Promethazine in the treatment of postoperative nausea and vomiting: a systematic review (Views : 550 times)
Josko Markic, Anna Louise Ridge
Abstract
Postoperative nausea and vomiting (PONV) is among the most important concerns of patients undergoing surgery. The incidence ranges from 30% to 70%. The incidence of PONV correlates with a number of risk factors a patient possesses. Patient-related risk factors in adults are: female gender, history of PONV, duration of surgery > 60 min, nonsmoking status, history of motion sickness, and postoperative use of opioids. Risk factors in children are: duration of surgery ≥ 30 minutes, age ≥ 3 years, strabismus surgery, and a history of PONV in the patient, parent or sibling. Treatment of PONV includes various classes of medications and none of them is entirely effective. If it is necessary to use combination therapy, then medicines with different sites of activity should be used. Promethazine is a phenothiazine derivate available as a medicine since its introduction in 1946. In this article, a search was performed to identify all published papers and reports evaluating the effectiveness of promethazine for the management of postoperative nausea and vomiting in adults and children. The results of this review support the finding that promethazine is not recommended as a first-line agent in the treatment of PONV, but can be considered for use as a rescue antiemetic.
Key words: promethazine, postoperative nausea and vomiting, treatment
The endocannabinoid system in sepsis – a potential target to improve microcirculation? (Views : 995 times)
Christian Lehmann, Mandana Kianian, Juan Zhou, Vladimir Cerny, Melanie Kelly
Abstract
During the last decade, research has identified the endocannabinoid system (ECS) as a key regulator of essential physiological functions, including the regulation of microvascular and immune function. Indeed, increasing evidence now suggests that release of endocannabinoids and activation of cannabinoid receptors occurs during sepsis and that manipulation of the ECS may represent an important therapeutic target to improve microcirculation in sepsis. In this review, the pharmacology and physiology of the ECS and the involvement of cannabinoids, cannabinoid receptors and non-CB1R/CB2R pathways related to ECS activation will be described. This information will increase our comprehension of the role of lipid signaling pathways in sepsis and may lead to the identification of new drug targets for the treatment of impaired microcirculation.
Key words: systemic inflammation, sepsis, microcirculation, lipid mediators, cannabinoids, cannabinoid receptors
NHE-1 Inhibitors and Erythropoietin for Maintaining Myocardial Function during Cardiopulmonary Resuscitation (Views : 1182 times)
Raul J.Gazmuri, Iyad M. Ayoub, Jeejabai Radhakrishnan
Abstract
Efforts to successfully restore life in cardiac arrest victims are formidably challenging. They require not only that cardiac activity be initially reestablished but that injury to vital organs be prevented or minimized. In this article, we discuss the effects that cardiac arrest and resuscitation have on the myocardium, describing first the functional myocardial abnormalities that occur during cardiac resuscitation, which may limit the ability to reestablish cardiac activity. We then discuss strategies for minimizing myocardial injury and examine novel therapies aimed at minimizing ischemia and reperfusion injury. Finally, we discuss sodium-hydrogen exchanger isoform-1(NHE-1) inhibitors and erythropoietin for maintaining myocardial function during cardiopulmonary resuscitation.
Keywords: myocardial ischemic injury, reperfusion myocardial injury, cardiopulmonary resuscitation, NHE-1 inhibitors, erythropoietin
Critical (Intensive) Care Medicine and CPR - A Personal History By Max Harry Weil (Views : 1135 times)
Abstract
I perceive that the most consitent pursuits of successful innovators and leaders in medicine, as in all endeavors, come from aspirations generated by dreams rather than hope or by fate alone; from the excitement with which the dreamer atracts collaborators who have prepared minds and skillful hands; they join talents and destinities to convert the dream to expert plans.Contigent on the vigor, the persistence and on the attention to detail with which they commit to the execution of their plans, the secure the advances that contribute to the social goods and bring ultimate success to all who have jioned destinies to seriously pursue those dreams.
Key words: cardiopulmonary resuscitation, critical care medicine, intensive care medicine, history, progress, future
From Science to Guidelines: The Future for Resuscitation (Views : 1196 times)
Abstract
The periodic development and publication of treatment guidelines is integral to the field of cardiopulmonary resuscitation and emergency cardiovascular care. The methods for guideline development have evolved over the past few decades, and the process itself has become the subject of increasing scientific investigation. An internationally validated tool for assessing the quality of clinical practice guidelines is The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. Applying this tool to the ILCOR 2010 International Consensus on CPR (cardiopulmonary resuscitation) and ECC (emergency cardiac care) Science with Treatment Recommendations (CoSTR) and the resulting member council guidelines will be a valuable initial step in evaluating both the process and the product. By doing so, important strengths can be recognized as well as opportunities for improvement moving forward. Beyond validated tools to assess and improve the quality of the traditional guidelines process, a critical reassessment of the overall strategy for improving cardiac arrest outcomes is indicated. From the lay-provider perspective, innovative approaches to facilitate performance of bystander CPR are needed. This is likely to entail more individualized instructional methods that are titrated to the provider's capabilities for learning and performance. What the future might hold for professional providers is a more individualized treatment strategy titrated to real-time physiologic monitoring with mechanized delivery of therapies guided by real-time computer-aided medical decision-making. These individualized instructional and treatment strategies could revolutionize our approach to cardiac arrest resuscitation, and dramatically change how guidelines are developed, implemented and evaluated.
Keywords: cardiac arrest, cardiopulmonary resuscitation, CPR, guidelines
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