46,581 research outputs found
Dexmedetomidine for LISA procedure in preterm infants: a pilot study
No full textreservedPresupposti. La LISA (Less Invasive Surfactant Administration) è la tecnica di somministrazione di surfattante attualmente raccomandata dalle Linee Guida Europee per la gestione della RDS nei neonati pretermine in respiro spontaneo supportati con CPAP. Tale tecnica comprende l’esecuzione di una laringoscopia, che è una procedura dolorosa, comportando quindi la necessità di un’adeguata analgosedazione. Il farmaco ideale in tale contesto dovrebbe avere un rapido onset e una breve durata d’azione, oltre a non impattare sul drive respiratorio ed essere sicuro nel breve e lungo termine. Finora sono stati studiati diversi farmaci per l’analgosedazione durante LISA, ma nessuno di essi è risultato ottimale a causa dell’aumentato rischio di depressione respiratoria osservato nei pazienti sedati. La dexmedetomidina, un agonista adrenergico α2-selettivo dall’effetto analgesico e sedativo con impatto minimo o assente sul drive respiratorio, potrebbe rappresentare un’opzione adatta alla premedicazione per LISA.
Obiettivi. Lo scopo di questo studio è indagare l’efficacia della dexmedetomidina in termini di analgesia e sedazione durante la procedura LISA e la sua sicurezza nei neonati pretermine.
Materiali e metodi. È stato condotto uno studio osservazionale longitudinale prospettico su neonati pretermine di età gestazionale compresa tra 26+0 e 36+6 settimane con RDS e necessità di terapia con surfattante, ricoverati presso una TIN di terzo livello. I pazienti sono stati inoltre suddivisi in due gruppi in base all’età gestazionale (< o ≥ 32 SG). La dexmedetomidina è stata somministrata in bolo lento alla dose di 1 μg/kg prima della LISA. Gli outcome primari sono stati l’efficacia della dexmedetomidina nel fornire adeguate analgesia e sedazione, misurate rispettivamente tramite gli score NIPS e N-PASS, e la sicurezza di tale farmaco in termini di effetti sul drive respiratorio (comparsa di apnea/desaturazione e necessità di intubazione) e di effetti collaterali cardiovascolari (bradicardia e ipotensione).
Risultati. Sono stati arruolati 47 neonati, di cui 30 di età compresa tra 26+0 e 31+6 SG e 17 di età tra 32+0 e 36+6 SG. La mediana (IQR) di età gestazionale e peso alla nascita è stata rispettivamente 29+6 (28+5, 33+1) SG e 1421 (1069, 2074) g. L’analgesia è stata adeguata, con il 76% dei pazienti con NIPS ≤ 4 durante la laringoscopia e percentuali maggiori, attorno al 90%, negli altri momenti della procedura. La sedazione, invece, è stata tardiva e prolungata, con solo 10 neonati (23%) al livello di sedazione desiderato (N-PASS tra -2 e -5) all’inizio della LISA, stato che si è protratto per almeno 60 minuti dopo la procedura. Sono stati rilevati cinque casi (11%) di apnea/desaturazione e sei pazienti (13%) hanno richiesto intubazione entro le 72 ore dalla procedura. Nessun paziente ha presentato bradicardia, mentre si è verificata ipotensione in tre neonati (6%).
Conclusioni. La dexmedetomidina ha garantito un’analgesia adeguata e permesso un’agevole esecuzione della procedura, senza causare al contempo effetti avversi gravi. Non ha, tuttavia, permesso di raggiungere il livello desiderato di sedazione al momento della LISA, dimostrando un effetto sedativo tardivo e prolungato nel tempo. La premedicazione con dexmedetomidina non sembra, quindi, ideale per la procedura LISA, che richiede un farmaco con un più rapido onset e una più breve durata d’azione.Background. Less invasive surfactant administration (LISA) is the surfactant administration method currently recommended by the European Guidelines for the management of respiratory distress syndrome (RDS) in preterm neonates spontaneously breathing on CPAP. This technique involves a laryngoscopy, a painful procedure that requires appropriate analgesia and sedation. The ideal drug for this purpose should have a rapid onset and a short duration of action, should not affect respiratory drive, and should be safe in both the short and long term. Several drugs have been tested for analgesia and sedation during LISA, but none have proven ideal due to an increased risk of respiratory depression. Dexmedetomidine, a selective α2-adrenergic agonist with analgesic and sedative effects and minimal or no impact on respiratory drive, seems a promising option for LISA premedication.
Objectives. This study aimed to evaluate the efficacy of dexmedetomidine for analgesia and sedation during the LISA procedure, as well as its safety in preterm neonates.
Methods. This prospective observational study enrolled preterm neonates with a gestational age between 26+0 and 36+6 weeks diagnosed with RDS and requiring surfactant therapy, admitted to a level III NICU. Patients were further divided into two groups based on gestational age (<32 or ≥32 weeks). Dexmedetomidine was administered as a slow bolus at a dose of 1 μg/kg before LISA. Primary outcomes were the efficacy of dexmedetomidine in providing adequate analgesia and sedation – evaluated using the Neonatal Infant Pain Scale (NIPS) and the Neonatal Pain, Agitation, and Sedation Scale (N-PASS), respectively – and its safety, determined by the lack of side effects, both respiratory (apnea/desaturation and need of intubation) and cardiovascular (bradycardia and hypotension) ones.
Results. A total of 47 neonates were enrolled, 30 aged between 26+0 and 31+6 weeks GA and 17 between 32 and 36+6 weeks GA. The median (IQR) gestational age and birth weight were 29+6 (28+5, 33+1) weeks and 1421 (1069, 2074) g, respectively. Analgesia was adequate, with 76% patients achieving a NIPS score ≤4 during laryngoscopy and around 90% at other time points during the procedure. However, sedation was delayed and prolonged, with only 10 neonates (23%) reaching the desired sedation level (N-PASS between -2 and -5) at the beginning of LISA, which persisted for at least 60 minutes after the procedure. Apnea/desaturation occurred in five cases (11%), and six patients (13%) required intubation within 72 hours. No episodes of bradycardia were observed, while hypotension occurred in three neonates (6%).
Conclusion. Dexmedetomidine provides adequate analgesia and good technical conditions without causing severe adverse effects. However, the desired level of sedation was not consistently achieved, due to a delayed and prolonged sedative effect. Therefore, dexmedetomidine may not be the optimal choice for LISA premedication, as this procedure requires a drug with a faster onset and shorter duration of action
Description of author Lisa Price\u27s hiking trip through the Hundred Mile Wilderne
No full textDescription of author Lisa Price\u27s hiking trip through the Hundred Mile Wilderness, the final section of the Appalachian Trail in Maine. Price, who has hiked the Appalachian Trail for four years, one section at a time, meets up with fellow hikers Noel and Caroline at Shaw\u27s Boarding House in Monson, and the three reach the summit of Mount Katahdin together
Conversatorio con Lisa Garforth=Conversation with Lisa Garforth
No full textJulia Ramírez-Blanco conversa con Lisa Garforth, autora del libro Green Utopias y especialista en utopías medioambientales. Con ella, hablamos acerca de las posibles maneras de definir las ecotopías, y cómo estas se manifiestan tanto en la literatura como en distintas formas de práctica social.Julia Ramírez-Blanco interviews Lisa Garforth, author of the book Green Utopias and specialist in environmental utopias. With her, we talk about the possible ways of defining ecotopias, and how they manifest themselves both in literature and in different forms of social practice.http://re-visiones.net/audio/Entrevista-Lisa-Garfoth.mp
An interview with Alfredo Falcone and Lisa Salvatore: RECOURSE and trifluridine/tipiracil in metastatic colorectal cancer
No full textProfessor Alfredo Falcone and Dr Lisa Salvatore speak to Roshaine Gunawardana, Managing Commissioning Editor: Professor Alfredo Falcone is the Director of the Department of Oncology and the Specialization School at the University Hospital of Pisa, Italy. He trained in Pisa and Genoa, Italy, and has held major positions in Italian oncology since 2000. He currently has more than 300 publications, including papers in peer-reviewed international and national journals, book chapters, and more than 600 abstracts of presentations to international and national conferences. The majority of his papers regard clinical and translational research, with a particular focus on metastatic colorectal cancer. Dr Lisa Salvatore is a medical oncologist in the Department of Translational Research and New Technologies in Medicine and Surgery at the University of Pisa. She has been an author on about 40 publications in major peer-reviewed publications and has made numerous presentations in national and international conferences. Her main interest is focused on clinical and translational research in metastatic colorectal cancer
Norman, Doris. Lisa Wilson interviewing Doris Norman, May 12, 2010, Roddickton, Newfoundland.
No full textLisa Wilson interviewing Doris Norman, May 12, 2010, Roddickton, Newfoundland. Mrs. Norman discusses knitting
Elliott, George. Lisa Wilson interviewing George Elliott, May 27, 2010, Main Brook, Newfoundland.
No full textLisa Wilson interviewing George Elliott, May 27, 2010, Main Brook, Newfoundland. Elliott discusses building boats and making snowshoes
Simmonds, Mary. Lisa Wilson interviews Mary Simmonds, May 9, 2010, Conche, Newfoundland.
No full textLisa Wilson interviews Mary Simmonds, May 9, 2010, Conche, Newfoundland. Simmonds describes her knitting and quilting projects
Elliott, George. Lisa Wilson interviewing George Elliott, May 19, 2010, Main Brook, Newfoundland.
No full textLisa Wilson interviewing George Elliott, May 19, 2010, Main Brook, Newfoundland. Elliott discusses boatbuilding, making cast nets, and making snowshoes
Roberts, Sharon. Lisa Wilson interviewing Sharon Roberts, May 29, 2010, Quirpon, Newfoundland.
No full textLisa Wilson interviewing Sharon Roberts, May 29, 2010, Quirpon, Newfoundland. Mrs. Roberts discusses quilting, knitting, and working away from Newfoundland
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