American journal of therapeutics
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Randomized Controlled Trial Comparative Study
Effect of oral clonidine, etoricoxib, and gabapentin as premedication on sensory and motor blocks and post operative analgesia in surgeries under subarachnoid block using bupivacaine.
Oral premedicant has better patient compliance since it avoids a potential needle prick, and hence can be considered closest to an ideal premedicant. This was a randomized prospective observational study on 120 patients after obtaining ethical committee approval and valid informed consent from patients to be part of the study. ⋯ It is recommended that clonidine, etoricoxib, and gabapentin be considered as good premedicants for patients undergoing surgery under spinal anesthesia. However, more research using these drugs needs to be carried out in the field of premedication.
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Abdominal compartment syndrome (ACS) is defined as an organ dysfunction caused by intra-abdominal hypertension (IAH). Up to 4.2% of the patients in intensive care unit may develop IAH with it being an independent predictor of mortality. However, overall, it still remains a relatively underdiagnosed condition, part in because physical examination alone is very unreliable. ⋯ We recommend that any patient with evidence of new onset oliguria in the setting of distended abdomen, unexplained respiratory failure, with or without hypotension should be suspected of having IAH/ACS. Intravesicular pressure measurement represents a safe, rapid, and cost-effective method of diagnosing IAH. We hereby review the pathophysiology, diagnosis, and management of ACS and its association with acute kidney injury.
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Liver function test (LFT) increase is an early sign of acetaminophen (APAP) toxicity. Typically, when an acute overdose patient is evaluated and has an initial undetectable APAP level and normal liver enzymes, the patient is not treated with N-acetylcysteine, and liver enzymes are not expected to increase later. We report a case of moderate LFT increase despite normal LFTs and an undetectable APAP level after delayed presentation of an APAP ingestion. ⋯ Other cases of LFT increase were excluded. Our case report illustrates that a moderate increase in liver transaminase may occur despite an initial undetectable APAP level and normal transaminases after a delayed presentation. In our case, no serious clinical effects were reported.