Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Medetomidine is a relatively new sedative analgesic drug that is approved for use in dogs in Canada. It is the most potent alpha2-adrenoreceptor available for clinical use in veterinary medicine and stimulates receptors centrally to produce dose-dependent sedation and analgesia. Significant dose sparing properties occur when medetomidine is combined with other anesthetic agents correlating with the high affinity of this drug to the alpha2-adrenoreceptor. Hypoventilation occurs with medetomidine sedation in dogs; however, respiratory depression becomes most significant when given in combination with other sedative or injectable agents. The typical negative cardiovascular effects produced with other alpha2-agonists (bradycardia, bradyarrhythmias, a reduction in cardiac output, hypertension +/- hypotension) are also produced with medetomidine, warranting precautions when it is used and necessitating appropriate patient selection (young, middle-aged healthy animals). While hypotension may occur, sedative doses of medetomidine typically raise the blood pressure, due to the effect on peripheral alpha2-adrenoreceptors. Anticholinergic premedication has been recommended with alpha2-agonists to prevent bradyarrhythmias and, potentially, the reduction in cardiac output produced by these agents; however, current research does not demonstrate a clear improvement in cardiovascular function. Negatively, the anticholinergic induced increase in heart rate potentiates the alpha2-agonist mediated hypertension and may increase myocardial oxygen tension, demand, and workload. Overall, reversal with the specific antagonist atipamezole is recommended when significant cardiorespiratory complications occur. Other physiological effects of medetomidine sedation include; vomiting, increased urine volumes, changes to endocrine function and uterine activity, decreased intestinal motility, decreased intraocular pressure and potentially hypothermia, muscle twitching, and cyanosis. Decreased doses of medetomidine, compared with the recommended label dose, should be considered in combination with other sedatives to enhance sedation and analgesia and lower the duration and potential severity of the negative cardiovascular side effects. The literature was searched in Pubmed, Medline, Agricola, CAB direct, and Biological Sciences.
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PMID:A review of the physiological effects of alpha2-agonists related to the clinical use of medetomidine in small animal practice. 1466 51

In order to evaluate the bacteremic episodes, the blood cultures performed in 867 patients during a 29-month period were reviewed. The incidence of significant bloodstream infections was 10/1000 admissions/year. About 47% of bacteremias were community-acquired (CAB), 22% nosocomial (NB), and 31% health care-associated (HCAB). The five most common pathogens were: Streptococcus pneumoniae, Staphylococcus aureus, Escherichia coli, Enterococcus spp. and coagulase-negative staphylococci, whereas the main sources were: respiratory, intraabdominal and unknown. The major organism in CAB was S. pneumoniae, and S. aureus in NB and HCAB. The ineffective empirical-antimicrobial-therapy [IEAT (total 26.5%)] was much higher in NB and HCAB vs. CAB (p < 0.05). There was no significant difference in mortality and IEAT between known vs. unknown sources. Old age (> 70 yrs), previous antibiotic therapy, hospitalization in clinical medical services, Enterococcus spp. and methicillin-resistant Staphylococcus isolates were more associated with IEAT (p < 0.05). Previous antibiotic therapy and longer hospital stays were more common in NB vs. CAB and HCAB (p < 0.05). Overall and septicemia-associated mortality was 28.9% and 21.7%, respectively. Univariate associations with increased mortality (p < 0.05) included: hypothermia, WBC < 1499/mm3, hypotension, presentation with septic-shock, hospital-stay 10 days, and polymicrobial bacteremia. The early administration of effective empirical antimicrobial therapy according to our epidemiological characteristics and an aggressive hemodynamic treatment in presence of septic shock could reduce bacteremia-associated morbidity and mortality, costs and length of hospital stays.
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PMID:[Microbiological and epidemiological analysis, and clinical outcome of patients with bloodstream infection from an Esquel hospital in the period 2007-200]. 2118 68

Recently published evidence has challenged some protocols related to oxygenation, ventilation, and airway management for out-of-hospital cardiac arrest. Interrupting chest compressions to attempt airway intervention in the early stages of OHCA in adults may worsen patient outcomes. The change of BLS algorithms from ABC to CAB was recommended by the AHA in 2010. Passive insufflation of oxygen into a patent airway may provide oxygenation in the early stages of cardiac arrest. Various alternatives to tracheal intubation or bag-mask ventilation have been trialled for prehospital airway management. Simple methods of airway management are associated with similar outcomes as tracheal intubation in patients with OHCA. The insertion of a laryngeal mask airway is probably associated with worse neurologically intact survival rates in comparison with other methods of airway management. Hyperoxemia following OHCA may have a deleterious effect on the neurological recovery of patients. Extracorporeal oxygenation techniques have been utilized by specialized centers, though their use in OHCA remains controversial. Chest hyperinflation and positive airway pressure may have a negative impact on hemodynamics during resuscitation and should be avoided. Dyscarbia in the postresuscitation period is relatively common, mainly in association with therapeutic hypothermia, and may worsen neurological outcome.
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PMID:Oxygenation, ventilation, and airway management in out-of-hospital cardiac arrest: a review. 2472 81