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Long term sedation

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https://www.readbyqxmd.com/read/28074297/-delirium-analgesia-and-sedation-in-intensive-care-medicine-development-of-a-protocol-based-management-approach
#1
A Wolf, R Mörgeli, A Müller, B Weiss, C Spies
Intensive care treatment has long-term consequences that are often not immediately apparent to the health care providers. The combination of muscle weakness, cognitive damage, and psychological disorders is comprised under the term post-intensive care syndrome (PICS). Analgesia and sedation protocols, as well as nonpharmacological preventive and therapeutic approaches, are effective tools for avoiding complications and improving long-term survival. The principle of "early goal-directed therapy" is fundamental...
January 10, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28063223/neurally-adjusted-ventilatory-assist-for-infants-under-prolonged-ventilation
#2
Juyoung Lee, Han-Suk Kim, Young Hwa Jung, Chang Won Choi, Yong Hoon Jun
BACKGROUND: Severe bronchopulmonary dysplasia (BPD) often leads to prolonged mechanical ventilation lasting several months. Cyanotic episodes frequently occur in these patients, which necessitate long-term sedation and/or intermittent muscle paralysis. Neurally adjusted ventilatory assist (NAVA) might provide precisely the amount of support that these patients need without sedation. METHODS: We reviewed the medical records of preterm infants who underwent a tracheostomy and required mechanical ventilation for more than 6 months during a period of 6 years...
January 7, 2017: Pediatrics International: Official Journal of the Japan Pediatric Society
https://www.readbyqxmd.com/read/28054285/drug-interactions-in-neurocritical-care
#3
Brian Spoelhof, Salia Farrokh, Lucia Rivera-Lara
Drug-drug interactions (DDIs) are common and avoidable complications that are associated with poor patient outcomes. Neurocritical care patients may be at particular risk for DDIs due to alterations in pharmacokinetic profiles and exposure to medications with a high DDI risk. This review describes the principles of DDI pharmacology, common and severe DDIs in Neurocritical care, and recommendations to minimize adverse outcomes. A review of published literature was performed using PubMed by searching for 'Drug Interaction' and several high DDI risk and common neurocritical care medications...
January 4, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28043062/pharmacokinetic-variability-efficacy-and-tolerability-of-eslicarbazepine-acetate-a-national-approach-to-the-evaluation-of-therapeutic-drug-monitoring-data-and-clinical-outcome
#4
Torleiv Svendsen, Eylert Brodtkorb, Arne Reimers, Espen Molden, Erik Sætre, Svein I Johannessen, Cecilie Johannessen Landmark
BACKGROUND: Eslicarbazepine acetate (ESL) is a new antiepileptic drug (AED), still insufficiently studied regarding pharmacokinetic variability, efficacy and tolerability. The purpose of this study was to evaluate therapeutic drug monitoring (TDM) data in Norway and relate pharmacokinetic variability to clinical efficacy and tolerability in a long-term clinical setting in patients with refractory epilepsy. METHODS: This retrospective observational study included TDM-data from the main laboratories and population data from the Norwegian Prescription Database in Norway, in addition to clinical data from medical records of adult patients using ESL for up to three years, whenever possible...
December 5, 2016: Epilepsy Research
https://www.readbyqxmd.com/read/28033670/a-mini-review-of-non-parenteral-clonidine-preparations-for-paediatric-sedation
#5
REVIEW
Sara M Hanning, Mine Orlu Gul, Irmgard Toni, Antje Neubert, Catherine Tuleu
OBJECTIVE: To provide an overview of non-parenteral clonidine formulations and assess the feasibility of their use for paediatric sedation. METHODS: A literature search was conducted using electronic databases and a combination of search terms. Forty articles met the inclusion criteria. Publications were grouped into different dosage forms and assessed for their potential application for sedation of children in intensive care. KEY FINDINGS: Several routes of clonidine administration have been investigated for numerous indications in children, including perioperative sedation and analgesia...
December 29, 2016: Journal of Pharmacy and Pharmacology
https://www.readbyqxmd.com/read/28032162/a-practical-technique-for-reduction-of-the-bony-nasal-dorsum-height-using-kazanjian-bone-cutting-forceps
#6
Yalcin Yontar, Sedat Tatar
BACKGROUND: Resection of the nasal hump is one of the most critical steps of the rhinoplasty procedure, which is quite prone to complications when performed improperly or inappropriately. In this article, a practical, facile and minimally traumatic hump resection technique using Kazanjian bone-cutting forceps is presented with excellent cosmetic and functional results. METHODS: Fifty-seven consecutive primary (septo-)rhinoplasty patients with wide nasal bases, and various sizes of nasal humps, were enrolled in the study...
December 28, 2016: Aesthetic Plastic Surgery
https://www.readbyqxmd.com/read/27995433/direct-percutaneous-endoscopic-jejunostomy-dpej-tube-placement-a-single-institution-experience-and-outcomes-to-30-days-and-beyond
#7
Andrew T Strong, Gautam Sharma, Matthew Davis, Michael Mulcahy, Suriya Punchai, Colin P O'Rourke, Stacy A Brethauer, John Rodriguez, Jeffrey L Ponsky, Matthew D Kroh
INTRODUCTION: Patients with prior foregut surgery requiring long-term enteral access typically undergo operative jejunostomy tube placement; however, direct percutaneous endoscopic jejunostomy (DPEJ) is a viable alternative. METHODS: All de novo DPEJ procedures performed by surgical and advanced endoscopists from May 2003 to June 2015 were retrospectively reviewed following approval by the Institutional Review Board. There were 59 cases identified. RESULTS: Our cohort had a mean age of 50...
December 19, 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/27992862/endobronchial-valves-for-endoscopic-lung-volume-reduction-best-practice-recommendations-from-expert-panel-on-endoscopic-lung-volume-reduction
#8
Dirk-Jan Slebos, Pallav L Shah, Felix J F Herth, Arschang Valipour
Endoscopic lung volume reduction (ELVR) is being adopted as a treatment option for carefully selected patients suffering from severe emphysema. ELVR with the one-way endobronchial Zephyr valves (EBV) has been demonstrated to improve pulmonary function, exercise capacity, and quality of life in patients with both heterogeneous and homogenous emphysema without collateral ventilation. In this "expert best practices" review, we will highlight the practical aspects of this therapy. Key selection criteria for ELVR are hyperinflation with a residual volume >175% of predicted, forced expiratory volume <50% of predicted, and a 6-min walking distance >100 m...
December 20, 2016: Respiration; International Review of Thoracic Diseases
https://www.readbyqxmd.com/read/27965833/protocol-for-a-feasibility-study-of-a-self-help-cognitive-behavioural-therapy-resource-for-the-reduction-of-dental-anxiety-in-young-people
#9
Zoe Marshman, Annie Morgan, Jenny Porritt, Ekta Gupta, Sarah Baker, Cathy Creswell, Tim Newton, Katherine Stevens, Christopher Williams, Suneeta Prasad, Jennifer Kirby, Helen Rodd
BACKGROUND: Childhood dental anxiety is very common, with 10-20 % of children and young people reporting high levels of dental anxiety. It is distressing and has a negative impact on the quality of life of young people and their parents as well as being associated with poor oral health. Affected individuals may develop a lifelong reliance on general anaesthetic or sedation for necessary dental treatment thus requiring the support of specialist dental services. Children and young people with dental anxiety therefore require additional clinical time and can be costly to treat in the long term...
2016: Pilot and Feasibility Studies
https://www.readbyqxmd.com/read/27960654/a-case-of-dose-escalation-of-quetiapine-in-persistent-insomnia-disorder
#10
Claudia Cornelis, Ann Van Gastel, Glenn Dumont, Violette Coppens, Bernard Sabbe, Manuel Morrens, Filip Van Den Eede
Quetiapine, an atypical antipsychotic drug, is recommended for the treatment of schizophrenia and mood disorders. In addition, given its sedative effects, a low dose of the agent is also widely used in the treatment of anxiety disorders, personality disorders, substance abuse, and sleep disturbances. In this case study, quetiapine was the first effective drug in reducing chronic insomnia in a male patient with a long treatment history. Because its effect declined over time, in the course of two years, a gradual dose increase led to a posology 50 times higher than the off-label dosage used to obtain sedation, i...
December 14, 2016: Acta Clinica Belgica
https://www.readbyqxmd.com/read/27936948/high-intensity-focused-ultrasonic-ablation-of-sacral-chordoma-is-feasible-a-series-of-four-cases-and-details-of-a-national-clinical-trial
#11
Martin J Gillies, Paul C Lyon, Feng Wu, Tom Leslie, Daniel Y Chung, Fergus Gleeson, David Cranston, Stana Bojanic
High-intensity focused ultrasound describes the use of high-intensity focused ultrasound (HIFU) to ablate tumours without requiring an incision or other invasive procedure. This technique has been trialled on a range of tumours including uterine fibroids, prostate, liver and renal cancer. We describe our experience of using HIFU to ablate sacral chordoma in four patients with advanced tumours. Patients were treated under general anaesthetic or sedation using an ultrasound-guided HIFU device. HIFU therapy was associated with a reduction in tumour volume over time in three patients for whom follow up scans were available...
December 12, 2016: British Journal of Neurosurgery
https://www.readbyqxmd.com/read/27933953/synthesis-and-characterization-of-a-novel-%C3%AE-aminobutyric-acid-type-a-gabaa-receptor-ligand-that-combines-outstanding-metabolic-stability-pharmacokinetics-and-anxiolytic-efficacy
#12
Michael M Poe, Kashi Reddy Methuku, Guanguan Li, Ashwini R Verma, Kelly A Teske, Douglas C Stafford, Leggy A Arnold, Jeffrey W Cramer, Timothy M Jones, Rok Cerne, Michael J Krambis, Jeffrey M Witkin, Enrique Jambrina, Sabah Rehman, Margot Ernst, James M Cook, Jeffrey M Schkeryantz
1,4-Benzodiazepines are used in the treatment of anxiety disorders but have limited long-term use due to adverse effects. HZ-166 (2) has been shown to have anxiolytic-like effects with reduced sedative/ataxic liabilities. A 1,3-oxazole KRM-II-81 (9) was discovered from a series of six bioisosteres with significantly improved pharmacokinetic and pharmacodynamic properties as compared to 2. Oxazole 9 was further characterized and exhibited improved anxiolytic-like effects in a mouse marble burying assay and a rat Vogel conflict test...
December 8, 2016: Journal of Medicinal Chemistry
https://www.readbyqxmd.com/read/27918326/anesthetic-considerations-for-patients-with-congenital-central-hypoventilation-syndrome-a-systematic-review-of-the-literature
#13
Saptashree M Basu, Frances F Chung, Shireen F AbdelHakim, Jean Wong
Congenital central hypoventilation syndrome (CCHS) is a form of sleep-disordered breathing characterized by a diminished drive to breathe during sleep, despite progressive hypercapnia and hypoxia. The condition results from mutations in the paired-like homeobox 2B (PHOX2B) gene. The aim of this review was to conduct a systematic search of the current data on CCHS as it relates to perioperative considerations and to discuss the classification, prevalence, pathophysiology, presentation, genetics, and management of the condition...
January 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27911257/individualized-antibiotic-therapy-in-patients-with-ventilator-associated-pneumonia
#14
Gurdal Yilmaz, Sedat Saylan, Firdevs Aksoy, Iftihar Koksal
The optimal duration of treatment of ventilator-associated pneumonia (VAP) is still the subject of debate. While 1-week treatment has been reported as possibly sufficient, patients generally receive antibiotic therapy for 10-14 days. The purpose of our study was to investigate whether length of treatment in patients with VAP can be reduced with an individualized therapeutic strategy. The study was performed prospectively with patients diagnosed with VAP in our hospital's intensive care units between 1 January and 31 December, 2015...
December 1, 2016: Journal of Medical Microbiology
https://www.readbyqxmd.com/read/27908308/remarkable-damage-along-with-poor-quality-of-life-in-takayasu-arteritis-cross-sectional-results-of-a-long-term-followed-up-multicentre-cohort
#15
Ahmet Omma, Burak Erer, Omer Karadag, Neslihan Yilmaz, Fatma Alibaz-Oner, Fatih Yildiz, Melike Kalfa, Gezmis Kimyon, Sedat Kiraz, Haner Direskeneli, Eren Erken, Kenan Aksu, Ahmet Mesut Onat, Ahmet Gül, Lale Ocal, Murat Inanc, Sevil Kamali
OBJECTIVES: We aimed to assess the outcome of a large Takayasu arteritis (TAK) cohort using the vasculitis damage index (VDI) and quality of life (QoL) scale, tools which have been validated for vasculitis. METHODS: Disease activity, damage and QoL were cross-sectionally evaluated in 165 TAK patients from 6 centres. SF-36 were applied to 51 age-matched healthy controls (HC). Persistent activity for ≥6 months was considered as treatment resistance (r-TAK). The correlation between VDI, clinical characteristics and mental (MCS)/physical (PCS) component scores of SF-36 were analysed...
November 10, 2016: Clinical and Experimental Rheumatology
https://www.readbyqxmd.com/read/27907964/critical-care-neurology-perspective-on-delirium
#16
Matthew B Maas, Andrew M Naidech
The evidence linking delirium to poor outcomes after critical illness is compelling, including higher mortality, prolonged mechanical ventilation, longer length of intensive care unit stay, and long-term cognitive impairments. The attitude toward delirium in the neurologic community is shifting away from viewing it as an unmodifiable, inevitable consequence of severe illness to treating it is as a neurologic emergency, akin to seizures or encephalitis. Delirium, like other manifestations of critical illness encephalopathy, is an organ dysfunction syndrome...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27885664/haloperidol-plus-promethazine-for-psychosis-induced-aggression
#17
REVIEW
Gisele Huf, Jacob Alexander, Pinky Gandhi, Michael H Allen
BACKGROUND: Health services often manage agitated or violent people, and such behaviour is particularly prevalent in emergency psychiatric services (10%). The drugs used in such situations should ensure that the person becomes calm swiftly and safely. OBJECTIVES: To examine whether haloperidol plus promethazine is an effective treatment for psychosis-induced aggression. SEARCH METHODS: On 6 May 2015 we searched the Cochrane Schizophrenia Group's Register of Trials, which is compiled by systematic searches of major resources (including MEDLINE, EMBASE, AMED, BIOSIS, CINAHL, PsycINFO, PubMed, and registries of clinical trials) and their monthly updates, handsearches, grey literature, and conference proceedings...
25, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27881185/melatonin-and-melatonin-agonists-to-prevent-and-treat-delirium-in-critical-illness-a-systematic-review-protocol
#18
Jennifer Foster, Lisa D Burry, Lehana Thabane, Karen Choong, Kusum Menon, Mark Duffett, Alexandra Cheung, Melanie Guenette, Timothy Chimunda, Louise Rose
BACKGROUND: Delirium is a syndrome characterized by acute fluctuations and alterations in attention and arousal. Critically ill patients are at particularly high risk, and those that develop delirium are more likely to experience poor clinical outcomes such as prolonged duration of ICU and hospital length of stay, and increased mortality. Melatonin and melatonin agonists (MMA) have the potential to decrease the incidence and severity of delirium through their hypnotic and sedative-sparing effects, thus improving health-related outcomes...
November 24, 2016: Systematic Reviews
https://www.readbyqxmd.com/read/27862227/one-year-safety-and-efficacy-study-of-bilastine-treatment-in-japanese-patients-with-chronic-spontaneous-urticaria-or-pruritus-associated-with-skin-diseases
#19
Akiko Yagami, Masutaka Furue, Michinori Togawa, Akihiro Saito, Michihiro Hide
A number of second-generation non-sedating antihistamines are used in clinical practices over the world. However, long-term safety and efficacy have not been proved high level evidence based medicine. We have performed an open-label, multicenter, phase III study to evaluate the long-term safety and efficacy of bilastine, a novel non-sedating H1 -antihistamine for patients with chronic spontaneous urticaria (CSU) or pruritus associated with skin diseases (trial registration no. JapicCTI-142528). Patients aged 18-74 years were treated with bilastine 20 mg once daily for up to 52 weeks...
November 14, 2016: Journal of Dermatology
https://www.readbyqxmd.com/read/27861433/understanding-phenotypes-of-obstructive-sleep-apnea-applications-in-anesthesia-surgery-and-perioperative-medicine
#20
Yamini Subramani, Mandeep Singh, Jean Wong, Clete A Kushida, Atul Malhotra, Frances Chung
Obstructive sleep apnea (OSA) is a prevalent sleep-disordered breathing with potential long-term major neurocognitive and cardiovascular sequelae. The pathophysiology of OSA varies between individuals and is composed of different underlying mechanisms. Several components including the upper airway anatomy, effectiveness of the upper airway dilator muscles such as the genioglossus, arousal threshold of the individual, and inherent stability of the respiratory control system determine the pathogenesis of OSA...
January 2017: Anesthesia and Analgesia
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