Sa1667 – Use of [Lys5, Meleu9,NLE10]-NKA(4–10) (LMN-NKA) as a Rapid-Onset, Short-Duration, Drug-Induced, Defecation Therapy IN Chronic Spinal Rats Across 30 Days of Subcutaneous B.I.D. Administration

Bleomycin treats malignancies, such as germ cell tumours and Hodgkin lymphoma. While efficacious, it can cause severe drug-induced lung injury. We present a 42-year-old patient with stage IIB seminoma treated with radical orchiectomy followed by adjuvant chemotherapy with bleomycin, etoposide and cisplatin. His postbleomycin course was complicated by the rapid onset of hypoxic respiratory failure, progressing to acute respiratory distress syndrome and requiring venovenous extracorporeal membrane oxygenation (VV-ECMO) support. Although the patient was treated with high dose systemic steroids and ultra-protective ventilator strategies to minimise ventilator-induced lung injury while on VV-ECMO, his lung injury failed to improve. Care was withdrawn 29 days later. Lung autopsy revealed diffuse organising pneumonia. We found six case reports (including this one) of bleomycin-induced lung injury requiring VV-ECMO with a cumulative survival of 33% (2/6). While VV-ECMO may be used to bridge patients to recovery or lung transplant, the mortality is high.

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Dose-Ranging Study in Younger Adult and Elderly Patients of ORG 9487, a New, Rapid-Onset, Short-Duration Muscle Relaxant

Anesthesia & Analgesia ◽

10.1213/00000539-199705000-00011 ◽

1997 ◽

Vol 84 (5) ◽

pp. 1011-1018 ◽

Cited By ~ 44

Author(s):

Raymond Kahwaji ◽

David R. Bevan ◽

George Bikhazi ◽

Colin A. Shanks ◽

Robert J. Fragen ◽

...

Keyword(s):

Elderly Patients ◽

Short Duration ◽

Muscle Relaxant ◽

Rapid Onset ◽

Org 9487 ◽

Dose Ranging

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Cluster Headache: Severity and Temporal Profiles of Attacks and Patient Activity Prior to And During Attacks

Cephalalgia ◽

10.1046/j.1468-2982.1981.0104209.x ◽

1981 ◽

Vol 1 (4) ◽

pp. 209-216 ◽

Cited By ~ 81

Author(s):

David Russell

Keyword(s):

Clinical Study ◽

Cluster Headache ◽

Short Duration ◽

Refractory Period ◽

Significant Positive Correlation ◽

Total Duration ◽

Rapid Onset ◽

Headache Severity ◽

Significant Difference ◽

Temporal Profiles

A detailed clinical study of 77 spontaneous cluster headache attacks has been carried out. The information was recorded during a period when patients were without medication and with the use of methods which were not dependent on the patients' memory of events. The findings stress the usual rapid onset and termination of attacks, and their short duration. There was a preponderance of attacks beginning during sleep and the majority of daytime attacks began when patients were physically relaxed. No significant difference between nocturnal and daytime attacks was found as regards severity or temporal profiles. A significant positive correlation was found between severity of maximal pain and both duration of maximal pain and total duration of attacks. “Abortive attacks” accounted for 16% of attacks. The apparent spontaneous arrest of these attacks does not appear to be due to special features of patient activity prior to or during attacks, nor are they restricted to a refractory period following more severe attacks.

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Mechanism of action of dextromethorphan/quinidine: comparison with ketamine

CNS Spectrums ◽

10.1017/s109285291300062x ◽

2013 ◽

Vol 18 (5) ◽

pp. 225-227 ◽

Cited By ~ 12

Author(s):

Stephen M. Stahl

Keyword(s):

Mood Disorders ◽

Short Duration ◽

Mechanism Of Action ◽

Intravenous Administration ◽

Rapid Onset ◽

Treatment Resistant ◽

Antidepressant Effects ◽

Repeated Doses

ISSUE:Reports of rapid-onset but short-duration antidepressant effects in patients with treatment-resistant mood disorders after intravenous administration of ketamine have prompted efforts to find an agent with ketamine's properties that can be administered orally in repeated doses in order to sustain that action. One candidate for this is dextromethorphan, and here the pharmacologic mechanism of action is compared and contrasted with that of ketamine.

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Clinical features of anaphylaxis in children

Allergy and Asthma Proceedings ◽

10.2500/aap.2022.43.210089 ◽

2022 ◽

Vol 43 (1) ◽

pp. 50-56 ◽

Cited By ~ 1

Author(s):

Mahir Serbes ◽

Ayse Senay Sasihuseyinoglu ◽

Dilek Ozcan ◽

Derya Ufuk Altıntas

Keyword(s):

Clinical Features ◽

Considerable Increase ◽

Age Groups ◽

Gastrointestinal Symptoms ◽

Rapid Onset ◽

Older Children ◽

Drug Induced ◽

Male Predominance ◽

Severe Anaphylaxis ◽

The Mean

Background: Despite the considerable increase in anaphylaxis frequency, there are limited studies on clinical features of anaphylaxis in children in developing countries. Objective: We aimed to analyze the demographic and clinical features of anaphylaxis in children in Turkey by comparing different age groups and triggers. Methods: Medical records of 147 children, ages 0‐18 years, diagnosed with anaphylaxis between 2010 and 2019 were retrospectively analyzed. Results: The mean ± standard deviation age at first anaphylaxis episode was 5.9 ± 5.2 years, with a male predominance (63.9%); 25.2% were infants and 52.4% were < 6 years of age at their first anaphylaxis episode; 78.2% were atopic, with the highest frequency in children with food-induced anaphylaxis (FIA). The home (51.7%) was the most frequent setting. The overall leading cause of anaphylaxis was food (44.2%), which was more frequent at < 6 years of age, followed by drugs (28.6%) and bee venom (22.4%), both were more frequent among older children (>6 years). The patients with venom allergy had the highest rate of rapid onset of symptoms (p < 0.001). Gastrointestinal symptoms were observed significantly more in infants (48.6%) and in children with FIA (38.5%); cardiovascular symptoms were more frequently observed in children > 6 years of age (48.6%) and in children with drug-induced anaphylaxis (64.3%). Although recurrent anaphylaxis was reported for 23.1% of the patients, it was highest in the patients with FIA (35.9%). Overall, only 47.6% of the patients received epinephrine in the emergency department (ED) and 27.3% were referred to an allergy specialist, with the patients with FIA having the lowest rate for both, 32.3% and 10.8%, respectively. Children with drug-induced anaphylaxis had the highest rate of severe anaphylaxis (57.1%). Conclusion: There is a need to improve anaphylaxis recognition and management in all children regardless of age and trigger. Inadequate treatment was most evident in infants and patients with FIA.

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The Effects of Althesin on the Electroencephalograph

Anaesthesia and Intensive Care ◽

10.1177/0310057x8000800221 ◽

1980 ◽

Vol 8 (2) ◽

pp. 206-210 ◽

Cited By ~ 2

Author(s):

Albert Saady ◽

R. G. Hicks

Keyword(s):

Continuous Infusion ◽

Short Duration ◽

Rapid Onset ◽

Burst Suppression ◽

General Anaesthetic ◽

Basic Pattern ◽

Anaesthetic Agents

The EEG was continuously recorded on 43 patients who received Althesin. A basic pattern for this drug, typical of most general anaesthetic agents at a level of light surgical anaesthesia, was established. Four significant levels of change could be discriminated in the EEG following administration of incremental boluses of undiluted Althesin, reflecting deeper levels of anaesthesia. These ranged from a mild slowing of the dominant rhythms to burst-suppression activity at the deepest level reached with larger doses. The EEG demonstrated that althesin has a rapid onset and a short duration and that recovery is rapid and complete after continuous infusion.

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An Unusual Case of Drug-Induced Thrombocytopenia

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709620947891 ◽

2020 ◽

Vol 8 ◽

pp. 232470962094789

Author(s):

Shiyu Wang ◽

Khalid Sawalha ◽

Atif Khan

Keyword(s):

Conformational Changes ◽

Rapid Onset ◽

Drug Eluting Stent ◽

Inpatient Setting ◽

Drug Induced ◽

Platelet Surface ◽

Naturally Occurring ◽

Antiplatelet Medication ◽

Platelet Receptor ◽

Obtuse Marginal

Drug-induced thrombocytopenia (DIT) is a differential diagnosis for consideration when acute thrombocytopenia is encountered in the outpatient or inpatient setting. The mechanism of thrombocytopenia induced by different antiplatelet therapies varies. DIT may occur due to antibody formation following the exposure to a drug, or naturally occurring preexisting antibodies may produce rapid-onset thrombocytopenia when a drug molecule binds to a platelet receptor inducing a conformational change thus rendering it to be an antigen target for naturally occurring antibodies. A 66-year-old female with history of hypertension presented with non-ST elevation myocardial infarction, had drug eluting stent placed in first obtuse marginal artery of left circumflex coronary artery. Started on antiplatelet medications aspirin 81 mg, ticagrelor 90 mg (which was later transitioned to clopidogrel 75 mg), as well as tirofiban 12.5 mg (for 12 hours only). Tirofiban is a GP IIb/IIIa antagonist, other drugs in this class have been documented to induce thrombocytopenia as well, but rates for tirofiban appear to be the highest, the reason is unclear. These antibodies are thought to be either naturally occurring or induced from conformational changes to GP IIb/IIIa binding site after binding to the GP IIb/IIIa receptor, binding of these drugs to the receptor precipitates an epitope much more specific for platelet surface antigens. Tirofiban and clopidogrel/ticagrelor can cause thrombocytopenia, but onset in this case is unusual: acute antibody reaction would be expected within hours, not delayed 30 hours after starting antiplatelet medication, and nonacute reaction would present 1 to 2 weeks out.

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Comparison of the Intubation Conditions Provided by Rapacuronium (ORG 9487) or Succinylcholine in Humans during Anesthesia with Fentanyl and Propofol

Anesthesiology ◽

10.1097/00000542-199911000-00023 ◽

1999 ◽

Vol 91 (5) ◽

pp. 1311-1311 ◽

Cited By ~ 33

Author(s):

Neal W. Fleming ◽

Frances Chung ◽

Peter S. A. Glass ◽

John B. Kitts ◽

Hans Kirkegaard-Nielsen ◽

...

Keyword(s):

Tracheal Intubation ◽

Short Duration ◽

Rapid Onset ◽

Neuromuscular Function ◽

Neuromuscular Blocking ◽

Blocking Drug ◽

Duration Of Action ◽

Prospective Randomized Clinical Trial ◽

Org 9487 ◽

Train Of Four

Background Currently, the only approved muscle relaxant with a rapid onset and short duration of action is succinylcholine, a drug with some undesirable effects. Rapacuronium is an investigational nondepolarizing relaxant that also has a rapid onset and short duration and consequently should be compared with succinylcholine in its ability to facilitate rapid tracheal intubation. Methods This prospective, randomized clinical trial involved 336 patients. Anesthesia was induced with fentanyl and propofol and either 1.5 mg/kg rapacuronium or 1.0 mg/kg succinylcholine. The goal was to accomplish tracheal intubation by 60 s after administration of the neuromuscular blocking drug. Endotracheal intubation was performed, and conditions were graded by a blinded investigator. Recovery of neuromuscular function was assessed by electromyography. Results Intubation conditions were evaluated in 236 patients. Intubation by 60 s after drug administration occurred in 100% of patients with rapacuronium and in 98% with succinylcholine. Intubation conditions were excellent or good in 87% of patients with rapacuronium and in 95% with succinylcholine (P < 0.05). The time (median and range) to the first recovery of the train-of-four response was 8.0 (2.8-20.0) min with rapacuronium and 5.7 (1.8-17.7) min with succinylcholine (P < 0.05). The overall incidence of adverse effects was similar with both drugs. Conclusions A 1.5-mg/kg dose of rapacuronium effectively facilitates rapid tracheal intubation. It can be considered a valid alternative to 1.0 mg/kg succinylcholine for this purpose.

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