- Pulmonary hypertension can be treated with single or combination therapy employing calcium channel blockers, phosphodiesterase inhibitors, guanylate cyclase stimulators, endothelin receptor antagonists, and prostanoids.
- Levosimendan is a calcium sensitizer used to treat cardiogenic shock and right heart failure.
- Clevidipine is an ultra-rapid acting calcium channel blocker used for perioperative hypertension management in cardiovascular and vascular diseases, neurosurgery, and surgery for pheochromocytoma.
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
- 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
- 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
- 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
Injuries to the Upper Urogenital Tract
- Most grade III and IV injuries, including those with devitalized parenchymal fragments and urinary extravasation, are managed nonoperatively
- Angioembolization of persistent or delayed kidney bleeding (pseudoaneurysm) obviates the need for exploration in a majority of cases
- A high index of suspicion is necessary to diagnose a ureteral injury to prevent late complications such as urinoma, sepsis, and nephrectomy
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.
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.
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