Pharmaceutical Opioid Use and Dependence among People Living with Chronic Pain: Associations Observed within the Pain and Opioids in Treatment (POINT) Cohort.

Authors: Campbell G et al; Pain Med, 2015 May 22 OBJECTIVE: There is increasing concern about the appropriateness of prescribing pharmaceutical opioids for chronic non-cancer pain (CNCP), given the risks of problematic use and dependence. This article examines pharmaceutical opioid dose and dependence and examines the correlates of each. DESIGN: Baseline data were obtained from a […]

FDA OKs First Patient-Controlled Patch for Postop Pain

The US Food and Drug Administration has approved fentanyl iontophoretic transdermal system (Ionsys, The Medicines Co), the first needle-free, patient-controlled, preprogrammed fentanyl delivery system for management of acute postoperative pain in adults requiring opioid analgesia in the hospital, according to a company news release. Ionsys is a “novel alternative” to traditional intravenous patient-controlled analgesia that uses […]

Postoperative recovery after anesthesia in morbidly obese patients: a systematic review and meta-analysis of randomized controlled trials.

Authors: Liu FL et al; Can J Anaesth. 2015 May PURPOSE: Obese patients present a challenge to safe general anesthesia because of impaired cardiopulmonary physiology and increased risks of aspiration and acute upper airway obstruction. Since studies are lacking regarding the postoperative effects on recovery from general anesthesia in morbidly obese patients, we conducted a systematic […]

FDA warns that Maquet’s anesthesia system could lead to a fatal stop in ventilation

Troubled Maquet’s woes continue. On the heels of a permanent injunction from the Department of Justice that resulted in the halt of manufacturing at one of its facilities, the suspension of 5 of its devices from the market and a $6 million fine, the FDA just warned practitioners that the company’s Flow-i Anesthesia Systems have a problem that […]

Does Brain Stimulation Help Treat Low Back Pain?

Authors: Luedtke K et al., BMJ 2015 350:h1640 A study of transcranial stimulation preceding behavioral cognitive therapy does not support the effectiveness of this procedure for the treatment of low back pain. Chronic low back pain is a frequent and costly problem for which few interventions are effective. Chronic low back pain is characterized by a number […]

Readmission Location Linked to Post-Surgical Mortality Rates

Patients with complications after major surgery are 26% more likely to survive if they return to the hospital where they had their operation, researchers find. Patients with complications after major surgery have better survival odds if they’re readmitted to the same hospital where the surgery was performed, throwing into doubt the assumption that travel long […]

Reversing Dabigatran-Induced Anticoagulation

Authors: Pollack CV Jr et al., N Engl J Med 2015 Jun 22 Idarucizumab immediately reversed dabigatran-induced increases in clotting variables without causing serious adverse events. Dabigatran is a direct thrombin inhibitor that is approved for the prevention of stroke in atrial fibrillation and for the treatment of venous thromboembolism. Bleeding is usually managed by discontinuing the drug or, […]

Two Trials Support High-Flow Oxygen Use in Patients with Hypoxemic Respiratory Failure

Authors: Stéphan F et al., JAMA 2015 Jun 16; 313:2331 In one trial, intubation rates were similar to those of noninvasive positive pressure ventilation, and 90-day mortality was lower. Use of noninvasive positive pressure ventilation (NPPV) in patients with chronic obstructive pulmonary disease exacerbations and cardiogenic pulmonary edema is well established, but its value in treating patients […]

Less-Than-Goal Enteral Nutrition Is OK for Critically Ill Patients

Authors: Arabi YM et al., N Engl J Med 2015 Jun 18; 372:2398 Outcomes did not differ among patients who received permissive underfeeding or full feeds. What is the right amount of nutrition for a critically ill patient? Two randomized, controlled trials demonstrated that higher-rate enteral nutrition was not necessarily better than low-rate enteral feeds (CMAJ 2004; […]

ECMO + CPR for VFib?

Authors: Siao FY et al., Resuscitation 2015 Jul 92:70 A small Taiwanese study showed significant improvement in long-term neurological function with this intensive intervention. Survival after cardiac arrest remains low, even in patients with shockable rhythms. Extracorporeal membrane oxygenation (ECMO) may improve tissue perfusion during resuscitation, and case reports have described its use in emergency department (ED) […]