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A Pourmand, M Mazer-Amirshahi, C Royall, R Alhawas, R Shesser
There is a need for alternative non-opioid analgesics for the treatment of acute, chronic, and refractory pain in the emergency department (ED). Ketamine is a fast acting N-methyl-d-aspartate (NMDA) receptor antagonist that provides safe and effective analgesia. The use of low dose ketamine (LDK) (<1mg/kg) provides sub-dissociative levels of analgesia and has been studied as an alternative and/or adjunct to opioid analgesics. We reviewed 11 studies using LDK either alone or in combination with opioid analgesics in the ED...
March 2, 2017: American Journal of Emergency Medicine
Takashi Asai
No abstract text is available yet for this article.
March 3, 2017: Journal of Anesthesia
Jeff Riddell, Alexander Tran, Rimon Bengiamin, Gregory W Hendey, Patil Armenian
OBJECTIVE: Emergency physicians often need to control agitated patients who present a danger to themselves and hospital personnel. Commonly used medications have limitations. Our primary objective was to compare the time to a defined reduction in agitation scores for ketamine versus benzodiazepines and haloperidol, alone or in combination. Our secondary objectives were to compare rates of medication redosing, vital sign changes, and adverse events in the different treatment groups. METHODS: We conducted a single-center, prospective, observational study examining agitation levels in acutely agitated emergency department patients between the ages of 18 and 65 who required sedation medication for acute agitation...
February 13, 2017: American Journal of Emergency Medicine
Kevin James Tierney, Tiffany Murano, Brenda Natal
BACKGROUND: Local anesthetics are commonly used in the emergency department (ED). Overdoses can lead to disastrous complications including cardiac toxicity and arrest. Recognition of local anesthetic systemic toxicity (LAST) is important; however, prevention is even more critical. Knowledge of proper lidocaine dosage can prevent LAST. LAST may be effectively treated with lipid emulsion therapy. Although the mechanism is not well understood, its use may have a profound impact on morbidity and mortality...
January 2016: Journal of Emergency Medicine
Başak Ceyda Meço, Ahmet Onat Bermede, Zekeriyya Alanoğlu, Olcay Yaka, Neslihan Alkış
OBJECTIVE: This prospective, randomized, double-blinded study aimed to compare the effects of three different doses of ketamine or lidocaine on intubating conditions and haemodynamics in a rapid-sequence induction model with 3 mg kg(-1) propofol and 0.6 mg kg(-1) rocuronium. METHODS: A total of 128 ASA I-III patients who were scheduled for elective surgery were randomized in the following five groups: Group 1 (n=24), 1 mg kg(-1) lidocaine+3 mg kg(-1) propofol+0...
February 2016: Turkish Journal of Anaesthesiology and Reanimation
Ghada M N Bashandy
The endothelial glycocalyx is a labile, fine structure coating the luminal membrane of intact healthy vascular endothelium. For many decades, no physiologic importance was linked to this structure. It is crucial for vascular barrier function. There has been an immense interest in recent years for studying this important structure, and research is needed to disclose more information about it. Perioperative damage of the glycocalyx has been demonstrated, and is linked with morbidity and even mortality in surgical patients...
April 2015: Journal of Anesthesia
Ashish Udeshi, Shawn Michael Cantie, Edgar Pierre
Postobstructive pulmonary edema (POPE; also known as negative pressure pulmonary edema) is a potentially life-threatening complication in which pulmonary edema occurs shortly after the relief of an upper airway obstruction. The incidence of POPE has been reported to be as high as 1 in 1000 general anesthetic cases and commonly presents as acute respiratory distress that requires immediate intervention. This review examines the 2 subclasses of POPE and describes the etiologic factors, pathophysiology, clinical manifestations, diagnostic criteria, and treatment strategies associated with each...
September 2010: Journal of Critical Care
Lei Yang, Hui Liu, Hai-Ying Sun, Gui-Rong Li
BACKGROUND: Propofol is widely used clinically for the induction and maintenance of anesthesia. Clinical case reports have shown that propofol has an antiatrial tachycardia/fibrillation effect; however, the related ionic mechanisms are not fully understood. The current study investigates the effects of propofol on human cardiac potassium channels. METHODS: The whole cell patch voltage clamp technique was used to record transient outward potassium current (Ito) and ultrarapidly activating delayed rectifier potassium current (IKur) in human atrial myocytes and hKv1...
March 2015: Anesthesiology
Christopher B Wolff, David W Green
The paper examines the effects of anaesthesia on circulatory physiology and their implications regarding improvement in perioperative anaesthetic management. Changes to current anaesthetic practice, recommended recently, such as the use of flow monitoring in high risk patients, are already beginning to have an impact in reducing complications but not mortality [1]. Better understanding of the patho-physiology should help improve management even further. Analysis of selected individual clinical trials has been used to illustrate particular areas of patho-physiology and how changes in practice have improved outcome...
December 2014: International Journal of Surgery
Martín Cuesta, Christopher Thompson
BACKGROUND: Hyponatraemia is the most common electrolyte disturbance in hospitalized patients. There is an increasing awareness of the impact of hyponatraemia on the perioperative management of surgical patients. METHODS: We performed a literature review. We have included relevant data from different surgical disciplines for analysis. In this review we discuss the differential diagnosis of hyponatraemia, and explain the specific relevance of hyponatraemia to pre-, peri- and post-operative care...
June 2015: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Thomas Schricker, Ralph Lattermann
PURPOSE: This article reviews the pathophysiology, clinical relevance, and therapy of the catabolic response to surgical stress. PRINCIPLE FINDINGS: The key clinical features of perioperative catabolism are hyperglycemia and loss of body protein, both metabolic consequences of impaired insulin function. Muscle weakness and (even moderate) increases in perioperative blood glucose are associated with morbidity after major surgery. Although the optimal glucose concentration for improving clinical outcomes is unknown, most medical associations recommend treatment of random blood glucose > 10 mmol·L(-1)...
February 2015: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Sebnem Eren Cevik, Tanju Tasyurek, Ozlem Guneysel
Intravenous lipid emulsion (ILE) is a lifesaving treatment of lipophilic drug intoxications. Not only does ILE have demonstrable efficacy as an antidote to local anesthetic toxicity, it is also effective in lipophilic drug intoxications. Our case series involved 10 patients with ingestion of different types of lipophilic drugs. Intravenous lipid emulsion treatment improved Glasgow Coma Scale or blood pressure and pulse rate or both according to the drug type. Complications were observed in 2 patients (minimal change pancreatitis and probable ILE treatment-related fat infiltration in lungs)...
September 2014: American Journal of Emergency Medicine
Megan Corrigan, Suprat Saely Wilson, Jeremy Hampton
PURPOSE: The safety and efficacy of medications that may be administered via the intranasal route in adult patients in the prehospital and emergency department (ED) settings are reviewed. SUMMARY: When medications of appropriate molecular character and concentration are delivered intranasally, they are quickly transported across this capillary network and delivered to the systemic circulation, thereby avoiding the absorption-limiting effects of first-pass metabolism...
September 15, 2015: American Journal of Health-system Pharmacy: AJHP
Robert H Thiele, Marcel E Durieux
Qualitative arterial waveform analysis has been in existence for millennia; quantitative arterial waveform analysis techniques, which can be traced back to Euler's work in the 18th century, have not been widely used by anesthesiologists and other clinicians. This is likely attributable, in part, to the widespread use of the sphygmomanometer, which allows the practitioner to assess arterial blood pressure without having to develop a sense for the higher-order characteristics of the arterial waveform. The 20-year delay in the development of devices that measure these traits is a testament to the primitiveness of our appreciation for this information...
October 2011: Anesthesia and Analgesia
Joseph Miller, Chuan-Xing Ho, Joy Tang, Richard Thompson, Jared Goldberg, Ahmed Amer, Bashar Nahab
OBJECTIVES: The primary objective of this study was to test if fasting volunteers exhibit fluid responsiveness using noninvasive hemodynamic measurements. The secondary objective was to test a passive leg raise (PLR) maneuver as a diagnostic predictor of fluid responsiveness. METHODS: This was a quasi-experimental design involving healthy volunteers. Subjects were excluded for pregnancy and congestive heart failure. Following a 12-hour fast, subjects had baseline hemodynamic monitoring recorded using noninvasive, continuous pulse contour analysis...
February 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Michelle M McCarthy, ShiNung Ching, Miles A Whittington, Nancy Kopell
Dynamics of neuronal networks can be altered in at least two ways: by changes in connectivity, that is, the physical architecture of the network, or changes in the amplitudes and kinetics of the intrinsic and synaptic currents within and between the elements making up a network. We argue that the latter changes are often overlooked as sources of alterations in network behavior when there are also structural (connectivity) abnormalities present; indeed, they may even give rise to the structural changes observed in these states...
August 2012: Current Opinion in Neurobiology
Wonki Kim, In Ho Song, Yong Hoon Lim, Mi-Ryoung Kim, Young Eun Kim, Jae Ha Hwang, In Keyoung Kim, Sang Woo Song, Jin Wook Kim, Woong-Woo Lee, Han-Joon Kim, Cheolyoung Kim, Hee Chan Kim, In Young Kim, Hee Pyoung Park, Dong Gyu Kim, Beom Seok Jeon, Sun Ha Paek
We investigated the effect of propofol and fentanyl on microelectrode recording (MER) and its clinical applicability during subthalamic nucleus (STN) deep brain stimulation (DBS) surgery. We analyzed 8 patients with Parkinson's disease, underwent bilateral STN DBS with MER. Their left sides were done under awake and then their right sides were done with a continuous infusion of propofol and fentanyl under local anesthesia. The electrode position was evaluated by preoperative MRI and postoperative CT. The clinical outcomes were assessed at six months after surgery...
September 2014: Journal of Korean Medical Science
Karen J Bowers, Kelly B McAllister, Meredith Ray, Corey Heitz
OBJECTIVES: This study had five objectives: 1) to measure and compare total opioid use and number of opioid doses in patients treated with opioids versus ketamine in conjunction with opioids; 2) to measure pain scores up to 2 hours after presentation in the ED patient with pain, comparing standard opioid pain control to ketamine in conjunction with opioids; 3) to compare patient satisfaction with pain control using opioids alone versus ketamine in conjunction with opioids; 4) to monitor and compare side effects in patients treated with opioids versus ketamine in conjunction with opioids; and 5) to identify effect variation between different subgroups of patients, with the purpose of focusing future research...
February 8, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Lars W Andersen, Asger Granfeldt, Clifton W Callaway, Steven M Bradley, Jasmeet Soar, Jerry P Nolan, Tobias Kurth, Michael W Donnino
Importance: Tracheal intubation is common during adult in-hospital cardiac arrest, but little is known about the association between tracheal intubation and survival in this setting. Objective: To determine whether tracheal intubation during adult in-hospital cardiac arrest is associated with survival to hospital discharge. Design, Setting, and Participants: Observational cohort study of adult patients who had an in-hospital cardiac arrest from January 2000 through December 2014 included in the Get With The Guidelines-Resuscitation registry, a US-based multicenter registry of in-hospital cardiac arrest...
February 7, 2017: JAMA: the Journal of the American Medical Association
John C Sakles, G Judson Corn, Patrick Hollinger, Brittany Arcaris, Asad E Patanwala, Jarrod M Mosier
BACKGROUND: The objective was to determine the impact of a soiled airway on firstpass success when using the GlideScope video laryngoscope or the direct laryngoscope for intubation in the emergency department (ED). METHODS: Data were prospectively collected on all patients intubated in an academic ED from July 1, 2007, to June 30, 2016. Patients ≥ 18 years of age, who underwent rapid sequence intubation by an emergency medicine resident with the GlideScope or the direct laryngoscope, were included in the analysis...
January 20, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
2017-02-05 22:47:25
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