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1.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(6): 677-680, 2020 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-32684211

RESUMO

OBJECTIVE: To compare the therapeutic effects and safety of dexmedetomidine and midazolam on patients with severe coronavirus disease 2019 (COVID-19) who received non-invasive ventilation. METHODS: Patients with COVID-19 who needed non-invasive ventilation in one critical care medicine ward of Wuhan Jinyintan Hospital during the team support period from the department of critical care medicine of Renmin Hospital of Wuhan University from January 23rd to February 15th in 2020 were investigated retrospectively. Ramsay score, mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), arterial oxygen partial pressure (PaO2) before sedation and at 1, 12, 24 hours after sedation, sleep time were collected, and the side effects such as excessive sedation, fall of tongue, abdominal distension, aspiration, bradycardia, escalation to invasive mechanical ventilation during 24 hours were also collected. According to different sedative drugs, patients were divided into the control group (without sedative drugs), dexmedetomidine group and midazolam group. The changes of indicators among the three groups were compared. RESULTS: Fourteen patients were injected with dexmedetomidine (loading dose of 1 µg/kg for 10 minutes, maintained at 0.2-0.7 µg×kg-1×h-1); 9 patients were injected with midazolam (loading dose of 0.05 mg/kg for 2 minutes, maintained at 0.02-0.10 mg×kg-1×h-1); 12 patients didn't use sedative drugs due to limitations of previous hospital or patients' rejection. In dexmedetomidine group and midazolam group, the Ramsay score was maintained at 2-3 points after sedation, which were higher than those of control group at different time points after sedation, and there was no significant difference between dexmedetomidine group and midazolam group. MAP of dexmedetomidine group and midazolam group decreased gradually after sedation. MAP after 1-hour sedation was significantly lower than that before sedation, and MAP after 24 hours sedation was significantly lower than that in the control group [mmHg (1 mmHg = 0.133 kPa): 109.7±11.5, 107.1±12.3 vs. 121.1±13.3, both P < 0.05]. HR decreased gradually after sedation treatment, which was significantly lower after 12 hours of sedation than that before sedation, and HR in dexmedetomidine group was significantly lower than that in control group after 12 hours of sedation (bpm: 84.0±13.9 vs. 92.8±15.4 at 12 hours; 81.0±16.7 vs 92.6±12.7 at 24 hours, both P < 0.05). PaO2 increased and RR decreased in all three groups after ventilation. PaO2 in dexmedetomidine group and midazolam group were significantly higher than that in the control group after 12 hours of sedation [cmH2O (1 cmH2O = 0.098 kPa): 79.0±6.5, 79.0±8.9 vs. 70.0±7.8, both P < 0.05]; the decreases of RR in dexmedetomidine group and midazolam group were significant than that in control group after 1 hour of sedation (bpm: 34.0±3.9, 33.8±4.6 vs. 39.0±3.6, both P < 0.05). There were no differences of MAP, HR, PaO2 and RR between dexmedetomidine group and midazolam group at different time points. The sleep duration in dexmedetomidine group and midazolam group were significantly longer than that in the control group (hours: 4.9±1.9, 5.8±2.4 vs. 3.0±1.8, both P < 0.05), but there was no difference between dexmedetomidine group and midazolam group (P > 0.05). Adverse events occurred in all three groups. In midazolam group, there were 2 cases of excessive sedation with fall of tongue and abdominal distension, including 1 case of aspiration, 1 case receiving intubation due to refractory hypoxemia and 1 case due to unconsciousness. In dexmedetomidine group, there were 2 cases of bradycardia, 1 case of intubation due to refractory hypoxemia. In control group, 4 cases underwent intubation due to refractory hypoxemia. CONCLUSIONS: Non-invasive mechanical ventilation is an important respiratory support technology for patients with severe COVID-19. Appropriate sedation can increase the efficiency of non-invasive mechanical ventilation. Dexmedetomidine is more effective and safer than midazolam in these patients, but attention should be paid to HR and blood pressure monitoring.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Dexmedetomidina/uso terapêutico , Midazolam/uso terapêutico , Ventilação não Invasiva , Pandemias , Pneumonia Viral , Infecções por Coronavirus/terapia , Humanos , Hipnóticos e Sedativos , Unidades de Terapia Intensiva , Pneumonia Viral/terapia , Estudos Retrospectivos
2.
Brasília; s.n; 29 jul. 2020.
Não convencional em Português | LILACS, BRISA/RedTESA, PIE | ID: biblio-1117728

RESUMO

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referentes ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 16 artigos e 3 protocolos.


Assuntos
Humanos , Pneumonia Viral/tratamento farmacológico , Infecções por Coronavirus/tratamento farmacológico , Betacoronavirus/efeitos dos fármacos , Avaliação da Tecnologia Biomédica , Midazolam/uso terapêutico , Imunoglobulinas/uso terapêutico , Metilprednisolona/uso terapêutico , Vacinas contra Influenza/uso terapêutico , Propofol/uso terapêutico , Cloroquina/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Fentanila/uso terapêutico , Estudos Transversais , Estudos de Coortes , Enoxaparina/uso terapêutico , Azitromicina/uso terapêutico , Ritonavir/uso terapêutico , Cobre/uso terapêutico , Lopinavir/uso terapêutico , Resveratrol/uso terapêutico , Interferon alfa-2/uso terapêutico , Hidroxicloroquina/uso terapêutico , Ketamina/uso terapêutico
5.
Medicine (Baltimore) ; 99(5): e18956, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000420

RESUMO

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.


Assuntos
Hipnóticos e Sedativos/uso terapêutico , Intussuscepção/terapia , Administração Intravenosa , Atropina/uso terapêutico , Pré-Escolar , Feminino , Humanos , Lactente , Ketamina/uso terapêutico , Laparoscopia , Masculino , Midazolam/uso terapêutico , Retratamento , Estudos Retrospectivos , Resultado do Tratamento
6.
Am J Psychiatry ; 177(2): 125-133, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31786934

RESUMO

OBJECTIVE: Pharmacotherapy and behavioral treatments for alcohol use disorder are limited in their effectiveness, and new treatments with innovative mechanisms would be valuable. In this pilot study, the authors tested whether a single subanesthetic infusion of ketamine administered to adults with alcohol dependence and engaged in motivational enhancement therapy affects drinking outcomes. METHODS: Participants were randomly assigned to a 52-minute intravenous administration of ketamine (0.71 mg/kg, N=17) or the active control midazolam (0.025 mg/kg, N=23), provided during the second week of a 5-week outpatient regimen of motivational enhancement therapy. Alcohol use following the infusion was assessed with timeline followback method, with abstinence confirmed by urine ethyl glucuronide testing. A longitudinal logistic mixed-effects model was used to model daily abstinence from alcohol over the 21 days after ketamine infusion. RESULTS: Participants (N=40) were mostly middle-aged (mean age=53 years [SD=9.8]), predominantly white (70.3%), and largely employed (71.8%) and consumed an average of five drinks per day prior to entering the study. Ketamine significantly increased the likelihood of abstinence, delayed the time to relapse, and reduced the likelihood of heavy drinking days compared with midazolam. Infusions were well tolerated, with no participants removed from the study as a result of adverse events. CONCLUSIONS: A single ketamine infusion was found to improve measures of drinking in persons with alcohol dependence engaged in motivational enhancement therapy. These preliminary data suggest new directions in integrated pharmacotherapy-behavioral treatments for alcohol use disorder. Further research is needed to replicate these promising results in a larger sample.


Assuntos
Alcoolismo/terapia , Ketamina/administração & dosagem , Ketamina/uso terapêutico , Psicoterapia/métodos , Alcoolismo/tratamento farmacológico , Terapia Combinada/métodos , Método Duplo-Cego , Feminino , Humanos , Infusões Intravenosas , Masculino , Midazolam/uso terapêutico , Pessoa de Meia-Idade , Projetos Piloto
7.
J Pharmacol Exp Ther ; 372(3): 285-298, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31843812

RESUMO

Epilepsy is often treated with a combination of antiepileptic drugs. Although neurosteroids are potent anticonvulsants, little is known about their combination potential for the treatment of refractory epilepsy. Here, we investigated the combination efficacy of neurosteroids allopregnanolone (AP, brexanolone) and ganaxolone (GX) with the GABA-reuptake inhibitor tiagabine (TG) or the benzodiazepine midazolam (MDZ) on tonic inhibition in dentate gyrus granule cells and seizure protection in the hippocampus kindling and 6-Hz seizure models. Isobolographic analysis indicated that combinations of GX and TG or AP and TG at three standard ratios (1:1, 3:1, and 1:3) displayed significant synergism in augmenting tonic inhibition. In pharmacological studies, GX, AP, and TG produced dose-dependent antiseizure effects in mice (ED50 = 1.46, 4.20, and 0.20 mg/kg, respectively). The combination of GX and TG at the fixed ratio of 1:1 exerted the greatest combination index (CI = 0.53), indicating strong synergistic interaction in seizure protection. In addition, combination regimens of AP and TG showed robust synergism for seizure protection (CI = 0.4). Finally, combination regimens of GX and MDZ elicited synergistic (CI = 0.6) responses for seizure protection. These results demonstrate striking synergism of neurosteroids and TG combination for seizure protection, likely because of their effects at extrasynaptic GABA type A (GABA-A) receptors from TG-induced elevation in GABA levels. Superadditive antiseizure activity of neurosteroid-MDZ combinations may stem from their actions at both synaptic and extrasynaptic GABA-A receptors. Together, these findings provide a potential mechanistic basis for combination potential of neurosteroids with TG or benzodiazepines for the management of refractory epilepsy, status epilepticus, and seizure disorders. SIGNIFICANCE STATEMENT: This paper investigates for the first time the potential synergistic interactions between two neurosteroids with anticonvulsant properties, allopregnanolone (brexanolone) and the very similar synthetic analog, ganaxolone, and two conventional antiepileptic drugs active at GABA type A receptors: the GABA-reuptake inhibitor tiagabine and a benzodiazepine, midazolam. The results demonstrate a synergistic protective effect of neurosteroid-tiagabine combinations, as well as neurosteroid-midazolam regimens in seizure models.


Assuntos
Anticonvulsivantes/administração & dosagem , Hipocampo/efeitos dos fármacos , Neuroesteroides/administração & dosagem , Receptores de GABA-A/metabolismo , Convulsões/tratamento farmacológico , Animais , Anticonvulsivantes/uso terapêutico , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Combinação de Medicamentos , Sinergismo Farmacológico , Quimioterapia Combinada , Hipocampo/metabolismo , Hipocampo/fisiologia , Técnicas In Vitro , Masculino , Potenciais da Membrana/efeitos dos fármacos , Camundongos , Camundongos Endogâmicos C57BL , Midazolam/administração & dosagem , Midazolam/uso terapêutico , Neuroesteroides/uso terapêutico , Técnicas de Patch-Clamp , Pregnanolona/administração & dosagem , Pregnanolona/análogos & derivados , Pregnanolona/uso terapêutico , Convulsões/metabolismo , Convulsões/fisiopatologia , Tiagabina/administração & dosagem , Tiagabina/uso terapêutico , beta-Ciclodextrinas/administração & dosagem , beta-Ciclodextrinas/uso terapêutico
8.
Ann Otol Rhinol Laryngol ; 129(1): 55-62, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31801377

RESUMO

OBJECTIVE: The purpose of this study was to describe typical anesthesia practices for children with obstructive sleep apnea (OSA). STUDY DESIGN: Online survey. METHOD: A sample of pediatric anesthesiologists received the survey by email. RESULTS: 110 respondents were included. 46.4% worked in a free-standing children's hospital and 32.7% worked in a children's facility within a general hospital. 73.6% taught residents. 44.4% saw at least one child with OSA per week, 25.5% saw them daily. On a 100-mm visual analog scale, respondents rated their comfort with managing these children as 84.94 (SD 17.59). For children with severe OSA, 53.6% gave oral midazolam preoperatively, but 24.5% typically withheld premedication and had the parent present for induction. 68.2% would typically use nitrous oxide for inhalational induction. 68.2% used fentanyl intraoperatively, while 20.0% used morphine. 61.5% reduced their intraop narcotic dose for children with OSA. 98.2% used intraoperative dexamethasone, 58.2% used 0.5 mg/kg for the dose. 98.2% used ondansetron, 62.7% used IV acetaminophen, and 8.2% used IV NSAIDs. 83.6% extubated awake. 27.3% of respondents stated that their institution had standardized guidelines for perioperative management of children with OSA undergoing adenotonsillectomy. People who worked in children's hospitals, who had >10 years of experience, or who saw children with OSA frequently were significantly more comfortable dealing with children with OSA (P < 0.05). CONCLUSION: Apart from using intraoperative dexamethasone and ondansetron, management varied. These children would likely benefit from best practices perioperative management guidelines.


Assuntos
Analgésicos/uso terapêutico , Anestesiologia , Anestésicos/uso terapêutico , Antieméticos/uso terapêutico , Pediatria , Padrões de Prática Médica , Apneia Obstrutiva do Sono/cirurgia , Tonsilectomia , Acetaminofen/uso terapêutico , Adenoidectomia , Extubação/métodos , Anti-Inflamatórios não Esteroides/uso terapêutico , Dexametasona/uso terapêutico , Fentanila/uso terapêutico , Humanos , Midazolam/uso terapêutico , Morfina/uso terapêutico , Óxido Nitroso/uso terapêutico , Ondansetron/uso terapêutico , Guias de Prática Clínica como Assunto , Inquéritos e Questionários
9.
Québec; INESSS; 2020.
Não convencional em Francês | BRISA/RedTESA | ID: biblio-1103470

RESUMO

CONTEXTE: Le présent document ainsi que les constats qu'il énonce ont été rédigés en réponse à une interpellation du ministère de la Santé et des Services sociaux dans le contexte de l'urgence sanitaire liée à la maladie à coronavirus (COVID-19) au Québec. L'objectif est de réaliser une recension sommaire des données publiées et de mobiliser les savoirs clés afin d'informer les décideurs publics et les professionnels de la santé et des services sociaux. Vu la nature rapide de cette réponse, les constats ou les positions qui en découlent ne reposent pas sur un repérage exhaustif des données publiées, une évaluation de la qualité méthodologique des études avec une méthode systématique ou sur un processus de consultation élaboré. Dans les circonstances d'une telle urgence de santé publique, l'INESSS reste à l'affût de toutes nouvelles données susceptibles de lui faire modifier cette réponse rapide. PRÉSENTATION DE LA DEMANDE: Le midazolam (VersedMC), lorazépam (AtivanMC) ainsi que le phénobarbital font partie des médicaments administrés en soins palliatifs. Le contexte actuel d'urgence sanitaire lié à la COVID-19 exerce une forte pression sur l'usage de ces médicaments. Afin d'être en mesure d'offrir des soins palliatifs de qualité aux personnes qui le nécessitent, et ce, même en cas de pénurie, le MSSS a demandé à l'INESSS de rechercher les médicaments pouvant constituer des alternatives au lorazépam, midazolam et au phénobarbital en soins palliatifs, tout en tenant compte des ruptures de stock actuelles et anticipées de ces médicaments. Une attention particulière a été portée aux moyens permettant de limiter les pertes de produits, ainsi que l'usage du matériel pouvant être appelé à manquer, tels les pompes volumétriques. MÉTHODOLOGIE: Revue de littérature Questions d'évaluation: 1. Quelles sont les alternatives au midazolam (VersedMC), au lorazépam (AtivanMC) et au phénobarbital en soins palliatifs? 2. Quels seraient les moyens permettant de limiter les pertes de ces médicaments? Repérage des publications : Date de la recherche: 9 avril. Une recherche rapide a été effectuée en utilisant les bases de données Pubmed, Medline, Embase, EBM Reviews et le moteur de recherche Google avec les mots-clés suivants: midazolam, lorazepam, phenobarbital, palliative care, palliative sedation, drug shortage. Une recherche manuelle de la littérature a également été effectuée en consultant les sites Web des agences règlementaires, d'agences d'évaluation des technologies de la santé ainsi que ceux d'organismes gouvernementaux, d'associations ou ordres professionnels en lien avec le thème des travaux. CONSTATS DE L'INESSS: Basé sur la documentation scientifique disponible au moment de sa rédaction, et sur les consultations menées, malgré l'incertitude existante dans cette documentation et dans la démarche utilisée, l'INESSS met en lumière que: La pénurie de médicaments, réelle ou potentielle, doit être communiquée localement dès maintenant aux différents intervenants et des actions mises en place immédiatement, si ce n'est pas déjà fait, dans tous les centres hospitaliers du Québec, qu'ils reçoivent ou non des patients atteints de la COVID-19. L'utilisation des options alternatives devrait donc être favorisée dès maintenant afin d'éviter une pression à la baisse sur les stocks des molécules déjà à risque de pénurie. Dans un contexte d'approvisionnement limité et incertain, il faut éviter le gaspillage et minimiser les pertes; de plus, l'usage de certains produits critiques devrait être priorisé et réservé aux situations pour lesquelles les options alternatives sont peu ou pas envisageables. Il est important de bien adapter le choix des médicaments en fonction des symptômes que l'on souhaite soulager, de l'état du patient et du degré de sédation désiré. Pour soutenir les plus petits centres hospitaliers dans l'usage des options alternatives en soins palliatifs, il serait important de faciliter le partage des connaissances développées dans les grands centres hospitaliers au moyen, par exemple, d'un programme de mentorat. Les patients atteints de COVID-19 chez qui l'approche préconisée est palliative devront faire l'objet d'une prise en charge adaptée qui tient compte de la mitigation des risques de transmission ou contamination. Considérant l'évolution de la pandémie et les milieux d'exercice des soins de fin de vie, les pratiques devront néanmoins s'adapter en tenant compte des éléments d'expertise locale et de capacité du milieu à offrir certains soins.


Assuntos
Humanos , Cuidados Paliativos/organização & administração , Fenobarbital/uso terapêutico , Midazolam/uso terapêutico , Infecções por Coronavirus/epidemiologia , Substituição de Medicamentos , Lorazepam/uso terapêutico , Avaliação da Tecnologia Biomédica , Avaliação em Saúde
10.
Drug Metab Pers Ther ; 34(4)2019 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-31874096

RESUMO

Background Psychomotor agitation can be problematic in an overcrowded emergency department (ED) during uncontrolled procedural sedation. Although emergence phenomena have been studied, various presentations may exist. Case presentation During procedural sedation, a 58-year-old man was sedated with a dissociative dose of ketamine in conjunction with propofol. His shoulder dislocation was reduced successfully but eventually, an exaggerated agitation occurred resembling a post-traumatic stress disorder (PTSD) flashback of past war scenes He was controlled by physical and chemical restraint with an intramuscular injection of 0.1 mg/kg midazolam. After resolution of sedation in rather stable psychiatric conditions, he left the ED with his relatives insisting for discharge against medical advice. Conclusions A PTSD flashback may occur from ketamine sedation in patients with a past history of military experience and can be a manifestation of psychologic adverse effects of ketamine.


Assuntos
Analgesia , Sedação Consciente , Agitação Psicomotora/complicações , Transtornos de Estresse Pós-Traumáticos/complicações , Analgésicos/administração & dosagem , Analgésicos/efeitos adversos , Serviço Hospitalar de Emergência , Humanos , Injeções Intramusculares , Ketamina/administração & dosagem , Ketamina/efeitos adversos , Masculino , Midazolam/administração & dosagem , Midazolam/uso terapêutico , Pessoa de Meia-Idade , Propofol/administração & dosagem , Propofol/efeitos adversos , Agitação Psicomotora/tratamento farmacológico , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico
11.
Agri ; 31(4): 202-205, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31741348

RESUMO

Congenital insensitivity to pain with anhidrosis (CIPA) is a rare syndrome characterized by a lack of sensitivity to pain due to congenital sensory and autonomic neuropathies, anhidrosis, an inability to regulate body temperature, growth retardation, mental retardation at different levels of severity, and inadvertent self-harm. It is an autosomal recessive disorder that is result of a mutation in the neurotrophic receptor tyrosine kinase 1 gene, which encodes neurotrophic tyrosine kinase. CIPA patients are frequently admitted to hospitals with unrecognized traumatic fractures and unhealed wounds due to the lack of a pain response. Presently described is the method of anesthetic management used for 2 siblings, aged 17 and 14 years, with a generalized lack of pain, anhidrosis, mental retardation, and septic arthritis. Sedation with midazolam alone provided satisfactory surgical comfort without causing hemodynamic instability in these 2 patients with CIPA syndrome.


Assuntos
Anestesia , Articulação do Tornozelo/cirurgia , Artrite Infecciosa/cirurgia , Neuropatias Hereditárias Sensoriais e Autônomas , Hipnóticos e Sedativos/uso terapêutico , Midazolam/uso terapêutico , Adolescente , Feminino , Humanos , Masculino , Medição da Dor , Irmãos
12.
Epileptic Disord ; 21(5): 475-478, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31649004

RESUMO

Stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs), an unusual pattern in electroencephalography, have been described in critically-ill encephalopathic patients in response to alerting stimuli. The phenomenon may be seen in patients with a broad range of aetiologies, including cerebral infarct, haemorrhage, anoxia, and degenerative diseases. Here, we report a unique case of status epilepticus presenting with SIRPIDs during funduscopic examination-induced focal to bilateral tonic-clonic seizures.


Assuntos
Midazolam/uso terapêutico , Fenitoína/uso terapêutico , Estado Epiléptico/tratamento farmacológico , Estado Epiléptico/fisiopatologia , Eletroencefalografia/métodos , Humanos , Masculino , Alta do Paciente , Convulsões/diagnóstico , Convulsões/tratamento farmacológico , Estado Epiléptico/diagnóstico , Adulto Jovem
13.
J Vet Intern Med ; 33(6): 2709-2717, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31580527

RESUMO

BACKGROUND: The intranasal (IN) route for rapid drug administration in patients with brain disorders, including status epilepticus, has been investigated. Status epilepticus is an emergency, and the IN route offers a valuable alternative to other routes, especially when these fail. OBJECTIVES: To compare IN versus IV midazolam (MDZ) at the same dosage (0.2 mg/kg) for controlling status epilepticus in dogs. ANIMALS: Client-owned dogs (n = 44) with idiopathic epilepsy, structural epilepsy, or epilepsy of unknown origin manifesting as status epilepticus. METHODS: Randomized parallel group clinical trial. Patients were randomly allocated to the IN-MDZ (n = 21) or IV-MDZ (n = 23) group. Number of successfully treated cases (defined as seizure cessation within 5 minutes and lasting for ≥10 minutes), seizure cessation time, and adverse effects were recorded. Comparisons were performed using the Fisher's exact and Wilcoxon rank sum tests with statistical significance set at α < .05. RESULTS: IN-MDZ and IV-MDZ successfully stopped status epilepticus in 76% and 61% of cases, respectively (P = .34). The median seizure cessation time was 33 and 64 seconds for IN-MDZ and IV-MDZ, respectively (P = .63). When the time to place an IV catheter was taken into account, IN-MDZ (100 seconds) was superior (P = .04) to IV-MDZ (270 seconds). Sedation and ataxia were seen in 88% and 79% of the dogs treated with IN-MDZ and IV-MDZ, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE: Both routes are quick, safe, and effective for controlling status epilepticus. However, the IN route demonstrated superiority when the time needed to place an IV catheter was taken into account.


Assuntos
Doenças do Cão/tratamento farmacológico , Midazolam/administração & dosagem , Estado Epiléptico/veterinária , Administração Intranasal , Animais , Cães , Feminino , Injeções Intravenosas , Masculino , Midazolam/uso terapêutico , Estado Epiléptico/tratamento farmacológico
14.
Med Hypotheses ; 132: 109233, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31606702

RESUMO

The guidelines for cardiopulmonary resuscitation (CPR) in pediatric advanced life support suggest that midazolam is the preferred agent for sedation in patients with mild hypothermia, whereas children with cardiac arrest (CA) are at a crucial stage regarding their immature nervous system. Studies have shown that midazolam may have a detrimental effect on the developmental of the pediatric nervous system. Our previous study found that midazolam induced neuronal damage after CPR in young rats. It is speculated that: midazolam causes the potential injury of neurons by inhibiting mitochondrial autophagy expression and is an important factor for the poor prognosis in children after successful CPR. This project intends to adopt the modified asphyxiant CPR model in juvenile rats. Survival rate, neurological function and histopathological changes were evaluated to determine the protective effects of appropriate sedation depth on cerebral ischemia-reperfusion injury in juvenile rats after CPR. Combined with cell biology and molecular biology related technologies, the mechanism by which the mitochondrial pinkl-parkin signaling pathway induces autophagy to inhibit neuronal apoptosis may be key factor in the protective effects of sedation depth on the brain. The aim of this study is to provide experimental evidence and elucidate the mechanisms of improvement of cerebral ischemia-reperfusion injury by sedation depth in children after successful CPR and to lay a theoretical and experimental basis for clinical treatment.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca/terapia , Hipnóticos e Sedativos/uso terapêutico , Hipotermia Induzida/métodos , Midazolam/uso terapêutico , Ubiquitina-Proteína Ligases/genética , Animais , Apoptose , Encéfalo , Criança , Modelos Animais de Doenças , Eletroencefalografia , Fentanila/uso terapêutico , Humanos , Camundongos , Camundongos Endogâmicos C57BL , Modelos Cardiovasculares , Sistema Nervoso/efeitos dos fármacos , Neurônios/metabolismo , Pediatria , Prognóstico , Ratos , Traumatismo por Reperfusão , Transdução de Sinais
15.
AANA J ; 87(3): 179-183, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31584394

RESUMO

Midazolam, a short-acting benzodiazepine used for preoperative anxiolysis, may also have pharmacologic properties that could further reduce the incidence of postoperative nausea and vomiting (PONV) in high-risk patients when included in a multimodal antiemetic protocol. However, concerns remain that the sedating properties of midazolam will delay discharge after short outpatient procedures. A retrospective data analysis (N = 4,057) investigated effects of midazolam on postoperative antiemetic administration and length of stay following cancer-related outpatient procedures over 15 months. Following initial univariate analysis, a multivariable model adjusting for Apfel score, surgical service, age, length of surgery, and type of anesthesia was created to test these associations. The multivariable analysis demonstrated that midazolam was associated with reduced need for postoperative antiemetic medications (3.2% lower than no-midazolam group; 95% confidence interval = 0.03%-6.0%, P = .032). Furthermore, the multivariable analysis demonstrated no clinically significant effect on postoperative length of stay (7.9 minutes shorter in midazolam group; 95% confidence interval = -20 to 4.4, P = .2). In patients for whom midazolam is not otherwise indicated, evidence is insufficient to warrant midazolam administration solely to prevent PONV. Randomized trials are needed to provide an accurate estimation of the effect size of midazolam for PONV in these patients.


Assuntos
Anestesia Geral , Hipnóticos e Sedativos/uso terapêutico , Midazolam/uso terapêutico , Neoplasias/cirurgia , Náusea e Vômito Pós-Operatórios/prevenção & controle , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Laparoscopia , Masculino , Midazolam/administração & dosagem , Pessoa de Meia-Idade , Enfermeiras Anestesistas , Alta do Paciente , Período Perioperatório , Estudos Retrospectivos , Resultado do Tratamento
16.
S D Med ; 72(9): 414-417, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31581376

RESUMO

BACKGROUND: Use of procedural sedation to promote anxiolysis, analgesia, and amnesia enhances both pediatric patient experience and procedural outcomes. Sanford Children's outpatient sedation clinic currently uses oral midazolam for minimal sedation. METHODS: A research survey was designed to evaluate parent/guardian satisfaction with midazolam for pediatric sedation in simple outpatient procedures including, bot linum toxin injections, voiding cystourethrogram (VCUG), and intravenous line placement. Parents'/ guardians' understanding of the sedation and procedural logistics were surveyed and their satisfaction with the child's comfort, recovery time, and overall satisfaction were assessed. Each component was rated on a scale of 1-10, 1 being not satisfied and 10 as extremely satisfied. RESULTS: The study was conducted at a single pediatric outpatient center. Forty-one parents/guardians of patients aged 22 months-17 years were recruited; of these, 41 consented and enrolled in the study. Average age was 6.1 years with 22 females and 19 males. Of the surveys collected, 30 were botulinum toxin injections, eight VCUG, one contrast enema, and two were not recorded. Mean survey results were 8.7 (95 percent CI, 8.2-9.2) for satisfaction of recovery time, 8.0 (95 percent CI, 7.4-8.6) for control of discomfort and 8.4 (95 percent CI, 7.9-8.9) for overall satisfaction. CONCLUSION: When evaluating midazolam as a sedation agent in pediatric procedures, parents/guardians were most satisfied with the duration of recovery and had the lowest satisfaction on control of the patient's discomfort. Overall, it can be concluded that midazolam is a moderately good agent for pediatric patients receiving minimal sedation, with the greatest satisfaction in the duration of recovery.


Assuntos
Sedação Consciente , Midazolam , Criança , Feminino , Humanos , Lactente , Masculino , Midazolam/uso terapêutico , Pais , Satisfação Pessoal , Inquéritos e Questionários
18.
BMC Anesthesiol ; 19(1): 138, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370793

RESUMO

BACKGROUND: The comparative efficacy of ancillary drugs on sevoflurane related emergence agitation (EA) in children undergoing ophthalmic surgery remains controversial. METHODS: The databases were retrieved in an orderly manner from the dates of their establishment to October, 2018, including PubMed, The Cochrane Library and Web of Science, to collect randomized controlled trials (RCT) of different anesthetic drugs combined with sevoflurane for ophthalmic surgery. Then a network meta-analysis was conducted using R and Stata 12.0 softwares. RESULTS: The meta-analysis showed that, in reducing sevoflurane related EA, dexmedetomidine, ketamine, propofol, fentanyl, midazolam, sufentanil, remifentanil and clonidine were superior to placebo (P < 0.05). The network meta-analysis showed that the effects of ancillary drugs combine with sevoflurane in reducing risk of EA in children undergoing ophthalmic surgery was superior to placebo: dexmedetomidine (OR = 0.17, 95% CrI 0.12-0.22), ketamine (OR = 0.30, 95% CrI 0.11-0.49), propofol (OR = 0.24, 95% CrI 0.09-0.63), fentanyl (OR = 0.16, 95% CrI 0.08-0.56), midazolam (OR = 0.20, 95% CrI 0.09-0.40), sufentanil (OR = 0.27, 95% CrI 0.14-0.41), remifentanil (OR = 0.18, 95% CrI 0.08-0.54) and clonidine (OR = 0.14, 95% CrI 0.07-0.41). The SUCRA of placebo, dexmedetomidine, ketamine, propofol, fentanyl, midazolam, sufentanil, remifentanil, clonidine were respectively 0.26, 77.93, 27.71, 42.8, 69.43, 52.89, 59.83, 57.62 and 61.53%. CONCLUSIONS: The effects of dexmedetomidine combine with sevoflurane in reducing risk of emergence agitation in children undergoing ophthalmic surgery was superior to other drugs.


Assuntos
Acatisia Induzida por Medicamentos/prevenção & controle , Período de Recuperação da Anestesia , Anestésicos Inalatórios/efeitos adversos , Sevoflurano/efeitos adversos , Analgésicos/uso terapêutico , Teorema de Bayes , Criança , Clonidina/uso terapêutico , Dexmedetomidina/uso terapêutico , Quimioterapia Combinada , Fentanila/uso terapêutico , Humanos , Ketamina/uso terapêutico , Midazolam/uso terapêutico , Metanálise em Rede , Procedimentos Cirúrgicos Oftalmológicos , Propofol/uso terapêutico , Agitação Psicomotora , Remifentanil/uso terapêutico , Sufentanil/uso terapêutico
19.
Vet Anaesth Analg ; 46(5): 587-596, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31395483

RESUMO

OBJECTIVE: To determine whether the use of a single dose of midazolam affects quality and duration of the recovery period in healthy dogs undergoing elective castration or ovariohysterectomy. STUDY DESIGN: Prospective, randomized, placebo-controlled, masked clinical trial. ANIMAL POPULATION: Seventy-four client-owned dogs undergoing neutering. METHODS: Following cage demeanour scoring using a simple descriptive scale (SDS), dogs were premedicated with acepromazine (0.03 mg kg-1) and pethidine (3 mg kg-1) intramuscularly (quadriceps muscle). Twenty minutes later sedation was scored with an SDS. Male dogs were induced with midazolam (0.25 mg kg-1) (group M) or an equivalent amount of Hartmann's solution (group P) and propofol intravenously (IV). Female dogs were induced with propofol alone and were administered midazolam (group M) or Hartmann's solution (group P) 5 minutes before intraoperative manipulation of the first ovary. Anaesthesia was maintained with isoflurane in oxygen. Intraoperative analgesia was provided with morphine (0.3 mg kg-1 IV) prior to the start of surgery. Male dogs were administered intratesticular lidocaine (1 mg kg-1). All dogs were administered meloxicam (0.2 mg kg-1 IV) at the end of the procedure, and recovery was scored with an SDS following extubation and 30 minutes later. Time to extubation, head lift, sternal position and standing and complications during recovery were recorded. Data are presented as median (range). RESULTS: Time to standing was significantly longer in animals in group M [56 (13-179) minutes] than in group P [44 (4-137) minutes], and the early recovery score in group M [3 (2-6)] was overall worse than in group P [3 (1-5)]. Significantly more dogs in group M (n = 30) than in group P (n = 22) displayed hypotension. CONCLUSIONS AND CLINICAL RELEVANCE: The administration of midazolam prolonged time to standing and had a mild negative effect on the quality of recovery in a pooled population of healthy male and female dogs undergoing neutering.


Assuntos
Anestesia Geral/veterinária , Anestésicos Intravenosos/uso terapêutico , Cães/cirurgia , Midazolam/uso terapêutico , Período de Recuperação da Anestesia , Anestésicos Intravenosos/administração & dosagem , Animais , Cães/fisiologia , Feminino , Masculino , Midazolam/administração & dosagem , Orquiectomia/veterinária , Ovariectomia/veterinária , Estudos Prospectivos
20.
J Med Life ; 12(2): 173-177, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31406520

RESUMO

Patients feel uncomfortable with cervical manipulation, uterine distension and stimulation of peritoneum during hysterosalpingography (HSG) and experience lower abdominal pain during and after the procedure. Pain during the procedure has a negative effect on the adaptation of patients to treatment and physicians are trying to overcome this unpleasant situation. Therefore, the aim of this study was to compare the effect of midazolam and dexmedetomidine on reducing pain and spasm of fallopian tubes during and after HSG procedure in women with infertility. In a double-blind randomized controlled trial, 102 patients were randomly divided into two groups, midazolam and dexmedetomidine. The pain was recorded during injection and immediately after injection and 30 minutes after HSG, and then the complications of injection were recorded. Finally, the data were analyzed using SPSS version 20. Based on the results presented herein, no significant difference was found between the two groups in terms of vasovagal reaction, spasticity of the tube and the side of the spastic tube and uterine cavity anomalies (p <0.05). However, the pain showed a significant difference between the two groups during the injection, immediately or at 30 minutes after the procedure (p = 0.0001). The pain in the midazolam group was less than that of dexmedetomidine. Furthermore, there was no significant difference between the two groups regarding spasticity (p <0.05). There is a benefit in terms of pain reduction with the use of dexmedetomidine when comparing with midazolam injection. However, dexmedetomidine does not cause side effects in patients and can be used to reduce pain during injection.


Assuntos
Dexmedetomidina/uso terapêutico , Histerossalpingografia/efeitos adversos , Infertilidade Feminina/diagnóstico por imagem , Midazolam/uso terapêutico , Dor/tratamento farmacológico , Adulto , Método Duplo-Cego , Feminino , Humanos , Dor/etiologia , Adulto Jovem
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