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

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.

Shock

    • Early recognition of shock is difficult but essential for preservation of cellular and organ function and survival. The earliest clinical signs are nonspecific, with the initial inflammatory response including tachycardia, fevers, or cool or clammy skin. 
    • The approach to shock ultimately requires understanding and correcting its etiology (eg, antibiotics and source control for sepsis, thrombectomy after massive pulmonary embolus, hemorrhage control after trauma, and so forth). However, until these are diagnosed and addressed directly, clinicians ultimately have three approaches in their armamentarium: volume expansion, vasopressors, and cardioactive agents.
    • The PAC was introduced in 1970. Its use increased over the next 3 decades and eventually was considered the standard of care for most critically ill patients. However, the use of PACs declined rapidly after the results of the randomized, controlled trial published in the New England Journal of Medicine revealing no benefit in high-risk surgical patients.

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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