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Terminal sedation

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https://www.readbyqxmd.com/read/29236646/evaluation-of-bone-mineral-density-bmd-and-indicators-of-bone-turnover-in-patients-with-hemophilia
#1
Mehmet Dagli, Ali Kutlucan, Sedat Abusoglu, Abdulkadir Basturk, Mehmet Sozen, Leyla Kutlucan, Ali Unlu, Farise Yilmaz
A decrease in bone mass is observed in hemophilic patients. The aim of this study was to evaluate bone mineral density (BMD), parathyroid hormone (PTH), 25-hydroxy vitamin D (vitamin D), and a bone formation and resorption marker, procollagen type I N-terminal propeptide (PINP) and urinary N-terminal telopeptide (uNTX) respectively, in hemophilic patients and healthy controls. Laboratory parameters related to the pathogenesis of bone loss such as neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) were also evaluated...
December 13, 2017: Bosnian Journal of Basic Medical Sciences
https://www.readbyqxmd.com/read/29232253/postoperative-nausea-and-vomiting-after-unrestricted-clear-fluids-before-day-surgery-a-retrospective-analysis
#2
Graham C McCracken, Jane Montgomery
BACKGROUND: Guidance on pre-operative fluids fasting policy continues to evolve. Current European guidelines encourage the intake of oral fluids up to 2 h before the induction of general anaesthesia. From October 2014, Torbay Hospital Day Surgery Unit commenced an unrestricted fluid policy, encouraging patients to drink clear fluids up until the time of transfer to theatre. OBJECTIVE: The aim of this study was to assess the incidence of postoperative nausea and vomiting before and after the change to the unrestricted pre-operative clear oral fluids...
December 11, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29216521/the-use-of-palliative-medications-before-death-from-prostate-cancer-swedish-population-based-study-with-a-comparative-overview-of-european-data
#3
Magdalena Lycken, Linda Drevin, Hans Garmo, Pär Stattin, Jan Adolfsson, Ingela Franck Lissbrant, Lars Holmberg, Anna Bill-Axelson
BACKGROUND: Symptoms of terminal cancer have previously been reported as undertreated. The aim of this study was to assess the use of palliative medications before death from prostate cancer. METHODS: This Swedish register study included men who died from 2009 to 2012 with prostate cancer as the underlying cause of death. We assessed the proportion who collected a prescription of androgen deprivation therapy, non-steroidal anti-inflammatory drugs, paracetamol, opioids, glucocorticoids, antidepressants, anxiolytics and sedative-hypnotics and the differences in treatment related to age, time since diagnosis, educational level, close relatives and comorbidities...
December 4, 2017: European Journal of Cancer
https://www.readbyqxmd.com/read/29207895/nonpharmacological-management-of-neonatal-abstinence-syndrome-a-review-of-the-literature
#4
Gareth Ryan, Anishnaabe Bimaadiziwin, Joe Dooley, Lianne Gerber Finn, Len Kelly
BACKGROUND: Infants with neonatal abstinence syndrome (NAS) experience withdrawal that occurs as a result of termination of placental opioid supply following delivery. Common symptoms include restlessness, tremors, agitation and gastrointestinal disturbances. Severe NAS is often treated using opioids and/or sedatives. Although commonly employed effectively in neonatal care, there is a lack of published information regarding nonpharmacological management of the NAS infant. OBJECTIVE: The purpose of this review was to summarize the current literature on nonpharmacological management of NAS...
December 5, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29177688/trifurcation-of-the-tibial-nerve-within-the-tarsal-tunnel
#5
Sedat Develi
The tibial nerve is the larger terminal branch of the sciatic nerve and it terminates in the tarsal tunnel by giving lateral and medial plantar nerves. We present a rare case of trifurcation of the tibial nerve within the tarsal tunnel. The variant nerve curves laterally after branching from the tibial nerve and courses deep to quadratus plantae muscle. Interestingly, posterior tibial artery was also terminating by giving three branches. These branches were accompanying the terminal branches of the tibial nerve...
November 24, 2017: Surgical and Radiologic Anatomy: SRA
https://www.readbyqxmd.com/read/29174282/intranasal-dexmedetomidine-in-termination-of-first-trimester-pregnancy-of-suction-evacuation
#6
Hang Shi, Duo Yang, Jie Liu
BACKGROUND AND AIM: Deep sedation without intubation for termination of first trimester pregnancy of suction evacuation entails use of sedatives such as propofol or a combination of propofol and sulfentanil, with unwanted complications. Dexmedetomidine is an α2-adrenoreceptor agonist which provides sedation, anxiolysis and analgesia, without any of the complications associated with the popular sedatives. METHODS: A total number of 90 patients were randomized to three groups: 1...
September 24, 2017: Asian Journal of Anesthesiology
https://www.readbyqxmd.com/read/29173079/what-influences-intentions-to-request-physician-assisted-euthanasia-or-continuous-deep-sedation
#7
Anne-Lore Scherrens, Marc Roelands, L Van den Block, B Deforche, Luc Deliens, J Cohen
The increasing prevalence of euthanasia in Belgium has been linked to changing attitudes. Using National health survey data (N = 9651), we investigated Belgian adults' intention to ask a physician for euthanasia or continuous deep sedation in the hypothetical scenario of a terminal illness, and examined its connection to sociodemographic and health characteristics. Respectively, 38.3% and 25.8% could envisage asking for euthanasia and continuous deep sedation. Those with very bad to fair subjective health and with depression more likely had an intention to ask for euthanasia, which suggests need for attention in the evaluation of requests from specific patient groups...
November 27, 2017: Death Studies
https://www.readbyqxmd.com/read/29118101/japanese-physicians-experiences-of-terminally-ill-patients-voluntarily-stopping-eating-and-drinking-a-national-survey
#8
Takuya Shinjo, Tatsuya Morita, Daisuke Kiuchi, Masayuki Ikenaga, Hirofumi Abo, Sayaka Maeda, Satoru Tsuneto, Yoshiyuki Kizawa
OBJECTIVES: Voluntarily stopping eating and drinking (VSED) could be regarded as a patients' own non-treatment decision that hastens death, which involves patients voluntarily forgoing food and liquid until death. The aims of this study were to investigate the experience of home hospice physicians and palliative care specialists who care for patients during VSED in Japan, and their opinions on continuous deep sedation (CDS) as a means to relieve patient symptoms during VSED. METHODS: 219 home hospice physicians and 695 palliative care specialists across Japan were surveyed by mail questionnaire in 2016...
November 8, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/29109631/comparative-evaluation-of-midazolam-dexmedetomidine-and-propofol-as-intensive-care-unit-sedatives-in-postoperative-electively-ventilated-eclamptic-patients
#9
Malik Rameez Rashid, Rukhsana Najeeb, Saima Mushtaq, Rizwana Habib
Background and Aims: Eclampsia is a common hypertensive disorder of pregnancy and treatment often includes termination of pregnancy with elective postoperative mechanical ventilation. The present study was aimed to compare midazolam, propofol, and dexmedetomidine for sedation and antihypertensive requirements of such patients admitted to Intensive Care Unit (ICU) after termination of pregnancy. Material and Methods: A total of ninety eclamptic patients administered general anesthesia for the termination of pregnancy through cesarean section and who also required postoperative ventilation were taken up for the study and were randomly allocated into three groups...
July 2017: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/29108407/periprocedural-analgesic-efficacy-of-a-single-pre-emptive-administration-of-propacetamol-in-catheter-ablation-for-atrial-fibrillation-a-randomized-controlled-trial
#10
Sung Yeon Ham, Jong-Wook Song, Jae-Kwang Shim, Woo Kyung Lee, Hee-Jung Kim, Young-Lan Kwak
BACKGROUND: Anesthetic care for termination of atrial fibrillation with catheter ablation poses significant challenges due to significant pain lengthy procedure. A delicate polypharmacy combining anaesthetic agents to minimize respiratory depression and hemodynamic changes and to provide satisfactory sedation and analgesia is needed. METHODS: Ninety-eight patients were randomized into two groups receiving either two gram of propacetamol or normal saline intravenously for 20 min before anesthesia...
November 6, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29102388/-end-of-life-debate-citizen-s-point-of-view-about-deep-and-continuous-sedation
#11
J Toporski, T Jonveaux-Rivasseau, C Lamouille-Chevalier
INTRODUCTION: Sedation in palliative care meets a precise definition and corresponds to a medical practice. We assessed the comprehension of this practice by the French population. METHOD: In 2015, citizen expressed their views on the Claeys-Leonetti bill by means of a consultative forum made available on the Internet site of the National Assembly. The content of the messages filed, regarding the right to deep and continuous sedation until death was analyzed using the ALCESTE textual data analysis software, supplemented by a thematic analysis in order to identify the perception that Internet users had of this practice...
November 1, 2017: La Revue de Médecine Interne
https://www.readbyqxmd.com/read/29072020/-xingnao-kaiqiao-needling-stimulation-promotes-resuscitation-of-general-anesthesia-patients-undergoing-anodynia-gastrointestinal-endoscopy
#12
Yan Zhang, Zhe-Hua Li, A-Qin Xiong
OBJECTIVE: To observe the effect of "Xingnao Kaiqiao" needling on the recovery of general anesthesia in mid-aged and elderly patients undergoing painless gastrointestinal endoscopy. METHODS: A total of 140 patients were randomly divided into control and treatment groups, with 70 cases in each group. After termination of the endoscopy, patients of the treatment group received acupuncture stimulation of Neiguan (PC 6), Shuigou (GV 26) and Sanyinjiao (SP 6) with sterilized disposable filiform needles which were manipulated with twirling-reducing method for 3 min in PC 6, with lifting-thrusting reinforcing method in SP 6, and with bird-peck needling in GV 26...
August 25, 2017: Zhen Ci Yan Jiu, Acupuncture Research
https://www.readbyqxmd.com/read/29056584/the-french-exception-the-right-to-continuous-deep-sedation-at-the-end-of-life
#13
Ruth Horn
In 2016, a law came into force in France granting terminally ill patients the right to continuous deep sedation (CDS) until death. This right was proposed as an alternative to euthanasia and presented as the 'French response' to problems at the end of life. The law draws a distinction between CDS and euthanasia and other forms of sympton control at the end of life. France is the first country in the world to legislate on CDS . This short report describes the particular context and underlying social values that led to this piece of legislation, and explores its meaning in the wider French context...
October 22, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29026357/use-of-digital-pupillometry-to-measure-sedative-response-to-propofol
#14
Jody H Haddock, Donald E Mercante, Rose Paccione, Jacob L Breaux, Sarah E Jolley, Jessica L Johnson, Sean E Connolly, Bennett P deBoisblanc
BACKGROUND: Digital pupillometry (DP) accurately and precisely measures pupillary responses. Little is known about using DP to measure the sedative effect of isolated propofol administration. METHODS: We conducted a cross-sectional study of 19 adults undergoing moderate sedation with propofol during which we measured pupillary changes using DP. RESULTS: Maximum and minimum pupillary diameters decreased significantly with propofol (mean change from baseline to procedural termination -1...
2017: Ochsner Journal
https://www.readbyqxmd.com/read/28960387/population-pharmacodynamic-modelling-of-midazolam-induced-sedation-in-terminally-ill-adult-patients
#15
Linda G Franken, Brenda C M de Winter, Anniek D Masman, Monique van Dijk, Frans P M Baar, Dick Tibboel, Birgit C P Koch, Teun van Gelder, Ron A A Mathot
AIMS: Midazolam is the drug of choice for palliative sedation and is titrated to achieve the desired level of sedation. A previous pharmacokinetic (PK) study showed that variability between patients could be partly explained by renal function and inflammatory status. The goal of this study was to combine this PK information with pharmacodynamic (PD) data, to evaluate the variability in response to midazolam and to find clinically relevant covariates that may predict PD response. METHOD: A population PD analysis using nonlinear mixed effect models was performed with data from 43 terminally ill patients...
September 27, 2017: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28955248/aicar-administration-attenuates-hemorrhagic-hyperglycemia-and-lowers-oxygen-debt-in-anesthetized-male-rabbits
#16
Yi Huang, Paul H Ratz, Amy S Miner, Victoria A Locke, Grace Chen, Yang Chen, Robert W Barbee
Background: Many strategies have been utilized to treat traumatic shock via improved oxygen delivery (DO2), while fewer have been used to in an attempt to reduce oxygen demand (VO2). The cellular energy sensor 5' adenosine monophosphate-activated protein kinase (AMPK) has the potential to modulate both whole-body DO2 and VO2. Therefore, we determined the effect of the AMPK activator AICAR (5-aminoimidazole-4-carboxamide 1-β-D-ribonucleoside) given acutely or chronically on key metabolites, hemodynamics, and oxygen consumption/delivery before and during hemorrhage in anesthetized male rabbits...
2017: Frontiers in Physiology
https://www.readbyqxmd.com/read/28945130/pharmacokinetics-and-selected-pharmacodynamics-of-trazodone-following-intravenous-and-oral-administration-to-horses-undergoing-fitness-training
#17
Heather K Knych, Khursheed R Mama, Eugene P Steffey, Scott D Stanley, Philip H Kass
OBJECTIVE To measure concentrations of trazodone and its major metabolite in plasma and urine after administration to healthy horses and concurrently assess selected physiologic and behavioral effects of the drug. ANIMALS 11 Thoroughbred horses enrolled in a fitness training program. PROCEDURES In a pilot investigation, 4 horses received trazodone IV (n = 2) or orally (2) to select a dose for the full study; 1 horse received a vehicle control treatment IV. For the full study, trazodone was initially administered IV (1...
October 2017: American Journal of Veterinary Research
https://www.readbyqxmd.com/read/28936695/early-application-of-airway-pressure-release-ventilation-may-reduce-the-duration-of-mechanical-ventilation-in-acute-respiratory-distress-syndrome
#18
Yongfang Zhou, Xiaodong Jin, Yinxia Lv, Peng Wang, Yunqing Yang, Guopeng Liang, Bo Wang, Yan Kang
PURPOSE: Experimental animal models of acute respiratory distress syndrome (ARDS) have shown that the updated airway pressure release ventilation (APRV) methodologies may significantly improve oxygenation, maximize lung recruitment, and attenuate lung injury, without circulatory depression. This led us to hypothesize that early application of APRV in patients with ARDS would allow pulmonary function to recover faster and would reduce the duration of mechanical ventilation as compared with low tidal volume lung protective ventilation (LTV)...
November 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28899924/relationship-between-ugt1a9-gene-polymorphisms-efficacy-and-safety-of-propofol-in-induced-abortions-amongst-chinese-population-a-population-based-study
#19
Ying-Bin Wang, Rong-Zhi Zhang, Sheng-Hui Huang, Shu-Bao Wang, Jian-Qin Xie
The present study aimed to investigate the influence of UGT1A9 gene polymorphisms on the efficacy of propofol in patients undergoing the painless induced abortion method. A total of 156 women seeking voluntary pregnancy termination procedures were selected for the study, and subsequently underwent painless induced abortions, following anesthesia by means of propofol administration. PCR-restriction fragment length polymorphism (PCR-RFLP) was performed to detect the polymorphisms of UGT1A9 gene at -440C/T, -1818C/T, and -1887T/G loci...
October 31, 2017: Bioscience Reports
https://www.readbyqxmd.com/read/28880142/-an-elderly-couple-dies-of-natural-causes-on-the-same-day
#20
S Zwart, E H E Vermeijlen
BACKGROUND: A 77-year-old woman died of metastatic colorectal cancer. On that same day, her 82-year-old husband, who had stayed in bed next to her during the last days of her life, also died. CASE DESCRIPTION: We describe their two separate trajectories to death: anticipated dying and unexpected death with diagnostic uncertainty. We analysed the general practitioner's role in this scenario. Existential suffering was partly the reason for commencing palliative sedation for the husband after his wife had died...
2017: Nederlands Tijdschrift Voor Geneeskunde
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