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https://www.readbyqxmd.com/read/29140927/clinical-trial-designs-and-models-for-analgesic-medications-for-acute-pain-in-neonates-infants-toddlers-children-and-adolescents-acttion-recommendations
#1
Gary A Walco, Ernest A Kopecky, Steven J Weisman, Jennifer Stinson, Bonnie Stevens, Paul J Desjardins, Charles B Berde, Elliot J Krane, Kanwaljeet Js Anand, Myron Yaster, Carlton D Dampier, Robert H Dworkin, Ian Gilron, Anne M Lynn, Lynne G Maxwell, Srinivasa Raja, Bernard Schachtel, Dennis C Turk
Clinical trials to test the safety and efficacy of analgesics across all pediatric age cohorts are needed to avoid inappropriate extrapolation of adult data to children. However, the selection of acute pain models and trial design attributes to maximize assay sensitivity, by pediatric age cohort, remains problematic. Acute pain models used for drug treatment trials in adults are not directly applicable to the pediatric age cohorts - neonates, infants, toddlers, children, and adolescents. Developmental maturation of metabolic enzymes in infants and children must be taken into consideration when designing trials to test analgesic treatments for acute pain...
November 13, 2017: Pain
https://www.readbyqxmd.com/read/29139031/in-vivo-analysis-of-the-anti-atrial-fibrillatory-proarrhythmic-and-cardiodepressive-profiles-of-dronedarone-as-a-guide-for-safety-pharmacological-evaluation-of-antiarrhythmic-drugs
#2
Yoshiyuki Motokawa, Yuji Nakamura, Mihoko Hagiwara-Nagasawa, Ai Goto, Koki Chiba, Nur Jaharat Lubna, Hiroko Izumi-Nakaseko, Kentaro Ando, Atsuhiko T Naito, Hiroshi Yamazaki, Atsushi Sugiyama
Anti-atrial fibrillatory, proarrhythmic and cardiodepressive profiles of dronedarone were analyzed using the halothane-anesthetized beagle dogs (n = 4) to create a standard protocol for clarifying both efficacy and adverse effects of anti-atrial fibrillatory drugs. Intravenous administration of dronedarone hydrochloride in doses of 0.3 and 3 mg/kg over 30 s attained the peak plasma concentrations of 61 and 1248 ng/mL, respectively, reflecting sub- to supra-therapeutic ones. The low dose decreased the left ventricular contraction and mean blood pressure, which were enhanced at the high dose...
November 14, 2017: Cardiovascular Toxicology
https://www.readbyqxmd.com/read/29126680/anesthetic-and-perioperative-considerations-for-combined-heart-kidney-transplantation
#3
Santiago Mc Loughlin, Juan C Bianco, Ricardo G Marenchino
OBJECTIVE: To describe detailed perioperative features of combined heart and kidney transplant (HKT). DESIGN: Retrospective study. SETTING: Tertiary care university hospital. PARTICIPANTS: All consecutive HKT recipients aged 18 years and older. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: After approval of the Institutional Review Board, the authors studied all consecutive adult patients who underwent HKT between January 2013 and July 2016...
September 15, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29110798/intraoperative-anesthetic-management-of-lung-transplantation-patients
#4
REVIEW
Bessie Kachulis, Ludmil Mitrev, Desmond Jordan
Lung transplantation is a high-risk procedure that requires a highly trained cardiothoracic anesthesiologist and a considerable degree of vigilance. In the 50 years since the first lung transplantation, improvements in immunosuppression, preservation solutions, and surgical techniques and technologies have led to increased survival rates. The development of the extracorporeal circulatory membrane oxygenation allowed for bridge to transplantation and for donor organ recovery from primary graft dysfunction post transplantation [1]...
June 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29110795/anesthetic-management-of-the-patient-with-extracorporeal-membrane-oxygenator-support
#5
REVIEW
Marie-Louise Meng, Matthew D Bacchetta, Jessica Spellman
The use of short-term mechanical circulatory support in the form of extracorporeal membrane oxygenation (ECMO) in adult patients has increased over the last decade. Cardiothoracic anesthesiologists may care for these patients during ECMO placement and for procedures while ECMO support is in place. An understanding of ECMO capabilities, indications, and complications is essential to the anesthesiologist caring for these patients. Below we review the anesthetic considerations for the implantation of ECMO and concerns when caring for patients on ECMO...
June 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29110794/anesthetic-management-of-the-patient-with-a-ventricular-assist-device
#6
REVIEW
Marie-Louise Meng, Jessica Spellman
The use of long- and short-term mechanical circulatory support in the form of ventricular assist device (VAD) has increased over the last decade. Although cardiothoracic anesthesiologists care for these patients during device placement, increasingly higher numbers of general anesthesiologists are involved in the management of VAD patients during noncardiac surgery and procedures. An understanding of devices, their indications, and complications is essential to the anesthesiologists caring for these patients...
June 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29101959/pediatric-anesthesia-considerations-for-interventional-radiology
#7
REVIEW
Olivia Nelson, Philip D Bailey
Anesthesiologists are increasingly called on to care for pediatric patients undergoing diagnostic imaging and invasive procedures in interventional radiology. These procedures are typically classified as either nonvascular or vascular, and can range from short diagnostic imaging studies or biopsies to significantly longer and more invasive intravascular procedures. Anesthesia providers must consider each child's ability to cooperate reliably during the procedure, their age, and any cognitive impairment to define the best anesthetic plan...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29090255/anesthetic-considerations-for-a-pediatric-patient-with-wolf-hirschhorn-syndrome-a-case-report
#8
Masanori Tsukamoto, Hitoshi Yamanaka, Takeshi Yokoyama
Wolf-Hirschhorn syndrome is a rare hereditary disease that results from a 4p chromosome deletion. Patients with this syndrome are characterized by craniofacial dysgenesis, seizures, growth delay, intellectual disability, and congenital heart disease. Although several cases have been reported, very little information is available on anesthetic management for patients with Wolf-Hirschhorn syndrome. We encountered a case requiring anesthetic management for a 2-year-old girl with Wolf-Hirschhorn syndrome. The selection of an appropriately sized tracheal tube and maintaining intraoperatively stable hemodynamics might be critical problems for anesthetic management...
September 2017: J Dent Anesth Pain Med
https://www.readbyqxmd.com/read/29077663/anesthetic-management-of-a-patient-with-de-novo-hereditary-sensory-and-autonomic-neuropathy-type-vii-a-case-report
#9
Lorenzo Rafer, James Mooney
An 18-month-old patient with hereditary sensory and autonomic neuropathy, type VII undergoing general anesthesia for Nissen fundoplication and gastrostomy tube is presented. This is the first reported case of a patient with this particular genetic mutation receiving general anesthesia. We presented the major intraoperative events during the procedure. The anesthetic considerations and implications of caring for a patient with this particular mutation and patients with other variations of hereditary sensory and autonomic neuropathy are also discussed...
October 26, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/29076431/pharmacology-and-perioperative-considerations-of-pain-medications
#10
Ryan M Chadha, Stephen Aniskevich, Brian J Egan
BACKGROUND: Pain continues to be the most common medical concern, and perioperative health care providers are encountering increasing numbers of patients with chronic pain conditions. It is important to have a clear understanding of how long-term use of pain medications impacts anesthesia during the intraoperative and postoperative periods. OBJECTIVE: To review common medications used to treat chronic pain and summarize current recommendations regarding perioperative care...
October 27, 2017: Current Clinical Pharmacology
https://www.readbyqxmd.com/read/29075176/retinal-and-cortical-blood-flow-dynamics-following-systemic-blood-neural-barrier-disruption
#11
Flora Hui, Christine T O Nguyen, Zheng He, Algis J Vingrys, Rachel Gurrell, Rebecca L Fish, Bang V Bui
To consider whether imaging retinal vasculature may be used as a marker for cortical vessels, we compared fluorescein angiography flow dynamics before and after pharmacological disruption of blood-neural barriers. Sodium fluorescein (1%, 200 μl/kg) was intravenously delivered in anesthetized adult Long Evans rats (n = 44, brain = 18, retina = 26). In the brain cohort, a cranial window was created to allow direct visualization of surface cortical vessels. Video fluorescein angiography was captured using a rodent retinal camera at 30 frames/second and fluorescence intensity profiles were evaluated for the time to reach 50% brightness (half-rise), 50% decay (half-fall), and the plateau level of remnant fluorescence (offset, %)...
2017: Frontiers in Neuroscience
https://www.readbyqxmd.com/read/29053803/effect-of-radiation-on-sucrose-detection-thresholds-of-mice
#12
Benjamin C Jewkes, Linda A Barlow, Eugene R Delay
Radiotherapy is one of the most common treatments for head and neck cancers, with an almost obligate side effect of altered taste (Conger 1973). In mice, targeted irradiation of the head and neck causes transient repression of proliferation of basal epithelial cells responsible for taste cell replacement, leading to a temporary depletion of taste sensory cells within taste buds, including Type II taste cells involved in detection of sweet stimuli (Nguyen et al. 2012). These findings suggest that irradiation may elevate sucrose detection thresholds, peaking at 7 days post-irradiation when loss of Type II cells is greatest...
October 19, 2017: Chemical Senses
https://www.readbyqxmd.com/read/29047321/perioperative-and-anesthetic-considerations-in-pulmonary-atresia-with-intact-ventricular-septum
#13
Stephen Gleich, Gregory J Latham, Denise Joffe, Faith J Ross
Pulmonary atresia with intact ventricular septum (PA/IVS) is a rare right-heart obstructive lesion with a wide anatomic and physiologic spectrum of disease, ranging from simple membranous pulmonary valve atresia with a fully developed right ventricle (RV) to a severely hypoplastic RV and ventriculocoronary (RV-coronary) fistulas. Affected neonates are dependent on prostaglandin for adequate pulmonary blood flow. Depending on the severity of disease, treatment options range from transcatheter pulmonary valve perforation and ultimate biventricular repair to staged single-ventricle palliation...
October 1, 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29046779/anesthetic-management-during-the-first-combined-heart-liver-transplant-performed-in-korea-a-case-report
#14
Hyejin Park, Jungchan Park, Jonghwan Lee, Gaabsoo Kim
Herein, we describe the anesthetic management during the first combined heart-liver transplant (CHLT) performed in Korea. Though CHLT is a rare procedure, accumulating evidence suggests that it is a feasible option for patients with coexisting heart and liver failure. A 45-year-old female patient presented with severe cardiac dysfunction requiring extracorporeal membrane oxygenation (ECMO) support and secondary congestive hepatopathy. The patient underwent consecutive heart and liver transplantation using extracorporeal circulatory devices-heart transplant with cardiopulmonary bypass, and liver transplant with peripheral ECMO...
October 2017: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/29033732/double-aortic-arch-presenting-with-respiratory-distress-a-case-report-and-review-of-the-literature
#15
Abdelhafid Houba, Mustapha Bensghir, Redouane Ahtil, Badr Slioui, Hicham Balkhi, Salim Jaafar Lalaoui
Tracheal compression by vascular structures in infants is uncommon and may be masked by nonspecific respiratory symptoms. Double aortic arch (DAA) is the most common vascular ring. We describe a case of a 9-month-old male infant presented with respiratory distress and found to have a DAA. In this report, the authors emphasize the consideration of this pathology-induced respiratory distress and discuss its anesthetic management.
October 2017: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/29032753/halogenated-agents-and-cardiovascular-surgery-has-mortality-really-decreased
#16
Giovanni Landoni, Juan Carlos Lopez-Delgado, Chiara Sartini, Simona Tamà, Alberto Zangrillo
Halogenated anesthetic agents (desflurane, isoflurane and sevoflurane) may have cardioprotective properties at therapeutic doses against myocardial intraoperative ischemia-reperfusion injury. Cardioprotection mechanisms are related to mitochondrial and anti-apoptotic signaling pathways. Experimental and human studies have proven that their use may reduce morbidity and mortality in the setting of cardiac surgery, including a reduction in myocardial infarct size and mechanical ventilation needs. On the contrary, total intra-venous propofol based anesthesia may be detrimental...
October 10, 2017: Current Vascular Pharmacology
https://www.readbyqxmd.com/read/29030928/pharmacokinetics-of-s-ketamine-during-prolonged-sedation-at-the-pediatric-intensive-care-unit
#17
Robert B Flint, Carole N M Brouwer, Anne S C Kränzlin, Loraine Lie-A-Huen, Albert P Bos, Ron A A Mathôt
BACKGROUND: S-ketamine is the S(+)-enantiomer of the racemic mixture ketamine, an anesthetic drug providing both sedation and analgesia. In clinical practice, significant interpatient variability in drug effect of S-ketamine is observed during long-term sedation. AIMS: The aim of this study was to evaluate the pharmacokinetic variability of S-ketamine in children aged 0-18 years during long-term sedation. Twenty-five children (median age: 0.42 years, range: 0...
November 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29030927/suitability-of-the-forearm-for-non-invasive-blood-pressure-measurement-in-children
#18
David Greaney, Solmaz Nakhjavani, Fiona Desmond, Mark Tormey, Ian Dawkins, Brendan O'Hare
BACKGROUND: Measurement of forearm blood pressure (BP) in pediatric patients during general anesthesia is periodically employed despite a lack of evidence for this practice. Upper arm BP measurement may be impossible to perform for either patient or surgical reasons, and the forearm has theoretical benefits over the lower leg when an alternate site is required. We hypothesize that forearm BP measurement provides an accurate and reliable alternative to the upper arm. Published adult data do not support this hypothesis, and the little pediatric data published contain methodological shortcomings...
November 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29029882/anesthetic-considerations-in-a-parturient-with-renal-tubular-acidosis-and-hypothyroidism-undergoing-cesarean-delivery
#19
P Sangwan, B Srinivasan, S Janweja, S Jangid
Renal tubular acidosis, associated with hypothyroidism, is rare. We present the case of a woman with known renal tubular acidosis and treated hypothyroidism who underwent emergency cesarean delivery under uneventful combined spinal-epidural anesthesia. The rationale for choosing the anesthetic technique and the potential risks associated with anesthesia and renal tubular acidosis are discussed.
August 31, 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28975032/propofol-2-6-diisopropylphenol-is-an-applicable-immersion-anesthetic-in-the-axolotl-with-potential-uses-in-hemodynamic-and-neurophysiological-experiments
#20
Mathias Møller Thygesen, Mikkel Mylius Rasmussen, Jesper Guldsmed Madsen, Michael Pedersen, Henrik Lauridsen
The Mexican axolotl (Ambystoma mexicanum) is an important model species in regenerative biology. Traditionally, axolotls are anesthetized using benzocaine or MS-222, both of which act to inhibit voltage gated sodium channels thereby preventing action potential propagation. In some neurophysiological experiments this is not desirable; therefore we tested propofol as an alternative anesthetic in the axolotl. We evaluated benzocaine, MS-222, and propofol's cardiovascular effects, effects on action potential propagation in the spinal cord, and gross limb regenerative effects...
June 2017: Regeneration
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