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Remimazolam (CNS 7056) is a new benzodiazepine metabolized by tissue esterases so that it has a rapid, more predictable offset of action than other clinically available benzodiazepines. The first clinical studies of remimazolam (CNS 7056) were published recently. The first phase I study was a relatively compre- hensive, placebo and active midazolam controlled  single-dose escalation study in 81 subjects . Ten cohorts of subjects received remimazolam from 0.01 to 0.30 mg/kg, or midazolam 0.075 mg/kg or placebo for comparison. Frequent arterial and venous blood samples were taken for pharmaco- kinetic analysis, and Modified Observer’s Assess- ment of Alertness/Sedation (MOAA/S) scores and bispectral index (BIS) monitoring were used as the main assessments of sedation. Remimazolam produced rapid dose-dependent sedation at doses from 0.075 mg/kg, with onset times of 1 – 3 min. Remimazolam 0.075 – 0.20 mg/...

There is minimal evidence of cross-reactivity between sulfonamide antibiotics and non-antibiotics . Despite this, the U.S. FDA-approved product information for many non-antibiotic sulfonamide drugs contains warnings concerning possible cross-reactions. Key Findings from a New Review Article [1] : An estimated 3-6% of the general population is allergic to sulfonamides. Structurally, none of the non-antibiotic sulfonamides exhibit both of the features shown to be responsible for sulfonamide reactions (i.e., an N-containing ring attached to the N1 nitrogen of the sulfonamide group and an arylamine group at the N4 position). A comprehensive literature search (1966-December 2011) identified only 9 case reports indicating possible cross-reactivity to sulfonamide medications; however, in most cases, adequate patient testing was not conducted to firmly establish either sulfa allergy or sulfonamide cross-sensitivity. Take home msg : You can...

Serum lipase is generally thought to be more sensitive and specific than amylase, but either enzyme may be used to diagnose acute pancreatitis (see diagnostic criteria). In a retrospective study of 306 patients, Chase et al. reported the following sensitivities and specificities for amylase and lipase at > 3x the upper limit of normal. Both enzymes typically begin to rise within the first 2-6 hrs and peak in 12-30 hrs.  Lipase, however, remains elevated for longer and may not return to baseline for 7-14 days compared with 2-4 days for amylase Kiriyama S, Gabata T, et al., New Diagnostic Criteria of Acute Pancreatitis. J Hepatobiliary Pancreat Sci. 2010;17: 24-36.

Meta-analysis of secure randomised controlled trials of β-blockade to prevent perioperative death in non-cardiac surgery Heart   doi:10.1136/heartjnl-2013-304262 Abstract Background  Current European and American guidelines recommend the perioperative initiation of a course of β-blockers in those at risk of cardiac events undergoing high- or intermediate-risk surgery or vascular surgery. The Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography (DECREASE) family of trials, the bedrock of evidence for this, are no longer secure. We therefore conducted a meta-analysis of randomised controlled trials of β-blockade on perioperative mortality, non-fatal myocardial infarction, stroke and hypotension in non-cardiac surgery using the secure data. Methods  The randomised controlled trials of initiation of β-blockers before non-cardiac surgery were examined. Primary outcome was all-cause mortality at 30 days or at discharge. The DECREA...