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Rahul Bhat, Maryann Mazer-Amirshahi, Christie Sun, Janelle Vaughns, Maria Dynin, Eshetu Tefera, Daryn Towle, Munish Goyal
OBJECTIVE: There are limited data regarding appropriateness of sedative and paralytic dosing of obese patients undergoing rapid sequence intubation (RSI) in the emergency department. The goal of this study was to compare rates of appropriate succinylcholine and etomidate doses in obese and nonobese patients. METHODS: Retrospective review using a database of endotracheally intubated patients using RSI in an urban, tertiary care academic emergency department, from November 2009 to June 2011...
September 28, 2016: American Journal of Emergency Medicine
YanQiu Liu, YiMin Ren, Hong Gao, Li Zeng, ShaoFeng Lin, KaiQiang Zhang
OBJECTIVE: This research studied the influence of different blood lipid components on the rate of alveolar-capillary uptake of sevoflurane. METHOD: 104 patients aged 20 - 50 years undergoing elective operations under general anesthesia were mechanically ventilated through endotracheal intubation after intravenous injections of midazolam, vecuronium, fentanyl, and etomidate. They inhaled 2% sevoflurane at an oxygen flow of 2 L/min, then the inspired concentrations (FI) and expired concentrations (FA of sevoflurane were recorded at 1, 3, 5, 7, 10, 15, 20, and 30 minutes...
October 10, 2016: International Journal of Clinical Pharmacology and Therapeutics
Masoud Ghorbanlo, Mahmoud Reza Mohaghegh, Forozan Yazdanian, Mehrdad Mesbah, Ziya Totonchi
BACKGROUND: The need for muscle relaxants in general anesthesia in different surgeries including cardiac surgeries, and the type of relaxant to be used considering its different hemodynamic effects on patients with heart disease can be of considerable importance. In this study, the hemodynamic effects of two muscle relaxants, Cisatracurium and Atracurium in patients whit low function of left ventricle who are candidate for open heart surgery have been considered. METHOD: This study has been designed as a randomized prospective double-blind clinical trial...
July 27, 2016: Medical Archives
Brian E Driver, Robert F Reardon
Some patients are agitated and unable to tolerate conventional preoxygenation methods, including face mask oxygen or noninvasive positive-pressure ventilation. Sedation with ketamine for preoxygenation, also known as delayed sequence intubation, is a technique that can be used to achieve preoxygenation in this patient population. No complications of delayed sequence intubation have previously been reported. A 60-year-old woman presented with acute hypoxic respiratory failure. Despite application of high-flow oxygen (60 L/min) with a nonrebreather face mask, her oxygen saturation remained at 93%...
September 27, 2016: Annals of Emergency Medicine
Leressè Pillay, Timothy Hardcastle
INTRODUCTION: Establishing a definitive airway in order to ensure adequate ventilation and oxygenation is an important aspect of resuscitation of the polytrauma patient . AIM: To review the relevant literature that compares the different drugs used for rapid sequence intubation (RSI) of trauma patients, specifically reviewing: premedication, induction agents and neuromuscular blocking agents across the prehospital, emergency department and operating room setting, and to present the best practices based on the reviewed evidence...
September 19, 2016: World Journal of Surgery
T Vogiatzaki, T Tsoleridis, S Eleftheriadis, C Iatrou
OBJECTIVE: The objective of this case report is to describe the management of anesthesia of a patient with an LVAD that underwent an emergency open appendectomy. Literature regarding emergency anesthesia management of such patients is still limited. A search in the PubMed engine with the keywords "LVAD appendectomy anesthesia management" revealed no results. CASE REPORT: The case regards a 54 years old male patient that received an LVAD implant 2 months before the current incident...
August 2016: European Review for Medical and Pharmacological Sciences
Qing-Tao Meng, Chen Cao, Hui-Min Liu, Zhong-Yuan Xia, Wei Li, Ling-Hua Tang, Rong Chen, Meng Jiang, Yang Wu, Yan Leng, Chris C Lee
The aim of the present study is to compare the safety, efficacy and cost effectiveness of anesthetic regimens by compound, using etomidate and propofol in elderly patients undergoing gastroscopy. A total of 200 volunteers (65-79 years of age) scheduled for gastroscopy under anesthesia were randomly divided into the following groups: P, propofol (1.5-2.0 mg/kg); E, etomidate (0.15-0.2 mg/kg); P+E, propofol (0.75-1 mg/kg) followed by etomidate (0.075-0.1 mg/kg); and E+P, etomidate (0.075-0.01 mg/kg) followed by propofol (0...
September 2016: Experimental and Therapeutic Medicine
Maria Fleseriu, Frederic Castinetti
PURPOSE: Endogenous Cushing's syndrome (CS) is a rare disease that results from exposure to high levels of cortisol; Cushing's disease (CD) is the most frequent form of CS. Patients with CS suffer from a variety of comorbidities that increase the risk of mortality. Surgical resection of the disease-causing lesion is generally the first-line treatment of CS. However, some patients may not be eligible for surgery due to comorbidities, and approximately 25 % of patients, especially those with CD, have recurrent disease...
September 6, 2016: Pituitary
Robert S Green, Dean A Fergusson, Alexis F Turgeon, Lauralyn A McIntyre, George J Kovacs, Donald E Griesdale, Ryan Zarychanski, Michael B Butler, Nelofar Kureshi, Mete Erdogan
OBJECTIVES: Various medications and devices are available for facilitation of emergent endotracheal intubations (EETIs). The objective of this study was to survey which medications and devices are being utilized for intubation by Canadian physicians. METHODS: A clinical scenario-based survey was developed to determine which medications physicians would administer to facilitate EETI, their first choice of intubation device, and backup strategy should their first choice fail...
August 30, 2016: CJEM
Bao Fu, Yuan Wang, Hao Yang, Tian Yu
Although accumulative evidence indicates that the thalamocortical system is an important target for general anesthetics, the underlying mechanisms of anesthetic action on thalamocortical neurotransmission are not fully understood. The aim of the study is to explore the action of etomidate on glutamatergic and GABAergic transmission in rat thalamocortical slices by using whole cell patch-clamp recording. We found that etomidate mainly prolonged the decay time of spontaneous GABAergic inhibitory postsynaptic currents (sIPSCs), without changing the frequency...
August 26, 2016: Neurochemical Research
Ryu Komatsu, Natalya Makarova, Jing You, Daniel I Sessler, David G Anthony, Yusuke Kasuya, Edward G Soltesz, Alparslan Turan
OBJECTIVE: To compare incidence of atrial arrhythmia, duration of care, and major complications after cardiac surgery between patients who received etomidate and those who received other induction agents. DESIGN: Retrospective cohort study utilizing propensity score matching. SETTING: A single academic, tertiary care hospital. PARTICIPANTS: Eight thousand nine hundred seventy-eight patients undergoing coronary artery bypass grafting (CABG), valve, or combined valve/CABG surgery requiring cardiopulmonary bypass between January 2005 and December 2010...
April 28, 2016: Journal of Cardiothoracic and Vascular Anesthesia
Lia Mesbah-Oskui, Richard L Horner
BACKGROUND: Alterations in thalamic γ-aminobutyric acid-mediated signaling are thought to underlie the increased frontal α-β frequency electrocortical activity that signals anesthetic-induced loss of consciousness with γ-aminobutyric acid receptor type A (GABAAR)-targeting general anesthetics. The general anesthetic etomidate elicits phasic extrasynaptic GABAAR activation ("spillover" inhibition) at thalamocortical neurons in vitro. We hypothesize that this action of etomidate at the thalamus is sufficient to trigger an increase in frontal α-β frequency electrocortical activity and that this effect of etomidate is fully recapitulated by enhanced thalamic spillover inhibition in vivo...
November 2016: Anesthesiology
Ervin Pejo, Xiaojuan Zhou, S Shaukat Husain, Douglas E Raines
BACKGROUND: Etomidate potently suppresses adrenocortical steroid synthesis with potentially deleterious consequences by binding to 11β-hydroxylase and inhibiting its function. The authors hypothesized that other sedative-hypnotics currently in clinical use or under development (or their metabolites) might bind to the same site at clinically relevant concentrations. The authors tested this hypothesis by defining etomidate's affinity for this site and the potencies with which other sedative-hypnotics (and their metabolites) inhibit etomidate binding...
November 2016: Anesthesiology
Caroline Cole
CASE SUMMARY: A 6 yr old 45 kg child with severe Cushinoid features was admitted to PICU with probable hypertensive encephalopathy. She presented with increasing headaches, vomiting and seizures becoming unresponsive with a GCS of 3. She was profoundly hypertensive and her cortisol levels were significantly elevated (>2000 nmol/L). Rapid reduction in cortisol levels was required to stabilise her condition prior to surgery. Etomidate is the only readily available intravenous preparation which reliably suppresses adrenocortical function...
September 2016: Archives of Disease in Childhood
Yang Shen, Mei-Hua Cai, Wei Ji, Jie Bai, Yue Huang, Ying Sun, Lin Lin, Jing Niu, Ma-Zhong Zhang
BACKGROUND: Pathophysiologic changes in children with congenital heart disease may alter the effect of drugs by influencing the pharmacokinetics (PK). Considering the limited literature that describes the PK of etomidate in pediatric patients, especially in those with tetralogy of Fallot (TOF), our aim was to characterize the PK of etomidate and explore the effects of TOF. METHODS: Twenty-nine pediatric patients (15 with TOF and 14 with normal cardiac anatomy) scheduled to undergo elective surgery under general anesthesia were recruited in the study...
September 2016: Anesthesia and Analgesia
Bram Peeters, Fabian Güiza, Eva Boonen, Philippe Meersseman, Lies Langouche, Greet Van den Berghe
OBJECTIVE: Critical illness is hallmarked by low plasma ACTH in the face of high plasma cortisol. We hypothesized that frequently used drugs could play a role by affecting the hypothalamic-pituitary-adrenal axis. DESIGN: Observational association study. PATIENTS: A total of 156 medical-surgical critically ill patients. MEASUREMENTS: Plasma concentrations of ACTH and total/free cortisol were quantified upon ICU admission and throughout the first 3 ICU days...
July 16, 2016: Clinical Endocrinology
Hyvernat Hervé, Barel Rémy, Anne Gentilhomme, Cesari-Giordani Jean François, Annie Freche, Michel Kaidomar, Goubaux Bernard, Christian Pradier, Jean Dellamonica, Gilles Bernardin
PURPOSE: The Surviving Sepsis Campaign guidelines recommend hydrocortisone in septic shock only when fluid resuscitation and vasopressors fail to restore hemodynamic stability. Hydrocortisone administration modalities are supported only by low-grade recommendations. Our main objective here was to determine differences in 28-day mortality between two low-dose hydrocortisone regimens for the treatment of septic shock. METHOD: We performed a multicenter, prospective, randomized, double-blind, pilot study in four adult medical intensive care units...
July 11, 2016: Shock
Man Zhang, Hua-Jing Yin, Wei-Ping Wang, Jiang Li, Xiao-Liang Wang
AIM: Recent studies have shown that the two-pore-domain potassium channel TREK-1 is involved in the proliferation of neural stem cells, astrocytes and human osteoblasts. In this study, we investigated how TREK-1 affected the proliferation of Chinese hamster ovary (CHO) cells in vitro. METHODS: A CHO cell line stably expressing hTREK-1 (CHO/hTREK-1 cells) was generated. TREK-1 channel currents in the cells were recorded using whole-cell voltage-clamp recording. The cell cycle distribution was assessed using flow cytometry analysis...
September 2016: Acta Pharmacologica Sinica
Deepanwita Das, Chaitali Sen, Anupam Goswami
INTRODUCTION: Etomidate is usually preferred in the induction of cardiac compromised patients due to its relative cardiovascular stability. However, the use of this drug has been limited as etomidate induces suppression of cortisol biosynthesis as a result of blockade of 11-beta-hydroxylation in the adrenal gland, mediated by the imidazole radical of etomidate. This study was carried out to observe the effect of Vitamin C on adrenal suppression after etomidate induction in patients undergoing cardiac surgery...
July 2016: Annals of Cardiac Anaesthesia
Wen-Jie DU, Jiu-Lin DU, Tian Yu
Despite the wide application of general anesthetic drugs in clinic, it is still unclear how these drugs induce the state of general anesthesia. Larval zebrafish has emerged as an ideal model for dissecting the mechanism of neural systems due to the conserved and simple brain structure. In the present study, we established an anesthesia model from behavioral to electrophysiological levels using larval zebrafish for the first time. Bath application of etomidate, as a kind of intravenous anesthetic drugs, suppressed the spontaneous locomotion of zebrafish in a concentration-dependent manner...
June 25, 2016: Sheng Li Xue Bao: [Acta Physiologica Sinica]
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