Month: June 2018

Medical News weekly

Epidiolex (cannabidiol) approved for rare epilepsy in US link

15% high schoolers report at least one sports related concussion  link

Maternal diabetes, Type 1 predominantly linked to increased autism link in offspring  link

C  Difficile infections decreasing in Canada link

Tamsulosin did not significantly increase the renal stone passage rate  link

Latest osteoporosis screening guidelines  link

 

ARDS Recruitment Maneuver

A meta-analysis has findings that are at odds with some previous work on recruitment maneuvers in ARDS. “Recruitment maneuver along with co-interventions such as PEEP titration does not provide any benefit in terms of mortality, length of ICU and hospital stay. Further studies are required to know the clinical benefits of recruitment maneuver without PEEP titration in ARDS patients”.

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Complications and Mortality

A study on complications associated with mortality in the NSQIP database identified the most serious complications and concluded: “The most common causes of attributable mortality (attributable deaths per million patients) were bleeding (n = 368), respiratory failure (n = 358), septic shock (n = 170), and renal failure (n = 88). Some complications, such as urinary tract infection and pneumonia, were associated with attributable mortality only in older patients”.

20% of all 30-day mortality is independently attributable to a postoperative complication. Unplanned intubation, septic shock, and bleeding are associated with the greatest number of years of life lost.These are clearly areas to focus on especially in younger patients.

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Dexmedetomidine IV Prolongs ISBPB

The conclusion of this study was: “Intravenous Dexmedetomidine at a dose of 2.0 μg/kg significantly increased the duration of Interscalene Brachial Plexus Block analgesia without prolonging motor blockade and reduced the cumulative opioid consumption at the first 24 hours in patients undergoing arthroscopic shoulder surgery“. There was no greater degree of hypotension, bradycardia or sedation.

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Nebulized Dexmedetomidine Sedation

A study compared nebulized Dexmedetomidine 2mcg/kg, Ketamine 2mg/kg and Midazolam 0.2mg/kg for sedation in children 3 – 7 year olds prior to GA for bone marrow aspiration.  “Preschool children premedicated with nebulised dexmedetomidine had more satisfactory sedation, shorter recovery time, and less postoperative agitation than those who received nebulised ketamine or midazolam“.

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