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The Journal of Vascular Access May 2021Transradial access for interventions has been well studied in the adult population, but there is a paucity of literature of its use in the pediatric population.
BACKGROUND
Transradial access for interventions has been well studied in the adult population, but there is a paucity of literature of its use in the pediatric population.
METHODS
We conducted a systematic literature review and gathered and synthesized all of the available data into a cohesive resource for review and analysis of the topic.
RESULTS
Pooled analysis of the available data shows that transradial access in pediatric patients has a success rate of 91%, a vasospasm rate of 11.4%, and loss of pulse rate of 3.0% for a total complication rate of 14%. No permanent complications, or complications requiring surgery, were observed in any study. After stratifying for indication of intervention, neurological indications were associated with a lower complication rate compared to cardiac indications (0.1 vs 0.43, respectively, p = 0.004). In addition, studies published after 2013 were associated with a lower complication rate compared to those published during or before 2013 (0.11 vs 0.33, respectively, p = 0.01).
CONCLUSION
Compared to prior studies on pediatric transfemoral access, transradial access has a higher complication rate. But there may be a lower rate of complications that require surgical intervention. Further studies are needed to clarify any advantages that transradial access may have over transfemoral access for pediatric patients.
Topics: Adolescent; Age Factors; Catheterization, Peripheral; Child; Child, Preschool; Female; Humans; Male; Punctures; Radial Artery; Risk Factors; Treatment Outcome; Vascular System Injuries; Vasoconstriction
PubMed: 32781881
DOI: 10.1177/1129729820948688 -
The Journal of Craniofacial Surgery Oct 2020The aim of this study was to systematically review the effects of lidocaine mixed with epinephrine and bicarbonate in plastic surgery in terms of onset, duration, and...
The aim of this study was to systematically review the effects of lidocaine mixed with epinephrine and bicarbonate in plastic surgery in terms of onset, duration, and the pain score.In PubMed, Embase, Web of Science, and the Cochrane Library, the terms "epinephrine" AND "lidocaine" AND "plastic surgery" were searched, resulting in 210 titles. Among them, 25 full papers were reviewed, 11 were excluded, and 5 mined papers were added. Therefore, 19 papers were analyzed.The mean time for the onset of maximum vasoconstriction caused by lidocaine with epinephrine (LE) ranged from 1.3 minutes (1:50,000 epinephrine) to 25.9 minutes (1:100,000 epinephrine). The mean duration of vasoconstriction caused by LE ranged from 40 minutes (1:100,000 epinephrine) to 136.7 minutes (1:50,000 epinephrine) on the forearm, and 60 minutes (1:100,000 and 1:200,000 epinephrine) on the face. The mean duration of local anesthesia ranged from 112.0 minutes (1:1,600,000 epinephrine) to 480 minutes (1:80,000 epinephrine). Before sodium bicarbonate (SB) was mixed with 1% lidocaine and 1:100,000 epinephrine, the mean pH ranged from 4.05 to 4.24. After mixing SB with 1% lidocaine and 1:100,000 epinephrine, the solution became alkalized, and the mean pH ranged from 7.05 to 7.66. For alkalization, the ratio of LE to SB was 9:1 to 10:1. Before alkalization of LE, the mean pain score ranged from 2.35 to 7.6. In contrast, after alkalizing the mixture by adding 8.4% SB, the mean pain score ranged from 0.64 to 4.3.The results of this study may be helpful for using lidocaine in plastic surgery.
Topics: Anesthesia, Local; Anesthetics, Local; Drug Combinations; Epinephrine; Humans; Lidocaine; Pain; Pain Management; Plastic Surgery Procedures; Sodium Bicarbonate; Surgery, Plastic
PubMed: 32604282
DOI: 10.1097/SCS.0000000000006627 -
International Journal of Environmental... Jun 2020The fatigue of the respiratory muscles causes the so-called metabolic reflex or metaboreflex, resulting in vasoconstriction of the blood vessels in the peripheral... (Meta-Analysis)
Meta-Analysis
The fatigue of the respiratory muscles causes the so-called metabolic reflex or metaboreflex, resulting in vasoconstriction of the blood vessels in the peripheral muscles, which leads to a decrease in respiratory performance. Training the respiratory muscles is a possible solution to avoid this type of impairment in intermittent sports. The objective of this systematic review was to evaluate the results obtained with inspiratory muscle training (IMT) in intermittent sports modalities, intending to determine whether its implementation would be adequate and useful in intermittent sports. A search in the Web of Science (WOS) and Scopus databases was conducted, following the Preferred Reporting Elements for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The methodological quality of the articles was assessed using the PEDro (Physiotherapy Evidence Database) scale. In conclusion, the introduction of specific devices of IMT seems to be a suitable method to improve performance in intermittent sports, mainly due to a reduction of the metaboreflex, fatigue sensation, and dyspnea. The ideal protocol would consist of a combination of acute and chronic treatment, and, even if IMT is done daily, the duration will not exceed one hour per week.
Topics: Breathing Exercises; Humans; Muscle Strength; Physical Therapy Modalities; Respiratory Muscles; Sports
PubMed: 32575827
DOI: 10.3390/ijerph17124448 -
Otolaryngology--head and Neck Surgery :... Sep 2020To assess the safety and efficacy of topical epinephrine in adults undergoing endoscopic sinus surgery (ESS). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess the safety and efficacy of topical epinephrine in adults undergoing endoscopic sinus surgery (ESS).
DATA SOURCES
PubMed, Embase, and Ovid MEDLINE online databases.
REVIEW METHODS
Non-case report English articles studying the effects of topical epinephrine as the topical vasoconstrictor used in adult ESS were found from the online databases through January 2019. The PRISMA literature selection process was used (Preferred Reporting Items for Systematic Reviews and Meta-analyses).
RESULTS
An overall 2216 articles were identified, with 9 meeting inclusion criteria involving a total of 5043 patients. All 9 studies assessed the safety of topical epinephrine, while 5 examined efficacy. Intraoperative average blood loss (ABL) ranged from 60 to 426 mL. Topical epinephrine concentrations varied from 1:1000 to 1:100,000, and 3 major complications were found for a rate of 0.06%. There were no reports of ophthalmic, orbital, or skull base injury, nor were there reports of cerebrospinal fluid leaks. A meta-analysis was performed on the 4 studies examining ABL. Estimated mean (95% CI) ABL was 119.4 mL (39.1-199.6) in the higher-concentration cohort (>1:10,000) and 372.2 mL (296.8-447.5) in the lower-concentration cohort (≤1:10,000) ( = .001).
CONCLUSION
Topical epinephrine is generally safe and provides acceptable hemostasis during ESS, with higher concentrations (>1:10,000) providing improved hemostasis. Caution is advised for its use in patients with preexisting cardiovascular disease or in combination with other topical or injected vasoconstrictive agents. More prospective comparative studies are necessary to determine the ideal hemostatic concentration of epinephrine in ESS.
Topics: Administration, Topical; Endoscopy; Epinephrine; Humans; Paranasal Sinuses; Postoperative Complications; Vasoconstrictor Agents
PubMed: 32284027
DOI: 10.1177/0194599820915478 -
Pulmonary Circulation 2020Acute pulmonary embolism is the third most common cause of cardiovascular death. Pulmonary embolism increases right ventricular afterload, which causes right ventricular... (Review)
Review
Acute pulmonary embolism is the third most common cause of cardiovascular death. Pulmonary embolism increases right ventricular afterload, which causes right ventricular failure, circulatory collapse and death. Most treatments focus on removal of the mechanical obstruction caused by the embolism, but pulmonary vasoconstriction is a significant contributor to the increased right ventricular afterload and is often left untreated. Pulmonary thromboembolism causes mechanical obstruction of the pulmonary vasculature coupled with a complex interaction between humoral factors from the activated platelets, endothelial effects, reflexes and hypoxia to cause pulmonary vasoconstriction that worsens right ventricular afterload. Vasoconstrictors include serotonin, thromboxane, prostaglandins and endothelins, counterbalanced by vasodilators such as nitric oxide and prostacyclins. Exogenous administration of pulmonary vasodilators in acute pulmonary embolism seems attractive but all come with a risk of systemic vasodilation or worsening of pulmonary ventilation-perfusion mismatch. In animal models of acute pulmonary embolism, modulators of the nitric oxide-cyclic guanosine monophosphate-protein kinase G pathway, endothelin pathway and prostaglandin pathway have been investigated. But only a small number of clinical case reports and prospective clinical trials exist. The aim of this review is to give an overview of the causes of pulmonary embolism-induced pulmonary vasoconstriction and of experimental and human investigations of pulmonary vasodilation in acute pulmonary embolism.
PubMed: 32180938
DOI: 10.1177/2045894019899775 -
Frontiers in Neurology 2019Posterior reversible encephalopathy syndrome (PRES) is a rare clinical and radiological entity characterized by a typical brain edema. Although several case reports...
Posterior reversible encephalopathy syndrome (PRES) is a rare clinical and radiological entity characterized by a typical brain edema. Although several case reports have described PRES in a context of poisoning, to our knowledge, a comprehensive assessment has not been performed. The aim of this systematic review was to raise awareness on poisoning-specific PRES features and to encourage consistent and detailed reporting of substance abuse-and drug overdose-associated PRES. Medline/PubMed, Web of Science, and PsycINFO were screened through May 31, 2019, to systematically identify case reports and case series describing PRES associated with poisoning (i.e., alcohol, drugs, illicit drugs, natural toxins, chemical substances) in accidental context, intentional overdose, and substance abuse. The methodological quality of eligible case reports/series was assessed. Patients and exposure characteristics were recorded; relevant toxicological, radiological, and clinical data were extracted. Forty-one case reports and one case series reporting 42 unique cases were included. The median time to PRES onset from the start of exposure was 3 days (IQR 2-10). Acute high blood pressure, visual disturbance, and seizure were reported in 70, 55, and 50% of patients, respectively. The initial clinical presentation was alertness disorders in 64% of patients. Nine patients (21%) required mechanical ventilation. One-third of patients had at least one risk factor for PRES such as chronic hypertension (17%) or acute/chronic kidney failure (24%). The main imaging pattern (67%) was the combination of classical parieto-occipital edema with another anatomical region (e.g., frontal, basal ganglia, posterior fossa involvement). Vasogenic edema was found in 86% of patients. Intracranial hemorrhage occurred in 14% of patients. Both brain infarction and reversible cerebral vasoconstriction syndrome were diagnosed in 5% of patients. Three patients (12%, 3/25) had non-reversible lesions on follow-up magnetic resonance imaging. The median time required to hospital discharge was 14 days (IQR 7-18). Mortality and neurological recurrence rate were null. Comorbidities such as chronic hypertension and kidney failure were less frequent than in patients with other PRES etiologies. Imaging analysis did not highlight a specific pattern for poisoning-induced PRES. Although less described, PRES in the context of poisoning, which shares most of the clinical and radiological characteristics of other etiologies, is not to be ignored.
PubMed: 32116991
DOI: 10.3389/fneur.2019.01420 -
Clinical Orthopaedics and Related... Mar 2020Blood flow restriction (BFR) is a process of using inflatable cuffs to create vascular occlusion within a limb during exercise. The technique can stimulate muscle...
BACKGROUND
Blood flow restriction (BFR) is a process of using inflatable cuffs to create vascular occlusion within a limb during exercise. The technique can stimulate muscle hypertrophy and improve physical function; however, most of these studies have enrolled healthy, young men with a focus on athletic performance. Furthermore, much of the information on BFR comes from studies with small samples sizes, limited follow-up time, and varied research designs resulting in greater design, selection, and sampling bias. Despite these limitations, BFR's popularity is increasing as a clinical rehabilitation tool for aging patients. It is important for practitioners to have a clear understanding of the reported effects of BFR specifically in older adults while simultaneously critically evaluating the available literature before deciding to employ the technique.
QUESTIONS/PURPOSES
(1) Does BFR induce skeletal muscle hypertrophy in adults older than 50 years of age? (2) Does BFR improve muscle strength and/or physical function in adults older than 50 years?
METHODS
Using PubMed, Google Scholar, Web of Science, and Science Direct, we conducted a systematic review of articles using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to assess the reported effects of BFR on skeletal muscle in older adults. Included articles enrolled participants 50 years of age or older and used BFR in conjunction with exercise to study the effects of BFR on musculoskeletal outcomes and functionality. The following search terms were used: "blood flow restriction" OR "KAATSU" OR "ischemic training" AND "clinical" AND "elderly." After duplicates were removed, 1574 articles were reviewed for eligibility, and 30 articles were retained with interventions duration ranging from cross-sectional to 16 weeks. Sample sizes ranged from 6 to 56 participants, and exercise tasks included passive mobilization or electrical stimulation; walking; resistance training using machines, free weights, body weight, or elastic bands; and water-based activities. Furthermore, healthy participants and those with cardiovascular disease, osteoarthritis, osteoporosis, sporadic inclusion body myositis, spinal cord injuries, and current coma patients were studied. Lastly, retained articles were assigned a risk of bias score using aspects of the Risk of Bias in Nonrandomized Studies of Interventions and the Cochrane Collaboration's tool for assessing the risk of bias in randomized trials.
RESULTS
BFR, in combination with a variety of exercises, was found to result in muscle hypertrophy as measured by muscle cross-sectional area, thickness, volume, mass, or circumference. Effect sizes for BFR's ability to induce muscle hypertrophy were calculated for 16 of the 30 papers and averaged 0.75. BFR was also shown to improve muscle strength and functional performance. Effect sizes were calculated for 21 of the 30 papers averaging 1.15.
CONCLUSIONS
Available evidence suggests BFR may demonstrate utility in aiding rehabilitation efforts in adults older than 50 years of age, especially for inducing muscle hypertrophy, combating muscle atrophy, increasing muscle strength, and improving muscle function. However, most studies in this systematic review were at moderate or high risk of bias; that being so, the findings in this systematic review should be confirmed, ideally using greater sample sizes, randomization of participants, and extended follow-up durations.
LEVEL OF EVIDENCE
Level II, systematic review.
Topics: Aged; Exercise Therapy; Female; Humans; Hypertrophy; Male; Middle Aged; Muscle Strength; Muscle, Skeletal; Orthopedic Procedures; Regional Blood Flow; Vasoconstriction
PubMed: 31860546
DOI: 10.1097/CORR.0000000000001090 -
Canadian Journal of Anaesthesia =... Mar 2020Hemodynamic management of adults with distributive shock often includes the use of catecholamine-based vasoconstricting medications. It is unclear whether adding...
PURPOSE
Hemodynamic management of adults with distributive shock often includes the use of catecholamine-based vasoconstricting medications. It is unclear whether adding vasopressin or vasopressin analogues to catecholamine therapy is beneficial in the management of patients with distributive shock. The purpose of this guideline was to develop an evidence-based recommendation regarding the addition of vasopressin to catecholamine vasopressors in the management of adults with distributive shock.
METHODS
We summarized the evidence informing this recommendation by updating a recently published meta-analysis. Then, a multidisciplinary panel from the Canadian Critical Care Society developed the recommendation using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology.
RESULTS
The updated systematic review identified 25 randomized controlled trials including a total of 3,737 patients with distributive shock. Compared with catecholamine therapy alone, the addition of vasopressin or its analogues was associated with a reduced risk of mortality (relative risk [RR], 0.91; 95% confidence interval [CI], 0.85 to 0.99; low certainty), reduced risk of atrial fibrillation (RR, 0.77; 95% CI, 0.67 to 0.88; high certainty), and increased risk of digital ischemia (RR, 2.56; 95% CI, 1.24 to 5.25; moderate certainty).
CONCLUSIONS
After considering certainty in the evidence, values and preferences, cost, and other factors, the expert guideline panel suggests using vasopressin or vasopressin analogues in addition to catecholamines over catecholamine vasopressors alone for the management of distributive shock (conditional recommendation, low certainty evidence).
Topics: Adult; Canada; Critical Care; Critical Illness; Humans; Shock; Vasopressins
PubMed: 31797234
DOI: 10.1007/s12630-019-01546-x -
PloS One 2019Angiotensin-converting enzyme (ACE) converts angiotensin I to angiotensin II which causes vasoconstriction. ACE inhibitors reduce blood pressure by inhibiting ACE. A...
Angiotensin-converting enzyme (ACE) converts angiotensin I to angiotensin II which causes vasoconstriction. ACE inhibitors reduce blood pressure by inhibiting ACE. A well-known adverse drug reaction to ACE inhibitors is ACE inhibitor-induced angioedema (ACEi-AE). Angioedema is a swelling of skin and mucosa, which can be fatal if the airway is compromised. We have performed a systematic review of the evidence suggesting that genetic polymorphisms are associated with ACEi-AE and evaluated the methodological approaches of the included studies. The Cochrane Database of Systematic Reviews, Google Scholar, and PubMed were searched. Studies investigating the association between genetic markers and ACEi-AE were included. The Q-genie tool was used to evaluate the quality of the study methodologies. Seven studies were included. With the exception of one whole genome study, all of the included studies were candidate gene association studies. Study quality assessment scores ranged from 36 to 55. One study was found to be of good quality, suggesting that the detected associations may be unreliable. The inferior quality of some studies was due to poor organization, lack of analyses and missing information. Polymorphisms within XPEPNP2, BDKRB2-9/+ 9 and neprilysin genes, were reported to be associated with increased risk of ACEi-AE. However, due to low quality, these associations need to be confirmed in larger studies.
Topics: Angioedema; Angiotensin-Converting Enzyme Inhibitors; Genetic Predisposition to Disease; Humans; Outcome Assessment, Health Care; Polymorphism, Genetic
PubMed: 31710633
DOI: 10.1371/journal.pone.0224858 -
Molecular Genetics and Metabolism Nov 2019An association between neuropsychiatric manifestations and neuroimaging suggestive of posterior reversible encephalopathy syndrome (PRES) during porphyric attacks has...
BACKGROUND AND AIM
An association between neuropsychiatric manifestations and neuroimaging suggestive of posterior reversible encephalopathy syndrome (PRES) during porphyric attacks has been described in numerous case reports. We aimed to systematically review clinical-radiological features and likely pathogenic mechanisms of PRES in patients with acute hepatic porphyrias (AHP) and porphyric attacks.
METHODS
PubMed, Scopus, Ovid MEDLINE, and Google Scholar were searched (July 30, 2019). We included articles describing patients with convincing evidence of an AHP, confirmed porphyric attacks, and PRES in neuroimaging.
RESULTS
Forty-three out of 269 articles were included, which reported on 46 patients. Thirty-nine (84.8%) patients were women. The median age was 24 ± 13.8 years. 52.2% had unspecified AHP, 41.3% acute intermittent porphyria, 4.3% hereditary coproporphyria, and 2.2% variegate porphyria. 70.2% had systemic arterial hypertension. Seizures, mental changes, arterial hypertension, and hyponatremia occurred more frequently than expected for porphyric attacks (p < .001). Seizures and hyponatremia were also more frequent than expected for PRES. The most common distributions of brain lesions were occipital (81.4%), parietal (65.1%), frontal (60.5%), subcortical (40%), and cortical (32.5%). Cerebral vasoconstriction was demonstrated in 41.7% of the patients who underwent angiography. 19.6% of the patients had ischemic lesions, and 4.3% developed long-term sequelae (cognitive decline and focal neurological deficits).
CONCLUSIONS
Brain edema, vasoconstriction, and ischemia in the context of PRES likely account for central nervous symptoms in some porphyric attacks.
Topics: Adolescent; Adult; Brain; Central Nervous System; Child; Female; Humans; Magnetic Resonance Imaging; Male; Neuroimaging; Porphyrias; Posterior Leukoencephalopathy Syndrome; Young Adult
PubMed: 31706631
DOI: 10.1016/j.ymgme.2019.10.011