- Intravenous lidocaine for acute pain: a systematic review. [Journal Article]
- PPharmacotherapy 2018 Oct 10
- The purpose of this systematic review is to evaluate the safety and efficacy of intravenous (IV) lidocaine for the treatment of acute pain in adult patients. The PubMed database was searched for rand...
The purpose of this systematic review is to evaluate the safety and efficacy of intravenous (IV) lidocaine for the treatment of acute pain in adult patients. The PubMed database was searched for randomized controlled trials, retrospective cohort studies, case series, and case reports evaluating use of IV lidocaine for the treatment of acute pain in adult patients, published between January 1970 and January 2018. The primary outcome was pain reduction via Visual Analog Scale, Verbal Rating Scale, or Numeric Rating Scale among patients treated with IV lidocaine and placebo or active controls. Safety outcomes included both nonserious and serious adverse events. A total of 347 titles and abstracts were screened and after full-text review, 13 studies met the inclusion criteria, involving 512 patients. The four active controls studied were IV morphine, IV ketorolac, IV dihydroergotamine (DHE), and IV chlorpromazine (CPZ). The dosing of IV lidocaine varied among studies between a weight-based dose of 1- to 2-mg/kg bolus, a fixed bolus dose of 50 to 100 mg, and a 1-mg/kg/hour continuous infusion. Monitoring of serum lidocaine concentrations was not routinely done. Intravenous lidocaine had superior efficacy to morphine for renal colic and critical limb ischemia, superior efficacy to DHE for acute migraine, and equivalent efficacy to ketorolac for acute radicular lower back pain. However, lidocaine was less effective than CPZ for the treatment of acute migraine. The most common adverse event reported among all studies included neurologic effects, such as altered mental status and slurred speech. Due to the inconsistency in dosing, length of administration, and lack of serum monitoring, the absolute safety of IV lidocaine for acute pain is unknown. Larger, prospective studies are needed before the routine use of IV lidocaine can be recommended for all types of acute pain. This article is protected by copyright. All rights reserved.
- Assessment of microvascular dysfunction in acute limb ischemia-reperfusion injury. [Journal Article]
- JMJ Magn Reson Imaging 2018 Oct 09
- CONCLUSIONS: While conventional DCE-MRI shows normalization after the acute phase, our new approach reveals sustained functional impairment in muscle microvasculature following I/R injury, with compromised response in vasomotor tone present for at least 21 days.
- Contemporary outcomes of thoracofemoral bypass. [Journal Article]
- JVJ Vasc Surg 2018 Oct 03
- CONCLUSIONS: This experience represents one of the largest and most current series of retroperitoneal TFB. We demonstrate that TFB can be performed with good outcomes for patients with severe AIOD, especially if concomitant visceral/infrainguinal reconstruction is warranted. These results support a continued role for TFB in select patients.
- Clinical efficacy of a stent-in-stent procedure for stent fracture in a narrowing anastomosis of femoral-popliteal bypass represented repetitive acute limb ischemia. [Journal Article]
- JCJ Cardiol Cases 2018; 17(1):21-24
- A 72-year-old male with sudden onset pain and coldness in his left lower limb was referred to our hospital. An emergency angiography of the lower limbs demonstrated the cause of acute limb ischemia a...
A 72-year-old male with sudden onset pain and coldness in his left lower limb was referred to our hospital. An emergency angiography of the lower limbs demonstrated the cause of acute limb ischemia as a subsequent acute thromboembolism at the site of a narrowing anastomosis of femoral-popliteal bypass (FPB). In particular, the site of the narrowing anastomosis had already been fixed using a nitinol stent 4 years previously. We confirmed that the severe stent fracture resulted from misalignment. After local lysis therapy, we decided to deploy another nitinol stent to in-stent restenosis (ISR) lesion of the stent fracture. Final angiography confirmed full patency in FPB without flow delay. Additionally, to maintain the patency of arterial flow, we prescribed aspirin and warfarin. After 2 years of operation, his follow-up ankle-brachial pressure index on the left side remained 0.86 and no ischemic leg pain was observed to date. Stent-in-stent procedure using another nitinol stent for ISR treatment for the narrowing anastomosis in FPB indicated feasible and effective results. <Learning objective: Endovascular intervention for acute limb ischemia (ALI) is one of the most challenging cases. Physicians often come up against a problem as no-flow phenomenon after revascularization. Local lysis therapy has established its own position in ALI treatment. However, the effectiveness of various interventional treatments for ALI has not been clarified. This report highlights the potential of a combination of local lysis and intervention in achieving good outcomes in represented repetitive ALI.>.
- Catheter-directed thrombolysis for acute limb ischemia in an Asian population. [Journal Article]
- AVAnn Vasc Surg 2018 Sep 29
- CONCLUSIONS: This study demonstrates that thrombolytic treatment of peripheral arterial occlusions in an Asian patient cohort yields comparable treatment success rates to Western cohorts; however, higher rates of bleeding complications are hazardous and remain a detrimental drawback of this treatment.
- Survival of Patients and Treatment-related Outcome after Intra-Arterial Thrombolysis for Acute Lower Limb Ischemia. [Journal Article]
- AVAnn Vasc Surg 2018 Sep 29
- CONCLUSIONS: The long-term patency after CDT is unfavorable, and additional procedures are needed to preserve adequate distal perfusion. Approximately 50% of the patients are alive at 10 years after the initial CDT. Increasing age and atrial fibrillation have a negative effect on the patients' survival.
- Transplantation of Cardiac Mesenchymal Stem Cell-Derived Exosomes for Angiogenesis. [Journal Article]
- JCJ Cardiovasc Transl Res 2018 Oct 01
- We demonstrated the effects of exosomes secreted by cardiac mesenchymal stem cells (C-MSC-Exo) in protecting acute ischemic myocardium from reperfusion injury. To investigate the effect of exosomes f...
We demonstrated the effects of exosomes secreted by cardiac mesenchymal stem cells (C-MSC-Exo) in protecting acute ischemic myocardium from reperfusion injury. To investigate the effect of exosomes from C-MSC on angiogenesis, we injected C-MSC-Exo or PBS intramuscularly into ischemic hind limb. Blood perfusion of limb was evaluated by laser Doppler Imaging. We observed that ischemic limb treated with C-MSC-Exo exhibits improved blood perfusion compared to ischemic limb treated with PBS at 2 weeks and 1 month after induction of limb ischemia. To explore the potential mechanisms underlying C-MSC-Exo's angiogenetic effect, we performed microRNA array analysis and identify mmu-miR-7116-5p as the most abundant enriched miRNA detected in C-MSC-Exo. Bioinformatics' analysis shows that miR-7116-5p negatively regulates protein polyubiquitination. In conclusion, our study demonstrated that intramuscular delivery of C-MSC-Exo after limb ischemia improves blood perfusion, and we identified the most abundant miRNAs that are preferentially enriched in C-MSC-Exo.
- The Future Is Determined Now. [Editorial]
- JACCJ Am Coll Cardiol 2018 Oct 02; 72(14):1573-1575
- Cardiovascular Outcomes After Lower Extremity Endovascular or Surgical Revascularization: The EUCLID Trial. [Journal Article]
- JACCJ Am Coll Cardiol 2018 Oct 02; 72(14):1563-1572
- CONCLUSIONS: In the EUCLID trial, LER was most often endovascular. Following LER, there was an increased hazard for the primary endpoint (with higher event rates in the surgical group) and a markedly increased risk for MALE events (with similar event rates between surgical and endovascular LER procedures). (A Study Comparing Cardiovascular Effects of Ticagrelor and Clopidogrel in Patients With Peripheral Artery Disease [EUCLID]; NCT01732822).
New Search Next
- Patient Demographics and Extracorporeal Membranous Oxygenation (ECMO)-Related Complications Associated With Survival to Discharge or 30-Day Survival in Adult Patients Receiving Venoarterial (VA) and Venovenous (VV) ECMO in a Quaternary Care Urban Center. [Journal Article]
- JCJ Cardiothorac Vasc Anesth 2018 Aug 23
- CONCLUSIONS: The most significant findings of advancing age, time spent on ECMO, AKI, ECMO use in the setting of cardiogenic shock, ECPR, and limb ischemia as a complication of ECMO all independently increase the odds of in-hospital and 30-day mortality. To the best of the authors' knowledge, this study is the first to demonstrate a significant relationship between limb ischemia and mortality.