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Terminal sedation

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https://www.readbyqxmd.com/read/28822974/sedative-and-cardiopulmonary-effects-of-dexmedetomidine-infusions-randomly-receiving-or-not-butorphanol-in-standing-horses
#1
Luíza Quintão Medeiros, Miguel Gozalo-Marcilla, Polly M Taylor, Daniela Campagnol, Flávia Augusta de Oliveira, Marcos Jun Watanabe, Antonio José de Araujo Aguiar
Dexmedetomidine (DEX) alone, or combined with butorphanol (BUT), may be administered by constant rate infusions (CRIs) in standing horses. This blinded, randomised, crossover study in six healthy adult horses aimed to determine the sedative and cardiopulmonary effects of DEX (dexmedetomidine (3.5 µg/kg+5 µg/kg/hour CRI) and DEX/BUT (dexmedetomidine (3.5 µg/kg+3.5 µg/kg/hour CRI) and butorphanol (20 µg/kg+24 µg/kg/hour CRI)). Head height above ground (HHAG), ataxia, responses to tactile/auditory stimuli and cardiopulmonary variables were recorded before, at 5/15/30/60/90 minutes and after CRIs terminated (15/30/60 minutes)...
August 19, 2017: Veterinary Record
https://www.readbyqxmd.com/read/28807643/-use-of-subcutaneous-route-for-comfort-care%C3%A2-in-neonatal-palliative-population-systematic-review-and-survey-of-practices-in-france
#2
N Pouvreau, J Tandonnet, O Tandonnet, L Renesme
INTRODUCTION: Subcutaneous hydration (hypodermoclysis) and drug administration is a widely used method of analgesic therapy in adult palliative care medicine. Very little is known about its use in neonatal medicine. Evidence-based guidelines do not exist due to a lack of data. In this study, the advantages of subcutaneous analgesic therapy in terms of comfort in neonatal palliative care situations were investigated. METHODS: This report details the results of a systematic review associated with a survey in neonatal intensive care units (NICUs) and pediatric palliative care departments (PPCTs) in France...
August 11, 2017: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/28792784/improved-pain-control-in-terminally-ill-cancer-patients-by-introducing-low-dose-oral-methadone-in-addition-to-ongoing-opioid-treatment
#3
Per Fürst, Staffan Lundström, Pål Klepstad, Sara Runesdotter, Peter Strang
BACKGROUND: Cancer pain is often not well controlled and there is a need for improved treatment strategies. Methadone exhibits unique properties among opioids and recent reports show promising results from adding a low dose of methadone to regular opioid therapy. OBJECTIVE: To examine the effects of oral low-dose methadone added to regular scheduled opioids in terminally ill patients with complex cancer-related pain. DESIGN: This was a retrospective chart review...
August 9, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28782218/was-sigmund-freud-s-death-hastened
#4
Alastair D Sandy Macleod
The terminal illness of Sigmund Freud has been considered by many authors to be an example of physician-enacted euthanasia. A review and a reconsideration of the published literature by Freud's doctors and biographers cast doubt on this opinion. Over his last 48 h, Freud was administered substantial morphine doses to sedate and relieve his pain. However, from a pharmacological perspective, the timing of his death would not be consistent with that of a fatal dose of opioid. Freud died a natural death.
August 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28735270/subcutaneous-levetiracetam-for-the-management-of-seizures-at-the-end-of-life
#5
REVIEW
Anna Elizabeth Sutherland, John Curtin, Victoria Bradley, Olivia Bush, Maggie Presswood, Victoria Hedges, Katrien Naessens
OBJECTIVES: To report the results of a combined case series analysis of subcutaneous levetiracetam (Keppra) for the management of seizures in palliative care patients. METHODS: A comprehensive literature review on the use of subcutaneous levetiracetam was performed, and these data were combined with a prospective observational audit of its use in terminal care undertaken in a regional palliative care network. RESULTS: 7 papers were identified from the literature review-four case reports and three observational case series-reporting on a total of 53 cases where subcutaneous levetiracetam was administered...
July 22, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28733205/-dehydrofukinone-modulates-membrane-potential-and-delays-seizure-onset-by-gabaa-receptor-mediated-mechanism-in-mice
#6
Quelen Iane Garlet, Luana da Costa Pires, Laura Hautrive Milanesi, Joseane Righes Marafiga, Bernardo Baldisserotto, Carlos Fernando Mello, Berta Maria Heinzmann
(+)-Dehydrofukinone (DHF), isolated from Nectandra grandiflora (Lauraceae) essential oil, induces sedation and anesthesia by modulation of GABAa receptors. However, no study has addressed whether DHF modulates other cellular events involved in the control of cellular excitability, such as seizure behavior. Therefore, the aim of the present study was to investigate the effect of DHF on cellular excitability and seizure behavior in mice. For this purpose, we used isolated nerve terminals (synaptosomes) to examine the effect of DHF on the plasma membrane potential, the involvement of GABAa receptors and the downstream activation of Ca(2+) mobilization...
July 18, 2017: Toxicology and Applied Pharmacology
https://www.readbyqxmd.com/read/28724494/pharmacokinetics-of-a-novel-transdermal-fentanyl-solution-in-rhesus-macaques-macaca-mulatta
#7
Gregory W Salyards, Marie-Josee Lemoy, Heather K Knych, Ashley E Hill, Kari L Christe
Rhesus macaques (Macaca mulatta) are the most commonly used NHP biomedical model and experience both research and clinical procedures requiring analgesia. Opioids are a mainstay of analgesic therapy. A novel, transdermal fentanyl solution (TFS) has been developed as a long-acting, single-administration topical opioid and was reported to provide at least 4 d of effective plasma concentrations in beagles (Canis familiaris). To evaluate the pharmacokinetic profile of TFS in healthy adult rhesus macaques, we used a 2-period, 2-treatment crossover study of a single topical administration of 1...
July 1, 2017: Journal of the American Association for Laboratory Animal Science: JAALAS
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
#8
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
https://www.readbyqxmd.com/read/28667196/patient-safety-during-procedural-sedation-using-capnography-monitoring-a-systematic-review-and-meta-analysis
#9
Rhodri Saunders, Michel M R F Struys, Richard F Pollock, Michael Mestek, Jenifer R Lightdale
OBJECTIVE: To evaluate the effect of capnography monitoring on sedation-related adverse events during procedural sedation and analgesia (PSA) administered for ambulatory surgery relative to visual assessment and pulse oximetry alone. DESIGN AND SETTING: Systematic literature review and random effects meta-analysis of randomised controlled trials (RCTs) reporting sedation-related adverse event incidence when adding capnography to visual assessment and pulse oximetry in patients undergoing PSA during ambulatory surgery in the hospital setting...
June 30, 2017: BMJ Open
https://www.readbyqxmd.com/read/28639827/the-effects-of-alcohol-expectancy-and-intake-on-slot-machine-gambling-behavior
#10
Dominic Sagoe, Rune Aune Mentzoni, Tony Leino, Helge Molde, Sondre Haga, Mikjel Fredericson Gjernes, Daniel Hanss, Ståle Pallesen
Background and aims Although alcohol intake and gambling often co-occur in related venues, there is conflicting evidence regarding the effects of alcohol expectancy and intake on gambling behavior. We therefore conducted an experimental investigation of the effects of alcohol expectancy and intake on slot machine gambling behavior. Methods Participants were 184 (females = 94) individuals [age range: 18-40 (mean = 21.9) years] randomized to four independent conditions differing in information/expectancy about beverage (told they received either alcohol or placebo) and beverage intake [actually ingesting low (target blood alcohol concentration [BAC] < 0...
June 1, 2017: Journal of Behavioral Addictions
https://www.readbyqxmd.com/read/28610957/effectiveness-of-heart-rate-control-on-hemodynamics-in-critically-ill-patients-with-atrial-tachyarrhythmias-managed-by-amiodarone
#11
Joe-Elie Salem, Pauline Dureau, Christian Funck-Brentano, Jean-Sébastien Hulot, Maria El-Aissaoui, Nadia Aissaoui, Saik Urien, Christophe Faisy
Atrial tachyarrhythmias (AT) are common in intensive care unit (ICU) patients and might contribute to hemodynamic instability if heart rate (HR) is persistently too rapid. We aimed to assess if HR control below 115 or 130bpm with amiodarone improves hemodynamics in ICU patients with AT. This observational study included 73 ICU patients with disabling AT receiving amiodarone for HR control. A total of 525 changes (mainly within 4-8h) in mean arterial pressure (MAP) and 167 changes in plasma lactate in response to HR variations above 115 or 130bpm were analyzed...
August 2017: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/28602377/end-of-life-care-in-the-treatment-of-heart-failure-in-older-adults
#12
REVIEW
John Arthur McClung
Heart failure presents unique challenges to the clinician who desires to provide excellent and humane care near the end of life. Accurate prediction of mortality in the individual patient is complicated by a chronic disease that is punctuated by recurrent acute episodes and sudden death. Health care providers continue to have difficulty communicating effectively with terminally ill patients and their caregivers regarding end-of-life care preferences, all of which needs to occur earlier rather than later. This article also discusses various means of providing palliative care, and specific issues regarding device therapy, cardiopulmonary resuscitation, and palliative sedation with concurrent discussion of the ethical ramifications and pitfalls of each...
July 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/28599888/cardiopulmonary-effects-of-pleural-insufflation-with-co2-during-two-lung-ventilation-in-dorsally-recumbent-anesthetized-horses
#13
Kaylee S Bohaychuk-Preuss, M Valentina Carrozzo, Tanya Duke-Novakovski
OBJECTIVE: To record the cardiopulmonary effects of pleural CO2 positive pressure insufflation in anesthetized horses. STUDY DESIGN: Prospective study. ANIMALS: Seven horses (mean ± standard deviation, 530.9 ± 68.1 kg) undergoing terminal surgery. METHODS: Horses were sedated with xylazine. Anesthesia was induced with ketamine-propofol and maintained with isoflurane, positive pressure ventilation, detomidine infusion, and butorphanol with the horses in dorsal recumbency...
January 10, 2017: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/28580858/suboptimal-palliative-sedation-in-primary-care-an-exploration
#14
Peter Pype, Inge Teuwen, Fien Mertens, Marij Sercu, An De Sutter
OBJECTIVES: Palliative sedation is a therapeutic option to control refractory symptoms in terminal palliative patients. This study aims at describing the occurrence and characteristics of suboptimal palliative sedations in primary care and at exploring the way general practitioners (GPs) experience suboptimal palliative sedation in their practice. METHODS: We conducted a mixed methods study with a quantitative prospective survey in primary care and qualitative semi-structured interviews with GPs...
June 5, 2017: Acta Clinica Belgica
https://www.readbyqxmd.com/read/28567467/endomorphin-1-analogs-containing-%C3%AE-methyl-%C3%AE-amino-acids-exhibit-potent-analgesic-activity-after-peripheral-administration
#15
Yuan Wang, Junxian Yang, Xin Liu, Long Zhao, Dongxu Yang, Jingjing Zhou, Dan Wang, Lingyun Mou, Rui Wang
This study describes the design and synthesis of endomorphin-1 analogs containing C-terminal aromatic α-methyl-β-amino acids and an N-terminal native tyrosine or 2,6-dimethyl-tyrosine. We show that, in comparison with the parent peptide, these analogs exhibit improved bioactivity and blood-brain barrier penetration after intravenous administration, and have a lower tendency to induce constipation and sedation than morphine.
June 14, 2017: Organic & Biomolecular Chemistry
https://www.readbyqxmd.com/read/28552271/comparing-the-success-rates-of-standard-and-modified-valsalva-maneuvers-to-terminate-psvt-a-randomized-controlled-trial
#16
Şeref Kerem Çorbacıoğlu, Emine Akıncı, Yunsur Çevik, Halit Aytar, Mehmet Veysel Öncül, Sedat Akkan, Hüseyin Uzunosmanoğlu
PURPOSE: The study aimed to detect whether modified Valsalva maneuver (VM) is more effective than the standard VM in terminating paroxysmal supraventricular tachycardia (PSVT). METHODOLOGY: This randomized controlled trial was conducted in the emergency department of a training and research hospital between Dec. 1, 2015 and Dec. 31, 2016. Participants were divided into two groups, randomly assigned standard VM or modified VM, as the first treatment with two-dimensional permutation blocks; in the order of arrival of the patients...
May 22, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28543780/intranasal-midazolam-versus-rectal-diazepam-for-the-management-of-canine-status-epilepticus-a-multicenter-randomized-parallel-group-clinical-trial
#17
M Charalambous, S F M Bhatti, L Van Ham, S Platt, N D Jeffery, A Tipold, J Siedenburg, H A Volk, D Hasegawa, A Gallucci, G Gandini, M Musteata, E Ives, A E Vanhaesebrouck
BACKGROUND: Intranasal administration of benzodiazepines has shown superiority over rectal administration for terminating emergency epileptic seizures in human trials. No such clinical trials have been performed in dogs. OBJECTIVE: To evaluate the clinical efficacy of intranasal midazolam (IN-MDZ), via a mucosal atomization device, as a first-line management option for canine status epilepticus and compare it to rectal administration of diazepam (R-DZP) for controlling status epilepticus before intravenous access is available...
July 2017: Journal of Veterinary Internal Medicine
https://www.readbyqxmd.com/read/28510296/pharmacokinetics-and-safety-of-single-dose-inhaled-loxapine-in-children-and-adolescents
#18
Sally Selim, Robert Riesenberg, James Cassella, Jeevan Kunta, Edward Hellriegel, Mark A Smith, Alexander A Vinks, Laura Rabinovich-Guilatt
This multisite open-label study sought to characterize the pharmacokinetics and safety of a single dose of inhaled loxapine in children and adolescents. Loxapine powder for oral inhalation was administered via a single-use handheld drug device to children and adolescents (aged 10-17 years) with any condition warranting chronic antipsychotic use. Patients were dosed according to body weight and cohort (<50 kg [n = 15], 2.5 or 5 mg; ≥50 kg [n = 15], 5 or 10 mg); the first 6 patients (cohort 1) enrolled in each weight group received the lower dose...
May 16, 2017: Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28506099/propofol-based-palliative-sedation-to-treat-antipsychotic-resistant-agitated-delirium
#19
Alfredo Covarrubias-Gómez, Maria López Collada-Estrada
Delirium is a common problem in terminally ill patients that is associated with significant distress and, hence, considered a palliative care emergency. The three subtypes of delirium are hyperactive, hypoactive, and mixed, depending on the level of psychomotor activity and arousal disturbance. When agitated delirium becomes refractory in the setting of imminent dying, the agitation may be so severe that palliative sedation (PS) is required. Palliative sedation involves the administration of sedative medications with the purpose of reducing level of consciousness for patients with refractory suffering in the setting of a terminal illness...
May 16, 2017: Journal of Pain & Palliative Care Pharmacotherapy
https://www.readbyqxmd.com/read/28488178/a-prospective-randomized-study-of-the-use-of-an-ultrathin-colonoscope-versus-a-pediatric-colonoscope-in-sedation-optional-colonoscopy
#20
Koichiro Sato, Sayo Ito, Tomoyuki Kitagawa, Koichi Hirahata, Daisuke Hihara, Kenji Tominaga, Ichiro Yasuda, Iruru Maetani
BACKGROUND: Ultrathin colonoscopes (UTC) reportedly produce less pain during colonoscopy than standard colonoscopes. The aim of this study was to assess the tolerability of an UTC compared with that of a pediatric colonoscope. METHODS: A total of 270 adult patients scheduled to undergo colonoscopy were randomized, with 134 allocated to the UTC group and 136 to the pediatric colonoscope group. Pain was assessed using a visual analog scale. For all procedures, sedation was administered only if requested...
May 9, 2017: Surgical Endoscopy
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