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Terminal sedation

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https://www.readbyqxmd.com/read/28510296/pharmacokinetics-and-safety-of-single-dose-inhaled-loxapine-in-children-and-adolescents
#1
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
#2
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
#3
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
https://www.readbyqxmd.com/read/28480864/-antiseizure-activity-of-c-ephalaria-gigantea-root-extract
#4
N Gogitidze, N Mushkiashvili, M Gedevanishvili, N Tabatadze, G Dekanosidze
Antiseizure activity of Cephalaria gigantea root extract was studied using PTZ- and/or audiogenic seizure models in outbred Wistar and inbred Krouchinsky- Molodkina rats respectively. In PTZ - model onset of tonic- clonic seizures, latencies to the beginning of the seizure activity, and mortality, and similarly in audiogenic seizures behavioral convulsive reactions , facial automatisms and latency to wild running were evaluated. The extract is used traditionally in Georgian folk medicine as anticonvulsant drug...
March 2017: Georgian Medical News
https://www.readbyqxmd.com/read/28446017/dexmedetomidine-oral-mucosa-patch-for-sedation-suppresses-apoptosis-in-hippocampus-of-normal-rats
#5
Je Hoon Park, Il Gyu Ko, Sung Eun Kim, Jun Jang Jin, Lakkyong Hwang, Chang Ju Kim, Soo Hwan Yoon, Jongki Hong, Jun Young Chung, Deok Won Lee
PURPOSE: Dexmedetomidine, an α2-adrenergic agonist, provides sedative and analgesic effects without significant respiratory depression. Dexmedetomidine has been suggested to have an antiapoptotic effect in response to various brain insults. We developed an oral mucosa patch using dexmedetomidine for sedation. The effects of the dexmedetomidine oral mucosa patch on cell proliferation and apoptosis in the hippocampus were evaluated. METHODS: A hydrogel oral mucosa patch was adhered onto the oral cavity of physiologically normal rats, and was attached for 2 hours, 6 hours, 12 hours, or 24 hours...
April 2017: International Neurourology Journal
https://www.readbyqxmd.com/read/28434027/can-ultrasound-be-used-as-the-primary-imaging-in-children-with-suspected-crohn-disease
#6
Timothy L Tsai, Megan B Marine, Matthew R Wanner, Matthew L Cooper, Steven J Steiner, Fangqian Ouyang, S Gregory Jennings, Boaz Karmazyn
BACKGROUND: There is growing literature on the use of ultrasound (US) for evaluation of Crohn disease in adults, but few studies have been conducted on children. Several studies demonstrated high accuracy of US in the diagnosis of Crohn disease. Using US as the primary screening imaging modality for Crohn disease can reduce health care costs, the need for sedation and ionizing radiation exposure. OBJECTIVE: The aim of our study is to determine if US can be used for screening evaluation of pediatric Crohn disease...
April 22, 2017: Pediatric Radiology
https://www.readbyqxmd.com/read/28399846/palliative-sedation-challenging-the-professional-competency-of-health-care-providers-and-staff-a-qualitative-focus-group-and-personal-written-narrative-study
#7
Danièle Leboul, Régis Aubry, Jean-Michel Peter, Victor Royer, Jean-François Richard, Frédéric Guirimand
BACKGROUND: Despite recent advances in palliative medicine, sedating a terminally ill patient is regarded as an indispensable treatment to manage unbearable suffering. With the prospect of widespread use of palliative sedation, the feelings and representations of health care providers and staff (carers) regarding sedation must be carefully explored if we are to gain a better understanding of its impact and potential pitfalls. The objective of the study was to provide a comprehensive description of the opinions of carers about the use of sedation practices in palliative care units (PCU), which have become a focus of public attention following changes in legislation...
April 11, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28352158/cardioprotection-with-halogenated-gases-how-does-it-occur
#8
REVIEW
Jose Luis Guerrero-Orriach, Juan Jose Escalona Belmonte, Alicia Ramirez Fernandez, Marta Ramirez Aliaga, Manuel Rubio Navarro, Jose Cruz Mañas
Numerous studies have studied the effect of halogenated agents on the myocardium, highlighting the beneficial cardiac effect of the pharmacological mechanism (preconditioning and postconditioning) when employed before and after ischemia in patients with ischemic heart disease. Anesthetic preconditioning is related to the dose-dependent signal, while the degree of protection is related to the concentration of the administered drug and the duration of the administration itself. Triggers for postconditioning and preconditioning might have numerous pathways in common; mitochondrial protection and a decrease in inflammatory mediators could be the major biochemical elements...
2017: Drug Design, Development and Therapy
https://www.readbyqxmd.com/read/28240955/pharmacokinetics-and-pharmacodynamics-of-buprenorphine-and-sustained-release-buprenorphine-after-administration-to-adult-alpacas
#9
S Bryce Dooley, Turi K Aarnes, Jeffrey Lakritz, Phillip Lerche, Richard M Bednarski, John A E Hubbell
OBJECTIVE To determine pharmacokinetics and pharmacodynamics of buprenorphine after IV and SC administration and of sustained-release (SR) buprenorphine after SC administration to adult alpacas. ANIMALS 6 alpacas. PROCEDURES Buprenorphine (0.02 mg/kg, IV and SC) and SR buprenorphine (0.12 mg/kg, SC) were administered to each alpaca, with a 14-day washout period between administrations. Twenty-one venous blood samples were collected over 96 hours and used to determine plasma concentrations of buprenorphine. Pharmacokinetic parameters were calculated by use of noncompartmental analysis...
March 2017: American Journal of Veterinary Research
https://www.readbyqxmd.com/read/28192224/qualitative-study-on-the-perceptions-of-terminally-ill-cancer-patients-and-their-family-members-regarding-end-of-life-experiences-focusing-on-palliative-sedation
#10
Young Eun, In-Wha Hong, Eduardo Bruera, Jung Hun Kang
CONTEXT: Patients with terminal cancer experience refractory symptoms in the last days of life. Although palliative sedation (PS) is recommended for patients suffering unbearable symptoms with imminent death, it requires clear communication between physicians and patients/caregivers. Understanding the demands and perceptions of patients and caregivers in the end-of-life phase are needed for effective communication. OBJECTIVE: To explore patient experiences regarding end-of-life status and PS...
February 10, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28181893/gebruik-van-comedicatie-tijdens-palliatieve-sedatie
#11
H Westdorp, S M C H Langenberg, C Kramers, C A H H V M Verhagen
- Palliative sedation is a treatment option for patients in the terminal stage of their disease who have one or more refractory symptoms.- In giving palliative sedation it is important to take into account the pharmacokinetic and pharmacodynamic properties of medications that contribute to good palliation: this covers both medication used in palliative sedation and continued chronic medication.- This article provides tools for clinical practice to deal with the difficulties concerning stopping or continuing chronic medication and on interaction between medications in palliative sedation...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28177137/hypoalbuminaemia-and-decreased-midazolam-clearance-in-terminally-ill-adult-patients-an-inflammatory-effect
#12
Linda G Franken, Anniek D Masman, Brenda C M de Winter, Frans P M Baar, Dick Tibboel, Teun van Gelder, Birgit C P Koch, Ron A A Mathot
AIMS: Midazolam is the drug of choice for palliative sedation and is titrated to achieve the desired level of sedation. Because of large inter-individual variability (IIV), however, the time it takes to achieve adequate sedation varies widely. It would therefore greatly improve clinical care if an individualized dose could be determined beforehand. To find clinically relevant parameters for dose individualization, we performed a pharmacokinetic study on midazolam, 1OH-midazolam (1-OH-M) and 1OH-midazolam-glucuronide (1-OH-MG) in terminally ill patients...
February 8, 2017: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28147385/presentation-of-a-sedation-standard-using-the-example-of-transesophageal-echocardiographies-tee-in-pediatric-outpatients
#13
H Sauer, J Pfeifer, S Gräber, H Abdul-Khaliq
Introduction Most pediatric patients require deep sedation for a TEE examination. We analyzed the data of our sedation protocols relating to all outpatient TEEs in patients under 18 years of age for the year 2011. On the basis of the data records of a total of 40 patients, we will describe our standard and compare it with the findings of the international literature. Material and Methods In a retrospective analysis, we inspected our sedation protocols in terms of patient-related data, vital parameters, drug applications, occurring complications and necessary interventions as well as nausea and vomiting during the post-sedative monitoring phase...
January 2017: Klinische Pädiatrie
https://www.readbyqxmd.com/read/28131553/-end-of-life-in-specialized-medical-pediatrics-department-a-french-national-survey
#14
Alice Ravanello, Isabelle Desguerre, Sandra Frache, Philippe Hubert, Daniel Orbach, Régis Aubry
AIMS: In France, most of children die in the hospital. This national survey aimed to achieve better understanding of end-of life care in specialized medical pediatrics departments for children facing the end-of-life, identify the available resources, put forward the difficulties encountered by professionals and describe end-of-life paths of children who died in these departments. MATERIAL AND METHODS: This study is based on a nationwide survey conducted among all existing specialized medical pediatrics departments (onco-haematology, neurology, reanimation) in France in 2015...
January 25, 2017: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/28123477/dexmedetomidine-alleviates-cerebral-ischemia-induced-short-term-memory-impairment-by-inhibiting-the-expression-of-apoptosis-related-molecules-in-the-hippocampus-of-gerbils
#15
In-Young Choi, Lakkyong Hwang, Jun-Jang Jin, Il-Gyu Ko, Sung-Eun Kim, Mal-Soon Shin, Key-Moon Shin, Chang-Ju Kim, Sung-Wook Park, Jin-Hee Han, Jae-Woo Yi
Cerebral ischemia results from cerebrovascular occlusion, which leads to neuronal cell death and eventually causes neurological impairments. Dexmedetomidine is a potent and highly selective α2-adrenoreceptor agonist with actions such as sedation, anxiolysis, analgesia and anesthetic-sparing effects. We investigated the effect of dexmedetomidine on apoptosis in the hippocampus after transient global ischemia in gerbils. Transient global ischemia was induced by ligation of both common carotid arteries. Dexmedetomidine was administrated intraperitoneally at three respective doses (0...
January 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28097665/pharmacokinetics-and-selected-pharmacodynamics-of-romifidine-following-low-dose-intravenous-administration-in-combination-with-exercise-to-quarter-horses
#16
H K Knych, S D Stanley, D S McKemie, S J Steinmetz
Romifidine is an alpha-2 adrenergic agonist used for sedation and analgesia in horses. As it is a prohibited substance, its purported use at low doses in performance horses necessitates further study. The primary goal of the study reported here was to describe the serum concentrations and pharmacokinetics of romifidine following low-dose administration immediately prior to exercise, utilizing a highly sensitive liquid chromatography-tandem mass spectrometry assay that is currently employed in many drug testing laboratories...
January 17, 2017: Journal of Veterinary Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28030555/trycycle-a-prospective-study-of-the-safety-and-feasibility-of-early-in-bed-cycling-in-mechanically-ventilated-patients
#17
Michelle E Kho, Alexander J Molloy, France J Clarke, Daana Ajami, Magda McCaughan, Kristy Obrovac, Christina Murphy, Laura Camposilvan, Margaret S Herridge, Karen K Y Koo, Jill Rudkowski, Andrew J E Seely, Jennifer M Zanni, Marina Mourtzakis, Thomas Piraino, Deborah J Cook
INTRODUCTION: The objective of this study was to assess the safety and feasibility of in-bed cycling started within the first 4 days of mechanical ventilation (MV) to inform a future randomized clinical trial. METHODS: We conducted a 33-patient prospective cohort study in a 21-bed adult academic medical-surgical intensive care unit (ICU) in Hamilton, ON, Canada. We included adult patients (≥ 18 years) receiving MV who walked independently pre-ICU. Our intervention was 30 minutes of in-bed supine cycling 6 days/week in the ICU...
2016: PloS One
https://www.readbyqxmd.com/read/27935778/anesthesia-involvement-in-palliative-care
#18
Amanda C Faircloth
Palliative care teams require multidisciplinary support. While this is an emerging area in anesthesia practice, there are many avenues for certified registered nurse anesthetists (CRNAs) to share their unrivaled clinical knowledge. CRNAs may become involved with or consult on palliative sedation, medical management, interventional pain management, terminal wean/extubation, and organ donation. Additionally, CRNAs need to understand the unique needs of this patient population so that they can appropriately care for palliative care patients presenting to the operating room for palliative surgery...
January 2017: Annual Review of Nursing Research
https://www.readbyqxmd.com/read/27879954/comparison-of-terminal-extubation-and-terminal-weaning-as-mechanical-ventilation-withdrawal-in-icu-patients
#19
Damien Thellier, Pierre Y Delannoy, Olivier Robineau, Agnès Meybeck, Nicolas Boussekey, Arnaud Chiche, Olivier Leroy, Hugues Georges
BACKGROUND: Terminal extubation (TE) is applied in some Intensive Care Units (ICU) patients when a decision of withdrawal of mechanical ventilation is decided. Other units prefer terminal weaning (TW) with no removal of the endotracheal tube. We report our experience with these two procedures. METHODS: We conducted a retrospective study analyzing patients deceased in our ICU after a decision of life sustained therapy (LST) during the year 2013. TE was proposed to family members for patients presenting with two medical conditions: lack of vasoactive drugs (VAD) and SaO2>95% with a FIO2<50%...
April 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/27845950/carbon-dioxide-insufflation-during-colonoscopy-in-inflammatory-bowel-disease-patients-a-double-blind-randomized-single-center-trial
#20
Přemysl Falt, Vít Šmajstrla, Petr Fojtík, Martin Hill, Ondřej Urban
OBJECTIVE: Bowel distension by insufflated air causes abdominal discomfort after colonoscopy. Carbon dioxide (CO2) instead of air insufflation during colonoscopy can reduce postprocedural discomfort in diagnostic and screening cases. Discomfort after colonoscopy and CO2 insufflation have never been studied in inflammatory bowel disease (IBD) patients, characterized by younger age, structural changes of the colon, and need for repeated and frequently uncomfortable colonoscopies. Our trial was designed to evaluate postprocedural discomfort associated with CO2 compared with air insufflation in unsedated or minimally sedated patients with known IBD...
March 2017: European Journal of Gastroenterology & Hepatology
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