Advances in therapy
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Advances in therapy · Jul 2007
Randomized Controlled Trial Multicenter Study Comparative StudyDouble-masked study of the effects of nepafenac 0.1% and ketorolac 0.4% on corneal epithelial wound healing and pain after photorefractive keratectomy.
Two NSAIDs--nepafenac 0.1% and ketorolac tromethamine 0.4%-were compared in terms of their effects on corneal reepithelialization and pain after photorefractive keratectomy (PRK) in a randomized, double-masked, contralateral eye, multicenter study. A total of 40 healthy adult patients who were undergoing sequential bilateral PRK received nepafenac 0.1% and ketorolac 0.4% in contralateral eyes, 1 drop 3 times daily for 3 d after bandage contact lens insertion. Patients were assessed on postoperative days 1, 3, 4, 5, and 7. ⋯ Mean overall comfort score was also significantly better for nepafenac 0.1% on day 3 (7.43 vs 6.41; P<.0001). Nepafenac 0.1% and ketorolac 0.4% provide postoperative pain relief after PRK surgery without associated adverse effects on corneal epithelial healing. Nepafenac 0.1% treatment may offer greater comfort upon instillation in patients who have undergone PRK.
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Advances in therapy · May 2007
Randomized Controlled Trial Comparative StudyCombination sedoanalgesia with remifentanil and propofol versus remifentanil and midazolam for elective cardioversion after coronary artery bypass grafting.
Postoperative atrial fibrillation (AF) occurs in up to 50% of cardiac surgery patients and represents the most common postoperative arrhythmic complication. Elective cardioversion, a short but painful procedure, remains an option for patients who do not convert to sinus rhythm with medical therapy. Combinations of remifentanil (a potent analgesic with a short elimination time) with propofol (a hypnotic agent) or midazolam (a sedative agent) produce a synergistic interaction. ⋯ Demographic data were similar (P>.05) and sufficient sedoanalgesia and successful cardioversion were achieved in both groups. Hemodynamic parameters revealed no significant differences between groups (P>.05); however, induction time, time to eye opening, recuperation time, and time to full recovery of psychomotor function were faster in group 1 than in group 2 (P<.05). The remifentanil/propofol combination provided sufficient analgesia, satisfactory hemodynamic stability, and mild respiratory depression, along with faster recovery and discharge times from the intensive care unit.
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Advances in therapy · May 2007
Randomized Controlled Trial Comparative StudyRemifentanil-propofol in vertebral disk operations: hemodynamics and recovery versus desflurane-n(2)o inhalation anesthesia.
The purpose of this study was to ascertain whether total intravenous anesthesia (TIVA) with propofol and remifentanil differs from inhalational anesthesia with desflurane and nitrous oxide in terms of hemodynamics, recovery profile, and postoperative analgesic demand in patients undergoing elective microsurgical vertebral disk resection. A total of 60 patients were randomly assigned to receive TIVA with propofol and remifentanil or inhalational anesthesia with desflurane and nitrous oxide. The TIVA group (n=30) then received 50%/50% N(2)O/O(2). ⋯ Although nausea and vomiting were more common in the desflurane group, no difference in bronchospasm was reported. In the TIVA group, a shorter recovery period and a greater demand for postoperative analgesia were seen. Because of the lack of residual analgesic effects, postoperative analgesic treatment should be initiated immediately in patients undergoing TIVA.
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Advances in therapy · May 2007
Hemostatic effects of microporous polysaccharide hemosphere in a rat model with severe femoral artery bleeding.
An appropriate hemostatic dressing for prehospital use should lower mortality due to uncontrolled hemorrhage. In this study, the investigators explored the hemostatic effects of Microporous Polysaccharide Hemosphere (MPH) applied in a rat model with severe femoral artery bleeding. Twelve rats were randomly assigned to MPH and control groups: The femoral artery of each rat was pierced to initiate bleeding. ⋯ In the control group, however, hemostasis could not be achieved in all 6 rats, even at 90 sec. The difference between the 2 groups was statistically significant (P=.007). Application of MPH and compression with a scale weight significantly decreased the time of hemostasis in the rat model with femoral arterial bleeding.
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Advances in therapy · Mar 2007
Morbidity and mortality among elderly Americans with different stroke subtypes.
The long-term outcomes of hemorrhagic stroke (HS), which includes subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH), are not well understood relative to ischemic stroke (IS). This analysis was undertaken to assess short and long-term survival and morbidity of patients with hemorrhagic stroke, as well as risk factors associated with these outcomes. American Medicare beneficiaries >65 y of age in whom SAH, ICH, or IS was diagnosed were identified and followed over 4 y through the use of longitudinal claims data. ⋯ The recurrence rate was highest among patients with SAH. Those with HS tended to be younger than those with IS and had a greater number of comorbidities at the time of stroke. Among the elderly, patients with HS have a substantially worse prognosis than do those with IS, which highlights the need for more effective treatment of patients with HS.