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Emergence agitation

James B Leonard, Kashif M Munir, Hong K Kim
Metoclopramide (MCP) is a commonly used anti-emetic in the emergency department (ED). Its use is generally well tolerated; although infrequent adverse reactions such as extrapyramidal reactions or tardive dyskinesia are reported. However, many ED providers are not familiar with the potentially life-threatening hypertensive emergency that can be precipitated by MCP administration in patients with pheochromocytoma. A previously healthy 36-year-old woman presented to the ED with headache and nausea. She developed acute hypertensive emergency (acute agitation, worsening headache, chest pain and wide complex tachycardia) when her blood pressure (BP) increased to 223/102mmHg (initial BP, 134/86mmHg) after receiving intravenous MCP...
March 5, 2018: American Journal of Emergency Medicine
Yoshito Kamijo, Michiko Takai, Yuji Fujita, Kiyotaka Usui
Objective We conducted a retrospective study on the epidemiological and clinical features of patients with acute caffeine poisoning in Japan. Methods Letters requesting participation were sent to 264 emergency departments of hospitals, and questionnaires were mailed to those that agreed to participate. Patients Participants were patients transported to emergency departments of hospitals between April 2011 and March 2016 after consuming large or massive amounts of caffeinated supplements and/or energy drinks (caffeine dose ≥1...
March 9, 2018: Internal Medicine
Jessica Trevena-Peters, Adam McKay, Jennie Ponsford
It is uncertain whether therapy delivered during posttraumatic amnesia (PTA) following traumatic brain injury can be effective due to risk of agitation and poor learning capacity. This study used goal attainment scaling (GAS) to assess gains in activities of daily living (ADL) retraining during PTA. Occupational therapists' perspectives on goal setting and therapy delivery were also explored qualitatively. Forty-nine rehabilitation inpatients were provided with manualised ADL retraining following errorless and procedural learning principles during PTA...
March 8, 2018: Neuropsychological Rehabilitation
Jenny Ringblom, Ingrid Wåhlin, Marie Proczkowska
BACKGROUND: Emergence delirium and emergence agitation have been a subject of interest since the early 1960s. This behavior has been associated with increased risk of injury in children and dissatisfaction with anesthesia care in their parents. The Pediatric Anesthesia Emergence Delirium Scale is a commonly used instrument for codifying and recording this behavior. AIMS: The aim of this study was to psychometrically evaluate the Pediatric Anesthesia Emergence Delirium scale, focusing on the factor structure, in a sample of children recovering from anesthesia after surgery or diagnostic procedures...
March 6, 2018: Paediatric Anaesthesia
Axel Rand, Peter K Zahn, Thomas A Schildhauer, Christian Waydhas, Uwe Hamsen
BACKGROUND: Inhalative sedation is an emerging method for long-term sedation in intensive care therapy. There is evidence that it is easy to control and may be beneficial compared to intravenous sedation. Yet little is known about the use in patients with compromised lung function. In this retrospective analysis, we searched files of patients receiving inhalative sedation under venovenous extracorporeal membrane oxygenator (vv-ECMO) support due to lung failure. METHODS: After ethical approval, we performed a retrospective analysis of patients receiving vv-ECMO support and inhalative sedation in the surgical ICU in 2015...
March 5, 2018: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Yushan Ma, Hao Li, Jin Liu, Xuemei Lin, Hui Liu
RATIONALE: Thyroid storm is a rare complication during caesarean section of patients with hyperthyroidism. It occurs abruptly, with a high mortality rate if not recognized immediately and aggressively treated. Herein, we reported a case of impending thyroid storm during a caesarean section. PATIENT CONCERNS: A healthy 23-year-old woman with undiagnosed hyperthyroidism underwent an emergency caesarean section under general anesthesia. After tracheal extubation, the patient exhibited abnormal tachycardia, agitation, sweating, and hyperpyrexia...
January 2018: Medicine (Baltimore)
Mitra Rahimi, Somaieh Lookzadeh, Roxana Sadeghi, Kambiz Soltaninejad, Shahin Shadnia, Abdolkarim Pajoumand, Hossein Hassanian-Moghaddam, Nasim Zamani, Masoud Latifi-Pour
Introduction: Amphetamine type stimulants (ATS) such as amphetamine and methamphetamine (MA) are one of the most important causes of poisoning in the world. In this study we aimed to define the predictive factors of mortality in acute ATS poisoning patients. Methods: This is a retrospective cross-sectional study on all cases with acute ATS poisoning who were referred to a referral center for poisoning, Tehran, Iran, from April 2011 to March 2014. Using patients' medical records, demographic data, route of exposure, type and amount of ATS, the cause of poisoning, clinical presentations, and electrocardiogram (ECG) and laboratory findings, as well as patient's outcomes were collected and analyzed regarding the independent predictive factors of mortality...
2018: Emergency (Tehran, Iran)
Canser Yilmaz Demir, Nureddin Yuzkat
BACKGROUND: Emergence agitation (EA), defined as restlessness, disorientation, excitation, and/or inconsolable crying, is a common phenomenon during early recovery from general anesthesia. In this study, we aimed to determine the (1) EA incidence after rhinoplasty operations in adults; (2) the effects of ketamine administered at sub-anesthetic doses just 20 min before the end of the surgery in rhinoplasty operations on agitation level, postoperative pain, side effects, and complications; and (3) to determine the risk factors for EA in adults after rhinoplasty...
February 20, 2018: Aesthetic Plastic Surgery
J J Luykx, J K Tijdink, W Tempelaar, C H Vinkers, L de Witte
A range of clinical syndromes may present with psychiatric symptoms, both in and out of hospital settings. In such situations agitation, suicidality, communication difficulties and legal aspects often play a role, making diagnosis and treatment a challenge. Based on several case studies, we illustrate how the recently-published Dutch open access source 'Acute Psychiatry' ( can be of help in acute psychiatric presentations both within and outside psychiatric hospitals.
2018: Nederlands Tijdschrift Voor Geneeskunde
Leslie S Zun
BACKGROUND: The management of acute agitation in the emergency department often requires the administration of rapid-acting antipsychotic agents. However, there are few comparative studies and little guidance regarding the risks associated with use of such drugs in the acute setting. OBJECTIVE: This structured evidence-based review compared the safety of antipsychotic pharmacotherapies for acute agitation using data from randomized controlled trials identified by a literature search of the PubMed database...
February 9, 2018: Journal of Emergency Medicine
Pranjali Kurhekar, Krishnagopal Vinod, Buddhan Rajarathinam, J Shesha Dhiviya Krishna, M S Raghuraman
Background: Emergence agitation (EA) in nasal surgeries is seen in around 22% of patients, which can go to dangerous levels. Dexmedetomidine is effective in prevention of EA in such patients. Midazolam given as premedication fails to prevent EA due to its short half-life. In this study, we compared efficacy of dexmedetomidine and midazolam by intravenous infusion for prevention of EA in adult nasal surgeries. Materials and Methods: Seventy patients belonging to American society of anesthesiologist Status I and II, between 18 and 60 years of age posted for elective nasal surgeries were randomly divided into two groups...
January 2018: Saudi Journal of Anaesthesia
Shikha Jain, Sameer Sethi, Babita Ghai, Jagat Ram
Background: In this study, we compared effectiveness of two doses of dexmedetomidine (0.15 μg/kg and 0.3 μg/kg) in preventing desflurane-induced emergence agitation (EA) in pediatric patients undergoing elective cataract surgery. Methods: It is a prospective double-blinded randomized study conducted on 65 American Society of Anesthesiologists 1 children (2-10 years) who underwent elective cataract surgery at our institute. They were randomized into two equal groups, who received either dexmedetomidine 0...
January 2018: Saudi Journal of Anaesthesia
Dae Hee Kim, Go Un Roh, Young Bok Lee, Chang Ik Choi, Jae Moon Lee, Yun Jeong Chae
Purpose: The development of emergence agitation (EA) is associated with several factors including age, preoperative anxiety, postoperative pain, anesthesia method, and surgery type. No studies have investigated whether the withdrawal reaction following rocuronium injection can predict the occurrence of EA. Therefore, we investigated this relationship in preschool-aged children undergoing inguinal herniorrhaphy, and which grade of withdrawal reaction is appropriate for identifying patients at risk of experiencing EA...
2018: Therapeutics and Clinical Risk Management
Manish B Kotwani, Anila D Malde
Background and Aims: Increasing number of pediatric ambulatory surgeries are being carried out in general anesthesia using supraglottic airways (SGAs). Literature comparing sevoflurane and desflurane for the maintenance of SGA-based anesthesia is limited. Hence, we planned this prospective randomized study to compare the maintenance, emergence and recovery characteristics of sevoflurane and desflurane for pediatric ambulatory surgery. Material and Methods: Sixty children aged 6 months to 6 years posted for short surgical procedures were enrolled into the study...
October 2017: Journal of Anaesthesiology, Clinical Pharmacology
Andy Forbes, Mary Hobart, John Ouyang, Lily Shi, Stephanie Pfister, Mika Hakala
Background: Brexpiprazole is a serotonin-dopamine activity modulator with efficacy in acute schizophrenia and relapse prevention. The aim of this Phase 3, multicenter study was to assess the long-term safety, tolerability, and efficacy of treatment with brexpiprazole flexible-dose 1-4 mg/day. Methods: Patients rolled over into this 52-week open-label study (amended to 26 weeks towards the end) from three randomized, double-blind, placebo-controlled Phase 3 studies...
February 3, 2018: International Journal of Neuropsychopharmacology
Michael Gottlieb, Brit Long, Alex Koyfman
BACKGROUND: Acute agitation is a common occurrence in the emergency department (ED) that requires rapid assessment and management. OBJECTIVE: This review provides an evidence-based summary of the current ED evaluation and management of acute agitation. DISCUSSION: Acute agitation is an increasingly common presentation to the ED and has a broad differential diagnosis including metabolic, neurologic, infectious, toxicologic, and psychiatric etiologies...
January 29, 2018: Journal of Emergency Medicine
M Ibrahim, A M Elnabtity, A Keera
BACKGROUND: Pain is the major determinant factor which affects the quality of recovery and postoperative agitation following nasal surgery with the patient under general anesthesia. Our objectives were to test the hypothesis that an external nasal nerve block will decrease pain intensity, decrease drug consumption, decrease the incidence of postoperative emergence agitation and improve quality of recovery. MATERIAL AND METHODS: In this study 100 adult patients who were scheduled for elective external nasal surgery with the patient under general anesthesia and nasal packing on each side, received external nasal nerve blocks postoperatively for 24 h with saline (group I) or 2% xylocaine (group II) with 1:200,000 epinephrine...
February 1, 2018: Der Anaesthesist
Hideaki Katagiri, Masanori Taketsuna, Shinpei Kondo, Kenta Kajimoto, Etsuko Aoi, Yuka Tanji
Objective: The objective of this study was to evaluate the safety and effectiveness of rapid-acting intramuscular (IM) olanzapine in the treatment of acute agitation associated with schizophrenia in real-world clinical settings in Japan. Methods: In this multicenter, postmarketing surveillance (PMS) study, patients with acute agitation associated with schizophrenia were treated with IM olanzapine daily in a daily clinical setting. The observational period ranged from 1 to 7 days, including the day of initial administration...
2018: Neuropsychiatric Disease and Treatment
Young Seok Jee, Hwang-Ju You, Tae-Yun Sung, Choon-Kyu Cho
BACKGROUND: Emergence agitation (EA) occurs frequently after nasal surgery. N-methyl-D-aspartate (NMDA) receptor antagonists and analgesics, such as fentanyl, have been shown to prevent EA. Nefopam inhibits the NMDA receptor and shows a potent analgesic effect. We investigated the effects of nefopam on EA in patients undergoing nasal surgery. METHODS: In this prospective, double-blind study, 100 adult patients were allocated randomly to 1 of 2 groups (each n = 50)...
November 2017: Medicine (Baltimore)
Ilona Hallikainen, Kristiina Hongisto, Tarja Välimäki, Tuomo Hänninen, Janne Martikainen, Anne M Koivisto
BACKGROUND: An improved understanding of the role of neuropsychiatric symptoms (NPS) in the course of Alzheimer's disease (AD) has recently emerged. NPS lead to hospitalization and caregiver stress, but are more variable during the course of the disease than other symptoms. Knowledge about the role of specific NPS in disease progression and prognosis is especially limited. OBJECTIVES: To examine the relationship between specific NPS and AD severity during a 5-year follow-up period, and to determine which baseline NPS predict AD progression...
2018: Journal of Alzheimer's Disease: JAD
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