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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Month: April 2008 (Page 1 of 2)

Myocardial effects of cardiac arrest and resuscitation with especial reference to mitochondrial injury

Abstract

The underlying mechanism of cell injury during ischemia and reperfusion is complex and timesesnsitive. Some processess develop coincidentally with the onset of ischemia and during reperfusion leading to abnormalities in energy metabolism, acid base status, and intracellular ion homeostasis. Other processes develop later and encompass activation of various signalling pathways that have deleterious or beneficial effects on specific effectors, but associated with sustained disruption of energy production contractile dysfunction and activation of apoptotic pathways. Discussion on the various cell mechanisms resposible for cell injury is beyond the scope of this review. However, pertinent to our discussion is the mounting evidence pointing to mitochondria as key target organelles of reperfusion injury.

Key words: cardiac arrest, mito-chondrial injury, cardiopulmonary resuscitation, apoptosis

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Pediatric Shock

Abstract

Millions of children die of shock due to various etiologies each year. Shock is a state of circulatory dysfunction where the metabolic demands of the tissue cannot be met by the circulation. Several different etiologies from hypovolemia to severe infection can result in shock. This review focuses on the definition of different types of shock seen in children and summarizes treatment strategies for the acute care practitioner based on pertinent recent literature. Early recognition and timely intervention are critical for successful treatment of pediatric shock. A strong index of suspicion by the treating clinician and early fluid resuscitation followed by ongoing assessment and timely transfer to a higher level of care can make the difference between life and death for the child who presents in shock.

Key words: shock, child, etiology, treatment

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Inpatient management of alcohol withdrawal: a practical approach

Abstract

Alcohol intake contributes directly or indirectly to 15 to 20% of medical problems in primary care or an inpatient setting. It is estimated that approximately 500,000 episodes of withdrawal will be severe enough to require pharmacologic intervention. The total cost to the United States economy from alcohol abuse was estimated to be $185 billion for 1998. This review attempts to put forth a practical and evidence based approach towards the inpatient management of alcohol withdrawal. Various agents and their pharmacology are described. Strength of evidence regards to efficacy and shorter inpatient stays is examined.

Key words: substance abuse, pharmacology, addiction, pathophysiology, critical care

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Emerging considerations in the reversal of neuromuscular blockade and residual block

Abstract

Incomplete recovery following reversal of neuromuscular blockade can present as a clinical problem in surgical patients. Emerging pharmacologic solutions may prevent such adverse outcomes in the future. We briefly review two methods of pharmacologic reversal of neuromuscular blockade. Both methods of reversal are effective. However the early studies of the new compound, sugammadex has been shown to achieve a more rapid, stable reversal of steroidal based neuromuscular blocking agents compared to neostigmine. Due to the novel mechanism of action of this agent, sugammadex has been demonstrated to be effective even when administered during profound neuromuscular block, without evidence of recurarization.

Key words: sugammadex, Org 25969, cyclodextrin, rocuronium, cholinesterase inhibitor

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Anthracycline-related cardiotoxicity: risk factors and therapeutic options in childhood cancers

Abstract

Anthracyclines play an important role in chemotherapeutic regimens for a wide spectrum of childhood tumors, but they can cause cytotoxic damage to cardiac cells, especially in combination with radiotherapy. Furthermore, cardiotoxicity increases with the cumulative dose and may lead to congestive heart failure and cardiomyopathy. Other factors, including age, pre-existing cardiac disease, length of follow-up, gender, route of administration, concomitant exposure to some chemotherapeutic drugs, trisomy 21 and black race, play a role in increasing the risk of cardiac dysfunction. The prevention of anthracycline-induced cardiotoxicity is mandatory as children are expected to survive for decades after being cured of their cancer. The purpose of this work is to point out the major risk factors of cardiotoxicity in children and to summarize some strategies to limit or prevent this complication and to treat the development of acute heart failure.

Keywords: anthracycline, cardiotoxicity, childhood cancer, risk factors, prevention, acute heart failure

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