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https://www.readbyqxmd.com/read/28097305/enhanced-recovery-after-surgery-a-review
#1
Olle Ljungqvist, Michael Scott, Kenneth C Fearon
Importance: Enhanced Recovery After Surgery (ERAS) is a paradigm shift in perioperative care, resulting in substantial improvements in clinical outcomes and cost savings. Observations: Enhanced Recovery After Surgery is a multimodal, multidisciplinary approach to the care of the surgical patient. Enhanced Recovery After Surgery process implementation involves a team consisting of surgeons, anesthetists, an ERAS coordinator (often a nurse or a physician assistant), and staff from units that care for the surgical patient...
January 11, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28096576/role-of-edaravone-in-managemant-of-septic-peritonitis
#2
Ghada Fouad Elbaradey, Nagat Sayed Elshmaa, Hossam Hodeib
BACKGROUND AND AIMS: Sepsis is a complex rapidly progressive infectious disease that remain a major cause of morbidity and mortality in surgical patients and trauma victims. Edaravone a novel free radical scavenger was approved in 2001 in Japan for treatment of acute cerebral and myocardial infarction. Hence, in this work we attempt to evaluate its role in cases of septic peritonitis (SP). MATERIAL AND METHODS: This is a prospective randomized observer-blinded study carried out in surgical Intensive Care Unit (ICU) after approval by Hospital Ethical Committee...
October 2016: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/28095967/intravenous-immunoglobulin-therapy-in-pediatric-narcolepsy-a-nonrandomized-open-label-controlled-longitudinal-observational-study
#3
Michel Lecendreux, Johanna Berthier, Jennifer Corny, Olivier Bourdon, Claire Dossier, Christophe Delclaux
STUDY OBJECTIVES: Previous case reports of intravenous immunoglobulins (IVIg) in pediatric narcolepsy have shown contradictory results. METHODS: This was a nonrandomized, open-label, controlled, longitudinal observational study of IVIg use in pediatric narcolepsy with retrospective data collection from medical files obtained from a single pediatric national reference center for the treatment of narcolepsy in France. Of 56 consecutively referred patients with narcolepsy, 24 received IVIg (3 infusions administered at 1-mo intervals) in addition to standard care (psychostimulants and/or anticataplectic agents), and 32 continued on standard care alone (controls)...
January 11, 2017: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
https://www.readbyqxmd.com/read/28095830/kv7-voltage-activated-potassium-channel-inhibitors-reduce-fluid-resuscitation-requirements-after-hemorrhagic-shock-in-rats
#4
Sean P Nassoiy, Kenneth L Byron, Matthias Majetschak
BACKGROUND: Recent evidence suggests that drugs targeting Kv7 channels could be used to modulate vascular function and blood pressure. Here, we studied whether Kv7 channel inhibitors can be utilized to stabilize hemodynamics and reduce resuscitation fluid requirements after hemorrhagic shock. METHODS: Anesthetized male Sprague-Dawley rats were instrumented with arterial and venous catheters for blood pressure monitoring, hemorrhage and fluid resuscitation. Series 1: Linopirdine (Kv7 channel blocker, 0...
January 17, 2017: Journal of Biomedical Science
https://www.readbyqxmd.com/read/28094172/interval-changes-in-myocardial-performance-index-predict-outcome-in-severe-sepsis
#5
Junaid Nizamuddin, Feroze Mahmood, Avery Tung, Ariel Mueller, Samuel M Brown, Shahzad Shaefi, Michael O'Connor, Daniel Talmor, Sajid Shahul
OBJECTIVES: Septic cardiomyopathy is a well-described consequence of septic shock and is associated with increased sepsis-related mortality. The myocardial performance index (MPI), a parameter derived from echocardiographic tissue Doppler measurements, allows for a more sensitive assessment of global cardiac function than do traditional metrics for cardiac function. The authors hypothesized that changes in left ventricular MPI in patients with severe sepsis would be associated with a higher 90-day mortality...
November 2, 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28094044/diagnosis-and-treatment-of-acute-retinal-necrosis-a-report-by-the-american-academy-of-ophthalmology
#6
Scott D Schoenberger, Stephen J Kim, Jennifer E Thorne, Prithvi Mruthyunjaya, Steven Yeh, Sophie J Bakri, Justis P Ehlers
PURPOSE: To evaluate the available evidence in peer-reviewed publications about the diagnosis and treatment of acute retinal necrosis (ARN). METHODS: Literature searches of the PubMed and Cochrane Library databases were last conducted on July 27, 2016. The searches identified 216 unique citations, and 49 articles of possible clinical relevance were reviewed in full text. Of these 49 articles, 27 were deemed sufficiently relevant or of interest, and they were rated according to strength of evidence...
January 13, 2017: Ophthalmology
https://www.readbyqxmd.com/read/28093641/dwell-times-and-risk-of-non-elective-removal-of-1-french-peripherally-inserted-central-catheters-according-to-catheter-tip-position-in-very-preterm-infants
#7
Daniela M Erhard, Sarah Nguyen, Katelyn J Guy, Dan M Casalaz, Kai König
: We investigated dwell times and risk of non-elective removal of 975 single-lumen 1-French peripherally inserted central catheters (1FR-PICC) according to tip position in a cohort of very preterm infants with a mean (SD) gestational age of 27(+6) (2(+1)) weeks and a mean (SD) birth weight of 988 (294) g over an eight-year period. Infants with a 1FR-PICC inserted for continuous infusion of intravenous fluids within the first 30 days of life were eligible. Dwell times of PICC with elective versus non-elective removal, risk of non-elective removal of PICC according to tip position, and differences between upper versus lower limb catheter insertion were analysed...
January 16, 2017: European Journal of Pediatrics
https://www.readbyqxmd.com/read/28092334/is-enhanced-recovery-the-new-standard-of-care-in-microsurgical-breast-reconstruction
#8
Anoushka Afonso, Sabine Oskar, Kay See Tan, Joseph J Disa, Babak J Mehrara, Jihan Ceyhan, Joseph H Dayan
BACKGROUND: Enhanced recovery pathways (ERPs) have been shown to aid in patient recovery and improve outcomes in many surgical settings. At present, there is limited data available regarding the use and feasibility of ERPs for patients undergoing microsurgical breast reconstruction. We sought to assess patient outcomes before and after the introduction of an ERP that was adopted by multiple surgeons at a single cancer center. METHODS: A multidisciplinary ERP was developed for patients undergoing deep inferior epigastric perforator (DIEP) or muscle-sparing free transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction...
January 12, 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28092314/novel-technique-for-subretinal-fluid-drainage-with-chandelier-assisted-scleral-buckle-surgery-cannula-controlled-drainage
#9
Abdulelah A Al-Abdullah
PURPOSE: To report a novel technique for subretinal fluid drainage in scleral buckle surgery. METHODS: A 26-gauge intravenous cannula with its needle was used to puncture the sclera; then, the needle (metallic part) was withdrawn to further introduce the cannula into the subretinal space. In addition, we describe using the 25-gauge microcannula of the chandelier light to inject the balanced salt solution to help restore the intraocular pressure and push the subretinal fluid through the intravenous cannula under direct visualization...
January 13, 2017: Retinal Cases & Brief Reports
https://www.readbyqxmd.com/read/28091837/peritoneal-fluid-of-low-ct-hounsfield-units-as-a-screening-criterion-for-traumatic-bowel-perforation
#10
Yon-Cheong Wong, Li-Jen Wang, Cheng-Hsien Wu, Huan-Wu Chen, Being-Chuan Lin, Yu-Pao Hsu
PURPOSE: To investigate whether peritoneal fluid of low CT Hounsfield units is an important screening criterion for traumatic bowel perforation. MATERIALS AND METHODS: We performed a retrospective study on two cohorts of blunt trauma patients who had peritoneal fluid. Intravenous and oral contrast was used for the first cohort (61 patients) as opposed to intravenous contrast only for the second cohort (60 patients). We compared the CT Hounsfield units of peritoneal fluid with bowel perforation...
January 13, 2017: Japanese Journal of Radiology
https://www.readbyqxmd.com/read/28090049/thyroid-storm-precipitated-by-diabetic-ketoacidosis-and-influenza-a-a-case-report-and-literature-review
#11
Toshiyuki Ikeoka, Hiroaki Otsuka, Naruhiro Fujita, Yukiko Masuda, Shigeto Maeda, Ichiro Horie, Takao Ando, Norio Abiru, Atsushi Kawakami
A 46-year-old woman with a history of Graves' disease presented with the chief complaints of appetite loss, weight loss, fatigue, nausea, and sweating. She was diagnosed with diabetic ketoacidosis (DKA), thyroid storm, and influenza A. She was treated with an intravenous insulin drip, intravenous fluid therapy, intravenous hydrocortisone, oral potassium iodine, and oral methimazole. As methimazole-induced neutropenia was suspected, the patient underwent thyroidectomy. It is important to maintain awareness that thyroid storm and DKA can coexist...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28088889/-spontaneous-bacterial-peritonitis
#12
Bálint Velkey, Eszter Vitális, Zsuzsanna Vitális
Spontaneous bacterial peritonitis occurs most commonly in cirrhotic patients with ascites. Pathogens get into the circulation by intestinal translocation and colonize in peritoneal fluid. Diagnosis of spontaneous bacterial peritonitis is based on elevated polymorphonuclear leukocyte count in the ascites (>0,25 G/L). Ascites culture is often negative but aids to get information about antibiotic sensitivity in positive cases. Treatment in stable patient can be intravenous then orally administrated ciprofloxacin or amoxicillin/clavulanic acid, while in severe cases intravenous III...
January 2017: Orvosi Hetilap
https://www.readbyqxmd.com/read/28078858/use-of-lactated-ringer%C3%A2-s-solution-does-not-eliminate-the-risk-of-strong-ion-difference-related-metabolic-acidosis-following-on-pump-cardiac-surgery
#13
T Jovaisa, V Vicka, G Linkaitė, J Guseinovaitė, D Ringaitienė, I Norkienė
There is a growing interest in the effects of plasma sodium levels on postoperative outcomes. A trend of using balanced crystalloid solutions is based on the extensive data on chloride and the strong ion difference-related acidosis. However, effects of sodium are often overlooked in this context. The aim of the study was to establish the effects of the routine use of Lactated Ringer’s Solution (RL) on postoperative changes in sodium concentrations and whether these changes result in metabolic acidosis. We performed database analysis of 358 consecutive elective on-pump cardiac surgery cases in a tertiary referral university hospital...
October 2016: Journal of Biological Regulators and Homeostatic Agents
https://www.readbyqxmd.com/read/28078682/population-pharmacokinetics-of-intravenous-clonidine-for-sedation-during-pediatric-extracorporeal-membrane-oxygenation-ecmo-and-continuous-veno-venous-hemofiltration-cvvh
#14
Niina Kleiber, Ron A A Mathôt, Maurice J Ahsman, Enno D Wildschut, Dick Tibboel, Saskia N de Wildt
AIMS: Clonidine is used for sedation in the pediatric intensive care unit. Extracorporeal membrane oxygenation (ECMO) provides temporary support if respiratory and cardiac function is threatened. ECMO influences the pharmacokinetics of drugs. Clonidine during pediatric ECMO cannot be effectively titrated as PK data are lacking. The aim of this study is to describe clonidine PK in a particular ECMO system and propose dosing guidelines for children on this particular ECMO circuit. METHODS: All children below the age of 18 who received clonidine during ECMO were eligible...
January 12, 2017: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28072899/endoluminal-vacuum-therapy-as-treatment-for-anastomotic-colorectal-leakage
#15
Giovanni Milito, Giorgio Lisi, Dario Venditti, Michela Campanelli, Elena Aronadio, Simona Grande, Francesca Cabry, Michele Grande
BACKGROUND: The clinical leakage rate after anterior resection varies from 2.8-20%, with a 6-22% mortality rate and a 10-80% risk of permanent stoma. Endo-SPONGE® (B. Braun Melsungen AG, Melsungen, Germany) may treat extraperitoneal anastomotic leakage in the lesser pelvis. It consists of an open-pored sponge inserted into the cavity. A drainage tube fixed to a low vacuum drainage system is then connected to the sponge through the anus. MATERIAL AND METHODS: Between January 2007 and December 2014, 14 patients with anastomotic leakage following low anterior resection were treated with Endo-SPONGE® and were prospectively evaluated...
January 10, 2017: Surgical Technology International
https://www.readbyqxmd.com/read/28071865/the-impact-of-evidence-based-sepsis-guidelines-on-emergency-department-clinical-practice-a-pre-post-medical-record-audit
#16
Bernadine Romero, Margaret Fry, Michael Roche
AIMS AND OBJECTIVES: The aim of this study was to explore the number of patients presenting with sepsis before and after guideline implementation; the impact of sepsis guidelines on triage assessment, Emergency Department management and time to antibiotics. BACKGROUND: Sepsis remains one of the leading causes of mortality and morbidity within hospitals. Globally, strategies have been implemented to reduce morbidity and mortality rates, which rely on the early recognition and management of sepsis...
January 10, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28070957/controlled-trial-of-hartmann-s-solution-versus-0-9-saline-for-diabetic-ketoacidosis
#17
Michael Yung, Georgia Letton, Steve Keeley
AIM: We aimed to determine whether using a balanced salt solution, Hartmann's solution (HS), in diabetic ketoacidosis (DKA) shortens the time to normalise acid-base status through the avoidance of hyperchloremic metabolic acidosis compared with 0.9% normal saline (NS). METHODS: We conducted a double-blind, randomised controlled trial comparing HS to NS as the initial intravenous fluid in children with DKA. Patients were stratified by severity (pH < 7.1) and known or new diabetes...
January 2017: Journal of Paediatrics and Child Health
https://www.readbyqxmd.com/read/28070846/development-of-a-convenient-in-vitro-gel-diffusion-model-for-predicting-the-in-vivo-performance-of-subcutaneous-parenteral-formulations-of-large-and-small-molecules
#18
Dennis H Leung, Yash Kapoor, Candice Alleyne, Erika Walsh, Andrew Leithead, Bahanu Habulihaz, Gino M Salituro, Annette Bak, Timothy Rhodes
Parenteral delivery remains a compelling drug delivery route for both large- and small-molecule drugs and can bypass issues encountered with oral absorption. For injectable drug products, there is a strong patient preference for subcutaneous administration due to its convenience over intravenous infusion. However, in subcutaneous injection, in contrast to intravenous administration, the formulation is in contact with an extracellular matrix environment that behaves more like a gel than a fluid. This can impact the expected performance of a formulation...
January 9, 2017: AAPS PharmSciTech
https://www.readbyqxmd.com/read/28069825/intravenous-anesthetic-propofol-binds-to-5-lipoxygenase-and-attenuates-leukotriene-b4-production
#19
Toshiaki Okuno, Sophia Koutsogiannaki, Mai Ohba, Matthew Chamberlain, Weiming Bu, Fu-Yan Lin, Roderic G Eckenhoff, Takehiko Yokomizo, Koichi Yuki
Propofol is an intravenous anesthetic that produces its anesthetic effect, largely via the GABAA receptor in the CNS, and also reduces the N-formyl-methionyl-leucyl-phenylalanine (fMLP)-induced neutrophil respiratory burst. Because fMLP-stimulated neutrophils produce leukotriene (LT)B4, we examined the effect of propofol on LTB4 production in vivo and in vitro Cecal ligation and puncture surgery was performed in mice, with or without exposure to propofol. Propofol attenuated the production of 5-lipoxygenase (5-LOX)-related arachidonic acid (AA) derivatives in the peritoneal fluid...
January 9, 2017: FASEB Journal: Official Publication of the Federation of American Societies for Experimental Biology
https://www.readbyqxmd.com/read/28069098/bolus-dose-of-epinephrine-for-refractory-post-arrest-hypotension
#20
Michael Gottlieb
Post-cardiac arrest hypotension is associated with worse outcomes. However, a significant proportion of patients may not be responsive to intravenous (IV) fluids, and vasopressor infusions require significant time to initiate. This case series describes the successful use of a bolus dose of epinephrine to rapidly treat IV fluid refractory hypotension among three patients in the post-arrest period. A bolus dose of epinephrine may be considered as a treatment for post-arrest hypotension that does not respond to IV fluids, but further studies should be performed prior to routine use...
January 10, 2017: CJEM
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