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Etomidate and its derivatives: time to say goodbye?
Br J Anaesth
January 2025
Universitätsmedizin Göttingen, Göttingen, Germany.
Etomidate, an intravenous hypnotic used for anaesthesia and critical care, is known for its undesirable side effects, including pain on injection, myoclonus, and adrenocortical depression. Despite its continued clinical use because of its haemodynamic stability and rapid onset and offset of effect, alternatives like propofol, ketamine, and remimazolam offer fewer drawbacks. Recent efforts to improve etomidate through chemical modifications, such as methoxyethyl etomidate hydrochloride (ET-26), have shown limited success, with persistent issues like involuntary muscle movements and adrenocortical suppression.
View Article and Find Full Text PDFPhysiological and clinical parameters under different protocols of total intravenous anesthesia in llama () undergoing unilateral ovariectomy.
Open Vet J
November 2024
Department of Molecular Biotechnology, Central Laboratory Unit, University Nacional Hermilio Valdizán, Huánuco, Perú.
Background: The limited and detailed literature on total intravenous anesthesia (TIVA), as well as the clinical indications for unilateral ovariectomy in llamas, are not well-defined. Therefore, it is necessary to understand the anesthetic events and the surgical intervention in this species.
Aim: The objective of this study was to evaluate the intraoperative physiological and clinical parameters in llamas undergoing unilateral ovariectomy, under three protocols of TIVA.
The nociceptive withdrawal reflex during spinal analgesia in pigs undergoing veno-arterial extracorporeal membrane oxygenation: a prospective observational study.
Front Vet Sci
December 2024
Experimental Surgery Facility, Experimental Animal Center, Faculty of Medicine, University of Bern, Bern, Switzerland.
Introduction: Use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is still in the focus of research, in which pigs are commonly involved. During VA-ECMO, cardiovascular parameters are artificially manipulated and therefore not reliable indicators of nociception. Nociceptive withdrawal reflex (NWR) thresholds can be a suitable alternative in such a context.
View Article and Find Full Text PDFEffects of vagus nerve stimulation on daily function and quality of life in markedly treatment-resistant major depression: Findings from a one-year, randomized, sham-controlled trial.
Brain Stimul
December 2024
Medical University of South Carolina, Department of Psychiatry, Charleston, SC, USA.
Background: Depression treatments aim to minimize symptom burden and optimize quality of life (QoL) and psychosocial function.
Objective: Compare the effects of adjunctive versus sham vagus nerve stimulation (VNS) on QoL and function in markedly treatment-resistant depression (TRD).
Methods: In this multicenter, double-blind, sham-controlled trial, 493 adults with TRD and ≥4 adequate but unsuccessful antidepressant treatment trials (current episode) were randomized to active (n = 249) or sham (n = 244) VNS (plus treatment as usual) over a 12-month observation period.
Midazolam and Ketamine for Convulsive Status Epilepticus in the Out-of-Hospital Setting.
Ann Emerg Med
December 2024
Department of Emergency Medicine, Mt. Sinai Medical Center, Miami Beach, FL; Department of Emergency Medicine and Critical Care, Herbert Wertheim College of Medicine at Florida International University, Miami, FL; Palm Beach County Fire Rescue, West Palm Beach, FL.
Study Objective: To determine if ketamine, when added to midazolam for the treatment of out-of-hospital seizures, is associated with an increase in the rate of cessation of convulsions prior to hospital arrival.
Methods: We performed a retrospective cohort study of out-of-hospital patients with an active convulsive seizure being transported to a hospital by a large emergency medical services system in Florida, using data from August 1, 2015 and August 5, 2024. Per protocol, patients received midazolam first for their seizure.
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