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Uncategorized Published - 11 May, 2017    By - Dr Clemens
Epidural Neostigmine versus Fentanyl to Decrease Bupivacaine Use in Patient-controlled Epidural Analgesia during Labor: A Randomized, Double-blind, Controlled Study

Authors: Jessica L. Booth, M.D. et al Anesthesiology published on May 11, 2017 Background: The addition of opioids to epidural local anesthetic reduces local anesthetic consumption by 20% but at the expense of side effects and time spent for regulatory compliance paperwork. Epidural neostigmine also reduces local anesthetic use. The authors hypothesized that epidural bupivacaine with neostigmine […]

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Uncategorized Published - 11 May, 2017    By - Dr Clemens
Meta-Analysis: Just a Week of NSAID Use Tied to Increased Heart Attack Risk

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM Use of nonsteroidal anti-inflammatory drugs (NSAIDs) for even 1 week is associated with increased risk for myocardial infarction, a meta-analysis in The BMJ finds. Using individual patient data from four studies from healthcare databases, researchers identified over 61,000 cases of acute MI and 385,000 controls […]

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Uncategorized Published - 11 May, 2017    By - Dr Clemens
Perioperative Troponin Predicts 30-Day Mortality After Noncardiac Surgery

Writing Committee for the VISION Study Investigators, JAMA 2017 Apr 25; 317:1642 Most troponin elevations were not obviously symptomatic. In a 2014 study, investigators showed that even modestly elevated non–high-sensitivity troponin T levels during the 3 days after noncardiac surgery were associated independently with excess 30-day mortality (NEJM JW Gen Med Apr 1 2014 and Anesthesiology 2014; 120:564). Now, this […]

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Uncategorized Published - 10 May, 2017    By - Dr Clemens
A Negative High-Sensitivity Troponin and Nonischemic ECG Can Rule Out AMI

Authors: Pickering JW et al., Ann Intern Med 2017 Apr 18; However, samples for the troponin assay should be drawn at least 3 hours after symptom onset, and a positive troponin does not rule in acute myocardial infarction. Several studies have demonstrated the potential utility of high-sensitivity cardiac troponin T (hs-cTnT) assays combined with electrocardiograms (ECGs) in […]

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Uncategorized Published - 10 May, 2017    By - Dr Clemens
Mivacurium: Return of a Drug Seeking an Indication?

Authors: Roy G. Soto, M.D. et al ASA Monitor 05 2017, Vol.81, 30-31. Mivacurium is a benzylisoquinolinium nondepolarizing neuromuscular-blocking drug that was developed in the early 1980s and disappeared from the U.S. market in 2006. It was reintroduced in December 2016, and many have asked what the appropriate niche is for this seemingly resurrected medication. Since […]

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