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Weili Chen, Ning Jin, Yingying Lin, Vincenzo Villani, Akira Shimizu, Xia Zhao, FangNa Lu, Cheng Li, KeGong Chen, Zhi Lin, Zhongquan Qi
BACKGROUND AND OBJECTIVES: Postoperatively, transplant recipients receive immunosuppressants, as well as sedatives and analgesics. The immunomodulatory effects of these other agents during the induction period following transplantation remain unclear. We aimed to determine whether the agents dexmedetomidine hydrochloride (Dex) and fentanyl (Fen) have immunomodulatory effects during the induction period following heart transplantation (HTx). METHODS: Fifty mice were used for antinociception tests after administration of Dex and Fen, and T cells from 3 naive animals were used for in vitro lymphocyte transformation test (study 1)...
March 5, 2018: Regional Anesthesia and Pain Medicine
Eddie Blay, Cynthia Barnard, Karl Y Bilimoria
No abstract text is available yet for this article.
February 6, 2018: JAMA: the Journal of the American Medical Association
Leslie S Zun
BACKGROUND: The main goal of antipsychotic medication in the management of acute agitation in the emergency department is to rapidly induce calm without oversedation, enabling patients to participate in their own care. However, there is a paucity of comparative studies, particularly with newer fast-acting second-generation antipsychotic agents. OBJECTIVE OF THE REVIEW: This structured evidence-based review compared the onset of efficacy of antipsychotic treatments for acute agitation using data from randomized controlled trials identified by a literature search of the PubMed database...
January 17, 2018: Journal of Emergency Medicine
Marlena A Fox, Jessica L Elefritz, Brandon M Huang, Charles Hunley
OBJECTIVE: To evaluate the efficacy and safety of lurasidone compared with quetiapine for treatment of delirium in critically ill patients. DESIGN: Prospective, observational cohort study. SETTING: Single-center community teaching hospital. PATIENTS: Forty adult intensive care unit (ICU) patients with delirium (Confusion Assessment Method in the ICU positive), tolerating enteral nutrition, and without active alcohol withdrawal or prior use of atypical antipsychotics...
January 1, 2018: Journal of Intensive Care Medicine
J L Davis, J Schirmer, E Medlin
Trazodone is a serotonin receptor antagonist and reuptake inhibitor used extensively as an anxiolytic in human and small animal veterinary medicine. The aims of this study were to determine the pharmacokinetics of oral trazodone in experimental horses and to evaluate the effect of oral trazodone in clinical horses. Six experimental horses were administered trazodone at 7.5 or 10 mg/kg. Plasma concentrations of trazodone and its metabolite (m-CPP) were determined via UPLC-MS/MS. Noncompartmental pharmacokinetic analysis, sedation and ataxia scores were determined...
January 14, 2018: Journal of Veterinary Pharmacology and Therapeutics
Julie Savelloni, Heather Gunter, Kelly C Lee, Chih Hsu, Cassia Yi, Kyle P Edmonds, Timothy Furnish, Rabia S Atayee
Introduction: The combination of opioids and central nervous system depressants such as benzodiazepines and barbiturates has an additive effect on the frequency of oversedation and respiratory depression requiring naloxone use in hospitalized patients. Gabapentinoids (gabapentin and pregabalin) are frequently prescribed with opioids for their opioid-sparing and adjuvant analgesic effects. There is limited literature on the risk of respiratory depression due to the combination of opioids and gabapentinoids requiring naloxone administration...
2017: Journal of Pain Research
Erik Vakil, Mona Sarkiss, David Ost, Macarena R Vial, Roberto F Casal, Georgie A Eapen, Horiana B Grosu
BACKGROUND: The optimal approach to sedation for pleuroscopy remains undefined. Propofol is the favored sedative-hypnotic for many proceduralists but has a narrow therapeutic window and the risk for oversedation is high. Propofol-based sedation administered by anesthesiologists and the routine use of end-tidal capnography and bispectral index (BIS) monitoring may attenuate risks of complications. OBJECTIVES: The purpose of our study was to evaluate the safety and efficacy of monitored anesthesia care for pleuroscopy...
September 16, 2017: Respiration; International Review of Thoracic Diseases
Melanie Guenette, Lisa Burry, Alexandra Cheung, Tara Farquharson, Marlene Traille, Ioanna Mantas, Sangeeta Mehta, Louise Rose
BACKGROUND: Restraining therapies (physical or pharmacological) are used to promote the safety of both patients and health care workers. Some guidelines recommend nonpharmacological or pharmacological interventions be used before physical restraints in critically ill patients. OBJECTIVES: To characterize psychotropic drug interventions before and after use of physical restraints in critically ill adults receiving mechanical ventilation. METHODS: A single-center, prospective, observational study documenting psychotropic drug use and Sedation-Agitation Scale (SAS) scores in the 2 hours before and the 6 hours after application of physical restraints...
September 2017: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
Adam Wichniak, Aleksandra Wierzbicka, Małgorzata Walęcka, Wojciech Jernajczyk
PURPOSE OF REVIEW: The aim of this review article was to summarize recent publications on effects of antidepressants on sleep and to show that these effects not only depend on the kind of antidepressant drugs but are also related to the dose, the time of drug administration, and the duration of the treatment. RECENT FINDINGS: Complaints of disrupted sleep are very common in patients suffering from depression, and they are listed among diagnostic criteria for this disorder...
August 9, 2017: Current Psychiatry Reports
Holly A Swartz, Paola Rucci, Michael E Thase, Meredith Wallace, Elisa Carretta, Karen L Celedonia, Ellen Frank
OBJECTIVE: Bipolar II disorder (BP-II) is associated with marked morbidity and mortality. Quetiapine, the treatment with greatest evidence for efficacy in BP-II depression, is associated with metabolic burden. Psychotherapy, a treatment with few side effects, has not been systematically evaluated in BP-II. This study compared psychotherapy plus placebo to psychotherapy plus pharmacotherapy as treatments for BP-II depression. METHODS: From 2010 to 2015, unmedicated adults (n = 92) with DSM-IV-TR BP-II depression were randomly assigned to weekly sessions of Interpersonal and Social Rhythm Therapy (IPSRT) plus placebo or IPSRT plus quetiapine and followed for 20 weeks...
July 11, 2017: Journal of Clinical Psychiatry
Heather N DeAtley, Amanda Burton, Michelle DeLuca Fraley, Joan Haltom
The authors sought to evaluate the impact on length of hospital stay and treatment duration of morphine after implementation of a change in the institutional protocol for managing neonatal abstinence syndrome (NAS) in an effort to improve patient outcomes. A single-center, retrospective chart review was conducted at a Level II nursery in a community hospital in Kentucky. Fifty-nine neonates born between January 1, 2014, and December 31, 2015, who were diagnosed with NAS and received morphine for treatment were included...
June 8, 2017: Pharmacotherapy
Turgut Namigar, Karacalar Serap, Akdaş Tekin Esra, Odacılar Özgül, Öztürk Ali Can, Ak Aysel, Ali Achmet
BACKGROUND AND OBJECTIVES: Sedative and analgesic treatment administered to critically ill patients need to be regularly assessed to ensure that previously stated goals are well achieved as the risk of complications of oversedation is minimized. We revised and prospectively tested the Ramsay Sedation Scale (RSS) for interrater reliability and compared it with the Riker Sedation-Agitation Scale (RSAS) and the Richmond Agitation Sedation Scale (RASS) to test construct validity during midazolam-remifentanil sedation...
July 2017: Revista Brasileira de Anestesiologia
Samantha Weimer, Justin Burleson, Mary Mancuso, Cameron Bell, Mary Beth Flynn Makic
Daily burn wound care for nonintubated patients involves administration of intravenous analgesic and sedation agents. Vital signs and oxygen saturation monitoring alone can result in late signs of oversedation and ineffective breathing. End-tidal carbon dioxide (EtCo2) monitoring provides immediate feedback of effective breathing during procedural sedation. The purpose of this study was to describe the nurse's sedation and analgesic therapy management of nonintubated patients during burn wound care when EtCo2 was used...
March 31, 2017: Journal of Burn Care & Research: Official Publication of the American Burn Association
Sukhtej Sahni, B S Chavan, Ajeet Sidana, Priyanka Kalra, Gurjit Kaur
BACKGROUND & OBJECTIVES: Clozapine may be more useful in treatment-naive patients with first-episode schizophrenia for better symptoms control and improving quality of life. The current study was carried out to compare the efficacy and tolerability of clozapine versus risperidone in treatment-naive, first-episode patients of schizophrenia. METHODS: This was a comparative, open-label, six months prospective study of treatment-naive, first-episode patients with schizophrenia between the age group of 18 and 40 yr diagnosed as per the International Classification of Diseases-10 (ICD-10) criteria...
November 2016: Indian Journal of Medical Research
Kitty M Garrett
Nursing management of pain, agitation, and delirium in mechanically ventilated patients is a challenge in critical care. Oversedation can lead to delayed extubation, prolonged ventilator days, unnecessary neurologic testing, and complications such as weakness and delirium. Undersedation can lead to self-extubation, invasive line removal, unnecessary patient distress, and injury to self or others. Acquiring an optimal level of sedation requires the bedside nurse to be more vigilant than ever with patient assessment and medication titration...
December 2016: Critical Care Nursing Clinics of North America
Roger J Smith, John D Santamaria, Espedito E Faraone, Jennifer A Holmes, David A Reid
OBJECTIVES: To describe the frequency and hospital mortality of problems (diagnoses) encountered by a rapid response team (RRT), and to identify the most common diagnoses for RRT triggers and for treating units. DESIGN: For each RRT event in 2015 at a tertiary hospital for adults, we chose the diagnosis that best explained the RRT event from a pre-defined list after reviewing relevant test results and clinical notes. RESULTS: There were 937 RRT events during 700 admissions and there were 58 different RRT diagnoses in 11 diagnosis groups...
March 2017: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
Dae H Kim, Krista F Huybrechts, Elisabetta Patorno, Edward R Marcantonio, Yoonyoung Park, Raisa Levin, Abdurrahman Abdurrob, Brian T Bateman
OBJECTIVES: To evaluate in-hospital adverse events associated with typical and atypical antipsychotic medications (APMs) after cardiac surgery. DESIGN: Retrospective cohort study. SETTING: Nationwide inpatient database, 2003 to 14. PARTICIPANTS: Individuals (mean age 70) newly treated with oral atypical (n = 2,580) or typical (n = 1,126 APMs) after coronary artery bypass grafting or valve surgery (N = 3,706). MEASUREMENTS: In-hospital mortality, arrhythmia, pneumonia, use of brain imaging (surrogate for oversedation and neurological events), and length of stay after drug initiation RESULTS: In the propensity score-matched cohort, median treatment duration was 3 days (interquartile range (IQR) 1-6 days) for atypical APMs and 2 days (IQR 1-3 days) for typical APMs...
June 2017: Journal of the American Geriatrics Society
A Wolf, R Mörgeli, A Müller, B Weiss, C Spies
Intensive care treatment has long-term consequences that are often not immediately apparent to the health care providers. The combination of muscle weakness, cognitive damage, and psychological disorders is comprised under the term post-intensive care syndrome (PICS). Analgesia and sedation protocols, as well as nonpharmacological preventive and therapeutic approaches, are effective tools for avoiding complications and improving long-term survival. The principle of "early goal-directed therapy" is fundamental...
February 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Tsukasa Ishiwata, Kenji Tsushima, Mai Fujie, Kenichi Suzuki, Kosuke Hirota, Mitsuhiro Abe, Naoko Kawata, Jiro Terada, Koichiro Tatsumi
BACKGROUND: Apnea developing as a result of oversedation is a potential clinical problem in patients undergoing flexible bronchoscopy (FB) under sedation. However, there are no reports of evaluation using a standardized method of the frequency of occurrence of apnea episodes during FB under sedation. The aim of this study was to investigate the frequency of apnea episodes during FB under sedation in the clinical setting by end-tidal capnography. METHODS: This study was a single-institution retrospective review of a prospectively maintained database and medical records, including capnographic data, from April 2015 to March 2016...
January 7, 2017: BMC Pulmonary Medicine
Barry Meisenberg, John Ness, Sumati Rao, Jane Rhule, Cathaleen Ley
PURPOSE: The implementation of interventions to mitigate the causes of opioid-induced oversedation and respiratory depression (OSRD) is reported. SUMMARY: A single-site retrospective review of eligible rescue naloxone cases was conducted to identify the causes of opioid-induced OSRD in a hospital as well as to identify risk factors. A survey was used to assess potential opioid knowledge deficits among hospitalist prescribers. Based on the findings of the case reviews and results of the opioid knowledge assessments, a series of interventions to address noted deficiencies was implemented over the ensuing months, including enhanced monitoring for sedation, improved clinical decision support in the electronic medical record (EMR), and various adjustments to dosing for high-risk patients...
December 19, 2016: American Journal of Health-system Pharmacy: AJHP
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