Latest Updates

Management of Drug Interactions between Anti-infectives and Common Anesthetics

    • Rocuronium-induced neuromuscular blockade is potentiated by a synergistic effect of gentamicin and clindamycin, which may delay recovery.
    • Penicillins form a complex with sugammadex, which may interfere with the therapeutically intended sugammadex-rocuronium complex.
    • Ondansetron can decrease the analgesic efficacy of acetaminophen at high doses.
    • Anesthesiologists are positioned to manage interactions between anesthetic agents and antimicrobials in the operating room.

Acute Liver Failure

Constantine J Karvellas, MD, SM, FRCPC, R. Todd Stravitz, MD, FACP, FACG, FAASLD
    • Improved intensive care management of patients with acute liver failure (ALF) has decreased the incidence of cerebral edema/intracranial hypertension
    • High-volume plasma exchange improves overall survival in patients with ALF
    • Improved understanding of the abnormalities of global hemostasis in patients with ALF
    • Improved sanitation and mass vaccination has decreased the incidence of ALF due to hepatotrophic viruses

Acute Liver Failure

Constantine J Karvellas, MD, SM, FRCPC, R. Todd Stravitz, MD, FACP, FACG, FAASLD
    • Improved intensive care management of patients with acute liver failure (ALF) has decreased the incidence of cerebral edema/intracranial hypertension
    • High-volume plasma exchange improves overall survival in patients with ALF
    • Improved understanding of the abnormalities of global hemostasis in patients with ALF
    • Improved sanitation and mass vaccination has decreased the incidence of ALF due to hepatotrophic viruses

Acute Liver Failure

Constantine J Karvellas, MD, SM, FRCPC, R. Todd Stravitz, MD, FACP, FACG, FAASLD
    • Improved intensive care management of patients with acute liver failure (ALF) has decreased the incidence of cerebral edema/intracranial hypertension
    • High-volume plasma exchange improves overall survival in patients with ALF
    • Improved understanding of the abnormalities of global hemostasis in patients with ALF
    • Improved sanitation and mass vaccination has decreased the incidence of ALF due to hepatotrophic viruses

Management of Chronic Kidney Disease and its Complications

    • 2024 KDIGO Practice Guidelines
    • Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada
    • Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder: Synopsis of the Kidney Disease: Improving Global Outcomes 2017 Clinical Practice Guideline Update.

Venous Thromboembolism

    • Updating consensus guideline recommendations up to January 2016      
    • Adding a duplex scan image showing a deep vein thrombosis (DVT) in the diagnosis section
    • Adding a computed tomographic (CT) scan showing a pulmonary embolism (PE)
    • Showing the various types of approved inferior vena cava filters
    • Adding five separate flow-chart figures depicting a stepwise management algorithm for the evaluation and treatment of DVT and PE
    • Adding a section on catheter-associated upper extremity thrombosis
    • Adding a section on extended prophylaxis, the use of non–vitamin K antagonists, updates on stockings
    • Writing five new multiple-choice questions based on the review

Iatrogenic Withdrawal Syndromes in Children: A Review of Sedative and Analgesic Weaning

    • Many iatrogenic withdrawal syndromes have been identified, the most common of which is opioid or benzodiazepine withdrawal. Generally speaking, the approach to treating opioid and/or benzodiazepine withdrawal is to provide enough medication to saturate target receptors, followed by a period of gradual dose reduction to allow the body to return to a state of homeostasis.
    • The Neonatal Abstinence Score (NAS) was designed to assess withdrawal symptoms in infants with multiple drug exposure during pregnancy. Because the NAS was validated in infants, it is not applicable in older children with iatrogenic withdrawal. In recent years, withdrawal assessment tools for pediatrics have been developed for iatrogenic withdrawal to provide an objective assessment of withdrawal.
    • There have been no randomized clinical trials that have compared the efficacy of various weaning strategies. However, a recent multicenter clinical trial, named the RESTORE trial, examined the effects of a standardized sedation protocol in pediatric intensive care units.

Noncandidal Fungal Infections

    • Members of the European Organisation for Research and Treatment of Cancer–Invasive Fungal Infection Cooperative Group and National Institute of Allergy and Infectious Diseases Mycoses Study Group formed a consensus committee to develop standard definitions for invasive fungal infections for clinical research.
    • The development of standardized methodology for antifungal susceptibility testing is another recent advance in the laboratory evaluation of Aspergillus species. Although azole resistance by Aspergillus species is unusual, patients exposed chronically to antifungal triazoles have been reported to have refractory infection caused by isolates with elevated minimum inhibitory concentrations.
    • Fusarium and Scedosporium species are increasingly common causes of infections in surgical patients, especially in recipients of stem cell or organ transplants.
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