Background and Objectives Perineural dexamethasone and intravenous (IV) dexamethasone have been shown to prolong peripheral nerve block duration. The effects of perineural and IV dexamethasone have only been compared at doses of 4 mg or greater. This triple-blind, randomized trial examined the effect of 1 mg IV versus perineural dexamethasone on interscalene block (ISB) analgesia duration. Methods Patients undergoing ambulatory shoulder arthroscopy received an ultrasound-guided ISB with 15 mL bupivacaine 0.5% and 1 mg preservative-free dexamethasone that was administered perineurally (PeriD) or IV (IVDex). All patients received IV ketorolac and were discharged on naproxen 500 mg 2 times a day plus oxycodone/acetaminophen as needed. Peripheral nerve block duration, pain, opioid consumption, and block satisfaction were assessed via telephone follow-ups. Results There were 63 PeriD patients and 62 IVDex patients who completed the primary outcome follow-up. The median time until analgesia from the ISB completely wore off was 3.5 hours (95% confidence interval, 1.0–6.0 hours) longer in the PeriD versus IVDex groups; P = 0.007). Time until the pain relief from the ISB began to wear off was also longer in the PeriD versus IVDex group (5.5 hours [95% confidence interval, 2.1–9.0 hours]; P = 0.002). Other secondary outcomes, including opioid consumption, satisfaction, and pain scores, were not different between groups. Conclusions In patients undergoing shoulder arthroscopy, low-dose perineural dexamethasone (1 mg) in combination with 15 mL of 0.5% bupivacaine prolonged the median time until pain relief from the ISB completely wore off compared with 1 mg IV dexamethasone. However, the degree of prolongation was smaller than the a priori–defined minimal clinically meaningful difference of 5 hours. Clinical Trial Registration This study was registered at Clinicaltrials.gov, identifier NCT02506660. Accepted for publication February 12, 2018. Address correspondence to: Richard L. Kahn, MD, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021 (e-mail: KahnR@HSS.edu). This study was funded by East River Medical Associates and the Research and Education Fund, Anesthesiology Department, Hospital for Special Surgery, New York, NY. REDCap use was supported by the National Center for Advancing Translational Science of the National Institutes of Health (UL1TR000457). This was presented in part at the Society for Ambulatory Anesthesia 32nd Annual Meeting (May 4–6, 2017) in Scottsdale, AZ. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.
from Anaesthesiology via xlomafota13 on Inoreader https://ift.tt/2l0Ds3f
via IFTTT
Σάββατο 9 Ιουνίου 2018
Time to epileptiform activity and EEG background recovery are independent predictors after cardiac arrest
Electroencephalography (EEG) is the most common tool used to support the clinical neurological examination when assessing prognosis in comatose patients resuscitated after cardiac arrest (CA)(Friberg et al., 2015). Continuous EEG-monitoring (cEEG) is increasingly used and recommended after CA(Claassen et al., 2013, Callaway et al., 2015) to detect electrographic seizure activity and may add important information about the temporal dynamics of brain function recovery or deterioration.
from Physiology via xlomafota13 on Inoreader https://ift.tt/2Jp4kbI
via IFTTT
Usefulness of EEG-EMG coherence analysis to confirm epileptic nature of spells mimicking hemifacial spasms
Source:Clinical Neurophysiology
Author(s): Edoardo Ferlazzo, Sara Gasparini, Chiara Sueri, Vittoria Cianci, Damiano Branca, Silvana Franceschetti, Ferruccio Panzica, Laura Canafoglia, Umberto Aguglia
from Physiology via xlomafota13 on Inoreader https://ift.tt/2xWZrBl
via IFTTT
Atypical Auditory Language Processing in Adolescents with Autism Spectrum Disorders
Source:Clinical Neurophysiology
Author(s): Junpei Tanigawa, Kuriko Kagitani-Shimono, Junko Matsuzaki, Rei Ogawa, Ryuzo Hanaie, Tomoka Yamamoto, Koji Tominaga, Shin Nabatame, Ikuko Mohri, Masako Taniike, Keiichi Ozono
ObjectiveIndividuals with autism spectrum disorder (ASD) often show characteristic differences in auditory processing. To clarify the mechanisms underlying communication impairment in ASD, we examined auditory language processing with both anatomical and functional methods.MethodsWe assessed the language abilities of adolescents with ASD and typically developing (TD) adolescents, and analyzed the surface-based morphometric structure between the groups using magnetic resonance imaging. Furthermore, we measured cortical responses to an auditory word comprehension task with magnetoencephalography and performed network-based statistics using the phase locking values.ResultsWe observed no structural differences between the groups. However, the volume of the left ventral central sulcus (vCS) showed a significant correlation with linguistic scores in ASD. Moreover, adolescents with ASD showed weaker cortical activation in the left vCS and superior temporal sulcus. Furthermore, these regions showed differential correlations with linguistic scores between the groups. Moreover, the ASD group had an atypical gamma band (25–40 Hz) network centered on the left vCS.ConclusionsAdolescents with ASD showed atypical responses on the auditory word comprehension task and functional brain differences.SignificanceOur results suggest that phonological processing and gamma band cortical activity play a critical role in auditory language processing-related pathophysiology in adolescents with ASD.
from Physiology via xlomafota13 on Inoreader https://ift.tt/2kX7eWi
via IFTTT
Small fibre neuropathy in mitochondrial diseases explored with sudoscan
Source:Clinical Neurophysiology, Volume 129, Issue 8
Author(s): Marco Luigetti, Guido Primiano, Cristina Cuccagna, Daniela Bernardo, Donato Sauchelli, Catello Vollono, Serenella Servidei
ObjectivePolyneuropathy in mitochondrial diseases (MDs) is relatively common and widely investigated, but few data are instead reported about small fibres involvement.MethodsIn order to investigate the involvement of small fibres in MDs we performed extensive neurophysiological test (nerve conduction studies; sympathetic skin response; sudoscan) in 27 patients with genetic diagnosis of MD (7 m.3243A > G; 4 m.8344A > G; 9 single mtDNA deletion; 7 multiple mtDNA deletions).ResultsNCS showed a polyneuropathy in 11/27 cases (41%). The incidence was very high in POLG1 (100%), m.8344A > G (75%) and m.3243A > G (43%), while only 11% of patients with single deletion had evidence of large fibres involvement. Sympathetic skin response was abnormal only in three patients (one progressive external ophthalmoplegia with single mtDNA deletion; one patient with m.3243A > G mutation; one patient with POLG1 mutation). Sudoscan revealed the presence of an autonomic small fibres dysfunction in 9/27 cases (33%), most of them (7/9) carrying a single mtDNA deletion. Sudoscan data were also confirmed in a sub-group of patients by laser evoked potentials study. Considering only patients with single mtDNA deletion 7/9 (78%) showed abnormal results at sudoscan.ConclusionsSmall fibre neuropathy is another feature to investigate in mitochondrial diseases and seems specifically associated with the presence of single mtDNA deletion.SignificanceThe correct identification through specific neurophysiological tests of small fibres involvement in MDs represents another tile in this challenging diagnosis.
from Physiology via xlomafota13 on Inoreader https://ift.tt/2sReRkQ
via IFTTT
Incidence of epileptiform discharges in children during induction of anaesthesia using Propofol versus Sevoflurane
Source:Clinical Neurophysiology
Author(s): Susanne Koch, Leopold Rupp, Christine Prager, Rudolf Mörgeli, Sylvia Kramer, Klaus Dieter Wernecke, Astrid Fahlenkamp, Claudia Spies
ObjectiveIn pediatric patients, anaesthesia induction is often performed with intravenous Propofol or Sevoflurane inhalation. Although epileptiform discharges have been observed during inductions with Sevoflurane, their occurrence has not been investigated for i.v. Propofol inductions. The aim of this study is to compare the incidence of epileptiform discharges in children during anaesthesia induction using Propofol versus Sevoflurane.MethodsProspective, observational cohort study in children aged 0.5 to 8 years undergoing elective surgery. Children were anaesthetized with either Propofol or Sevoflurane. Bi-frontal electroencephalograms electrodes were placed before start of anaesthesia. Visual electroencephalogram analysis was performed from start of anesthetic agent administration until Intubation with regard to identify epileptiform patterns, i.e. delta with spikes; rhythmic polyspikes; periodic, epileptiform discharges; or suppression with spikes.Results39 children were anaesthetized with Propofol, and 18 children with Sevoflurane. Epileptiform discharges were seen in 36% of the children in the Propofol group, versus 67% in the Sevoflurane group (p=0.03). Incidence of the distinct types of epileptiform discharge differed for periodic, epileptiform discharges (Sevoflurane group 39% vs. Propofol group 3%; p<0.001). Higher concentration of Remifentanil (≥ 0.15µg/kg/min) was associated with less frequent epileptiform discharges (Exp 5.8; CI 95% 1.6 / 21.2; p=0.008).ConclusionsPropofol i.v. induction of anaesthesia in children triggers epileptiform discharges, whereas to a lesser extent than Sevoflurane does.SignificancePresuming that epileptiform discharges have an impact on postoperative brain function, it is advisable to use Propofol rather than Sevoflurane and higher level of Remifentanil for anaesthesia induction in children.
from Physiology via xlomafota13 on Inoreader https://ift.tt/2kXT87b
via IFTTT
Dexmedetomidine facilitates extubation in children who require intubation and respiratory support after airway foreign body retrieval: a case–cohort analysis of 57 cases
Abstract
Purpose
This study aimed to investigate whether dexmedetomidine had sedative weaning advantage for extubation after airway foreign body (FB) removal in children.
Methods
A retrospective case–cohort comparison study with total of 57 critical children who required mechanical ventilation after rigid bronchoscopy was performed. After tracheal intubation, group D (received dexmedetomidine 1 µg/kg over 10 min, followed by an infusion of 0.8 µg/kg/h), and group RP (received remifentanil–propofol 6–10 µg/kg/h and 1–3 mg/kg/h, respectively). The primary outcome was successful extubation rate on first weaning trial. The minor outcomes included weaning time, emergency agitation, coughing score and the incidence of respiratory adverse complications on emergency.
Main results
All 57 patients were included in the analysis, with 30 patients in group D and 27 controlled cases in group RP. The success rate of first weaning trial in the D group was 96.7 vs 77.8% in the RP group, risk ratio (RR) 1.56, 95% CI [0.78–1.98]. Time for resuming spontaneous breathing after termination infusion was shorter in the D group (median 8 min, IQR 15 min) vs RP group (median 12 min, IQR 19 min, P = 0.02, RR 0.56, 95% CI 0.14–6.57).
Conclusions
In mechanical ventilation of pediatric patients following rigid bronchoscopy, in comparison to remifentanil–propofol, dexmedetomidine is proved to have high success rate for weaning strategy.
What is already known?
Remifentanil is proved to be effective for weaning in ICU patients. Dexmedetomedine can provide similar rates of smooth extubation for pediatric patients who underwent airway surgery.
What this article adds?
Invasive ventilation is used for patients with severe comorbidity after airway surgery, but the correct strategy for pediatric extubation after removal of airway foreign body remains unclear. For these patients with short-term mechanical ventilation, dexmedetomedine may improve the extubation rate, when compared with remifentanil–propofol.
from Anaesthesiology via xlomafota13 on Inoreader https://ift.tt/2xVSKzr
via IFTTT
Radionuclides in tea and their behaviour in the brewing process
Source:Journal of Environmental Radioactivity, Volume 192
Author(s): Markus Zehringer, Franziska Kammerer, Michael Wagmann
Tea plantations may be strongly affected by radioactive fallout. Tea plantations on the Turkish coast of the Black Sea were heavily contaminated by the fallout from the reactor fire at the Chernobyl nuclear power plant in 1986. Two years later, the contamination level was reduced by about 90%. When tea is brewed, the original contamination in the tea leaves is more or less leached into the tea water. While most of the radiocaesium (60–80%) is washed out by brewing, most of the radiostrontium remains in the leaves (70–80%). In food laws, a dilution factor of 40–50 is considered for tea brewing. Most laws only define limit values for radiocaesium. Radiostrontium is not specially regulated, even though its dose coefficients for ingestion are higher than the corresponding coefficients for radiocaesium. Radiostrontium in tea occurs primarily from global fallout (bomb tests from 1945-1965).
from Radiology via xlomafota13 on Inoreader https://ift.tt/2xWdcQL
via IFTTT
Postpartum Hospital Utilization among Massachusetts Women with Intellectual and Developmental Disabilities: A Retrospective Cohort Study
Abstract
Objectives This study examined the risk of postpartum hospital admissions and emergency department (ED) visits among US women with intellectual and developmental disabilities (IDD). Methods We used the 2002–2012 Pregnancy to Early Life Longitudinal Data System and identified deliveries to women with and without IDD. Women with IDD (n = 1104) or case subjects were identified from the International Classification of Diseases and Related Health Problems 9th Revision (ICD-9 CM) codes. The study primary outcome measures were any postpartum hospital admission and any ED visit during three critical postpartum periods (1–42, 43–90, and 1–365 days). We conducted unadjusted and adjusted survival analysis using Cox proportional hazard models to compare the occurrence of first hospital admission or ED visits between women with and without IDD. Results We found that women with IDD had markedly higher rates of postpartum hospital admissions and ED visits during the critical postpartum periods (within 1–42, 43–90, and 91–365 days) after a childbirth. Conclusion for Practice Given the heightened risk of pregnancy complications and adverse birth outcomes and the findings of this study, there is an urgent need for clinical guidelines related to the frequency and timing of postpartum care among new mothers with IDD. Further, this study provides evidence of the need for evidence-based interventions for new mothers with IDD to provide preventive care and routine assessments that would identify and manage complications for both the mother and the infant outside of the traditional postpartum health care framework.
from Health via xlomafota13 on Inoreader https://ift.tt/2sJnLS1
via IFTTT
Εγγραφή σε:
Αναρτήσεις (Atom)