scholarly journals Intranasal dexmedetomidine and intranasal ketamine association allows shorter induction time for pediatric sedation compared to intranasal dexmedetomidine and oral midazolam

2022 ◽  
Vol 48 (1) ◽  
Author(s):  
Francesca Cossovel ◽  
Andrea Trombetta ◽  
Augusto Ramondo ◽  
Guglielmo Riccio ◽  
Luca Ronfani ◽  
...  
Keyword(s):  
Success Rate ◽  
Induction Time ◽  
Standard Of Care ◽  
Diagnostic Procedures ◽  
New Combination ◽  
Onset Of Action ◽  
Historical Cohort ◽  
Oral Midazolam ◽  
Study Population ◽  
Pediatric Sedation

Abstract Background Non-painful diagnostic procedures require an inactive state for a prolonged time, so that sedation is often needed in younger children to perform the procedures. Our standard of care in this setting consists of the association between oral midazolam (0.5 mg/kg) and intranasal dexmedetomidine (4 mcg/kg). One of the limits of this approach is that the onset of action is quite delayed (up to 55 min) and poorly predictable. We chose to compare this association with intranasal-ketamine and intranasal-dexmedetomidine. Methods This is a “pre-post” study. The study population included the first forty children receiving sedation with the “new” combination intranasal ketamine (3 mg/kg) and intranasal dexmedetomidine (4 mcg/kg) compared to a historical cohort including the last forty children receiving sedation with our standard of care combination of intranasal dexmedetomidine (4mcg/kg) and oral midazolam (0,5 mg/kg). Results The association intranasal dexmedetomidine and intranasal ketamine allowed for a significantly shorter sedation induction time than the combination intranasal dexmedetomidine and oral midazolam (13,5 min versus 35 min). Both group’s cumulative data showed a correlation between age and sedation effectiveness, with younger children presenting a higher success rate and shorter induction time (p 0,001). Conclusions: This study suggests that the ketamine and dexmedetomidine intranasal association may have a shorter onset of action when compared to intranasal dexmedetomidine and oral midazolam.

scholarly journals 1758. Impact of Accelerate Pheno™ Rapid Blood Culture Detection System on Laboratory and Clinical Outcomes in Bacteremic Patients

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S61-S61 ◽  
Author(s):  
Ryan Dare ◽  
Kelsey McCain ◽  
Katherine Lusardi ◽  
Kay Daniels ◽  
Jacob Painter ◽  
...  
Keyword(s):  
Blood Culture ◽  
Clinical Outcomes ◽  
Bacterial Infections ◽  
Detection System ◽  
Positive Culture ◽  
Retrospective Chart Review ◽  
Improve Patient Care ◽  
Standard Of Care ◽  
Historical Cohort ◽  
Stewardship Program

Abstract Background Molecular-based automated systems for the rapid diagnosis of bacterial infections have potential to improve patient care. The Accelerate Pheno™ blood culture detection system (ACCEL) is an FDA approved platform that allows for identification (ID) and antimicrobial susceptibility testing (AST) 8 hours following growth in routine culture. Methods This is a single-center retrospective chart review of bacteremic adult inpatients before and after implementation of ACCEL. Laboratory and clinical data were collected February–March 2018 (intervention) and compared with a January–April 2017 historical cohort (standard of care). Standard of care ID and AST were performed using VITEK® MS (MALDI-TOF MS) and VITEK®2, respectively. An active antimicrobial stewardship program was in place during both study periods. Patients with polymicrobial cultures, off-panel isolates, previous positive culture, or who were discharged prior to final AST report were excluded. Primary outcome was length of stay (LOS). Secondary outcomes were inpatient antibiotic duration of therapy (DOT) and time to optimal therapy (TTOT). Nonparametric unadjusted analyses were performed due to non-normal distributions. Statistics were performed using SAS 9.4. Results Of the 143 positive cultures performed on ACCEL during intervention, 118 (83%) were identified as on-panel organisms. Seventy-five (64%) of these 118 cultures and 79 (70%) of 113 reviewed standard of care cultures met inclusion criteria. Patient comorbidities (P = NS), MEWS severity score (P = 0.10), source of bacteremia (P = NS), and pathogen detected (P = 0.30) were similar between cohorts. Time from collection to ID (28.2 ± 12.7 hours vs. 53.8 ± 20.9 hours; P < 0.001) and AST (31.9 ± 11 hours vs. 71.8 ± 20 hours; P < 0.001) were shorter in the intervention arm. Conclusion Compared with standard of care, ACCEL shortens laboratory turn-around-time and improves clinical outcomes. The use of this system has resulted in decreased mean antibiotic DOT, TTOT, and LOS. Further studies are needed to verify these findings. Disclosures All authors: No reported disclosures.

Impact of COVID19 pandemic on treatment outcome of locally-advanced head and neck squamous cell carcinoma (LA-HNSCC): IMPACCT study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6061-6061
Author(s):  
Pau Guillen Sentis ◽  
Carmen Castillo Manzano ◽  
Beatriz Quirós ◽  
Francisca Morey Cortes ◽  
Sara Tous ◽  
...  
Keyword(s):  
Negative Impact ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Stage Iii ◽  
Rank Test ◽  
Historical Cohort ◽  
First Semester ◽  
Kaplan Meier ◽  
Chi Squared ◽  
One Year

6061 Background: Treatment (ttm) of cancer patients (pts) was compromised during the first wave of COVID19 pandemic due to collapse of healthcare systems. Standard of care (SOC) for LA-HNSCC pts had to be adapted as operating rooms were temporarily unavailable, and to reduce risk of COVID19 exposure. The IMPACCT study evaluated the outcome of LA-HNSCC pts treated at the Catalan Institute of Oncology during the first semester of 2020 and compared it to a control cohort previously treated in the same institution. Methods: Retrospective single institution analysis of two consecutively-treated cohorts of newly-diagnosed HNSCC pts: from January to June of 2020 (CT20) and same period of 2018 and 2019 (CT18-19). Pt demographics and disease characteristics were obtained from our in-site prospective database. Ttm modifications from SOC as per COVID19-contingency protocol in CT20 for LA-HNSCC were collected. Chi-squared was used to compare variables and ttm response between cohorts. One-year recurrence-free survival (1yRFS) and overall survival (1yOS) of LA-HNSCC pts were estimated by Kaplan-Meier method and compared by Log-rank test. Results: A total of 306 pts were included: CT20=99; CT18-19=207. Baseline characteristics were balanced between cohorts (Table1). In pts treated with conservative ttm (non-surgical approach), persistence disease was higher in CT20 vs CT18-19 (26 vs. 10% p=0.02). Median follow-up of CT20 and CT18-19 was 6.8 months (IQR 5.1-7.9) and 12.3 (6.7-18.4), respectively. A trend towards lower 1yRFS and 1yOS was observed in CT20 vs CT18-19 (72 vs 83% p=0.06; 80 vs 84% p=0.07), respectively. Within CT20, 37 pts (37%) had one or more ttm modifications: switch from surgery to conservative ttm (n=13); altered radiotherapy fractionation (n=14); reduced cisplatin cumulative dose to 200mg/m2 (n=19); no adjuvant ttm (n=1). Pts who received modified ttm had no differences in 1yRFS vs those who did not (80 vs 66% p=0.31), but higher 1yOS was observed (97 vs 67% p<0.01). When stratified by stage, 1yOS difference remained significant in stage III/IVA (100 vs 61% p<0.01) but not in I/II (100 vs 77% p=0.28) or IVB (67 vs 50% p=0.54). Conclusions: COVID19 pandemic had a negative impact on ttm outcomes and survival in LA-HNSCC pts when compared to our historical cohort. Ttm modifications based on COVID19-contingency protocol did not compromise ttm efficacy in terms of RFS and was associated with better OS in Stage III/IVA.[Table: see text]

scholarly journals Randomized clinical trial on the efficacy of intranasal or oral ketamine-midazolam combinations compared to oral midazolam for outpatient pediatric sedation

PLoS ONE ◽  
2019 ◽  
Vol 14 (3) ◽  
pp. e0213074 ◽  
Author(s):  
Joji Sado-Filho ◽  
Karolline Alves Viana ◽  
Patrícia Corrêa-Faria ◽  
Luciane Rezende Costa ◽  
Paulo Sucasas Costa
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Oral Ketamine ◽  
Oral Midazolam ◽  
Pediatric Sedation

scholarly journals Propofol as Standard of Care for Pediatric Sedation for Short Procedures, Such As Upper Endoscopy

2020 ◽  
Vol 70 (2) ◽  
pp. e52
Author(s):  
Stefanny Andrade ◽  
Elena Battistuz ◽  
Grazia Di Leo ◽  
Egidio Barbi
Keyword(s):  
Standard Of Care ◽  
Upper Endoscopy ◽  
Pediatric Sedation

scholarly journals Diagnostic-driven management of invasive fungal disease in hematology in the era of prophylaxis and resistance emergence: Dutch courage?

2019 ◽  
Vol 57 (Supplement_3) ◽  
pp. S267-S273
Author(s):  
E A de Kort ◽  
J Maertens ◽  
P E Verweij ◽  
B J A Rijnders ◽  
N M A Blijlevens
Keyword(s):  
Antifungal Therapy ◽  
Standard Of Care ◽  
Diagnostic Procedures ◽  
Invasive Fungal Disease ◽  
Fungal Disease ◽  
Antifungal Treatment ◽  
Clinical Implementation ◽  
Hematopoietic Stem ◽  
Haematological Patient ◽  
Emergence Of Resistance

Abstract Patients receiving intensive anti-leukemic treatment or recipients of allogeneic hematopoietic stem cell transplantation (HSCT) are prone to develop invasive fungal disease caused by both Aspergillus and non-Aspergillus moulds. Overall mortality following invasive mould disease (IMD) is high; adequate and timely antifungal treatment seems to ameliorate the outcome, yet early diagnosis in the haematological patient remains a challenge for most clinicians. Prophylaxis and the empiric addition of antifungal therapy to neutropaenic patients with fever persisting or recurring during broad-spectrum antibiotic treatment is therefore standard of care in many institutions. However, aside from the potential for overtreatment and important side effects, the emergence of resistance to medical triazoles in Aspergillus fumigatus poses a risk for inadequate initial treatment. Initial voriconazole therapy in patients with azole-resistant invasive aspergillosis was recently shown to be associated with a 23% increased mortality rate compared to the patients with azole-susceptible infection, despite changing to appropriate antifungal therapy once resistance was detected. Moreover, fever is not always present with IMD; therefore, cases may be missed when relying solely on this symptom for starting diagnostic procedures and antifungal treatment. At our institution, a diagnostic-driven treatment approach for IMD was implemented relying on clinical but also laboratory markers to start antifungal treatment. We describe the basis and clinical implementation of our diagnostic-driven approach in this review.

Long-term outcome of transcanalicular microdrill dacryoplasty: a minimally invasive alternative for dacryocystorhinostomy

2020 ◽  
pp. bjophthalmol-2020-316146
Author(s):  
Natasa Mihailovic ◽  
Alina Friederike Blumberg ◽  
Friederike Rosenberger ◽  
Viktoria Constanze Brücher ◽  
Larissa Lahme ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Minimally Invasive ◽  
Success Rate ◽  
Complication Rate ◽  
Lacrimal Duct ◽  
Microdrill Dacryoplasty ◽  
Study Population ◽  
The Mean

Background/AimDacryocystorhinostomy (DCR) remains the gold standard therapy for nasolacrimal duct obstruction (NLDO), but is invasive and does not maintain the physiology of the lacrimal pathway. With transcanlicular microdrill dacryoplasty (MDP), there is a minimally invasive alternative surgical approach. This study aimed to present this modern lacrimal duct surgery technique and to evaluate its long-term success rate in a large study population.MethodsThe medical records of 1010 patients with acquired NLDO were retrospectively reviewed. Adult patients who had undergone transcanalicular MDP were included. The evaluation included the following parameters: age, gender, success rate, complication rate, obstruction grade and patient satisfaction. Long-term results regarding patient satisfaction and success rate were evaluated by a telephone survey. Only a complete resolution of symptoms was defined as success.Results793 eyes of 576 patients after transcanalicular MDP could be included in the study. The mean follow-up time was 8.7±0.9 years. Initial surgical success rate was 84.0%. At the time of the follow-up, 57.5% (n=229) still had full resolution of symptoms. The mean patient satisfaction with the procedure was 6.9±3.2 out of 10 points. Heavy bleeding occurred in two cases only (0.25%).ConclusionThis is the first study to show the success rate of microendoscopic lacrimal duct surgery after such a long follow-up period and in such a large study population. Transcanalicular MDP is a minimally invasive technique with a very low complication rate and can be used as an alternative procedure before performing more invasive lacrimal duct surgery such as DCR.

scholarly journals Efficacy of adrenal venous sampling is increased by point of care cortisol analysis

2013 ◽  
Vol 2 (4) ◽  
pp. 236-242 ◽  
Author(s):  
Kristin Viste ◽  
Marianne A Grytaas ◽  
Melissa D Jørstad ◽  
Dag E Jøssang ◽  
Eivind N Høyden ◽  
...  
Keyword(s):  
Success Rate ◽  
Point Of Care ◽  
Treatment Options ◽  
Secondary Hypertension ◽  
Adrenal Venous Sampling ◽  
Venous Sampling ◽  
Disease Treatment ◽  
Historical Cohort ◽  
Adrenal Disease ◽  
Representative Samples

Primary aldosteronism (PA) is a common cause of secondary hypertension and is caused by unilateral or bilateral adrenal disease. Treatment options depend on whether the disease is lateralized or not, which is preferably evaluated with selective adrenal venous sampling (AVS). This procedure is technically challenging, and obtaining representative samples from the adrenal veins can prove difficult. Unsuccessful AVS procedures often require reexamination. Analysis of cortisol during the procedure may enhance the success rate. We invited 21 consecutive patients to participate in a study with intra-procedural point of care cortisol analysis. When this assay showed nonrepresentative sampling, new samples were drawn after redirection of the catheter. The study patients were compared using the 21 previous procedures. The intra-procedural cortisol assay increased the success rate from 10/21 patients in the historical cohort to 17/21 patients in the study group. In four of the 17 successful procedures, repeated samples needed to be drawn. Successful sampling at first attempt improved from the first seven to the last seven study patients. Point of care cortisol analysis during AVS improves success rate and reduces the need for reexaminations, in accordance with previous studies. Successful AVS is crucial when deciding which patients with PA will benefit from surgical treatment.

scholarly journals HUBUNGAN ANTARA DERAJAT KEPARAHAN STROKE DENGAN KEJADIAN STROKE-ASSOCIATED PNEUMONIA

2018 ◽  
Vol 35 (2) ◽  
Author(s):  
Rega Dwi Wandira ◽  
Lisda Amalia ◽  
Iwan Fuadi
Keyword(s):  
National Institutes Of Health ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Exclusion Criteria ◽  
Chi Square ◽  
Historical Cohort ◽  
Cohort Design ◽  
Study Population ◽  
Neurological Ward

ASSOCIATION BETWEEN STROKE SEVERITY AND STROKE-ASSOCIATED PNEUMONIAABSTRACTIntroduction: Stroke-associated pneumonia (SAP) occurs in 5-26% and decreases the quality of life and clinical outcomes of stroke patients. One of the factors that affect the incidence of SAP is the stroke severity.Aims: To determine the association between the stroke severity and the incidence of stroke-associated pneumonia in the neurological ward of Dr. Hasan Sadikin Hospital, Bandung.Methods: This is an analytic retrospective (historical) cohort design study. The study population was stroke patients who were treated in the neurological ward of Dr. Hasan Sadikin Hospital, Bandung between 2014-2016. Exclusion criteria were patient with pneumonia other than SAP and using mechanical ventilation. Stroke severity was assessed using NIHSS (National Institute of Health Stroke Scale). Chi-square was used to determine inter-variable association.Results: Among 81 subjects, 24 were assessed as SAP (29.6%). The SAP prevalence were mostly male (58.3%), age group between 65-74 year old (41.7%) with hypertension risk (87.5%), stroke onset <48 hours, lesion location on left hemisphere, onset of SAP≥48 hours, and those with consciousness impairment. Those with high stroke severity tend to have higher risk of pneumonia 3.063 times compare to patients with low stroke severity.Discussion: There was a significant association between the severity of stroke and the incidence of SAP in the neu- rological ward of Dr. Hasan Sadikin Hospital, Bandung.Keywords: NIHSS, stroke-associated pneumonia, stroke severityABSTRAKPendahuluan: Stroke-associated pneumonia (SAP) cukup sering terjadi (5-26%) pada pasien stroke, sehingga menurunkan angka kualitas hidup dan luaran klinis. Salah satu faktor yang memengaruhi kejadian SAP adalah derajat keparahan stroke.Tujuan: Mengetahui hubungan antara derajat keparahan stroke dengan kejadian SAP di Ruang Rawat NeurologiRSUP Dr. Hasan Sadikin, Bandung.Metode: Penelitian analitik dengan desain kohort retrospektif (historikal) terhadap pasien stroke iskemik yang di rawat di Ruang Rawat Neurologi RSUP Dr. Hasan Sadikin, Bandung pada tahun 2014-2016. Kriteria eksklusi adalah pasien dengan pneumonia selain SAP dan menggunakan alat ventilasi mekanik. Derajat keparahan stroke dinilai menggu- nakan skor NIHSS (National Institutes of Health Stroke Scale). Uji korelasi Chi-square digunakan untuk melihat hubungan antar-variabel.Hasil: Didapatkan 81 subjek yang 24 orang di antaranya  mengalami SAP (29,6%). Prevalensi SAP tertinggi pada laki-laki (58,3%) kelompok usia 65-74 tahun (41,7%) dengan faktor risiko hipertensi (87,5%), onset stroke<48 jam, lokasi lesi di hemisfer kiri, onset SAP≥48 jam, serta pada subjek dengan penurunan kesadaran. Subjek dengan derajat keparahan stroke berat memiliki risiko terjadinya pneumonia 3,063 lebih tinggi dibandingkan dengan derajat keparahan ringan.Diskusi: Terdapat hubungan yang bermakna antara derajat keparahan stroke dengan kejadian SAP di Ruang Rawat Neurologi RSUP Dr. Hasan Sadikin, Bandung.Kata kunci: Derajat keparahan stroke, NIHSS, stroke-associated pneumonia

scholarly journals A Comparative Study of Small Dose of Ketamine and Midazolam as Co-Induction Agents to Propofol in Patients Undergoing Elective Surgeries under General Anaesthesia

2020 ◽  
Vol 7 (44) ◽  
pp. 2557-2561
Author(s):  
Disha Ubeja ◽  
Ravishankar R.B
Keyword(s):  
Respiratory Function ◽  
Anaesthetic Agent ◽  
Induction Agent ◽  
Age Group ◽  
Hemodynamic Stability ◽  
Onset Of Action ◽  
Induction Dose ◽  
Haemodynamic Parameters ◽  
Study Population ◽  
Primary Agent

BACKGROUND Intravenous anaesthesia is an integral part of modern anaesthesia. But till date there is no single intravenous agent which fulfils all the characteristics of an ideal anaesthetic agent. The technique of co-induction is to administer a subanaesthetic dose of another inducing or sedative agent, so as to reduce the dose of primary agent. Propofol in the most frequently used IV anaesthetic agent used today, providing faster onset of action, antiemesis, rapid recovery with attenuation of pharyngeal, laryngeal and tracheal reflexes. The major disadvantages of propofol induction are impaired cardiovascular and respiratory function, which may put the patient at a higher risk of bradycardia, hypotension and apnoea. METHODS 150 patients of either sex in the age group of 18 to 65 years, undergoing elective surgeries were randomly selected and informed consents were taken. The study population was divided into three groups with 50 patients in each group. Group KP- 0.4 mg/Kg ketamine; Group MP- 0.03 mg/Kg midazolam and Group C- 10 mL NS. RESULTS Requirement of induction dose was reduced in both the groups and the induction dose was the least in group KP. Changes in haemodynamic parameters ere greater in group c and group MP as compared to group KP. CONCLUSIONS Co-induction with ketamine provides better hemodynamic stability and lesser induction dose of propofol as compared to midazolam. Therefore, ketamine is preferred as a co-induction agent to propofol. KEYWORDS Propofol, Ketamine, Midazolam

Sign in / Sign up

Export Citation Format

Share Document