Medical science monitor : international medical journal of experimental and clinical research
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of intrathecal levobupivacaine with and without fentanyl in combined spinal epidural for labor analgesia.
The initiation of epidural infusion immediately after intrathecal (IT) injection to prolong labor analgesia has gained increasing popularity. The effect of additional intrathecal fentanyl on levobupivacaine for labor analgesia has not been fully investigated. We wished to determine if addition of IT fentanyl to IT levobupivacaine in combined spinal epidural (CSE) could prolong obstetric analgesia when epidural infusion is initiated promptly. ⋯ The addition of 25 microg intrathecal fentanyl to 2.5 mg levobupivacaine as part of CSE for labor analgesia decreased the incidence of labor breakthrough pain and resulted in a longer duration of labor pain relief. This may decrease the need for supplemental labor pain relief and the anesthetists' workload in the delivery suite.
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Case Reports
The use of drotrecogin alfa (activated) in severe sepsis during acute pancreatitis - two case studies.
Twenty-five percent of patients with diagnosed acute pancreatitis (AP) present a severe form of it. One of the most widespread complications of such a form is severe sepsis or septic shock, in which mortality can reach 80%. A complication of this state is multiple organ failure, which requires multi-directional treatment in an intensive care unit (ICU). Among the standard therapies are: control of the source of infection, supportive treatment of failed organ function, and others (e.g. dietary therapy, pain management, and physiotherapy). It is also now possible to use recombinant human activated protein C [drotrecogin alfa (activated); Xigris, Eli Lilly, USA] in the treatment of severe sepsis. ⋯ Both the cases presented indicate that drotrecogin alfa (activated) interrupts the developmental cascade of severe sepsis. Proofs of the efficacy of the treatment were improvements in the functions of organs previously insufficient during the course of sepsis. The rapid elimination of the drug allowed planning therapy strategies (the possibility of conducting surgical operations and smaller therapeutic interventions) without the risk of increased bleeding. The decision to use Xigris in severe sepsis during AP should always include consideration of the risk of bleeding in connection with the local status within the pancreas.