Pharmacotherapy
-
Case Reports
Peripheral neuropathy in healthy men volunteers anesthetized with 1.25 MAC sevoflurane for 8 hours.
Two men volunteers developed peripheral neuropathy after prolonged anesthesia with 1.25 minimum alveolar concentration sevoflurane at an inflow rate of 2 L/minute of fresh gas that caused concurrent administration of relatively large doses (ppm-hrs) of the degradation product of sevoflurane, compound A. Other similarly treated volunteers had lesser degrees of transient neuropathy. This result does not prove but raises the question of whether compound A or other factors associated with sevoflurane anesthesia can predispose patients to peripheral neuropathy.
-
Streptococcal toxic shock syndrome (STSS) is caused by infection with a toxicogenic strain of Streptococcus pyogenes. Clinical manifestations may be those of a mild illness, characterized by malaise, fever, and muscle pain, to severe sepsis and multisystem organ failure. The syndrome may be associated with several invasive infections including necrotizing fasciitis. ⋯ Intravenous immunoglobulin (IVIG) is reported to have beneficial effects in the management of STSS associated with necrotizing fasciitis. The agent was successful in conjunction with surgical excision and antibiotics in a patient with necrotizing fasciitis, toxic shock, and multisystem organ failure. On the basis of this experience and a thorough literature review, we concur that IVIG may be a useful adjunct in the treatment of STSS associated with necrotizing fasciitis.
-
Respiratory depression secondary to morphine intoxication occurred in an elderly patient with chronic renal failure (CRF). It was reversed with a continuous infusion of naloxone. Approximately 11 hours after the infusion was discontinued, the patient relapsed into respiratory depression consistent with opioid intoxication. ⋯ Serum naloxone concentrations measured after the end of the infusion suggest that the drug's pharmacokinetics were significantly altered. Further research is necessary to characterize pharmacokinetic changes that occur in CRF. In the absence of this information, similar patients should be closely monitored for relapse of respiratory depression after naloxone is discontinued.
-
Randomized Controlled Trial Clinical Trial
Monitoring unfractionated heparin therapy with antifactor Xa activity results in fewer monitoring tests and dosage changes than monitoring with the activated partial thromboplastin time.
To determine how much more costly it is to monitor unfractionated heparin (UFH) therapy by antifactor Xa heparin activity (HA) than by activated partial thromboplastin time (aPTT). ⋯ Monitoring UFH therapy over 96 hours with an HA assay costs $4.37 more than monitoring with aPTT. This modest increase may be acceptable given other advantages of the HA assay.
-
Review Case Reports
Mycobacterium fortuitum meningitis associated with an epidural catheter: case report and a review of the literature.
Mycobacterium fortuitum is a rapidly growing organism that has rarely been associated with meningitis. A patient developed M. fortuitum meningitis as the result of a permanent indwelling, contaminated, epidural catheter. Diagnosis and treatment of the disease are difficult in that clinical features may be indolent, and many antimicrobials with activity against M. fortuitum have minimal cerebrospinal fluid penetration. This patient was cured with an antibiotic regimen that consisted of doxycycline, ciprofloxacin, imipenem, and clarithromycin, and removal of the epidural catheter.