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https://www.readbyqxmd.com/read/28526145/alpha-2-agonists
#1
REVIEW
Viet Nguyen, Dawn Tiemann, Edward Park, Ali Salehi
Alpha-2 adrenergic receptors are spread throughout the central and peripheral nervous system, specifically in the pontine locus coeruleus, medullospinal tracts, rostral ventrolateral medulla, and the dorsal horn of the spinal cord. Alpha-2 agonist agents cause neuromodulation in these centers, leading to sedation, analgesia, vasodilatation, and bradycardia with little effect on the respiratory drive, which accounts for their good safety profile. The 2 major drugs in this group are clonidine and dexmedetomidine...
June 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28525514/perineural-dexmedetomidine-is-more-effective-than-clonidine-when-added-to-local-anesthetic-for-supraclavicular-brachial-plexus-block-a-systematic-review-and-meta-analysis
#2
Kariem El-Boghdadly, Richard Brull, Herman Sehmbi, Faraj W Abdallah
BACKGROUND: Clonidine, an α-2 agonist, has long been used as a local anesthetic adjunct with proven efficacy to prolong peripheral nerve block duration. Dexmedetomidine, a newer α-2 agonist, has a more favorable pharmacodynamic and safety profile; however, data comparing its efficacy as an adjunct to that of clonidine are inconsistent. We sought to compare the clinical efficacy of these 2 α-2 agonists by examining their effects on peripheral nerve block characteristics for upper extremity surgery...
June 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28525411/beta-blockers-and-traumatic-brain-injury-a-systematic-review-meta-analysis-and-eastern-association-for-the-surgery-of-trauma-guideline
#3
Aziz S Alali, Kaushik Mukherjee, Victoria A McCredie, Eyal Golan, Prakesh S Shah, James M Bardes, Susan E Hamblin, Elliott R Haut, James C Jackson, Kosar Khwaja, Nimitt J Patel, Satish R Raj, Laura D Wilson, Avery B Nathens, Mayur B Patel
OBJECTIVE: To determine if beta-(β)-blockers improve outcomes after acute traumatic brain injury (TBI). BACKGROUND: There have been no new inpatient pharmacologic therapies to improve TBI outcomes in a half-century. Treatment of TBI patients with β-blockers offers a potentially beneficial approach. METHODS: Using MEDLINE, EMBASE, and CENTRAL databases, eligible articles for our systematic review and meta-analysis (PROSPERO CRD42016048547) included adult (age ≥ 16 years) blunt trauma patients admitted with TBI...
May 18, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28520941/risk-factors-for-in-hospital-shunt-thrombosis-and-mortality-in-patients-weighing-less-than-3%C3%A2-kg-with-functionally-univentricular-heart-undergoing-a-modified-blalock-taussig-shunt%C3%A2
#4
Voravit Chittithavorn, Pongsanae Duangpakdee, Chareonkiat Rergkliang, Napat Pruekprasert
OBJECTIVES: To determine the association between several perioperative variables and in-hospital shunt thrombosis and mortality in patients weighing less than 3 kg with functional univentricular heart (UVH) who underwent modified Blalock-Taussig shunt. METHODS: Between January 2006 and February 2016, 85 patients who weighed less than 3 kg with functional UVH and underwent modified Blalock-Taussig shunt were reviewed. In-hospital shunt thrombosis and mortality were the primary outcomes...
May 17, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28515825/late-presentation-of-aortic-aneurysm-and-dissection-following-cardiac-catheterization
#5
Abimbola Shofu, G Mustafa Awan, Bassam Omar, Ghazanfar Qureshi
We report a 63-year-old female with hypertension, hyperlipidemia, and prior pacemaker insertion for atrial fibrillation with symptomatic bradycardia, who was admitted with substernal chest pressure and diaphoresis. Her electrocardiogram revealed atrial fibrillation with demand ventricular pacing and her cardiac biomarkers were negative for acute coronary syndrome. Echocardiogram revealed normal left ventricular systolic function and normal aortic root diameter. Coronary angiography revealed 60-70% obtuse marginal lesion, otherwise mild disease...
April 2017: Cardiology Research
https://www.readbyqxmd.com/read/28515518/is-segmental-epidural-anaesthesia-an-optimal-technique-for-patients-undergoing-percutaneous-nephrolithotomy
#6
Devangi A Parikh, Geeta A Patkar, Mayur S Ganvir, Ajit Sawant, Bharati A Tendolkar
BACKGROUND AND AIMS: Neuraxial anaesthesia has recently become popular for percutaneous nephrolithotomy (PCNL). We conducted a study comparing general anaesthesia (GA) with segmental (T6-T12) epidural anaesthesia (SEA) for PCNL with respect to anaesthesia and surgical characteristics. METHODS: Ninety American Society of Anesthesiologists Physical Status-I and II patients undergoing PCNL randomly received either GA or SEA. Overall patient satisfaction was the primary end point...
April 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/28515516/changes-in-cardiac-index-during-labour-analgesia-a-double-blind-randomised-controlled-trial-of-epidural-versus-combined-spinal-epidural-analgesia-a-preliminary-study
#7
Stephanie Yacoubian, Corrina M Oxford, Bhavani Shankar Kodali
BACKGROUND AND AIMS: Combined spinal-epidural (CSE) analgesia for labour and delivery is occasionally associated with foetal bradycardia. Decreases in cardiac index (CI) and/or uterine hypertonia are implicated as possible aetiological factors. No study has evaluated CI changes following combined spinal analgesia for labour and delivery. This prospective, double-blind, randomised controlled trial evaluates haemodynamic trends during CSE and epidural analgesia for labour. METHODS: Twenty-six parturients at term requesting labour analgesia were randomised to receive either epidural (E) or CSE analgesia...
April 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/28515502/ismp-adverse-drug-reactions-pregabalin-induced-stuttering-nitroglycerine-induced-bradycardia-progressing-to-asystole-minocycline-induced-dress-leading-to-liver-transplantation-and-type-1-diabetes-increased-risk-of-vertebral-fractures-in-women-receiving-thiazide
#8
Michael A Mancano
The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the US Food and Drug Administration's (FDA's) MedWatch program (800-FDA-1088). If you have reported an interesting, preventable ADR to MedWatch, please consider sharing the account with our readers. Write to Dr. Mancano at ISMP, 200 Lakeside Drive, Suite 200, Horsham, PA 19044 (phone: 215-707-4936; e-mail: mmancano@temple.edu). Your report will be published anonymously unless otherwise requested...
April 2017: Hospital Pharmacy
https://www.readbyqxmd.com/read/28507743/electrophysiological-testing-for-the-investigation-of-bradycardias
#9
Demosthenes G Katritsis, Mark E Josephson
In this article we review the role of electrophysiological testing in patients presenting with bradycardia due to sinus node or atrioventricular node disease. In sinus bradycardia the role of electrophysiology studies is not established. In AV conduction disturbances, an electrophysiology study may be necessary both for the establishment of atrioventricular block as the main cause of symptoms, and for identification of the anatomic site of block that may dictate the potential need of permanent pacing.
April 2017: Arrhythmia & Electrophysiology Review
https://www.readbyqxmd.com/read/28506601/a-flatline-lead-i-in-a-neonate-with-suspected-congenital-heart-disease
#10
Kristy Riniker, Luis Rigales, Irwin Hoffman
In a neonate with bradycardia and hypoxia, and clinical concern for critical congenital heart disease (CCHD), highly unusual ECG findings were present. These included a flatline Lead 1, and identical Leads 2, 3, and AVF. These abnormalities were due to bilateral arm to leg lead exchanges and not to heart disease. Complete cardiac workup including echocardiogram was normal.
April 21, 2017: Journal of Electrocardiology
https://www.readbyqxmd.com/read/28506502/autonomic-dysreflexia-after-spinal-cord-injury-systemic-pathophysiology-and-methods-of-management
#11
REVIEW
Khalid C Eldahan, Alexander G Rabchevsky
Traumatic spinal cord injury (SCI) has widespread physiological effects beyond the disruption of sensory and motor function, notably the loss of normal autonomic and cardiovascular control. Injury at or above the sixth thoracic spinal cord segment segregates critical spinal sympathetic neurons from supraspinal modulation which can result in a syndrome known as autonomic dysreflexia (AD). AD is defined as episodic hypertension and concomitant baroreflex-mediated bradycardia initiated by unmodulated sympathetic reflexes in the decentralized cord...
May 8, 2017: Autonomic Neuroscience: Basic & Clinical
https://www.readbyqxmd.com/read/28506112/resting-bradycardia-enhanced-postexercise-heart-rate-recovery-and-cardiorespiratory-fitness-in-recreational-ballroom-dancers
#12
Carlos Janssen Gomes da Cruz, Guilherme Eckhardt Molina, Luiz Guilherme Grossi Porto, Luiz Fernando Junqueira
PURPOSE: In a cross-sectional study design, we evaluated the resting heart rate (HRbaseline) and exercise and postexercise stress test-related chronotropic responses in male practitioners of recreational ballroom dancing (BD; n = 25, Mage = 26.6 ± 6.1 years) compared to a control group of insufficiently active nondancers (CG; n = 25, Mage = 25.9 ± 4.5 years). METHOD: All participants underwent a submaximal exercise test. At 85% of the maximal predicted HR, the recovery protocol was started, and heart rate recovery (HRR) was recorded during 1-min intervals for 5 min...
May 16, 2017: Research Quarterly for Exercise and Sport
https://www.readbyqxmd.com/read/28504991/tablet-e-logbooks-four-thousand-clinical-cases-and-complications-e-logged-by-14-nondoctor-anesthesia-providers-in-nepal
#13
Shristi Shah, Oliver Ross, Stephen Pickering, Stephen Knoble, Indra Rai
BACKGROUND: To meet the need for essential surgery across rural Nepal, anesthesia at district level is delivered by nondoctor anesthetists. They require support to maintain confidence and competence, and upgraded professional registration to secure their status. To meet these needs, a distance-blended learning course was pioneered and delivered. A core course requirement was to log all clinical cases; these were logged on a new e-logbook. METHODS: Fourteen nondoctor anesthesia providers working in 12 different districts across Nepal were enrolled in the 1-year course...
May 11, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28501825/maternal-bradycardia-occurring-prior-to-onset-of-hellp-syndrome-in-a-woman-with-pre-eclampsia
#14
Ami Hosokawa, Takeshi Umazume, Takahiro Yamada, Hisanori Minakami
A 36-year-old nulliparous woman developed pre-eclampsia at gestational week (GW) 28(-6/7) Cardiac status was checked regularly. Heart rate of 93 beats per minute (bpm) with left atrial diameter (LAD) of 35 mm, left ventricular hypertrophy and inferior vena cava diameter (IVCD) of 8 mm at GW 32(-0/7) decreased to 48 bpm with an expanded IVCD to 25 mm, dilated left atrium (LAD to 39 mm), increased pulmonary arterial pressure, increased systemic vascular resistance (approximate 3000  dyn s/cm(5)) and biphasic intrarenal venous flow pattern 3...
May 13, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28501797/predictors-of-procedural-complications-in-adult-fontan-patients-undergoing-non-cardiac-procedures
#15
Alexander C Egbe, Arooj R Khan, Naser M Ammash, David W Barbara, William C Oliver, Sameh M Said, Emmanuel Akintoye, Carole A Warnes, Heidi M Connolly
OBJECTIVE: Limited data exist regarding the outcomes of non-cardiac procedures (NCPs) in adult patients after Fontan operations (Fontan patients). METHODS: To compare procedural outcomes after NCPs in Fontan patients with outcomes for two matched control groups: patients with repaired congenital heart disease and biventricular circulation (CHD-BiV) and patients with no heart disease (NHD). We defined cyanosis as oxygen saturation <90% and procedural hypoxia as saturation <80% or a decrease in saturation >10% from baseline...
May 13, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28496924/atrial-fibrillation-triggered-by-drug-induced-bradycardia
#16
Gokhan Altunbas, Suleyman Ercan, Murat Sucu, Vedat Davutoglu
Atrial fibrillation (AF) is the most frequently observed arrhythmia in clinical practice. Many causative factors have been identified from well-known structural heart disease to less understood triggers. Both sympathetic and parasympathetic (vagal) stimuli are able to trigger paroxysms of AF. Vagally mediated AF is especially observed in young healthy subjects and especially during nights when the heart rate is considerably slow. Tachycardia induced AF is demonstrated and the possible mechanisms are explained...
October 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/28496358/analgesic-efficacy-adverse-effects-and-safety-of-oxycodone-administered-as-continuous-intravenous-infusion-in-patients-after-total-hip-arthroplasty
#17
Bogumił Olczak, Grzegorz Kowalski, Wojciech Leppert, Iwona Zaporowska-Stachowiak, Katarzyna Wieczorowska-Tobis
BACKGROUND: Total hip arthroplasty (THA) causes extensive tissue damage and severe pain. This study aimed to assess the analgesic efficacy, adverse effects (AEs), and safety of continuous intravenous (iv) oxycodone infusion with ketoprofen (injected into the iv line) in patients after THA, and to assay serum oxycodone levels. PATIENTS AND METHODS: Fourteen patients, aged 59‒82 years with American Society of Anesthesiologists (ASA) classification I or III, underwent THA with intrathecal analgesia and sedation induced by iv propofol...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28495845/edmund-goodwyn-and-the-first-description-of-diving-bradycardia
#18
Jose L Vega
Diving bradycardia is a primordial oxygen-conserving reflex by which the heart rate of air-breathing vertebrates, including humans, slows down in response to water immersion. Its discovery is attributed to Paul Bert whose seminal observation was published in 1870 as part of a series of experiments that examined physiological adaptations to asphyxia in ducks and other animals. However, Edmund Goodwyn, a British physician who studied medicine at the University of Edinburgh had already published descriptions of this reflex in his doctoral thesis, which was originally published in Latin in 1786, and again in English in 1788...
May 11, 2017: Journal of Applied Physiology
https://www.readbyqxmd.com/read/28488817/neladenoson-bialanate-hydrochloride-a-prodrug-of-a-partial-adenosine%C3%A2-a1-receptor-agonist-for-the-chronic-treatment-of-heart-diseases
#19
Daniel Meibom, Barbara Albrecht-Küpper, Nicole Diedrichs, Walter Hübsch, Raimund Kast, Thomas Krämer, Ursula Krenz, Hans-Georg Lerchen, Joachim Mittendorf, Peter G Nell, Frank Süssmeier, Alexandros Vakalopoulos, Katja Zimmermann
Adenosine is known to be released under a variety of physiological and pathophysiological conditions to facilitate the protection and regeneration of injured ischemic tissues. The activation of myocardial adenosine A1 receptors (A1 Rs) has been shown to inhibit myocardial pathologies associated with ischemia and reperfusion injury, suggesting several options for new cardiovascular therapies. When full A1 R agonists are used, the desired protective and regenerative cardiovascular effects are usually overshadowed by unintended pharmacological effects such as induction of bradycardia, atrioventricular (AV) blocks, and sedation...
May 10, 2017: ChemMedChem
https://www.readbyqxmd.com/read/28481791/a-comprehensive-safety-evaluation-of-68ga-psma-11-pet-ct-in-prostate-cancer-the-results-of-2-prospective-multicenter-trials
#20
Julie B Nielsen, Helle D Zacho, Uwe Haberkorn, Karin M Nielsen, Katja Dettmann, Niels C Langkilde, Lars J Petersen
PURPOSE: The aim of this study was to evaluate the clinical safety profile of the Ga-PSMA-11 ligand for PET/CT imaging in prospective clinical trials. METHODS: Eighty-eight patients with newly diagnosed or recurrent prostate cancer participated in 2 prospective trials. Safety reporting was identical in the 2 trials. The Ga-PSMA-11 ligand was administered as 2 MBq/kg body weight (mean, 9.2 μg, 9.7 nmol). The reporting of clinical adverse events (AEs) and the measurement of blood pressure (BP) and heart rate (HR) were performed prior to injection (baseline); immediately after injection of Ga-PSMA-11 (postinjection); at 1, 10, and 60 minutes after injection; and after acquisition of the PET/CT scan (postscan)...
May 6, 2017: Clinical Nuclear Medicine
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