with the RESPeRATE device (InterCure Ltd...
January 10, 2017: Polskie Archiwum Medycyny Wewnętrznej
https://www.readbyqxmd.com/read/28073853/resuscitation-of-prolonged-cardiac-arrest-from-massive-pulmonary-embolism-by-extracorporeal-membrane-oxygenation
#5
Yun Seok Kim, Wookjin Choi, Jaecheol Hwang
Extracorporeal cardiopulmonary resuscitation can be used as a rescue strategy in cases of prolonged cardiac arrest caused by massive pulmonary embolism. We present a case of a male patient who was in prolonged cardiac arrest following massive pulmonary embolism. Veno-arterial extracorporeal membrane oxygenation was initiated approximately 93 min after prolonged cardiopulmonary resuscitation. After resuscitation, bedside echocardiography and a chest computed tomography angiogram revealed a massive pulmonary embolism during extracorporeal membrane oxygenation support...
January 10, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28070029/the-relationship-between-scores-and-outcomes-for-polytrauma-patients-in-the-emergency-department-a-case-study
#6
Maria Gioffre-Florio, Letizia Maria Murabito, Carmela Visalli, Alessandra Villari, Floriana Lauritano, Carla Bramanti, Fausto Fama
AIM: Traumas are one of the most relevant pathological events in health care, because of clinical and prognostic relevance. Morbidity and mortality rates are strongly affected by the timely and correct approach to the patient (golden hour). The objective of this study was to investigate the possible influence of the diagnostic time and of the Injury Severity Score (ISS) on outcomes in trauma patients. MATERIAL OF STUDY: Out of a total of 240,833 emergency patients, we observed, 447 polytrauma...
December 29, 2016: Annali Italiani di Chirurgia
https://www.readbyqxmd.com/read/28011838/analysis-of-lead-placement-optimization-metrics-in-cardiac-resynchronization-therapy-with-computational-modelling
#7
Andrew Crozier, Bojan Blazevic, Pablo Lamata, Gernot Plank, Matthew Ginks, Simon Duckett, Manav Sohal, Anoop Shetty, Christopher A Rinaldi, Reza Razavi, Steven A Niederer, Nicolas P Smith
AIMS: The efficacy of cardiac resynchronization therapy (CRT) is known to vary considerably with pacing location, however the most effective set of metrics by which to select the optimal pacing site is not yet well understood. Computational modelling offers a powerful methodology to comprehensively test the effect of pacing location in silico and investigate how to best optimize therapy using clinically available metrics for the individual patient. METHODS AND RESULTS: Personalized computational models of cardiac electromechanics were used to perform an in silico left ventricle (LV) pacing site optimization study as part of biventricular CRT in three patient cases...
December 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28007868/systemic-right-ventricular-morphology-in-the-early-postoperative-course-after-extracardiac-fontan-operation-is-there-still-a-need-for-special-care
#8
Sarah Nordmeyer, Melanie Rohder, Johannes Nordmeyer, Oliver Miera, Björn Peters, Mi-Young Cho, Joachim Photiadis, Felix Berger, Stanislav Ovroutski
OBJECTIVES: We aimed to compare early postoperative outcome after extracardiac (EC) Fontan operation between patients with right (RV) or left (LV) systemic ventricles. METHODS: In total, 173 consecutive patients (median age 4 years, median weight 14 kg) underwent EC Fontan between 1995 and 2013. Pre- and intraoperative data as well as detailed postoperative haemodynamic variables were compared between patients with LV [n = 109 (63%)] and RV [n = 64 (37%)]...
December 22, 2016: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/27997586/determination-of-normal-ranges-of-shock-index-and-other-haemodynamic-variables-in-the-immediate-postpartum-period-a-cohort-study
#9
Hannah L Nathan, Kate Cottam, Natasha L Hezelgrave, Paul T Seed, Annette Briley, Susan Bewley, Lucy C Chappell, Andrew H Shennan
OBJECTIVE: To determine the normal ranges of vital signs, including blood pressure (BP), mean arterial pressure (MAP), heart rate (HR) and shock index (SI) (HR/systolic BP), in the immediate postpartum period to inform the development of robust obstetric early warning scores. STUDY DESIGN: We conducted a secondary analysis of a prospective observational cohort study evaluating vital signs collected within one hour following delivery in women with estimated blood loss (EBL) <500ml (316 women) delivering at a UK tertiary centre over a one-year period...
2016: PloS One
https://www.readbyqxmd.com/read/27984799/antidiabetic-activity-of-embelia-ribes-embelin-and-its-derivatives-a-systematic-review-and-meta-analysis
#10
REVIEW
Sharanbasappa Durg, Veeresh P Veerapur, Satrasala Neelima, Shivsharan B Dhadde
Embelia ribes (ER) has been documented in Ayurveda for treating various diseases, including diabetes mellitus (DM). The present systematic review and meta-analysis evaluated the efficacy and safety of ER and its active bio-marker, embelin and its derivatives in the treatment of DM. Literature search was performed in PubMed/MEDLINE, EMBASE, Scopus, ScienceDirect, Scifinder, and Google Scholar. Using Review Manager, meta-analysis of ER/embelin/derivatives of embelin versus diabetic control was performed with inverse-variance model, providing mean differences (MDs) and 95% confidence intervals (CIs)...
December 13, 2016: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
https://www.readbyqxmd.com/read/27933463/effect-of-tempol-and-tempol-plus-catalase-on-intra-renal-haemodynamics-in-spontaneously-hypertensive-stroke-prone-shsp-and-wistar-rats
#11
Ahmad F Ahmeda, Mark G Rae, Mohammed F Al Otaibi, Lamyia M Anweigi, Edward J Johns
Vasoconstriction within the renal medulla contributes to the development of hypertension. This study investigated the role of reactive oxygen species (ROS) in regulating renal medullary and cortical blood perfusion (MBP and CBP respectively) in both stroke-prone spontaneously hypertensive rats (SHRSP) and Wistar rats. CBP and MBP were measured using a laser-Doppler flow meter before and after intra-renal infusion of tempol, the superoxide dismutase (SOD) mimetic or tempol plus catalase, the hydrogen peroxide-degrading enzyme...
December 9, 2016: Journal of Physiology and Biochemistry
https://www.readbyqxmd.com/read/27931645/haemodynamic-coherence%C3%A2-%C3%A2-the-relevance-of-fluid-therapy
#12
REVIEW
Philip Arnemann, Laura Seidel, Christian Ertmer
The ultimate goal of fluid therapy is to improve the oxygenation of cells by improving the cardiac output, thus improving microcirculation by optimizing macrocirculation. This haemodynamic coherence is often altered in patients with haemorrhagic shock and sepsis. The loss of haemodynamic coherence is associated with adverse outcomes. It may be influenced by the mechanisms of the underlying disease and properties of different fluids used for resuscitation in these critically ill patients. Monitoring microcirculation and haemodynamic coherence may be an additional tool to predict the response to fluid administration...
December 2016: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/27880060/neurogenic-pulmonary-oedema-complicating-traumatic-posterior-fossa-extradural-haematoma-case-report-and-review
#13
Ajay Hegde, G Lakshmi Prasad, Priyanka Kini
INTRODUCTION: Pulmonary oedema is accumulation of fluid in the lung air spaces and interstitia. Neurogenic pulmonary oedema (NPE) is a potentially life-threatening condition which has been noted in head injury, subarachnoid haemorrhage (SAH), intracerebral haemorrhage (ICH) and others. Timely management is crucial to achieve good outcome; however, no specific guidelines have been defined. METHODS: A 33-year female involved in a motor vehicular accident had a GCS of 14/15 and CT scan showed a moderate-sized unilateral posterior fossa extradural haematoma (PFEDH)...
2017: Brain Injury: [BI]
https://www.readbyqxmd.com/read/27858465/established-and-novel-treatment-options-in-acute-myocarditis-with-or-without-heart-failure
#14
George Lazaros, Evangelos Oikonomou, Dimitris Tousoulis
Acute myocarditis is a disorder characterized by an unpredictable clinical course which ranges from asymptomatic, incidentally discovered forms, to cases with fulminant course and adverse outcome. The most challenging issues in the context of acute myocarditis are the appearance of difficult to treat heart failure in the acute phase and the potential progression in the long-term to dilated cardiomyopathy. Areas covered: With respect to available treatment options in acute myocarditis, in the absence of specific guidelines, management is supportive and overall empirical, especially for the oligo- or asymptomatic patients with preserved ejection fraction...
January 2017: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/27848906/-attempted-suicide-with-barbiturates-purchased-online
#15
S F Chavoushi, L Mesman, P G Noordzij, M A Sikma, E M van Maarseveen
BACKGROUND: Barbiturate intoxication is potentially lethal. With the availability of the newer anticonvulsants the use of barbiturates in treating epilepsy has decreased significantly, with a concurrent decrease in the incidence of overdose with these medications. There have, however, been recent alarm signals from governmental sources concerning the increase in the Internet purchase of illegal medications, including barbiturates, for use in attempted suicide. CASE DESCRIPTION: Here we describe two patient cases involving barbiturate intoxication with amobarbital and thiopental, respectively...
2016: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/27813339/metabolic-support-for-the-heart-complementary-therapy-for-heart-failure
#16
REVIEW
Ward A Heggermont, Anna-Pia Papageorgiou, Stephane Heymans, Marc van Bilsen
The failing heart has an increased metabolic demand and at the same time suffers from impaired energy efficiency, which is a detrimental combination. Therefore, therapies targeting the energy-deprived failing heart and rewiring cardiac metabolism are of great potential, but are lacking in daily clinical practice. Metabolic impairment in heart failure patients has been well characterized for patients with reduced ejection fraction, and is coming of age in patients with 'preserved' ejection fraction. Targeting cardiomyocyte metabolism in heart failure could complement current heart failure treatments that do improve cardiovascular haemodynamics, but not the energetic status of the heart...
December 2016: European Journal of Heart Failure
https://www.readbyqxmd.com/read/27797797/infrarenal-aortic-clamp-reviving-a-patient-from-acute-surgical-haemorrhagic-shock-a-novel-management-technique
#17
Ranjith Kumar, M V S Satya Prakash, Subhasree Das, Ramanitharan Manikandan
Surgical management of renal cell carcinoma extending into the inferior vena cava (IVC) is almost always accompanied by massive intraoperative blood loss and associated complications. It is a widely recognised problem, and its active management is essential in improving the perioperative morbidity and mortality. We share our experience with a similar case of open radical nephrectomy with massive blood loss of twice the circulating volume in a duration of <8 surgical hours. Although we emphasise the goals of securing haemostasis, restoration of circulating volume, and efficient management by replacing blood components, in the present case, despite the above-mentioned goals being fulfilled, we were unable to extricate the patient from haemorrhagic shock by conventional means and therefore resorted to desperate measures, namely the novel approach of infrarenal aortic clamping along with higher than recommended vasopressor support...
October 19, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27726292/rapid-pacing-using-the-0-035-in-retrograde-left-ventricular-support-wire-in-208-cases-of-transcatheter-aortic-valve-implantation-and-balloon-aortic-valvuloplasty
#18
Roland Hilling-Smith, James Cockburn, Maureen Dooley, Jessica Parker, Andrea Newton, Andrew Hill, Uday Trivedi, Adam de Belder, David Hildick-Smith
: Transcatheter aortic valve implantation (TAVI) and balloon aortic valvuloplasty (BAV) are now well established percutaneous procedures. These procedures almost always require bursts of rapid ventricular pacing to temporarily reduce cardiac output to facilitate the procedure, usually done via a temporary pacing wire inserted into the right ventricle. We describe a case series of 132 cases of TAVI and 76 BAV done using ventricular pacing via the left ventricular lead by simply connecting one electrode to the patient's skin and one electrode through the left ventricular (LV) wire...
October 11, 2016: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/27680819/h3-maternal-haedomynamics-in-hypertensive-disorders-of-pregnancy-a-case-control-study
#19
D Vinayagam, Elena Mantovani, B Thilaganthan, A Khalil
BACKGROUND: Hypertensive disorders in pregnancy (HDP) are associated with altered maternal haemodynamics, which can be investigated using non-invasive methodologies. OBJECTIVE: To assess maternal haemodynamics using USCOM 1A® in patients presenting with non-medicated, hypertensive disorders of pregnancy and normotensive controls. METHODS: A prospective, nested case-control study in 65 patients presenting with unmedicated hypertension. The control population consisted of 400 subjects who did not have a history of hypertensive disorders...
August 2016: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/27660252/sepsis-and-septic-shock-is-a-microcirculation-a-main-player
#20
Małgorzata Lipinska-Gediga
Shock, defined at a cellular level, is a condition in which oxygen delivery to the cells is not sufficient to sustain cellular activity and support organ function. The central role of microcirculation in providing oxygen to the cells makes it of prime importance in determining organ function. In sepsis and septic shock, macrocirculatory alterations and microcirculatory dysfunction participate concurrently in the pathophysiology of organ failure. Haemodynamic coherence in shock is a condition in which normalization of systemic haemodynamic variables results in simultaneous amelioration in the perfusion of the microcirculation and restoration of tissue oxygenation as a final result...
September 23, 2016: Anaesthesiology Intensive Therapy
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