New-onset atrial fibrillation detected by continuous capnography monitoring: a case report

Case series Patients: Male, 75-year-old Male, 72-year-oldFinal Diagnosis: Atrial fibrillationSymptoms: Apnea atrial fibrillationMedication: -Clinical Procedure: -Specialty: AnesthesiologyObjective: Unusual clinical courseBackground: Asymptomatic postoperative atrial fibrillation (AF) may go undetected. As part of a multicenter observational trial designed to develop a risk prediction score for respiratory depression, the respiratory patterns of patients admitted to standard wards were continuously assessed with capnography and pulse oximetry. The monitor measured end-tidal carbon dioxide, respiratory rate, heart rate (HR), and oxyhemoglobin saturation.Case Reports: Two men ages 75 and 72 experienced abrupt and variable postoperative changes in HR consistent with AF with rapid ventricular response, coinciding with an abnormal breathing pattern with apneic episodes. In both cases, the changes were not detected by routine clinical monitoring.Conclusions: Continuous capnography identified respiratory distress in 2 patients who experienced symptoms of AF. Continuous monitoring devices can help health care providers minimize the risk of morbidity and mortality for patients at risk of respiratory depression.Perioperative Medicine: Efficacy, Safety and Outcome (Anesthesiology/Intensive Care

Prediction of Opioid-Induced Respiratory Depression on Inpatient Wards Using Continuous Capnography and Oximetry: An International Prospective, Observational Trial.

BACKGROUND: Opioid-related adverse events are a serious problem in hospitalized patients. Little is known about patients who are likely to experience opioid-induced respiratory depression events on the general care floor and may benefit from improved monitoring and early intervention. The trial objective was to derive and validate a risk prediction tool for respiratory depression in patients receiving opioids, as detected by continuous pulse oximetry and capnography monitoring. METHODS: PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) was a prospective, observational trial of blinded continuous capnography and oximetry conducted at 16 sites in the United States, Europe, and Asia. Vital signs were intermittently monitored per standard of care. A total of 1335 patients receiving parenteral opioids and continuously monitored on the general care floor were included in the analysis. A respiratory depression episode was defined as respiratory rate ≤5 breaths/min (bpm), oxygen saturation ≤85%, or end-tidal carbon dioxide ≤15 or ≥60 mm Hg for ≥3 minutes; apnea episode lasting \u3e30 seconds; or any respiratory opioid-related adverse event. A risk prediction tool was derived using a multivariable logistic regression model of 46 a priori defined risk factors with stepwise selection and was internally validated by bootstrapping. RESULTS: One or more respiratory depression episodes were detected in 614 (46%) of 1335 general care floor patients (43% male; mean age, 58 ± 14 years) continuously monitored for a median of 24 hours (interquartile range [IQR], 17-26). A multivariable respiratory depression prediction model with area under the curve of 0.740 was developed using 5 independent variables: age ≥60 (in decades), sex, opioid naivety, sleep disorders, and chronic heart failure. The PRODIGY risk prediction tool showed significant separation between patients with and without respiratory depression (P \u3c .001) and an odds ratio of 6.07 (95% confidence interval [CI], 4.44-8.30; P \u3c .001) between the high- and low-risk groups. Compared to patients without respiratory depression episodes, mean hospital length of stay was 3 days longer in patients with ≥1 respiratory depression episode (10.5 ± 10.8 vs 7.7 ± 7.8 days; P \u3c .0001) identified using continuous oximetry and capnography monitoring. CONCLUSIONS: A PRODIGY risk prediction model, derived from continuous oximetry and capnography, accurately predicts respiratory depression episodes in patients receiving opioids on the general care floor. Implementation of the PRODIGY score to determine the need for continuous monitoring may be a first step to reduce the incidence and consequences of respiratory compromise in patients receiving opioids on the general care floor

Ibuprofeno intravenoso: Experiencia clínica en el tratamiento del dolor postoperatorio

About 30 % of surgical patients report high or extreme intensity postoperative pain as their main concern, which is even more relevant than satisfactory surgery results. NSAIDs are the most commonly prescribed drugs worldwide for the treatment of acute and chronic pain. Ibuprofen is widely used in prevention and treatment of pain. Recently, intravenous ibuprofen has been approved by the FDA (www.accessdata.fda.gov) for the management of mild-moderate pain and management of moderate-severe pain complementary to opioid analgesia. Additionally, has been approved for fever reduction. Given its potential as adjuvant therapy in multimodal analgesia, a review of the perioperative use of intravenous ibuprofen was conducted by analyzing literature available in English and Spanish in PubMed and Ovid MEDLINE through December 2015. The review included pharmacokinetic and pharmacodynamic data from patients of different ages as well as clinical studies where the use of opioids was quantified in the postoperative period and the synergy between these two types of drugs was analyzed. Intravenous ibuprofen offers advantages over oral presentation and is an alternative to the limited availability of intravenous NSAIDs as part of multimodal perioperative analgesia.El dolor postoperatorio de intensidad alta o extrema tiene una incidencia publicada cercana al 30 % de los pacientes quirúrgicos, siendo su principal preocupación, incluso más relevante que los resultados satisfactorios o no que pudiera tener el procedimiento en la resolución de su enfermedad. Los AINE son los fármacos más prescritos en el mundo para el tratamiento del dolor agudo y crónico de diferentes causas. El ibuprofeno es un analgésico ampliamente utilizado en la prevención y tratamiento del dolor. Recientemente, su forma intravenosa ha sido aprobada por la FDA (www.accessdata.fda.gov) para el tratamiento del dolor leve a moderado y moderado a severo complementario a la analgesia opioide. Adicionalmente, ha sido aprobado para la reducción de la fiebre. Dado su potencial como adyuvante en la analgesia multimodal, se realizó una revisión acerca del uso perioperatorio del ibuprofeno intravenoso, analizando la literatura disponible en inglés y español en PubMed y Ovid MEDLINE hasta diciembre 2015. Se incluyeron datos farmacocinéticos y farmacodinámicos provenientes de pacientes de diferentes edades, así como estudios clínicos, incluyendo aquellos en los que se cuantificó el uso de opioides en el periodo postoperatorio, analizando la sinergia entre ambos tipos de analgésicos. El ibuprofeno intravenoso ofrece ventajas sobre la presentación oral, siendo una alternativa a la limitada disponibilidad de AINE endovenosos como parte de la analgesia multimodal perioperatoria

Increase in rubisco activity and gene expression due to elevated temperature partially counteracts ultraviolet radiation-induced photoinhibition in the marine diatom thalassiosira weissflogii

We performed outdoor experiments to evaluate the effect of temperature on photoinhibition properties in the cosmopolitan diatom Thalassiosira weissflogii. Cultures were exposed to solar radiation with or without ultraviolet radiation (UVR, 280-400 nm), UV-A (320-400 nm), and UV-B (280-320 nm) at both 20°C and 25°C. Four possible cellular mechanisms involved in UVR stress were simultaneously addressed: carbon incorporation, chlorophyll a fluorescence of photosystem II, xanthophyll cycle activity, and ribulose-1,5-biphosphate carboxylase: oxygenase (Rubisco) activity and gene expression. Experiments consisted of daily cycles (i.e., the daylight period) and short-term incubations (i.e., 1 h centered on local noon). Samples incubated at 25°C had significantly less UVR-induced inhibition of carbon fixation and effective photochemical quantum yield compared to those incubated at 20°C. At 25°C Rubisco activity and gene expression were significantly higher than at 20°C. The higher Rubisco activity and gene expression were correlated with less dissipation of excess energy, evaluated via non-photochemical quenching, and the de-epoxidation state of the xanthophyll pigments, as more photons could be processed. An increase in temperature due to climate change would partially counteract the negative effects of UVR by increasing the response of metabolic pathways, such as those involved in Rubisco. This, in turn, may have important consequences for the ecosystem, as higher production (due to more Rubisco activity) could be expected under a scenario of global warming.Fil: Helbling, Eduardo Walter. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación Playa Unión. Estación de Fotobiología Playa Unión; ArgentinaFil: Buma, Anita G. J.. University of Groningen; Países BajosFil: Boelen, Peter. University of Groningen; Países BajosFil: van der Strate, Han J.. University of Groningen; Países BajosFil: Fiorda Giordanino, María Valeria. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación Playa Unión. Estación de Fotobiología Playa Unión; ArgentinaFil: Villafañe, Virginia Estela. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación Playa Unión. Estación de Fotobiología Playa Unión; Argentin