scholarly journals An Analysis of Prolonged, Continuous Ketamine Infusions

2021 ◽  
Author(s):  
Steven G Schauer ◽  
Jason F Naylor ◽  
William T Davis ◽  
Matthew A Borgman ◽  
Michael D April
Keyword(s):  
Blood Pressure ◽  
Medical Center ◽  
Vital Signs ◽  
Burn Patients ◽  
Inclusion Criteria ◽  
Hemodynamic Stability ◽  
Alternative Agent ◽  
The Mean ◽  
Further Development ◽  
Study Inclusion

Abstract Introduction Opioids carry high risk of dependence, and patients can rapidly build tolerance after repetitive dosing. Low-dose ketamine is an analgesic agent alternative that provides more hemodynamic stability. We sought to describe the effects of prolonged ketamine use in non-burn patients. Materials and Methods We queried the electronic health system at the Brooke Army Medical Center for patient encounters with ketamine infusions lasting >72 hours. We abstracted data describing demographics, vital signs, ketamine infusion dose and duration, and discharge diagnoses potentially relevant to ketamine side effects. Results We identified 194 subjects who met the study inclusion criteria. The median age was 39 years, most were male (67.0%), and most were primarily admitted for a non-trauma reason (59.2%). The mean ketamine drip strength was 43.9 mg/h (95% CI, 36.7-51.1; range 0.1-341.6) and the mean drip length was 130.8 hours (95% CI, 120.3-141.2; range 71-493). Most subjects underwent mechanical ventilation (56.1%) at some point during the infusion and most survived to hospital discharge (83.5%). On a per-day basis, the average heart rate was 93 beats per minute, systolic blood pressure was 128 mmHg, diastolic blood pressure was 71 mmHg, oxygen saturation was 96%, and respiratory rate was 22 respirations per minute. Conclusions We demonstrate that continuous ketamine infusions provide a useful adjunct for analgesia and/or sedation. Further development of this adjunct modality may serve as an alternative agent to opioids.

scholarly journals FRI0618-HPR EFFECTS OF MUSIC THERAPY ON PAIN, ANXIETY, AND VITAL SIGNS IN CHRONIC INFLAMMATORY RHEUMATIC DISEASES PATIENTS DURING BIOLOGICAL DRUGS INFUSION

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 914.2-914
Author(s):  
S. Boussaid ◽  
M. Ben Majdouba ◽  
S. Jriri ◽  
M. Abbes ◽  
S. Jammali ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Music Therapy ◽  
Systolic Blood Pressure ◽  
Respiratory Rate ◽  
Vital Signs ◽  
Biological Therapies ◽  
Biological Drugs ◽  
Pain Anxiety ◽  
The Mean

Background:Music therapy is based on ancient cross-cultural beliefs that music can have a “healing” effect on mind and body. Research determined that listening to music can increase comfort and relaxation, relieve pain, lower distress, reduce anxiety, improve positive emotions and mood, and decrease psychological symptoms. Music therapy has been used greatly in various medical procedures to reduce associated anxiety and pain. Patients have a high level of anxiety when they are in the hospital, this is the case of patients with rheumatic diseases who consult regularly to have intravenous infusion of biological therapies.Objectives:The purpose of this study was to examine the effectiveness of music therapy on pain, anxiety, and vital signs among patients with chronic inflammatory rheumatic diseases during intravenous infusion of biological drugs.Methods:Fifty patients were divided into two groups: The experimental group G1 (n=25) received drug infusion while lestening to soft music (30 minutes); and the control group G2 (n=25) received only drug infusion. Measures include pain, anxiety, vital signs (blood pressure, heart rate and respiratory rate). The pain was measured using visual analogic scale (VAS). The state-trait anxiety inventory (STAI) was used for measuring anxiety, low anxiety ranges from 20 to 39, the moderate anxiety ranges from 40 to 59, and high anxiety ranges from 60 to 80. Vital signs (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR], and respiratory rate [RR]) were measured before, during and immediately after the infusion.Statistical package for social sciences (SPSS) was used for analysis.Results:The mean age in G1 was 44.45 years (26-72) with a sex ratio (M/F) of 0.8. Including the 25 patients, 12 had rheumatoid arthritis, 10 had ankylosing spondylitis and 3 had psoriatic arthritis. The mean disease duration was 8 years. In G2, the mean age was 46 years (25-70) with a sex ratio (M/F) of 0.75, 12 had rheumatoid arthritis, 11 had ankylosing spondylitis and 2 had psoriatic arthritis. The mean disease duration was 7.5 years. The biological drugs used were: Infliximab in 30 cases, Tocilizumab in 12 cases and Rituximab in 8 cases.Before the infusion, the patients of experimental group had a mean VAS of 5/10±3, a mean STAI of 50.62±6.01, a mean SBP of 13.6 cmHg±1.4, a mean DBP of 8.6 cmHg±1, a mean HR of 85±10 and a mean RR of 18±3. While in control group the mean VAS was 5.5±2, the mean STAI was 50.89±5.5, the mean SBP was 13.4±1.2, the mean DBP was 8.8±1.1, the mean HR was 82±8 and the mean RR was 19±2.During the infusion and after music intervention in G1, the mean STAI became 38.35±5 in G1 versus 46.7±5.2 in G2 (p value=0.022), the mean SBP became 12.1±0.5 in G1 versus 13±1 in G2 (p=0.035), the mean DBP became 8.1±0.8 in G1 versus 8.4±0.9 in G2 (p=0.4), the mean HR became 76±9 in G1 versus 78±7 in G2 (p=0.04) and the mean RR became 17.3±2.1 in G1 versus 18.2±1.7 in G2 (p=0.39).This study found a statistically significant decrease in anxiety, systolic blood pressure and heart rate in patients receiving music interventions during biological therapies infusion, but no significant difference were identified in diastolic blood pressure and respiratory rate.Conclusion:The findings provide further evidence to support the use of music therapy to reduce anxiety, and lower systolic blood pressure and heart rate in patients with rheumatic disease during biological therapies infusion.References:[1] Lin, C., Hwang, S., Jiang, P., & Hsiung, N. (2019).Effect of Music Therapy on Pain After Orthopedic Surgery -A Systematic review and Meta-Analysis. Pain Practice.Disclosure of Interests:None declared

THE PREDICTIVE VALUE OF MODIFIED SHOCK INDEX FOR HOSPITAL MORTALITY

2021 ◽  
pp. 19-21
Author(s):  
Praveenkumar Biradar ◽  
Vijayakumara Vijayakumara ◽  
Veeresh B ◽  
Udaykumar Jaihind Khasage ◽  
Kartik Katti
Keyword(s):  
Blood Pressure ◽  
Hospital Mortality ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Clinical Severity ◽  
Age Group ◽  
Shock Index ◽  
Inclusion Criteria ◽  
The Mean ◽  
Lactate Levels

INTRODUCTION: Shock Index uses only systolic blood pressure; however, diastolic blood pressure is also of undeniable importance when determining patient's clinical severity. All METHODOLOGY: patients who t into the inclusion criteria were requested for consent to join the study. The patients were further divided into sub-groups as per their working diagnosis as medical or surgical cases and denitive diagnosis were noted. In the prese RESULTS: nt study, the mean age group for patients on whom lactate levels were done was found to be 53.2±15.9 years and the maximum study samples were in the age group 60-69. The mean of systolic blood pressure, diastolic blood pressure, heart rate, MAP, Shock Index, Modied Shock Index and lactate levels in our study was 104.1±26.8 mm/hg, 72.4±18.4 mm/hg, 116.9±18.7, 83.1±20.4 mm/hg, 1.2±0.5, 1.5±0.6 and 4.9±2.6 respectively. The p CONCLUSION: redictive value of MSI for hospital mortality was calculated by ROC curve where the sensitivity was 0.750 and specicity was 0.454.

Comparing the effects of cold compress and Xyla-p cream on hemodynamic changes in hemodialysis patients during venipuncture

2019 ◽  
Vol 17 (2) ◽  
Author(s):  
Ziba Ghoreyshi ◽  
Monireh Amerian ◽  
Farzaneh Amanpour ◽  
Reza Mohammadpourhodki ◽  
Hossein Ebrahimi
Keyword(s):  
Blood Pressure ◽  
Physiological State ◽  
Vital Signs ◽  
Hemodialysis Patients ◽  
Control Group ◽  
Intermittent Hemodialysis ◽  
Significant Difference ◽  
Before And After ◽  
The Mean ◽  
The Difference

AbstractBackgroundThe vital signs reflect the physiological state of patients in various clinical conditions. The purpose of this study was to compare the effects of cold compress and Xyla-P cream on hemodynamical changes during venipuncture in hemodialysis patients.Methods and MaterialIn this clinical trial study, 50 patients under hemodialysis were selected by simple random sampling. The patients were then randomly assigned to either Xyla-P cream, cold compress or placebo groups. The vital signs (blood pressure and pulse) were measured upon two intermittent hemodialysis sessions before and after venipuncture. Data were analyzed using repeated measures analysis of variance.ResultsThe mean alternation in systolic blood pressure was significantly different comparing the placebo and cold compress groups before and after intervention (p<0.001). However, the difference was not significant between the Xyla-P cream group and either placebo (p=0.402) or ice compress (p=0.698) groups. The difference of the mean diastolic blood pressure was significant comparing the placebo group with either the Xyla-P cream group (p=0.003) or cold compress group (p<0.001) before and after intervention. In addition, there was a significant difference in the mean number of heartbeats comparing the control group with either the Xyla-P cream group (p<0.001) or cold compress group (p<0.001) before and after the intervention.ConclusionsConsidering the beneficial effects of ice compress and the Xyla-P cream on reduction of cardiovascular parameters, it is recommended to use these methods in hemodialysis patients during venipuncture.

Blood Pressure Monitoring with Home Monitors versus Mercury Sphygmomanometer

2001 ◽  
Vol 35 (7-8) ◽  
pp. 817-822 ◽  
Author(s):  
Allison L Rotch ◽  
Joseph O Dean ◽  
Michael G Kendrach ◽  
Stephanie Gooch Wright ◽  
Thomas W Woolley
Keyword(s):  
Blood Pressure ◽  
Crossover Trial ◽  
Blood Pressure Monitoring ◽  
Blood Pressure Measurement ◽  
Mean Blood Pressure ◽  
Absolute Difference ◽  
Inclusion Criteria ◽  
End Point ◽  
The Mean ◽  
Mercury Sphygmomanometer

OBJECTIVE: To determine the accuracy of three automatic monitors (arm, wrist, finger) for blood pressure measurement manufactured by Omron compared with a standard mercury sphygmomanometer. PRIMARY END POINT: Difference in the mean blood pressure readings from each monitor; the secondary end point was difference in pulse readings. DESIGN: A single-visit, crossover trial tested each device twice on the left arm of each participant; the average of the two readings was recorded. The pulse readings from each monitor were also recorded. ANOVA was used to compare mean blood pressure readings and pulse readings from each device. RESULTS: A total of 55 persons (mean age 53 y; 36 women) met inclusion criteria and completed the study. The mean systolic and diastolic readings obtained from the electronic arm unit were comparable to the mercury readings (124.4/78.02 vs. 129.45/77.87 mm Hg, respectively; p > 0.05 for both readings). The mean results obtained from the wrist and finger monitors differed significantly from those of the mercury readings (145.44/89.58 and 113.94/69.07 mm Hg, respectively; p < 0.05 for both monitors compared with control). No difference was measured in the mean pulse readings between the comparisons (p = 0.72). The absolute difference in systolic and diastolic blood pressure readings from control varied the least with the arm monitor. CONCLUSIONS: Compared with the mercury sphygmomanometer, the arm monitor was the most accurate in measuring blood pressure. The wrist and finger monitors resulted in statistically significant mean systolic and diastolic differences compared with the mercury sphygmomanometer.

Blood Pressure in Native Americans Switched from Celecoxib to Rofecoxib

2005 ◽  
Vol 39 (5) ◽  
pp. 797-802 ◽  
Author(s):  
Jefferson Fredy ◽  
Daniel A Diggins ◽  
Gregory B Morrill
Keyword(s):  
Blood Pressure ◽  
Native American ◽  
Native Americans ◽  
Index Date ◽  
Medical Center ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Cardiovascular Safety ◽  
Antiinflammatory Drugs ◽  
The Mean ◽  
Cox 2

BACKGROUND: Nonsteroidal antiinflammatory drugs have been associated with exacerbation of hypertension. Differing effects on blood pressure (BP) have been reported in studies comparing celecoxib and rofecoxib. Concern regarding the cardiovascular safety of the cyclooxygenase-2 (COX-2) inhibitor class has intensified since the removal of rofecoxib from the market. OBJECTIVE: To evaluate the effect of a formulary change from celecoxib to rofecoxib on the BP of Native American patients at an Indian Health Service medical center. METHODS: Medical records of patients switched from celecoxib to rofecoxib were retrospectively reviewed. BP during the respective treatments was compared as follows: measurements recorded while taking celecoxib within 6 months before the index date and while taking rofecoxib from 1 week after the index date through 6 months of treatment were averaged. Differences in systolic and diastolic BP before and after the therapy change were evaluated using a paired Student's t-test. Subgroup analysis was performed for patients with preexisting hypertension. RESULTS: During rofecoxib therapy, the mean systolic BP was 2.9 mm Hg higher (p = 0.015) and the mean diastolic BP was 1.5 mm Hg higher (p = 0.042) than during celecoxib therapy. Among hypertensive patients, the respective mean systolic and diastolic BPs were 4.8 mm Hg (p = 0.009) and 2.0 mm Hg (p = 0.063) higher while taking rofecoxib. CONCLUSIONS: Switching patients from celecoxib to rofecoxib resulted in an increase in BP, with a larger difference observed in patients with hypertension. Future studies assessing the cardiovascular safety of currently marketed and investigational COX-2 inhibitors should evaluate the possible contribution of BP effects of these agents to overall risk.

scholarly journals Shock Index in Obstetric Hemorrhage as an Applicable Method to Anticipate Adverse Outcome

2021 ◽  
Author(s):  
Hend Saleh ◽  
Hala E Sherif ◽  
Ahmed H Elsayad ◽  
Eman M. Mahfouz ◽  
Ahmed Mahmoud Abdou ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Adverse Outcome ◽  
Hypovolemic Shock ◽  
Vital Signs ◽  
Adverse Outcomes ◽  
Maternal Outcomes ◽  
Shock Index ◽  
Obstetric Hemorrhage ◽  
Predictive Values ◽  
The Mean

Abstract BackgroundTo establish the ability of shock index and the different vital signs to predict the adverse maternal outcomes in the cases of obstetric hemorrhage . MethodsThis prospective - retrospective study comprised patients with primary PPH or hemorrhage due to obstetric cause who were referred to zagazig University hospital Egypt , from January 2018, to December 2019 . Data of vital signs of them ; systolic and diastolic blood pressure, pulse rate, pulse pressure, mean arterial pressure and shock index (heart rate divided by systolic blood pressure) at time of arrival were investigated . Adverse outcome like ,death , admission to the intensive care unit , massive transfusion and invasive procedures were revised and analyzed. AUROC (area under the receiver operating characteristic curve ) was used for shock index in comparison to each vital sign for predicting the adverse maternal outcomes. Sensitivity, specificity, and negative and positive predictive values were assessed to detect the best predictor. ResultsThe mean age of participants years (SD)was 29.2 ( ±7.3). of admission and 44% had altered. The most Common cause of hemorrhage was Iatrogenic ; either misuse of uterotonic or traumatic 30.2% The mean value of HR 108.1±26.6 , SBP 101± 28.7 mmHg , DBP 58.9±21.3 mmHg , SI 1.153±0.541 and mean blood loss 1922 (0.862) .For death, SI and SBP had the highest AUC value at 0.88 ( 0.81–0.95)with P=0.213 .). For ICU blood transfusion ≥ 5iu , admission and invasive surgical interventions, SI had the uppermost AUROC value at 0.76, 0.78 and 0.61. Sensitivity for all adverse outcomes of SI ≥ 0.7,is h from 99 to 90.0 . For death prediction SI≥ 0.7 had very low specificity ;0.6{0.2-1.3}and of SI ≥ 0.9 ;6.4{2.8-7.1}ConclusionShock index is a strapping applicable predictor of adverse outcomes. for patients who suffering from hypovolemic shock due to obstetric hemorrhage,

scholarly journals The Correlation between Calcium Serum and Calcium Urine Level with the Blood Pressure in Preeclampsia

2016 ◽  
Author(s):  
Deni W. Suryono
Keyword(s):  
Blood Pressure ◽  
Normal Pregnancy ◽  
Cross Sectional Study ◽  
Spearman Correlation ◽  
Sectional Study ◽  
Inclusion Criteria ◽  
Urine Level ◽  
Cross Sectional ◽  
Spearman Correlation Test ◽  
The Mean

Objective: To analyze the differences of calcium serum and calcium urine level in preeclampsia and normal pregnancy, and to analyze the correlation between calcium serum and calcium urine level with blood pressure. Method: This study is a cross sectional study with 44 women with preeclampsia and 45 women with normal pregnancies, that meet our inclusion criteria. The samples were obtained from Dr. Hasan Sadikin Hospital and six satellite hospitals from June to September 2011. The comparison of mean calcium serum and calcium urine level of the preeclampsia group was calculated using Mann-Whitney test, and the correlation between calcium serum and calcium urine level and preeclampsia were calculated using Rank Spearman correlation test. Result: The result of the characteristic test in two groups of study shows that both groups are homogenic and comparable. The mean of calcium serum level in women with preeclampsia (7.97 mg/dl) is lower than in normal pregnancy (8.82 mg/dl) with p

Abstract TP332: Utilizing a Neuro Intermediate Unit in Caring for Post-Thrombolysis Stroke Patients

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Leah C Ramos ◽  
Cynthia Steffen ◽  
Sarah Gay ◽  
Julio Chalela
Keyword(s):  
Blood Pressure ◽  
Medical Center ◽  
Academic Medical Center ◽  
Case Series ◽  
Stroke Care ◽  
Stroke Patients ◽  
Retrospective Case ◽  
Case Series Study ◽  
Intermediate Unit ◽  
The Mean

Background: Historically stroke patients receiving intravenous tPA are admitted to an intensive care unit (ICU). Providing post-tPA care in a non-ICU setting could result in cost reduction and allow allocation of ICU beds to other critically ill patients. We sought to determine if care can be provided safely and effectively for post-tPA patients in a Neuro Intermediate Unit (NIU). Materials and Methods: This is a retrospective case series study performed in a tertiary academic medical center with a comprehensive, accredited, stroke program. We analyzed ischemic stroke patients admitted to our NIU during a 24-month period. A standardized data collection form was used to abstract data from medical records. Results: During a 24-month period 104 patients were admitted for post-tPA stroke care. The sample is composed of 60 males and 44 females. The median age was 69.5 and the mean age was 67.96. The sample is composed of 72 (69%) White and 32 (31%) Black patients. The mean admission NIHSS was 9.32. The most common stroke risk factors were hypertension (76%), diabetes mellitus (25%), hyperlipidemia (51%), tobacco use (21%), atrial fibrillation (21%), prior stroke (26%), congestive heart failure (20%), and coronary artery disease (21%). Mean admission systolic blood pressure was 143.5 mm Hg. For blood pressure management, 18% of the patients received medication by intravenous push and 5.7% by continuous infusion to meet established goals. Gastrointestinal hemorrhage was seen in 1.9%, intracranial hemorrhage in 3.8%, and blood transfusions needed in 1.9%. Insulin drips were needed to control persistent hyperglycemia in 3.8%. Sepsis occurred in 0.96% patients. The rate of fatality was 3.8%. Excellent functional outcome as defined as Modified Rankin Score (mRS) less than 2 was seen in 46% of patients and minimal to no disability (mRS < 1 ) was seen in 35.6%. Conclusions: In this retrospective study, stroke patients receiving intravenous tPA admitted to an NIU had similar outcomes and complications to that described in previous data. Significant cost savings can be accomplished by admitting thrombolysis patients to an NIU without compromising patient safety. Specialized nursing care available in a stroke unit is a key component in improving patient outcome.

Comparison of Mean Efficacy of Gluma and Ultraez Desensitizer to Decrease Hypersensitivity of Vital Abutment Teeth Prepared for Full Coverage Restoration

2020 ◽  
Vol 10 (3) ◽  
pp. 192-196
Author(s):  
Hamid Bashir ◽  
Shoaib Rahim ◽  
Jawad Shah ◽  
Zarah Afreen ◽  
Ammarah Afreen ◽  
...  
Keyword(s):  
Potassium Nitrate ◽  
Inclusion Criteria ◽  
Full Coverage ◽  
Fixed Dental Prosthesis ◽  
Group A ◽  
Abutment Teeth ◽  
The Mean ◽  
Tooth Preparation ◽  
Group B ◽  
Study Inclusion

OBJECTIVE: To compare the mean change in hypersensitivity between Gluma and Potassium Nitrate (UltraEz) desensitizers, on vital abutment teeth prepared for full coverage restorations. Study Design and Setting: Randomized experimental study conducted at Watim Dental College, Rawalpindi, from February to August 2019. Methodology: Total 100 patients were included in this study. Inclusion criteria consisted of both male and female patients with age ranging from 20-40 years, consisting of vital teeth and no active carious lesion. Two hours after tooth preparation, vital abutment tooth was stimulated with a blast of air and hypersensitivity of the vital abutment was measured using Visual Analog Scale (VAS). Then Gluma Desensitizer was applied on vital abutment for one minute, air dried and then rinsed. After Gluma Desensitizer application, the abutment tooth was again stimulated with a blast of air and hypersensitivity of the vital abutment was measured using VAS. All the data was entered and analysed using SPSS version 20.0. P values of less than or equal to 0.05 was considered significant. RESULTS; All the teeth before tooth preparation had zero hypersensitivity. After preparation, Mean+ SD of hypersensitivity on VAS were 8.92 + 0.77 and 8.96 + 0.75 in Group A (Gluma) and Group B (UltraEz) respectively. After desensitizers application, Mean+ SD of hypersensitivity on VAS were 4.00 + 0.75 and 2.00 + 0.72 in Group A (Gluma) and Group B (UltraEz) respectively. CONCLUSION: It was concluded that both desensitizers reduce Hypersensitivity but UltraEz Desensitizer (containing Potassium Nitrate) relieves Hypersensitivity to a greater extent than Gluma Desensitizer when used on vital teeth prepared for providing conventional Fixed Dental Prosthesis

Paramedic On Scene Time for Patients Initially Refusing Treatment or Transport

1991 ◽  
Vol 6 (3) ◽  
pp. 293-297 ◽  
Author(s):  
John M. Heiser ◽  
Robert L. Norton ◽  
Keith W. Neely ◽  
Joe Acker ◽  
Jerris R. Hedges
Keyword(s):  
Blood Pressure ◽  
Respiratory Rate ◽  
Retrospective Analysis ◽  
Vital Signs ◽  
Altered Mental Status ◽  
Medication Administration ◽  
Base Station ◽  
Physician Time ◽  
The Mean ◽  
Mean Time

AbstractIntroduction:Patients initially refusing care (PIRC) place their health in jeopardy and consume paramedic and base-station physician time. This study quantifies the time spent on-scene related to PIRC cases.Methods:A retrospective analysis of 128 PIRC cases was performed in the Multomah County EMS system.Results:The PIRC cases had a significantly longer mean on-scene time than did non-refusal cases (30.3 vs 14.6 min; p<.001). Medication administration by paramedics (14% of patients) significantly increased the on-scene time. Overall, the mean time on-scene was not affected by age, gender, vital signs (pulse, blood pressure, respiratory rate), police involvement, and whether the patient was transported. The type of call had limited influence on on-scene time, although mean on-scene time was significantly longer for altered mental status cases than for trauma related cases (35.6 vs 22.4 min; p<.03).Conclusions:PIRC cases create a burden on the EMS system by consuming paramedic and base-station physician time and by preventing these personnel from responding to other calls.

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