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https://www.readbyqxmd.com/read/28797619/mechanical-ventilation-weaning-protocol-improves-medical-adherence-and-results
#1
Luís Guilherme Alegretti Borges, Augusto Savi, Cassiano Teixeira, Roselaine Pinheiro de Oliveira, Marcio Luiz Ferreira De Camillis, Ricardo Wickert, Sérgio Fernando Monteiro Brodt, Túlio Frederico Tonietto, Ricardo Cremonese, Leonardo Silveira da Silva, Fernanda Gehm, Eubrando Silvestre Oliveira, Jose Herve Diel Barth, Juçara Gasparetto Macari, Cíntia Dias de Barros, Sílvia Regina Rios Vieira
INTRODUCTION: Implementation of a weaning protocol is related to better patient prognosis. However, new approaches may take several years to become the standard of care in daily practice. We conducted a prospective cohort study to investigate the effectiveness of a multifaceted strategy to implement a protocol to wean patients from mechanical ventilation (MV) and to evaluate the weaning success rate as well as practitioner adherence to the protocol. METHODS: We investigated all consecutive MV-dependent subjects admitted to a medical-surgical intensive care unit (ICU) for >24h over 7years...
July 12, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28782830/altered-behavioral-responses-to-gamma-aminobutyric-acid-pharmacological-agents-in-a-mouse-model-of-huntington-s-disease
#2
Yi-Ting Hsu, Ya-Gin Chang, Ching-Pang Chang, Jian-Jing Siew, Hui-Mei Chen, Chon-Haw Tsai, Yijuang Chern
BACKGROUND: Disruptions in gamma-aminobutyric (GABA) acid signaling are believed to be involved in Huntington's disease pathogenesis, but the regulation of GABAergic signaling remains elusive. Here we evaluated GABAergic signaling by examining the function of GABAergic drugs in Huntington's disease and the expression of GABAergic molecules using mouse models and human brain tissues from Huntington's disease. METHODS: We treated wild-type and R6/2 mice (a transgenic Huntington's disease mouse model) acutely with vehicle, diazepam, or gaboxadol (drugs that selectively target synaptic or extrasynaptic GABAA receptors) and monitored their locomotor activity...
August 7, 2017: Movement Disorders: Official Journal of the Movement Disorder Society
https://www.readbyqxmd.com/read/28782097/interactions-between-cannabidiol-and-commonly-used-antiepileptic-drugs
#3
Tyler E Gaston, E Martina Bebin, Gary R Cutter, Yuliang Liu, Jerzy P Szaflarski
OBJECTIVE: To identify potential pharmacokinetic interactions between the pharmaceutical formulation of cannabidiol (CBD; Epidiolex) and the commonly used antiepileptic drugs (AEDs) through an open-label safety study. Serum levels were monitored to identify interactions between CBD and AEDs. METHODS: In 39 adults and 42 children, CBD dose was started at 5 mg/kg/day and increased every 2 weeks by 5 mg/kg/day up to a maximum of 50 mg/kg/day. Serum AED levels were obtained at baseline prior to CBD initiation and at most study visits...
August 6, 2017: Epilepsia
https://www.readbyqxmd.com/read/28781041/advancements-in-evidence-based-anesthesia-of-exotic-animals
#4
REVIEW
Julie A Balko, Sathya K Chinnadurai
Anesthesia and sedation of pet nondomestic species are often necessary for both invasive and noninvasive procedures. Even minimally invasive procedures can be stressful for small prey species that are not domesticated or acclimated to human contact and restraint. Recent advancements in evidence-based practice will continue to improve the field based on scientifically sound best practices and rely less on anecdotal recommendations. This article focuses on new scientific literature that has been published in the past 5 years...
September 2017: Veterinary Clinics of North America. Exotic Animal Practice
https://www.readbyqxmd.com/read/28776686/contralateral-r1-and-r2-components-of-the-laryngeal-adductor-reflex-in-humans-under-general-anesthesia
#5
Catherine F Sinclair, Maria J Téllez, Oscar R Tapia, Sedat Ulkatan
OBJECTIVES: To demonstrate that under total intravenous general anesthesia (TIVA), the contralateral R1 (cRI) and contralateral R2 (cR2) components of the laryngeal adductor reflex (LAR) can be reliably elicited; to determine effects of topical anesthesia and inhalational anesthesia on the LAR; and to discuss how this technique may be utilized to continuously monitor the vagus nerve reflex arc. STUDY DESIGN: Case series. METHODS: Vocal fold mucosa was electrically stimulated via endotracheal tube surface-based electrodes to elicit a LAR...
August 4, 2017: Laryngoscope
https://www.readbyqxmd.com/read/28774294/temperature-variability-in-the-day-night-cycle-is-associated-with-further-intracranial-pressure-during-therapeutic-hypothermia
#6
Adriano Barreto Nogueira, Eva Annen, Oliver Boss, Faraneh Farokhzad, Christopher Sikorski, Emanuela Keller
BACKGROUND: To assess whether circadian patterns of temperature correlate with further values of intracranial pressure (ICP) in severe brain injury treated with hypothermia. METHODS: We retrospectively analyzed temperature values in subarachnoid hemorrhage patients treated with hypothermia by endovascular cooling. The circadian patterns of temperature were correlated with the mean ICP across the following day (ICP24). RESULTS: We analyzed data from 17 days of monitoring of three subarachnoid hemorrhage patients that underwent aneurysm coiling, sedation and hypothermia due to refractory intracranial hypertension and/or cerebral vasospasm...
August 3, 2017: Journal of Translational Medicine
https://www.readbyqxmd.com/read/28769979/safety-and-effectiveness-of-endoscopist-directed-nurse-administered-sedation-during-gastric-endoscopic-submucosal-dissection
#7
Yong Suk Cho, Sang Youn Shin, Changhyeok Hwang, Jeonghun Seo, Jong Won Choi, Byung Kyu Park, Sun Young Won, Chun Kyon Lee, Yong Kang Lee, Han Ho Jeon
BACKGROUND AND AIMS: Endoscopic submucosal dissection (ESD) is routinely performed in treating gastric neoplasia and requires long-term higher levels of sedation. Endoscopist-directed nurse-administered sedation (EDNAS) has not been well studied in ESD. This study aimed to evaluate the safety and effectiveness of EDNAS for ESD. METHODS: Patients treated with ESD for gastric tumors between 2013 and 2015 were retrospectively collected. Patients were divided into a midazolam-treated group (M group) and a midazolam plus propofol-treated group (MP group)...
2017: Gastroenterology Research and Practice
https://www.readbyqxmd.com/read/28767471/high-flow-nasal-oxygen-in-patient-with-obstructive-sleep-apnea-undergoing-awake-craniotomy-a-case-report
#8
Jaclyn W M Wong, Amy H S Kong, Sau Yee Lam, Peter Y M Woo
Patients with obstructive sleep apnea are frequently considered unsuitable candidates for awake craniotomy due to anticipated problems with oxygenation, ventilation, and a potentially difficult airway. At present, only a handful of such accounts exist in the literature. Our report describes the novel use of high-flow nasal oxygen therapy for a patient with moderate obstructive sleep apnea who underwent an awake craniotomy under deep sedation. The intraoperative application of high-flow nasal oxygen therapy achieved satisfactory oxygenation, maintained the partial carbon dioxide pressure within a reasonable range even during periods of deep sedation, permitted responsive patient monitoring during mapping, and provided excellent patient and surgeon satisfaction...
August 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28765758/clinical-benefits-of-deep-sedation-with-a-supraglottic-airway-while-monitoring-the-bispectral-index-during-catheter-ablation-of-atrial-fibrillation
#9
Satoru Hida, Masao Takemoto, Akihiro Masumoto, Takahiro Mito, Kazuhiro Nagaoka, Hiroshi Kumeda, Yuki Kawano, Ryota Aoki, Honsa Kang, Atsushi Tanaka, Atsutoshi Matsuo, Kiyoshi Hironaga, Teiji Okazaki, Kiyonobu Yoshitake, Kei-Ichiro Tayama, Ken-Ichi Kosuga
BACKGROUND: Pulmonary vein antrum isolation (PVAI) under sedation has proven to be a useful strategy for catheter ablation of atrial fibrillation (AF). METHODS: To evaluate the clinical benefits of respiratory management using supraglottic airways (SGAs) under deep sedation while monitoring the bispectral (BIS) index during the PVAI and the durations from admission to the catheterization room to starting the radiofrequency energy delivery (Time α), and from starting the radiofrequency energy delivery to completion of the PVAI (Time β), X-ray time, frequency of dislocations of the three-dimensional maps (D3DM), procedure-related complications, and proportion of an AF-free rate 15 months after the PVAI (PAFFR) in patients who received deep sedation without SGAs (Group A: n=48) and those with SGAs (Group B: n=51) were evaluated...
August 2017: Journal of Arrhythmia
https://www.readbyqxmd.com/read/28763361/dexmedetomidine-associated-hyperthermia-a-series-of-9-cases-and-a-review-of-the-literature
#10
Bernard D Krüger, Judith Kurmann, Natascia Corti, Donat R Spahn, Dominique Bettex, Alain Rudiger
Dexmedetomidine, an α2-adrenergic agonist, can be used to perform mild to moderate sedation in critically ill patients. In this case series, 9 cardiovascular intensive care unit patients with hyperthermia during dexmedetomidine administration, suggestive of drug fever, are presented. Hyperthermia (>38.5°C) occurred 6 (4-10) hours (median [interquartile range]) after dexmedetomidine initiation at a dose of 1.0 (0.8-1.3) μg/kg/h and was resolved 3 (1-8) hours after discontinuation of dexmedetomidine. All patients were screened for infectious and noninfectious causes of hyperthermia, and the findings were analyzed by 2 adverse drug reaction (ADR) assessment methods-the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) Causality Assessment and the Naranjo ADR scale...
July 28, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28761693/effect-of-dexmedetomidine-in-the-prophylactic-endoscopic-injection-sclerotherapy-for-oesophageal-varices-a-study-protocol-for-prospective-interventional-study
#11
Hiroki Nishikawa, Yoshinori Iwata, Akio Ishii, Hirayuki Enomoto, Yukihisa Yuri, Noriko Ishii, Yuho Miyamoto, Kunihiro Hasegawa, Chikage Nakano, Ryo Takata, Takashi Nishimura, Kazunori Yoh, Nobuhiro Aizawa, Yoshiyuki Sakai, Naoto Ikeda, Tomoyuki Takashima, Hiroko Iijima, Shuhei Nishiguchi
BACKGROUND: Dexmedetomidine (DEX) is a novel, highly selective α2-adrenoceptor agonist that elicits sedative, amnestic, sympatholytic and analgesic effects in patients. Several Japanese investigators have reported the clinical usefulness of DEX for sedation in endoscopic therapies for gastrointestinal malignancies; however, there have been limited data regarding the usefulness and safety of DEX for sedation during endoscopic procedures for oesophageal varices (OVs), such as endoscopic injection sclerotherapy (EIS)...
2017: BMJ Open Gastroenterology
https://www.readbyqxmd.com/read/28759530/sevoflurane-attenuates-systemic-inflammation-compared-with-propofol-but-does-not-modulate-neuro-inflammation-a-laboratory-rat-study
#12
Beatrice Beck-Schimmer, Lukas Baumann, Tanja Restin, Philipp Eugster, Melanie Hasler, Christa Booy, Martin Schläpfer
BACKGROUND: Septic encephalopathy is believed to be a result of neuro-inflammation possibly triggered by endotoxins, such as lipopolysaccharides (LPS). Modulation of the immune system is a property of volatile anaesthetics. OBJECTIVE: We aimed to investigate the systemic and cerebral inflammatory response in a LPS-induced sepsis model in rats. We compared two different sedation strategies, intravenous propofol and the volatile anaesthetic sevoflurane, with the hypothesis that the latter may attenuate neuro-inflammatory processes...
July 28, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/28750729/-preparation-of-sedation-analgesia-procedures-in-spanish-paediatric-emergency-departments-a-descriptive-study
#13
Concepción Míguez, Niki Oikonomopoulou, Jorge Lorente, Paula Vázquez
INTRODUCTION: The objective of this study was to describe the current practice regarding the preparation of the sedation-analgesia (SA) procedures performed in the paediatric emergency centres in Spain. MATERIAL AND METHODS: A multicentre, observational and prospective analytical study was carried out on the SA procedures that were performed on children under 18 years-old in 18 paediatric emergency departments between February 2015 and January 2016. RESULTS: A total of 658 SA procedures were registered in 18 hospitals of Spain, most of them to children older than 24 months...
July 24, 2017: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría (A.E.P.)
https://www.readbyqxmd.com/read/28741229/inhaled-antimicrobials-for-ventilator-associated-pneumonia-practical-aspects
#14
Garyphallia Poulakou, Dimitrios K Matthaiou, David P Nicolau, Georgios Siakallis, George Dimopoulos
Positive experience with inhaled antibiotics in pulmonary infections of patients with cystic fibrosis has paved the way for their utilization in mechanically ventilated, critically ill patients with lower respiratory tract infections. A successful antibiotic delivery depends upon the size of the generated particle and the elimination of drug impaction in the large airways and the ventilator circuit. Generated droplet size is mainly affected by the type of the nebulizer employed. Currently, jet, ultrasonic, and vibrating mesh nebulizers are marketed; the latter can deliver optimal antibiotic particle size...
July 24, 2017: Drugs
https://www.readbyqxmd.com/read/28733841/analgosedation-of-adult-patients-with-elevated-intracranial-pressure-survey-of-current-clinical-practice-in-austria
#15
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/28727994/retrospective-evaluation-of-the-procedural-sedation-practices-of-expert-nurses-during-abortion-care
#16
Monica R McLemore, E Angel Aztlan
OBJECTIVE: To evaluate the provision of procedural sedation during abortion by expert nurses and to describe the factors that are associated with time to discharge for women who receive this sedation. DESIGN: Retrospective chart review. METHODS: Descriptive statistics were generated to describe a retrospective cohort of women presenting for abortion under procedural sedation. Analysis of variance was used to determine significant characteristics that influenced time to discharge...
July 17, 2017: Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN
https://www.readbyqxmd.com/read/28725247/novel-anesthetic-technique-for-combined-intracavitary-and-interstitial-brachytherapy-for-cervix-cancer-in-an-outpatient-setting
#17
Yiat Horng Leong, Kenneth Hock Soon Tan, Bok Ai Choo, Vicky Yaling Koh, Johann I-Hsiung Tang
PURPOSE: To determine the feasibility and safety of outpatient combined intracavitary and interstitial brachytherapy for cervix cancer with sedation and local anesthesia. MATERIAL AND METHODS: We included patients diagnosed with non-metastatic cervix cancer and have completed brachytherapy between December 2015 and December 2016. Moderate to deep sedation was achieved using intravenous midazolam, propofol, fentanyl, and oxycodone. Local anesthesia was achieved with 2% lignocaine gel and a paracervical block containing a mixture of 1% ropivacaine, 2% lignocaine, and 1 : 1,000 adrenaline...
June 2017: Journal of Contemporary Brachytherapy
https://www.readbyqxmd.com/read/28716685/the-use-of-alfaxalone-for-premedication-induction-and-maintenance-of-anaesthesia-in-pigs-a-pilot-study
#18
Sarah E Bigby, Jennifer E Carter, Sébastien Bauquier, Thierry Beths
OBJECTIVE: The evaluation of alfaxalone as a premedication agent and intravenous anaesthetic in pigs. STUDY DESIGN: Prospective, clinical trial. ANIMALS: Nine healthy, 6-8-week-old female Landrace pigs weighing 22.2 ± 1.0 kg, undergoing epidural catheter placement. METHODS: All pigs were premedicated with 4 mg kg(-1) alfaxalone, 40 μg kg(-1) medetomidine and 0.4 mg kg(-1) butorphanol administered in the cervical musculature...
March 21, 2017: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/28712906/a-comparison-of-pharmacologic-therapeutic-agents-used-for-the-reduction-of-intracranial-pressure-following-traumatic-brain-injury
#19
REVIEW
Ahmed M Alnemari, Brianna M Krafcik, Tarek R Mansour, Daniel Gaudin
OBJECTIVE: In neurotrauma care, a better understanding of treatments following traumatic brain injury (TBI) has led to a significant decrease in morbidity and mortality in this population. TBI represents a significant medical problem, and complications following TBI are associated with the initial injury and post-event intracranial processes such as elevated intracranial pressure (ICP) and brain edema. Consequently, appropriate therapeutic interventions are required to reduce brain tissue damage and improve cerebral perfusion...
July 13, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28710219/comparison-of-propofol-and-dexmedetomidine-infused-overnight-to-treat-hyperactive-and-mixed-icu-delirium-a-protocol-for-the-basel-prodex-clinical-trial
#20
Alexa Hollinger, Katrin Ledergerber, Stefanie von Felten, Raoul Sutter, Stephan Rüegg, Lukas Gantner, Sibylle Zimmermann, Andrea Blum, Luzius A Steiner, Stephan Marsch, Martin Siegemund
BACKGROUND/OBJECTIVES: Delirium is a neurobehavioural disturbance that frequently develops particularly in the intensive care unit (ICU) population. It was first described more than half a century ago, where it was already discovered as a state that might come along with serious complications such as prolonged ICU and hospital stay, reduced quality of life and increased mortality. However, in most cases, there is still lack of proof for causal relationship. Its presence frequently remains unrecognised due to suggested predominance of the hypoactive form...
July 13, 2017: BMJ Open
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