Therapeutics and clinical risk management
-
Ther Clin Risk Manag · Jan 2014
Efficacy of tramadol as a preincisional infiltration anesthetic in children undergoing inguinal hernia repair: a prospective randomized study.
Preincisional local anesthetic infiltration at the surgical site is a therapeutic option for postoperative pain relief for pediatric inguinal hernia. Additionally, tramadol has been used as an analgesic for postoperative pain in children. Recently, the local anesthetic effects of tramadol have been reported. The aim of this study was to determine both the systemic analgesic and the local anesthetic effects of tramadol and to determine how it differs from bupivacaine when administered preincisionally. ⋯ Tramadol shows equal analgesic effect to bupivacaine and decreases additional analgesic requirement, when used for preincisional infiltration anesthesia in children undergoing inguinal herniorrhaphy.
-
Ther Clin Risk Manag · Jan 2014
The dexmedetomidine concentration required after remifentanil anesthesia is three-fold higher than that after fentanyl anesthesia or that for general sedation in the ICU.
The general dexmedetomidine (DEX) concentration required for sedation of intensive care unit patients is considered to be approximately 0.7 ng/mL. However, higher DEX concentrations are considered to be required for sedation and/or pain management after major surgery using remifentanil. We determined the DEX concentration required after major surgery by using a target-controlled infusion (TCI) system for DEX. ⋯ The DEX concentration required after AAA surgery with remifentanil was three-fold higher than that required after AAA surgery with fentanyl or the conventional DEX concentration for sedation. High DEX concentration after remifentanil affords some benefits in anesthetic management.
-
Sepsis and septic shock are important causes of mortality in intensive care unit patients, hence early diagnosis and therapy are important in management of their treatment. The available information on sepsis patients is not enough to recommend or to discard the routine evaluation of triglyceride (TG) levels at the onset of sepsis. The aim of this study was to investigate the association of hypertriglyceridemia and clinical outcome (or mortality) in patients with severe sepsis. ⋯ It was observed in this study that patients in the intensive care unit with sepsis had high TG levels. We also observed that the TG level >150 mg/dL at 0 hour (onset of sepsis) was a significant predictive marker of sepsis mortality rate. The contribution of hypertriglyceridemia to mortality might be modest compared to increase in severity of illness, but, nevertheless, these simple measurements represent a potential therapeutic target in sepsis.
-
Ther Clin Risk Manag · Jan 2014
Superselective transcatheter renal artery embolization for the treatment of hemorrhage from non-iatrogenic blunt renal trauma: report of 16 clinical cases.
To explore the therapeutic efficacy and outcome of superselective transcatheter renal artery embolization for the treatment of hemorrhage from non-iatrogenic blunt renal trauma (BRT). ⋯ Superselective transcatheter renal artery embolization is an effective minimally invasive therapy for the treatment of BRT hemorrhage.
-
Ther Clin Risk Manag · Jan 2014
The King Vision™ video laryngoscope for awake intubation: series of cases and literature review.
Intubation of patients with a supraglottic mass causing obstruction of the glottis remains a difficult problem for the experienced anesthesiologist. Awake fiberscopic endotracheal intubation is the recommended approach in such cases; however, use of a video laryngoscope for awake intubation can be an alternative to a fiberscope. Here we present two cases of awake intubation using a King Vision™ video laryngoscope in patients with a supraglottic mass, and a literature review on use of video laryngoscopes for awake intubation. After topical anesthesia and sedation with opioids, the patients were successfully intubated.