Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.427
Filtrar
1.
Medicine (Baltimore) ; 99(7): e18995, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32049794

RESUMEN

AIM: To determine the risk factors related to hemorrhagic transformation in Chinese patients with acute ischemic stroke treated with intravenous thrombolysis. METHODS: Studies published in different languages were retrieved by systematically searching PubMed, EMBASE, Vip, CNKI, and WanFang Data from the establishment of the library to December 31, 2018, as well as manually examining the references of the original articles. The outcome measures of efficacy covered risk factors. Safety evaluation was measured by relative ratio of complications. RESULTS: A total of 36 studies involving 5597 participants were covered in this meta-analysis. The results indicated that age [WMD = 2.44, 95% CI (1.39,3.48)], male [OR = 1.21, 95% CI (1.02, 1.44)], diabetes [OR = 2.05, 95%CI (1.72,2.44)], atrial fibrillation [OR = 2.85, 95%CI (2.40, 3.39)], previous stroke [OR = 1.8, 95%CI (1.33, 2.44)], onset to treatment time (OTT) [WMD = 3.74, 95%CI (2.91, 4.58)], National Institute of Health stroke scale scores (NIHSS) [WMD = 4.17, 95% CI (3.37, 4.97)], infarct size [WMD = 4.11, 95% CI (3.15, 5.37)], ischemic signs of computed tomography (CT) [OR = 3.49, 95%CI (2.47, 4.93)] were associated with increased risk of hemorrhagic transformation after intravenous thrombolysis. CONCLUSION: The systematic review showed that male, age, diabetes, NIHSS, OTT, atrial fibrillation, post stroke, infarct size, and ischemic signs of CT were significantly correlated with hemorrhagic transformation (HT). PROSPERO REGISTRATION NUMBER: CRD42019127499.


Asunto(s)
Isquemia Encefálica/tratamiento farmacológico , Hemorragia Cerebral/epidemiología , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica/métodos , Administración Intravenosa , Factores de Edad , China , Femenino , Humanos , Masculino , Factores Sexuales
2.
Crit Care Resusc ; 22(1): 80-82, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32102646

RESUMEN

BACKGROUND: Due to the lack of double-blind randomised controlled trials, the true effect of intravenous sodium bicarbonate therapy in ICU patients with metabolic acidosis remains unclear. METHODS: We diluted 100 mL 8.4% sodium bicarbonate in 150 mL 5% dextrose (D5W) within a 250 mL polyolefin bag after removing 100 mL. We asked ICU clinicians to inspect a 250 mL bag containing sodium bicarbonate or a 250 mL bag where 100 mL of D5W had been removed and then returned. The bags were attached to intravenous giving sets. We asked participants to identify the contents of the bags. RESULTS: Among 60 participants (39 nursing staff [65%], 20 medical staff [33.3%] and one pharmacist), 36 (60%) answered correctly. The Cohen κ for agreement between test bag content and participants' answers was 0.20 (95% CI, -0.05 to 0.45; P = 0.12), implying the answers were correct by chance. In the group of 28 participants who indicated they used a clue to help them decide their answer, 15 (53.6%) answered correctly, whereas in the remainder (n = 32), 21 (65.6%) answered correctly (P = 0.49). CONCLUSION: When 100 mL of 8.4% sodium bicarbonate were diluted in 150 mL of D5W within a 250 mL polyolefin bag, clinicians were unable to correctly identify the contents of the bags. Our findings imply that sodium bicarbonate therapy can be successfully blinded.


Asunto(s)
Acidosis/tratamiento farmacológico , Glucosa/uso terapéutico , Bicarbonato de Sodio/uso terapéutico , Administración Intravenosa , Método Doble Ciego , Electrólitos , Glucosa/administración & dosificación , Humanos , Inyecciones Intravenosas , Sodio/sangre , Bicarbonato de Sodio/administración & dosificación , Resultado del Tratamiento
3.
Medicine (Baltimore) ; 99(5): e18943, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000415

RESUMEN

RATIONALE: The incidence of obstetric hemorrhage due to pernicious placenta previa (PPP) and placenta accreta is currently increasing in China. Parallel transverse uterine incision (PTUI) cesarean section (CS) is a novel technique designed to avoid transecting the placenta and control postpartum hemorrhage during CS in these patients in our hospital. A key point of anesthesia management related to PTUI CS involves keeping the uterus relaxed. General anesthesia (GA) has often been performed, and inhaled volatile anesthetics have traditionally been recommended for this purpose; however, GA may be contraindicated in patients with difficult airways. PATIENT CONCERNS: The patient was predicted to have a difficult airway, and GA may have resulted in potentially life-threatening complications. An alternative and safer method of achieving uterine relaxation during PTUI CS was thus required. DIAGNOSES: The patient was diagnosed with PPP, and a predicted difficult airway was suspected preoperatively. INTERVENTIONS: PTUI CS was planned to control postpartum hemorrhage and preserve fertility during CS. Uterine relaxation during PTUI CS was achieved with intravenous nitroglycerin under combined spinal-epidural anesthesia. OUTCOME: Intravenous nitroglycerin and combined spinal-epidural anesthesia achieved uterine relaxation during the time from delivery of the neonate to making the second transverse incision in the lower segment of the uterus during PTUI CS. Both the parturient and neonate were well and were discharged 4 days later. LESSIONS: Intravenous nitroglycerin and combined spinal-epidural anesthesia may offer an alternative to GA for achieving uterine relaxation in patients with PPP and a predicted difficult airway undergoing PTUI CS to control postpartum hemorrhage.


Asunto(s)
Cesárea/métodos , Nitroglicerina/uso terapéutico , Placenta Accreta/terapia , Placenta Previa/terapia , Hemorragia Posparto/prevención & control , Vasodilatadores/uso terapéutico , Administración Intravenosa , Adulto , Femenino , Humanos , Embarazo
4.
Medicine (Baltimore) ; 99(5): e18956, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000420

RESUMEN

Intussusception is common emergency condition in children. Pneumatic or hydrostatic reduction (HR) is considered the first-choice management strategy in cases lacking indications for surgical intervention. Generally, sedatives are not used in children undergoing interventional radiology procedures. Surgical management is associated with long hospitalization durations and high costs, unlike nonsurgical reduction. To avoid surgery, reduction procedures are repeated despite initial treatment failure. However, in cases involving repeated failures, children should be referred for surgery.To ensure good response to reduction, we planned HR under sedation during the third reduction attempt. Sedative reduction (SR) was performed with the administration of ketamine, midazolam, and atropine. All patients with contraindications against HR underwent laparoscopic reduction (LR) without HR.During 3 years, SR was performed in 43 patients, and in 28 (65.1%), the treatment was successful. Among the 15 patients in whom the procedure failed, 14 underwent LR without intestinal resection. There was no significant risk factor contributing to failed reduction under sedation.During the second or third HR attempt, successful reduction may be ensured with the SR procedure with intravenous ketamine, midazolam, and atropine; this procedure may further reduce surgery rates in pediatric intussusception.


Asunto(s)
Hipnóticos y Sedantes/uso terapéutico , Intususcepción/terapia , Administración Intravenosa , Atropina/uso terapéutico , Preescolar , Femenino , Humanos , Lactante , Ketamina/uso terapéutico , Laparoscopía , Masculino , Midazolam/uso terapéutico , Retratamiento , Estudios Retrospectivos , Resultado del Tratamiento
5.
Int J Pharm Compd ; 24(1): 44-50, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32023216

RESUMEN

Intravenous admixture compounding requires a knowledge of stability, compatibility, and incompatibility issues related to the complete composition and formulation of the admixture. Referring to tables, charts, etc. is valuable but not always sufficient to determine whether or not a specific intravenous admixture will be stable and compatible. In evaluating an intravenous admixture, one is not just concerned with the active ingredients but with all the excipients. Excipients used in the formulations of commercially available products may vary between manufacturers, and these variations can influence drug compatibility and stability. Clinical pharmaceutics involves the study and application or pharmaceutics to real-life clinical compounding situations to aid in the evaluation of each intravenous admixture. This series continues with compatibility considerations in intravenous admixture compounding and will cover most aspects of the issues involved, to include in-syringe admixtures and small-volume and large-volume admixtures.


Asunto(s)
Administración Intravenosa , Excipientes , Incompatibilidad de Medicamentos , Estabilidad de Medicamentos
6.
Medicine (Baltimore) ; 99(3): e18825, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32011494

RESUMEN

BACKGROUND: Patient-controlled intravenous analgesia (PCIA) has been suggested as an effective method of pain relief. There are several randomized controlled trials (RCTs) of dexmedetomidine (DEX) combined with tramadol for PCIA in Chinese surgical patients. The purpose of this study was to perform a systematic review and meta-analysis to evaluate the efficacy and safety of DEX combined with tramadol for PCIA in Chinese surgical patients from current data. METHODS: The RCTs of DEX combined with tramadol for PCIA were gathered from the PubMed, Excerpta Medica Database, Cochrane Library, Cochrane Library, China National Knowledge Infrastructure database, and VIP databases. After data extraction and quality assessment of the included RCTs, RevMan 5.3 software was employed for the meta-analysis of visual analog scale (VAS) scores, Ramsay sedation scores, effective pressure times for PCIA, tramadol consumption, and safety. RESULTS: Fourteen RCTs were included. Compared with tramadol alone, postoperative intravenous tramadol-DEX combination PCA led to lower VAS scores (weighted mean differences [WMD]12h = 0.14, 95% confidence interval [CI] v1.50 to 1.79; WMD24h = 0.78, 95% CI -0.92 to -0.62; WMD48h = 0.51, 95% CI -0.66 to -0.38; all P < .05), lower Ramsay sedation scores (WMD24h = 0.08, 95% CI -0.14 to -0.02; WMD48h = 0.09, 95% CI -0.11 to -0.07; all P < .05), and less postoperative tramadol consumption (WMD0-24h = -102.59 mg, 95% CI -149.68 to -55.49; WMD0-48h = -152.91 mg, 95% CI -259.93 to -45.89; all P < .05). With regard to safety, there was a significant difference between DEX-tramadol and tramadol for PCIA in terms of the incidence of postoperative nausea and vomiting, dizziness, chills, and restlessness (all P < .05). CONCLUSION: According to the domestic evidence, this systematic review and meta-analysis suggests that DEX-tramadol PCIA is superior to tramadol in terms of analgesic efficacy and safety for Chinese surgical patients. However, because of some clear limitations (sample size and heterogeneity), these results should be interpreted with caution. Further large-scale and well-designed studies are needed to summarize and analyze the data to draw a more convincing conclusion.


Asunto(s)
Analgesia Controlada por el Paciente , Analgésicos no Narcóticos/administración & dosificación , Analgésicos Opioides/administración & dosificación , Dexmedetomidina/administración & dosificación , Dolor Postoperatorio/tratamiento farmacológico , Tramadol/administración & dosificación , Administración Intravenosa , China , Combinación de Medicamentos , Humanos
7.
Br J Anaesth ; 124(3): 243-250, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31902590

RESUMEN

BACKGROUND: Preoperative anaemia affects one third of patients undergoing cardiac surgery and is associated with increased mortality and morbidity. Although it is recommended that perioperative teams should identify and treat patients with preoperative anaemia before surgery, introducing new treatment protocols can be challenging in surgical pathways. The aim of this study was to assess the feasibility and effectiveness of introducing a preoperative intravenous iron service as a national initiative in cardiac surgery. METHODS: We performed a multicentre, stepped, observational study using the UK Association of Cardiothoracic Anaesthesia and Critical Care Research Network. The primary feasibility outcome was the ability to set up an anaemia and intravenous iron clinic at each site. The primary efficacy outcome was change in haemoglobin (Hb) concentration between intervention and operation. Secondary outcomes included blood transfusion and hospital stay. Patients with anaemia were compared with non-anaemic patients and with those who received intravenous iron as part of their routine treatment protocol. RESULTS: Seven out of 11 NHS hospitals successfully set up iron clinics over 2 yr, and 228 patients were recruited into this study. Patients with anaemia who received intravenous iron were at higher surgical risk, were more likely to have a known previous history of iron deficiency or anaemia, had a higher rate of chronic kidney disease, and were slightly more anaemic than the non-treated group. Intravenous iron was administered a median (inter-quartile range, IQR [range]) of 33 (15-53 [4-303]) days before surgery. Preoperative intravenous iron increased [Hb] from baseline to pre-surgery; mean (95% confidence interval) change was +8.4 (5.0-11.8) g L-1 (P<0.001). Overall, anaemic compared with non-anaemic patients were more likely to be transfused (49% [59/136] vs 27% (22/92), P=0.001) and stayed longer in hospital (median days [IQR], 9 [7-15] vs 8 [6-11]; P=0.014). The number of days alive and at home was lower in the anaemic group (median days [IQR], 20 [14-22] vs 21 [17-23]; P=0.033). CONCLUSION: The development of an intravenous iron pathway is feasible but appears limited to selected high-risk cardiac patients in routine NHS practise. Although intravenous iron increased [Hb], there is a need for an appropriately powered clinical trial to assess the clinical effect of intravenous iron on patient-centred outcomes.


Asunto(s)
Anemia Ferropénica/tratamiento farmacológico , Procedimientos Quirúrgicos Cardíacos , Hierro/administración & dosificación , Cuidados Preoperatorios/métodos , Administración Intravenosa , Anciano , Anciano de 80 o más Años , Anemia Ferropénica/sangre , Anemia Ferropénica/complicaciones , Transfusión Sanguínea/estadística & datos numéricos , Vías Clínicas/organización & administración , Estudios de Factibilidad , Femenino , Hemoglobinas/metabolismo , Humanos , Hierro/uso terapéutico , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Medicina Estatal/organización & administración
8.
Curr Opin Anaesthesiol ; 33(2): 227-233, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31895124

RESUMEN

PURPOSE OF REVIEW: Traumatic injury has been described as a growing pandemic which has significant implications for global health. In the trauma setting, anemia is a common occurrence and is frequently inadequately addressed. It is associated with significant morbidity and incurs great cost - both to the patient and to the health system. The cause is multifactorial, and the pathophysiology is incompletely understood. Appropriate care of the trauma patient is a multidisciplinary responsibility and a focused approach to anemia is vital. The recommendation for restrictive transfusion strategies and the potential benefit of intravenous iron (IVI) in the perioperative setting, make the intervention an attractive proposition in the anemic trauma patient. RECENT FINDINGS: In an era where the importance of patient blood management is recognized, there is significant attention being given to both the implications and the appropriate management of anemia, in various settings. Advances have been made in the understanding of the mechanisms underlying the anemia associated with traumatic injury and the efficacy of current interventions is being explored. This increased understanding of the pathophysiology behind the condition has also facilitated the postulation of potential therapeutic targets for the future. SUMMARY: Suboptimally managed anemia impacts on clinical outcome and contributes to the burden of costs associated with trauma. The cause of the anemia associated with trauma is multifactorial and should be addressed at several levels. The role of IVI in this setting is yet to be clearly defined.


Asunto(s)
Hierro/administración & dosificación , Heridas y Traumatismos/terapia , Administración Intravenosa , Anemia/terapia , Humanos
9.
Gene ; 732: 144336, 2020 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-31935514

RESUMEN

In the present study, we aimed to evaluate effects of autologous mesenchymal stem cells (MSCs) intravenous administration on the response of B cells, BAFF, APRIL, and their receptors on the surface of B cells at 1, 6, and 12 month follow-up periods in refractory rheumatoid arthritis (RA) patients. Thirteen patients with refractory RA received autologous MSCs. Plasma levels of BAFF and APRIL were measured employing ELISA method, followed by estimating B cell population and BAFFRs evaluation by flow cytometry technique. Gene expression of BAFF, APRIL, and their receptors on B cell surface in PBMCs was evaluated by SYBR Green real-time PCR technique. Plasma concentration of BAFF significantly decreased 1 and 6 months after the MSCT (MSCs Transplantation). Plasma concentration of APRIL significantly decreased 1 month after the MSCT. Percentages of CD19 + B cells in the PBMC population significantly decreased 12 months after the MSCT. Percentages of BR3 + CD19 + B cells and BCMA + CD19 + B cells significantly decreased at the 12th month after the MSCT. The gene expression of BAFF in the PBMC population significantly decreased during 6, and 12 months after the MSCT. The gene expression of APRIL significantly decreased on month 6 after the MSCT. The gene expression of BR3 significantly decreased during 1, 6, and 12 months after the MSCT. The MSCT seems to decrease B cells response because of the reduced production of BAFF and APRIL cytokines and decrease the expression of their receptors on the surface of B cells.


Asunto(s)
Artritis Reumatoide/terapia , Factor Activador de Células B/metabolismo , Receptor del Factor Activador de Células B/metabolismo , Regulación hacia Abajo , Trasplante de Células Madre Mesenquimatosas/métodos , Miembro 13 de la Superfamilia de Ligandos de Factores de Necrosis Tumoral/metabolismo , Administración Intravenosa , Adulto , Antígenos CD19/metabolismo , Artritis Reumatoide/genética , Artritis Reumatoide/inmunología , Factor Activador de Células B/genética , Receptor del Factor Activador de Células B/genética , Linfocitos B/inmunología , Femenino , Perfilación de la Expresión Génica , Humanos , Persona de Mediana Edad , Resultado del Tratamiento , Miembro 13 de la Superfamilia de Ligandos de Factores de Necrosis Tumoral/genética
11.
BMC Infect Dis ; 20(1): 21, 2020 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-31910823

RESUMEN

BACKGROUND: Meningitis is a very rare atypical presenting feature of anti-NMDA receptor encephalitis. In our case report, we describe an unusual clinical presentation of anti-NMDA receptor encephalitis with a biphasic pattern of meningitis followed by encephalitis and discuss potential mechanisms underlying this presentation. We aim to widen the differential diagnosis to be considered in a patient presenting with clinical meningitis and pyrexia. CASE PRESENTATION: This is a case of a 33-year old Caucasian woman who initially presented with a lymphocytic meningitis attributed to a viral infection. She subsequently developed fluctuating consciousness, agitation, visual hallucinations, dyskinetic movements, a generalized tonic-clonic seizure, and autonomic instability. Investigations revealed a diagnosis of anti-NMDA receptor encephalitis secondary to a previously unidentified ovarian teratoma. She made an excellent recovery with immunotherapy and removal of the teratoma. CONCLUSION: Clinicians should consider autoimmune encephalitides in individuals with meningitis, particularly where extensive investigations fail to identify a causative pathogen and there is rapid development of an encephalitic phenotype.


Asunto(s)
Encefalitis Antirreceptor N-Metil-D-Aspartato/diagnóstico , Meningitis Viral/diagnóstico , Neoplasias Ováricas/patología , Teratoma/patología , Administración Intravenosa , Adulto , Encefalitis Antirreceptor N-Metil-D-Aspartato/complicaciones , Encefalitis Antirreceptor N-Metil-D-Aspartato/tratamiento farmacológico , Anticuerpos/sangre , Diagnóstico Diferencial , Encefalitis/diagnóstico , Femenino , Fiebre/diagnóstico , Glucocorticoides/administración & dosificación , Glucocorticoides/uso terapéutico , Enfermedad de Hashimoto/diagnóstico , Humanos , Inmunoterapia , Metilprednisolona/administración & dosificación , Metilprednisolona/uso terapéutico , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/etiología , Neoplasias Ováricas/cirugía , Intercambio Plasmático , Receptores de N-Metil-D-Aspartato/inmunología , Convulsiones/diagnóstico , Teratoma/tratamiento farmacológico , Teratoma/etiología , Teratoma/cirugía , Resultado del Tratamiento
12.
Einstein (Sao Paulo) ; 18: eAO4433, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31939523

RESUMEN

OBJECTIVE: To describe the pharmaceutical interventions of a vertical clinical pharmacy service to promote the rational use of intravenous omeprazole. METHODS: A prospective and descriptive study carried out at a university hospital in the Midwestern Region of Brazil, from November 2014 to May 2015. The service consisted of the analysis of adequacy of the route of administration of omeprazole in relation to the clinical conditions of the patient, as well as the use of the appropriate diluent. Interventions were recorded in medical records and subsequently evaluated for acceptance. RESULTS: A total of 770 prescriptions were evaluated. Interventions related to diluent replacement were more accepted (p<0.001), and surgeons were the specialty that used the intravenous route inappropriately (p<0.001). CONCLUSION: Although partially accepted, pharmaceutical interventions could contribute to improve patient safety, since they allowed the use of a safer route of administration.


Asunto(s)
Administración Intravenosa/métodos , Omeprazol/administración & dosificación , Servicio de Farmacia en Hospital/normas , Inhibidores de la Bomba de Protones/administración & dosificación , Adulto , Distribución por Edad , Anciano , Brasil , Prescripciones de Medicamentos/estadística & datos numéricos , Femenino , Hospitales Universitarios , Humanos , Masculino , Errores de Medicación/estadística & datos numéricos , Persona de Mediana Edad , Seguridad del Paciente , Estudios Prospectivos , Distribución por Sexo
13.
Medicine (Baltimore) ; 99(2): e18387, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914016

RESUMEN

RATIONALE: Congenital adrenal hyperplasia (CAH) is caused by various enzyme deficiencies, among which 21-hydroxylase (21-OH) deficiency accounts for more than 90% of cases. Neonatal screening became mandatory only a few decades ago. Many patients who were born before this went undiagnosed and some of the severely virilized females were raised as men. PATIENT CONCERNS: A 58-year old man with a history of excisional surgery in the external genitalia when he was a toddler presented with three days of dysuria and low abdominal pain. DIAGNOSIS: The patient's laboratory results showed leukocytosis and elevated C-reactive protein (CRP); thus, the physicians decided to perform a computed tomography (CT) scan. The CT demonstrated pelvic inflammatory disease (PID), left adrenal gland myelolipoma, and a mesenteric mass. Meanwhile, we suspected CAH based on the clinical history and assessed the patient's hormone levels. Seventeen-hydroxyprogesterone (17-OH-PG) was markedly elevated and the patient was diagnosed with classic simple virilizing CAH. INTERVENTIONS: Intravenous antibiotics were administered, and positron emission tomography-CT (PET-CT) was performed to evaluate any metastases. OUTCOMES: After 2 weeks of antibiotic treatment, CRP decreased to 0.12 mg/dL and PID was resolved. The patient opted for resection of the female genitalia along with the mesenteric and adrenal gland tumors in the near future, and was safely discharged. LESSONS: The adrenal gland myelolipoma was thought to have developed as a result of a longstanding exposure to adrenocorticotropic hormone. There are controversies regarding the management of female genitalia in CAH patients who identify themselves as men. In this case, the physician and patient decided to remove the female genitalia because the surgery for the mesenteric mass was inevitable and there was a possibility of recurrent PID. To our knowledge, this is the first article to report primary mesenteric tumor in a CAH patient to date. In conclusion, patients who were born before neonatal screening for CAH became the mainstay, who are suspected to have CAH from their history, and present with abdominal pain must be diagnosed by performing an imaging study, testing levels of serum 17-OH-PG, and screening for female genitalia and adrenal gland myelolipoma.


Asunto(s)
Hiperplasia Suprarrenal Congénita/diagnóstico , Antibacterianos/administración & dosificación , Genitales Femeninos/cirugía , Enfermedad Inflamatoria Pélvica/diagnóstico por imagen , 17-alfa-Hidroxiprogesterona/sangre , Administración Intravenosa , Hiperplasia Suprarrenal Congénita/tratamiento farmacológico , Hiperplasia Suprarrenal Congénita/patología , Antibacterianos/uso terapéutico , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mielolipoma/diagnóstico por imagen , Mielolipoma/patología , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
15.
Br J Anaesth ; 124(1): 92-100, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31711605

RESUMEN

BACKGROUND: Intravenous dexamethasone is thought to prolong the duration of peripheral nerve block, but the dose-response relationship remains unclear. The aim of this volunteer study was to evaluate the dose-response effect of i.v. dexamethasone on the prolongation of median nerve block. METHODS: In a double-blind, randomised controlled study, 18 volunteer subjects received two median nerve blocks separated by a washout period. One block was conducted alongside an infusion of saline and the other alongside i.v. dexamethasone 2, 4, or 8 mg. The primary outcome was time to return of normal pinprick sensation. Secondary outcomes included thermal quantitative sensory testing (QST) for the time to return of cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT), heat pain threshold (HPT), area under QST curves, grip strength, and the incidence of adverse effects. RESULTS: The primary outcome, time to recovery of pinprick sensation, was similar between volunteers receiving saline or i.v. dexamethasone, regardless of dose (P=0.99). The time to recovery of QST milestones was similar between groups, although area under QST curves indicated prolongation of CDT (0 vs 8 mg, P=0.002) and WDT (0 vs 2 mg, P=0.008; 0 vs 4 mg, P=0.001; 0 vs 8 mg, P<0.001). There was no difference in motor recovery or adverse effects. CONCLUSIONS: Intravenous dexamethasone failed to significantly prolong the duration of pinprick anaesthesia regardless of dose. However, area under QST curve analysis indicated a dose-independent prolongation of CDT and WDT, the clinical significance of which is unclear. CLINICAL TRIAL REGISTRATION: NCT02864602 (clinicaltrials.gov).


Asunto(s)
Adyuvantes Anestésicos , Dexametasona , Bloqueo Nervioso/métodos , Nervios Periféricos , Adyuvantes Anestésicos/administración & dosificación , Adyuvantes Anestésicos/efectos adversos , Administración Intravenosa , Adulto , Estudios Cruzados , Dexametasona/administración & dosificación , Dexametasona/efectos adversos , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Femenino , Fuerza de la Mano , Voluntarios Sanos , Humanos , Masculino , Nervio Mediano , Persona de Mediana Edad , Bloqueo Nervioso/efectos adversos , Umbral del Dolor/efectos de los fármacos , Sensación/efectos de los fármacos , Sensación Térmica/efectos de los fármacos , Adulto Joven
16.
J Stroke Cerebrovasc Dis ; 29(1): 104477, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31699573

RESUMEN

BACKGROUND: A nationally recommended practice to accelerate thrombolytic therapy for acute ischemic stroke is to route emergency medical services (EMS)-transported stroke patients directly to the computed tomography (CT) scanner on arrival. We evaluated door-to-needle time with direct-to-CT routing versus emergency department (ED)-bed first routing. METHODS: This was a retrospective analysis from a large regionalized stroke system. Paramedics utilize the modified Los Angeles Prehospital Stroke Screen and transport acute stroke patients to Approved Stroke Centers. Individual stroke centers postarrival protocols vary, with some routing patients directly to CT. Stroke centers report treatment and outcomes to a registry, from which data were abstracted from May 2015 through April 2016. Adult patients transported by EMS and treated with thrombolytic therapy were included. The primary outcome was door-to-needle time. Secondary outcome was door-to-imaging time. RESULTS: EMS transported 6315 patients for suspected stroke and 789 (13%) were treated with thrombolysis at 41 stroke centers, 171 (22%) at hospitals with direct-to-CT routing and 618 (78%) at hospitals with ED-bed routing. Patient characteristics were similar between groups. Door-to-needle time was not different in the 2 groups, median 57 minutes (interquartile range [IQR] 44-76) for CT routing versus 54 minutes (IQR 40-74) for ED routing, median difference 3 (95% CI -1, 7), P == .2. Door-to-imaging time was shorter with CT routing compared to ED routing, median 13 minutes (IQR 8-21) and 16 minutes (IQR 10-24), respectively. CONCLUSIONS: In this regional stroke system, hospitals with protocols for routing EMS-transported stroke patients directly to CT did not have reduced door-to-needle compared to hospitals without such protocols.


Asunto(s)
Servicio de Urgencia en Hospital , Fibrinolíticos/administración & dosificación , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica , Tiempo de Tratamiento , Tomógrafos Computarizados por Rayos X , Tomografía Computarizada por Rayos X/instrumentación , Transporte de Pacientes , Administración Intravenosa , Anciano , Anciano de 80 o más Años , Vías Clínicas , Femenino , Humanos , Los Angeles , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Sistema de Registros , Estudios Retrospectivos , Factores de Tiempo
18.
Br J Anaesth ; 124(1): 84-91, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31591018

RESUMEN

BACKGROUND: Efforts to prolong interscalene block (ISB) analgesia include the use of local anaesthetic adjuvants such as dexamethasone. Previous work showing prolonged block duration suggests that both perineural and intravenous (i.v.) routes can both prolong analgesia. The superiority of either route is controversial given the design of previous studies. As perineural dexamethasone is an off-label use, anaesthesiologists should be fully informed of the clinical differences, if any, on block duration. This study was designed to test whether perineural vs i.v. dexamethasone administration are equivalent. METHODS: We randomised 182 eligible patients scheduled for arthroscopic shoulder surgery to receive low-dose ISB (0.5% ropivacaine 5 ml) with perineural or i.v. dexamethasone 4 mg. Subjects, anaesthesiologists, and research personnel were blinded. All subjects also received a standardised general anaesthetic and multimodal analgesia. The primary outcome was duration of analgesia analysed as an equivalence outcome (2 h equivalency margin) using the two one-sided test (TOST) method. RESULTS: For the primary outcome, duration of analgesia, and perineural and i.v. administration of dexamethasone were not equivalent. The upper and lower bounds of the 90% confidence interval were 1 h (P=0.12) and -2.5 h (P=0.01), respectively. The observed difference in mean block duration was not clinically relevant (0.75 h longer for i.v. dexamethasone). There were no other clinically significant differences between groups. CONCLUSION: In the context of low-volume ISB with ropivacaine, perineural and i.v. dexamethasone were not equivalent in terms of their effects on block duration. However, there were no clinically significant differences in outcomes, and there is no advantage of perineural over intravenous dexamethasone. WWW.CLINICALTRIALS. GOV REGISTRATION: NCT02322242.


Asunto(s)
Adyuvantes Anestésicos/administración & dosificación , Adyuvantes Anestésicos/farmacología , Bloqueo del Plexo Braquial/métodos , Plexo Braquial , Dexametasona/administración & dosificación , Dexametasona/farmacología , Bloqueo Nervioso/métodos , Administración Intravenosa , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Artroscopía/métodos , Método Doble Ciego , Femenino , Humanos , Inyecciones , Masculino , Persona de Mediana Edad , Hombro/cirugía , Adulto Joven
19.
J Surg Res ; 246: 42-51, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31561177

RESUMEN

BACKGROUND: Patient blood management aims to maintain hemoglobin level, minimize blood loss, and avoid unnecessary blood transfusion. Ferric carboxymaltose, an intravenous iron agent, was included as a part of surgical patient blood management strategy. However, it is still controversial that ferric carboxymaltose can reduce transfusion requirements. The purpose of this systematic review and meta-analysis is to evaluate the benefits of perioperative ferric carboxymaltose on the postoperative hematological parameters and transfusion requirements. METHODS: Randomized controlled trials evaluating the effects of ferric carboxymaltose were searched through databases: MEDLINE, EMBASE, CENTRAL, CINAHL, Scopus, Web of Science, and KoreaMed. Meta-analysis was performed using random effect models. RESULTS: A total of 8 studies (n = 471) were included in the final analysis. Postoperative hemoglobin was higher in the ferric carboxymaltose group than in the control group (mean difference [MD], 0.58 g/dL; 95% confidence interval [CI], 0.36 to 0.80; P < 0.00001). Postoperative serum ferritin and transferrin saturation were also higher in the ferric carboxymaltose group (MD, 373.85 µg/L; 95% CI, 298.13 to 449.56; P < 0.00001; MD, 10.35%; 95% CI, 4.59 to 16.10; P < 0.00001, respectively). However, there were no significant differences in the number of transfused patients, length of hospital stay, and adverse events between groups. Subgroup analysis revealed that adverse events were lower in the ferric carboxymaltose group than the oral iron group. CONCLUSIONS: This study supports that ferric carboxymaltose may increase the postoperative hemoglobin level in surgical patients. However, transfusion requirements could not be reduced by ferric carboxymaltose. Optimal dose and time should be further analyzed.


Asunto(s)
Transfusión Sanguínea/estadística & datos numéricos , Compuestos Férricos/administración & dosificación , Hemoglobinas/análisis , Maltosa/análogos & derivados , Atención Perioperativa/métodos , Hemorragia Posoperatoria/sangre , Administración Intravenosa , Administración Oral , Pérdida de Sangre Quirúrgica/prevención & control , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Humanos , Maltosa/administración & dosificación , Hemorragia Posoperatoria/etiología , Hemorragia Posoperatoria/terapia , Periodo Posoperatorio , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
20.
Anaesthesia ; 75(2): 254-265, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31536172

RESUMEN

We conducted a Cochrane systematic review on the effectiveness of supplemental intravenous crystalloid administration in preventing postoperative nausea and vomiting. We included randomised controlled trials of patients undergoing surgery under general anaesthesia and given supplemental peri-operative intravenous crystalloid. Our primary outcomes were the risk of postoperative nausea and the risk of postoperative vomiting. We assessed the risk of bias for each included study and applied the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework for the certainty of evidence. We included 41 studies. We found that the intervention probably reduces the overall risk of postoperative nausea, the risk ratio (95%CI) being 0.62 (0.51-0.75) (I2  = 57%, p < 0.00001, 18 studies; 1766 participants; moderate-certainty evidence). It also probably reduces the risk of postoperative nausea within 6 h of surgery, with a risk ratio (95%CI) of 0.67 (0.58 to 0.78) (I2  = 9%, p < 0.00001, 20 studies; 2310 participants; moderate-certainty evidence) and by around 24 h, the risk ratio (95%CI) being 0.47 (0.32-0.69) (I2  = 38%, p = 0.0001, 17 studies; 1682 participants; moderate-certainty evidence). Supplemental intravenous crystalloid probably also reduces the overall risk of postoperative vomiting, with a risk ratio (95%CI) of 0.50 (0.40-0.63) (I2  = 31%, p < 0.00001, 20 studies; 1970 participants; moderate-certainty evidence). The beneficial effect on vomiting was seen both within 6 h and by around 24 h postoperatively.


Asunto(s)
Soluciones Cristaloides/uso terapéutico , Atención Perioperativa/métodos , Náusea y Vómito Posoperatorios/tratamiento farmacológico , Administración Intravenosa , Soluciones Cristaloides/administración & dosificación , Humanos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA