Advances in therapy
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Advances in therapy · Mar 2006
Randomized Controlled TrialIntrathecal morphine: effects on perioperative hemodynamics, postoperative analgesia, and stress response for total abdominal hysterectomy.
Intrathecal opioids provide postoperative analgesia and hemodynamic stability by depressing the neuroendocrine response during the perioperative period. The effects of preoperative intrathecal morphine on perioperative hemodynamics, stress response, and postoperative analgesia were evaluated in patients undergoing abdominal hysterectomy with general anesthesia. A total of 24 patients were randomly assigned to the morphine group (n=12) or the control group (n=12). ⋯ Intraoperative hemodynamics was similar in both groups, but postoperative HR and MAP values at 4 h, 8 h, 12 h, and 20 h were significantly lower in the morphine group (P<.05). Postoperative VAS scores, total morphine consumption, and plasma epinephrine, norepinephrine, and glucose levels were significantly lower in the morphine group than in the control group (P<.05). Preoperative intrathecal morphine enhanced the quality of postoperative analgesia, decreased morphine consumption, and depressed the systemic stress response in patients undergoing total abdominal hysterectomy with general anesthesia.
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Advances in therapy · Mar 2006
Case ReportsFatality due to septicemia and hemorrhage in a patient with spinal cord injury and ischemic heart disease with the need for long-term catheter drainage.
Percutaneous suprapubic cystostomy is generally considered to be a safe procedure provided the bladder is distended adequately, as palpable bladder is the landmark for insertion of a trocar. This report describes fatality due to septicemia and hemorrhage following suprapubic catheter insertion in a tetraplegic male patient with long-term indwelling urethral catheter drainage and urine infection with Escherichia coli, Pseudomonas species, and Enterococcus faecalis. Before the surgical procedure was begun, the urinary bladder was distended by repeated injection of 50 mL of sterile, 0.9% sodium chloride through the urethral catheter with a catheter-tip syringe until the bladder became palpable in the suprapubic region; by this time, the bladder had been filled forcibly with 500 mL of saline. ⋯ Postmortem examination revealed bilateral hydronephrosis with fluid and clotted blood in the renal pelves and ureters; the urinary bladder showed a thick wall and hemorrhagic mucosa. This fatal incident raises the question of whether forcible distention of the urinary bladder for percutaneous cystostomy is safe in patients with spinal cord injury who have a small-capacity bladder, infected urine, and ischemic heart disease. In such patients, it may be prudent to avoid forcible distention of the urinary bladder and instead perform ultrasound-guided or fluoroscopically guided suprapubic cystostomy.
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This 2-year prospective study was conducted to identify those at risk for ophthalmologic emergencies, to define the risk factors and reasons for eye injuries, to analyze treatment options, and to compare findings with those of previous studies. A total of 203 patients (74% male, mean age 27.3+/-13.9 y, 51% right eye injuries, 44% left eye injuries, 5% bilateral injuries) with injury to 208 eyes who presented to the emergency department for treatment were included in this study. All patients were evaluated by an ophthalmologist, who completed a formal questionnaire. ⋯ In this study, the leading cause of eye injury was workplace accidents, probably attributable to growing industrialization in the region. Ocular trauma continues to be an important health problem in Turkey. Investigators believe that with education about and use of proper eye protection, 90% of eye injuries could be prevented.
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Advances in therapy · Jan 2006
Application of physiology-based pharmacokinetic and pharmacodynamic modeling to individualized target-controlled propofol infusions.
This study compared the ability of the physiology-based pharmacokinetic (PBPK) model with that of compartmental models used in propofol infusion devices to predict the pharmacokinetics and pharmacodynamics of propofol in various patient groups (children, pregnant women, young men, normal weight adults, and obese adults). With a PBPK model, loss of consciousness (LOC) and recovery of consciousness (ROC) corresponded to a narrow range of brain tissue concentrations (2.2-4.0 mg/L). With the compartmental models, predicted effect concentrations were also within a narrow range at LOC, but were outside the range at ROC. ⋯ In obese individuals, however, interindividual CV values for brain or effect concentrations were 41% (PBPK) and 93% (compartmental). This comparison suggests the increased flexibility of PBPK models over compartmental models, the latter of which rely heavily on the patient group from which the model was derived. The incorporation of PBPK models may provide target-controlled infusions with enhanced ability to predict response in a wide variety of patients.
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Advances in therapy · Jan 2006
Tau protein as a serum marker of brain damage in mild traumatic brain injury: preliminary results.
The objective of this study was to investigate the diagnostic value of serum tau protein in determining the severity of traumatic brain injury in patients with mild traumatic brain injury (mTBI) and high-risk patients. Adult patients who presented to our emergency department (ED) with mTBI over 1 year were prospectively enrolled. Patients underwent cranial computed tomography (CT) and were subdivided into high- and low-risk groups, according to the probability of resultant intracranial injury. ⋯ Investigators of the present study noted that serum tau levels in patients with mTBI were increased. Therefore, it is believed that this biomarker may prove helpful in identifying high-risk patients with mTBI. However, additional studies are needed to establish the diagnostic value of serum tau in detecting traumatic brain injury in patients with mTBI.