Efficacy and Safety of Remifentanil in a Rapid Sequence Induction in elderly patients: a three-arm parallel double blind randomised controlled trial

Publication date: Available online 12 October 2019Source: Anaesthesia Critical Care &Pain MedicineAuthor(s): Arnaud Chaumeron, Jeremie Castanie, Louis Philippe Fortier, Patrick Basset, Sophie Bastide, Sandrine Alonso, Jean-Yves Lefrant, Philippe CuvillonABSTRACTBackground: Rapid sequence induction (RSI) is recommended in patients at risk of aspiration, but induced hemodynamic adverse events, including tachycardia. In elderly patients, this trial aimed to assess the impact of the addition of remifentanil during RSI on the occurrence of: tachycardia (primary outcome), hypertension (due to intubation) nor hypotension (remifentanil).Methods: In this three-arm parallel, double blind, multicentre controlled study, elderly patients (65 to 90 years old) hospitalised in three centres and requiring RSI were randomly allocated to three groups, where anaesthesia was induced with etomidate (0.3 mg/kg) followed within 15 seconds by either placebo, or low (0.5 µg/kg), or high (1.0 µg/kg) doses of Remifentanil, followed by succinylcholine 1.0 mg/kg. Heart rate (HR) and mean arterial pressure (MAP) were recorded before induction and after intubation.Results: In total, eighty patients were randomised and analysed. Baseline HR and MAP were similar between groups. For primary endpoint, the absolute change in HR between induction and intubation was greater in the control group (15 bpm; 95% CI [8-21]) than that in the remifentanil 0.5 µg/kg group (4 bpm; 95% CI [-1-+8]; p = 0...
Source: Anaesthesia, Critical Care and Pain Medicine - Category: Anesthesiology Source Type: research

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Publication date: November 2019Source: The Journal of Foot and Ankle Surgery, Volume 58, Issue 6Author(s): James Stimpson, Damien F. Gill, Arman Memarzadeh, Mike Dunne, Laura Perry, Ahmed Magan, Adam Devany, Chandra PasapulaAbstractWe evaluated whether moving the “line of crush” from thigh to the calf before onset of tourniquet-mediated hypertension would prevent or diminish it. We also evaluated any change in pain or functional outcome. Twenty adult patients were recruited and randomly assigned to either control or intervention groups. Inclusion criteria: any willing participant>18 years old with foot and/o...
Source: The Journal of Foot and Ankle Surgery - Category: Orthopaedics Source Type: research
ObjectivesThe local anesthetic bupivacaine is a common analgesic adjuvant medication used in combination with opioids in intrathecal drug delivery systems (IDDSs). While the acute effects of spinal bupivacaine injection on blood pressure (BP) have been studied, there is a dearth of data regarding long ‐term effects of continuous intrathecal bupivacaine infusion.Materials and MethodsA retrospective review of all noncancer pain patients receiving bupivacaine through IDDSs from January 2013 to November 2017 was performed. Blood pressure values before implantation, and after implant at the 1 ‐week, 3‐month, 6‐month and...
Source: Neuromodulation: Technology at the Neural Interface - Category: Biotechnology Authors: Tags: Clinical Research Source Type: research
CONCLUSIONS Ultrasonography of ONSD presents a good level of diagnostic accuracy for identifying epidural hypertension. In the clinical decision-making phase, this may help physicians to be more cautious about volume when performing epidural injections to treat this disease. PMID: 31551404 [PubMed - in process]
Source: Medical Science Monitor - Category: Research Tags: Med Sci Monit Source Type: research
Purpose of review To explore the data for and against the use of the various components of multimodal analgesia in cranial neurosurgery. Recent findings Postcraniotomy pain is a challenging clinical problem in that analgesia must be accomplished without affecting neurologic function (i.e. ‘losing the neurologic exam’). The traditional approach with low-dose opioids is often insufficient and can cause well recognized side effects. Newer multimodal analgesic approaches have proven beneficial in a variety of other surgical patient populations. The combined use of multiple nonopioid analgesics offers the promi...
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research
Publication date: Available online 8 June 2019Source: Journal of Dental SciencesAuthor(s): Junad Khan, Moin Anwer, Noma Noboru, Davis Thomas, Mythilli KalladkaAbstractBackground/purposeIntraoral and perioral burning sensations may be sequelae of burning mouth syndrome (BMSD) or burning mouth symptoms (BMSP), which present a diagnostic challenge. The aims of the study were to evaluate the efficacy of a topical anesthetic as a diagnostic test to differentiate BMSD from BMSP and to assess the comorbidities and responses to various pharmacologic treatments in BMSD and BMSP patients.Materials and methodsA total of forty-four ch...
Source: Journal of Dental Sciences - Category: Dentistry Source Type: research
​BY JENNIFER TUONG; IVAN KHARCHENKO; JEAN LUC AGARD; &AHMED RAZIUDDIN, MDA 65-year-old man who had HIV well-controlled with highly active antiretroviral therapy, hypertension, sciatica, and restless leg syndrome presented to the emergency department with left leg pain. He also had had chemotherapy and radiation for anal cancer. The patient said the pain had started 45 minutes earlier when he was sitting on the toilet.He described the pain as sore in quality and 10/10 on the pain scale. He reported that it had started in his lower back and radiated to his left leg. He said he had had no trauma or weakness to the regio...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
A 57-YEAR-OLD, 112 kg, 168 cm man with a history of poorly controlled type II diabetes mellitus, hypertension, hyperlipidemia, and obstructive sleep apnea presented to the authors ’ institution for evaluation of intermittent chest pain that typically lasted less than 1 minute and occurred at rest. His chest pain was not correlated with exercise nor did it substantially affect his activities of daily living. The patient also reported chronic, daily headaches that were treate d with acetaminophen-caffeine.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Diagnostic Dilemma Source Type: research
Conclusion: Talinolol loaded SNEDDS formulations could be a potential oral pharmaceutical product with high drug-loading capacity, improved drug dissolution, increased gut permeation, reduced/no human RBC toxicity, and enhanced oral bioavailability. GRAPHICAL ABSTRACT Graphical Abstract. Self-nanoemulsifying drug delivery systems (SNEDDS) of talinolol (TAL) were developed using lipid formulation classification systems (LFCS) that improved the solubility and released the drug completely in dissolution media. In vitro toxicity studies with human red blood cells (RBC) showed that the SNEDDS formulations were n...
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
Conclusion: Our results suggest that the AT1R mediated hypertensive response to angiotensin II within the NTS in normotensive rats is GABA and NO dependent. Nitric oxide produced within the NTS tonically potentiates local GABA and glutamate release. Introduction The central nervous system network that regulates the level of sympathetic tone and, hence, blood pressure, is located in the brainstem and consists mainly of the rostral ventrolateral medulla (RVLM), the paraventricular nucleus (PVN) of the hypothalamus and the nucleus tractus solitarii (NTS) (Guyenet, 2006). It is well-established that the RVLM, the so-ca...
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
Joong-Goo Kim1,2, Han-Bin Lee2 and Sang-Beom Jeon2* 1Department of Neurology, Jeju National University Hospital, Jeju, South Korea 2Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea Objectives: The use of dexmedetomidine and ketamine (DEX–KET) combination for magnetic resonance imaging (MRI) sedation has not been evaluated. We investigated the efficacy and safety of DEX–KET for sedation of patients undergoing MRI of the brain. Methods: This quasi-experimental study was conducted to compare the DEX–KET combination and midazolam for MRI sed...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
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