- Arguments to Apply Epinephrine for Pocket Hematoma Reduction. The MAITRE Study. [Review]
- JAJ Atr Fibrillation 2016 Jun-Jul; 9(1):1391
- Pocket hematoma (PH) is a common complication of implantations of cardiac electrophysiological devices with occurring at a particularly high rate in patients on oral anticoagulation or antiplatelet t...
Pocket hematoma (PH) is a common complication of implantations of cardiac electrophysiological devices with occurring at a particularly high rate in patients on oral anticoagulation or antiplatelet treatment. Different pharmacological agents with hemostatic effect are used to avoid PH. We supposed that the vasoconstrictor effects of epinephrine may reduce bleeding extent and be effective in prevention of PH. Maitre is the first clinical trial conducted with an aim to show the safety and efficacy of epinephrine in PH prophylaxis. We randomized 133 patients to receive either epinephrine or saline solution, which were added to a local anesthetic administered during pacemaker implantation. In cases of diffuse bleeding a method of pocket drainage was effectively used. Results showed that risk of PH was significantly higher in the group receiving epinephrine. We conclude that a local epinephrine effect may lead to a false impression of adequate hemostasis and force a surgeon to refuse from drainage insertion.
- Hospital Variation in Time to Epinephrine for Non-Shockable In-Hospital Cardiac Arrest. [Journal Article]
- CircCirculation 2016 Dec 01
- CONCLUSIONS: -Delays in epinephrine administration following in-hospital cardiac arrest are common and varies across hospitals. Hospitals with high rates of delayed epinephrine administration had lower rates of overall survival for in-hospital cardiac arrest due to non-shockable rhythm. Further studies are needed to determine if improving hospital performance on time to epinephrine administration, especially at hospitals with poor performance on this metric will lead to improved outcomes.
- Vasopressors and Inotropes in Sepsis. [Review]
- EMEmerg Med Clin North Am 2017; 35(1):75-91
- Vasopressor and inotropes are beneficial in shock states. Norepinephrine is considered the first-line vasopressor for patients with sepsis-associated hypotension. Dobutamine is considered the first-l...
Vasopressor and inotropes are beneficial in shock states. Norepinephrine is considered the first-line vasopressor for patients with sepsis-associated hypotension. Dobutamine is considered the first-line inotrope in sepsis, and should be considered for patients with evidence of myocardial dysfunction or ongoing signs of hypoperfusion. Vasopressor and inotrope therapy has complex effects that are often difficult to predict; emergency providers should consider the physiology and clinical trial data. It is essential to continually reevaluate the patient to determine if the selected treatment is having the intended result.
- A case of extreme hypokalaemia. [Journal Article]
- NJNeth J Med 2016; 74(9):406-409
- Hypokalaemia is a common clinical problem. It can lead to severe disturbances in cardiac, neurological and muscle function. We present the case of a 45-year-old woman who was transported to our hospi...
Hypokalaemia is a common clinical problem. It can lead to severe disturbances in cardiac, neurological and muscle function. We present the case of a 45-year-old woman who was transported to our hospital with cardiac arrest following ventricular fibrillation. Blood sampling revealed severe acidosis (pH 7.02) and extreme hypokalaemia (0.9 mmol/l). The low serum potassium level was most likely caused by the combination of a very deficient diet and use of a thiazide diuretic. She never reported any symptoms. An acute intracellular shift of potassium due to epinephrine and perhaps also the cathecholamines in Red Bull may have further decreased the serum potassium concentration. To our knowledge, this is the lowest potassium level reported in literature. Longer-lasting hypokalaemia might be asymptomatic but when combined with even minor triggers of acute hypokalaemia, serious morbidity or mortality can suddenly occur. Patients on diuretic treatment with suspected malnutrition or chronic gastrointestinal losses require regular monitoring of electrolytes.
- Pre-emptive injection of peri-articular-multimodal drug for post-operative pain management in total knee arthroplasty: a double-blind randomized clinical trial. [Journal Article]
- IOInt Orthop 2016 Nov 30
- CONCLUSIONS: Peri-articular multimodal injection including bupivacaine, morphine, and ketorolac preferably with pre-emptive injection method provided proper post-operative pain relief, less opioid consumption, and better early rehabilitation following TKA at 48 hours after surgery.
- Anti-aggregatory effect of boswellic acid in high-fat fed rats: involvement of redox and inflammatory cascades. [Journal Article]
- AMArch Med Sci 2016 Dec 1; 12(6):1354-1361
- CONCLUSIONS: The present data suggest that BA shows a promising anti-aggregatory effect by attenuating the enhanced hyperlipidemia, oxidative stress and inflammation associated with HFD.
- Comparative Assessment of the Effects of Three Local Anesthetics: Lidocaine, Prilocaine, and Mepivacaine on Blood Pressure Changes in Patients with Controlled Hypertension. [Journal Article]
- GJGlob J Health Sci 2016 10 1; 8(10):54157
- CONCLUSIONS: While no significant changes in blood pressure were observed in three groups, all dental procedures on the mentioned group of patients have to be performed under careful monitoring and aspiration. Moreover, the maximum epinephrine dose (0.04mg) should never be exceeded in these patients.
- Pilonidal Sinus Operations Performed Under Local Anesthesia versus the General Anesthesia: Clinical Trial Study. [Journal Article]
- GJGlob J Health Sci 2016 9 1; 8(9):53531
- CONCLUSIONS: this investigation revealed that local anesthesia has decreased pain during 48 hours after the surgery, shorter recovery time, and the less consumption of painkillers. So, we concluded that we can consider local anesthesia as a good alternative for the general anesthesia in the pilonidal sinus surgery.
- Insulin elevates leptin secretion and mRNA levels via cyclic AMP in 3T3-L1 adipocytes deprived of glucose. [Journal Article]
- HHeliyon 2016; 2(11):e00194
- CONCLUSIONS: Insulin alone stimulates leptin secretion and elevates leptin mRNA levels via cAMP under the lack of glucose metabolism, while glucose is a significant and ambivalent effector on the insulin effects of leptin.
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- Adrenalin and brain impairment. [Journal Article]
- NSNurs Stand 1998 Oct 21; 13(5):29
- Giving high doses of adrenalin during resuscitation might result in long term mental impairment, say researchers.
Giving high doses of adrenalin during resuscitation might result in long term mental impairment, say researchers.