American journal of therapeutics
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Randomized Controlled Trial Multicenter Study Comparative Study
Safety and Efficacy of Rocuronium With Sugammadex Reversal Versus Succinylcholine in Outpatient Surgery-A Multicenter, Randomized, Safety Assessor-Blinded Trial.
Complex surgical procedures are increasingly performed in an outpatient setting, with emphasis on rapid recovery and case turnover. In this study, the combination of rocuronium for neuromuscular blockade (NMB) reversed by single-dose sugammadex was compared with succinylcholine followed by spontaneous recovery in outpatient surgery. This multicenter, randomized, safety assessor-blinded study enrolled adults undergoing a short elective outpatient surgical procedure requiring NMB and tracheal intubation. ⋯ Health outcome variables were similar between the groups. Adverse events were reported in 87.1% and 93.8% of patients for rocuronium-sugammadex and succinylcholine, respectively. In conclusion, rocuronium for intubation followed by sugammadex for reversal of NMB offers a viable treatment option in outpatient surgery without prolonging recovery duration or jeopardizing safety.
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Meta Analysis Comparative Study
Safety and Efficacy of Dexmedetomidine as a Sedative Agent for Performing Awake Intubation: A Meta-analysis.
To compare the efficacy and safety of dexmedetomidine with other alternative sedative agents used for performing awake intubation. We conducted a meta-analysis of randomized controlled trials (RCTs) that compared the effects of dexmedetomidine with other alternative sedative agents used during awake intubation. The biomedical databases PubMed, Science Direct, and the Cochrane Library were searched for relevant RCTs with no restriction on the language of publication. ⋯ Its use was associated with better intubation conditions, preservation of airway patency, and reduced recall of intubation, as compared with the traditional sedative agents. The risk of bradycardia and hypotension was significantly higher with dexmedetomidine as compared with that with other sedatives. However, these were easily managed with atropine and vasoactive agents.
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One of the most fascinating drugs in the anesthesiologist's armament is ketamine, an N-methyl-D-aspartate receptor antagonist with a myriad of uses. The drug is a dissociative anesthetic and has been used more often as an analgesic in numerous hospital units, outpatient pain clinics, and in the prehospital realm. It has been used to treat postoperative pain, chronic pain, complex regional pain syndrome, phantom limb pain, and other neuropathic conditions requiring analgesia. ⋯ Such effects make it necessary for the clinician to use the drug only in situations where it will provide the greatest benefit with the fewest adverse effects. To the best of our knowledge, none of the reviews regarding ketamine have taken a comprehensive look at the drug's uses in all territories of medicine. This review will serve to touch on its chemical data, pharmacokinetics and pharmacodynamics, medical uses, and adverse effects while focusing specifically on the drugs usage in anesthesia and analgesia.
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The Coflex is one of the representatives of posterior dynamic interspinous process device, but no study with the application of Coflex interlaminar stabilization in L5/S1 level has been performed. The aim of this study was to evaluate the feasibility and validity of the Coflex interlaminar stabilization in the treatment of degenerative lumbar diseases on L5/S1 level. A retrospective study was conducted for a consecutive series of 33 patients with degenerative lumbar spinal stenosis or lumbar disc herniation located in L5/S1 between November 2007 and September 2010. ⋯ Radiological evaluation revealed that dorsal intervertebral space height and intervertebral foramen height of target level increased significantly in all cases postoperatively and maintained well to final follow-up. In addition, the sagittal range of motion of operated level was restricted (P < 0.05), and the range of motion of adjacent segment did not change much (P > 0.05). The Coflex is an efficacious dynamic interspinous process device for the treatment of degenerative lumbar diseases that can apply to L5/S1.
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Vitamin D deficiency is known to be common in the general population and has been linked to all-cause mortality. The classically recognized role of vitamin D is its involvement in calcium and phosphorous homeostasis and bone health. ⋯ Many of these studies have indicated that there is an association between vitamin D deficiency and clinical outcomes such as mortality, sepsis, duration of mechanical ventilation, and length of stay. This review article provides an overview of vitamin D physiology in adults, a summary of observational studies on vitamin D deficiency in critical illness, and an examination of the few clinical trials on vitamin D supplementation in intensive care patients.