ABSTRACT
This commentary discusses the issues related to the current pharmacotherapy using super long-acting opioids (for the potential convenience for both patients and medical providers) for opioid addiction and argues for the potential to use a non-scheduled short-acting opioid to taper off opioids to reduce total number of patients on opioids and ultimately reduce opioid-related death. This article also proposes to develop short-acting opioids for addiction management instead of the current long-acting regimen. The authors further suggest that dezocine, a previously FDA approved medication for perioperative pain management and a non-scheduled opioid, be brought back to clinical practice in the US as a potential alternative addiction management medication, especially for those who are highly motivated to quit opioids completely using a taper off strategy.
Subject(s)
Analgesics, Opioid , Opioid-Related Disorders , Humans , Analgesics, Opioid/therapeutic use , Opioid-Related Disorders/drug therapySubject(s)
Blood Coagulation Factors/adverse effects , Heart Diseases/chemically induced , Heart Diseases/diagnostic imaging , Thrombosis/chemically induced , Thrombosis/diagnostic imaging , Warfarin/adverse effects , Aged , Blood Coagulation Factors/administration & dosage , Female , Humans , International Normalized Ratio , Ultrasonography , Warfarin/administration & dosageSubject(s)
Anesthesia/methods , Aprotinin/adverse effects , Cardiovascular Surgical Procedures/methods , Safety-Based Drug Withdrawals/methods , Anesthesia/trends , Cardiovascular Surgical Procedures/trends , Humans , Intraoperative Complications/chemically induced , Intraoperative Complications/prevention & control , Retrospective Studies , Safety-Based Drug Withdrawals/trendsSubject(s)
Ductus Arteriosus, Patent/microbiology , Streptococcal Infections/pathology , Ductus Arteriosus, Patent/pathology , Ductus Arteriosus, Patent/surgery , Echocardiography, Doppler, Color , Echocardiography, Transesophageal , Gadolinium , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Pulmonary Artery/microbiology , Pulmonary Artery/pathology , Streptococcal Infections/drug therapy , Viridans Streptococci/isolation & purificationABSTRACT
Aspergillus endocarditis is very difficult to cure, even with aggressive surgical debridement and antifungal therapy. Patients with embolic involvement of the central nervous system have an extremely poor prognosis. We describe a patient with prosthetic valve endocarditis due to Aspergillus fumigatus who developed emboli in the brain, eye, and lower extremities. With aggressive surgical debridement of involved sites, aortic valve and root replacement, and long-term therapy with oral voriconazole, he remains without any evidence of infection 2 years later.
Subject(s)
Aspergillosis/drug therapy , Endocarditis/drug therapy , Endocarditis/microbiology , Heart Valve Prosthesis/microbiology , Pyrimidines/therapeutic use , Triazoles/therapeutic use , Adult , Antifungal Agents/therapeutic use , Humans , Male , VoriconazoleSubject(s)
Anesthesia, Intravenous/adverse effects , Anesthetics, Intravenous/adverse effects , Brain/physiopathology , Propofol/adverse effects , Thiopental/adverse effects , Craniotomy/adverse effects , Dose-Response Relationship, Drug , Fatal Outcome , Humans , Infusions, Intravenous , Male , Middle Aged , Multiple Organ Failure/etiology , Rhabdomyolysis/chemically induced , Shock, Cardiogenic/chemically induced , Status Epilepticus/chemically induced , Status Epilepticus/physiopathologyABSTRACT
This case report details the development of cardiogenic shock after craniotomy in a patient sedated with a propofol infusion. The patient survived with the assistance of extracorporeal membrane oxygenation. A literature review summarizes the syndrome of cardiogenic shock associated with prolonged propofol infusion. This is the first report of survival in this syndrome resuiting from mechanical circulatory support.
Subject(s)
Anesthetics, Intravenous/adverse effects , Extracorporeal Membrane Oxygenation , Propofol/adverse effects , Shock, Cardiogenic/therapy , Adolescent , Asthma/complications , Electrocardiography , Heart Conduction System , Humans , Infusions, Intravenous , Intracranial Arteriovenous Malformations/complications , Intracranial Arteriovenous Malformations/surgery , Intracranial Hemorrhages/etiology , Intracranial Hemorrhages/surgery , Male , Neurosurgical Procedures , Respiration, Artificial , Tachycardia/physiopathologyABSTRACT
No single monitoring tool in the last decade has had more of an effect on intraoperative decision making and surgical management of cardiac valvular pathologies than has TEE. It has become the standard of care for evaluating reparative valvular procedures, thus providing an immediate gauge of the surgical results and helping to avoid suboptimal surgical outcomes. As the technology of TEE and its application advance, so too should the ability to diagnose and manage valvular pathologies, broaden the range of surgical options, and ultimately improve patient outcomes.