Airway Extubation ; Anesthesia ; Animals ; Arterial Pressure ; Atrioventricular Block ; Bradycardia ; Brain Neoplasms ; Carbon Dioxide ; Dexmedetomidine ; Dihydroergotamine ; Dogs ; Fever ; Heart Rate ; Hypertension ; Hypotension ; Hypothermia ; Labetalol ; Neurosurgery ; Observational Study ; Odds Ratio ; Retrospective Studies ; Seizures ; Tachycardia

PURPOSE: This study aimed to investigate incidence of delirium in the pediatric intensive care unit (PICU) and to analyze associated risk factors. METHODS: The participants were 95 patients, newborn to 18 years, who were admitted to the PICU. The instruments used were the Richmond Agitation Sedation Scale (RASS), and the Cornell Assessment of Pediatric Delirium. Data analysis was performed using the descriptive, χ² test, t-test, and logistic regression analyses. RESULTS: The incidence of delirium in children admitted to the PICU was 42.1%. There were significant differences according to age (χ²=14.10, p=.007), admission type (χ²=7.40, p=.007), use of physical restraints (χ²=26.11, p<.001), RASS score (χ²=14.80, p=.001), need for oxygen (χ²=5.31, p=.021), use of a mechanical device (χ²=9.97, p=.041), feeding (χ²=7.85, p=.005), and the presence of familiar objects (χ²=29.21, p<.001). Factors associated with the diagnosis of delirium were the use of physical restraint (odds ratio [OR]=13.82, 95% confidence interval [CI]=4.16~45.95, p<.001) and the presence of familiar objects (OR=0.09, 95% CI=0.03~0.30, p=.002). CONCLUSION: Periodic delirium assessments and intervention should be actively performed. The use of restraints should be minimized if possible. The caregiver should surround the child with familiar objects and ensure a friendly hospital environment that is appropriate for the child.
Caregivers ; Child ; Critical Care ; Delirium ; Diagnosis ; Dihydroergotamine ; Humans ; Incidence ; Infant, Newborn ; Intensive Care Units ; Logistic Models ; Oxygen ; Pediatrics ; Restraint, Physical ; Risk Factors ; Statistics as Topic

BACKGROUND: Sub-umbilical surgery under caudal block in conjunction with sevoflurane sedation may be safe in terms of maintaining spontaneous breathing and avoiding complications associated with general anesthesia. However, sevoflurane-induced emergence agitation (EA) continues to be a clinically important phenomenon in children. To compare the incidence of EA in children undergoing sub-umbilical surgery under caudal block with two different doses of sevoflurane.METHODS: Forty children (aged 1–5 years) scheduled to undergo inguinal hernia repair under caudal block with sevoflurane sedation via a face mask were randomized into either the low-dose (1.0%) end-tidal sevoflurane concentration group (Group LS) or the high-dose (2.5%) end-tidal sevoflurane concentration group (Group HS). We monitored EA episodes at 5 and 30 min in the post-anesthetic care unit (PACU) by using the four-point agitation scale and the Pediatric Anesthesia Emergence Delirium (PAED) scale.RESULTS: The four-point agitation scale scores and PAED scores were not different between the groups at 5 min. However, the agitation score was higher in Group HS than in Group LS at 30 min after arriving in the PACU. The time required to recover from sedation was longer in Group HS than in Group LS.CONCLUSIONS: Face-mask sedation with 1.0% sevoflurane in conjunction with caudal block may be more effective than that with 2.5% sevoflurane in preventing EA.
Anesthesia ; Anesthesia, General ; Child ; Delirium ; Dihydroergotamine ; Hernia, Inguinal ; Humans ; Incidence ; Masks ; Respiration

BACKGROUND: Hydroxyethyl starch (HES), a class of synthetic colloid solutions, has been widely used to treat perioperative hypovolemia. The use of HES, however, is associated with the risk of allergic reactions.CASE: An 83-year-old man was scheduled to undergo an open reduction and internal fixation of a pertrochanteric fracture under spinal anesthesia. He had no history of allergy. Five minutes after HES administration, hypotension, agitation, and skin rash were developed. HES infusion was terminated due to a suspected anaphylactic reaction. The vital signs recovered following administration of phenylephrine, dexamethasone, and hydrocortisone. Serum tryptase and total immunoglobulin E levels were elevated in plasma samples collected following the commencement of the allergic reaction during surgery.CONCLUSIONS: In the present report, the risk of anaphylactic reaction with HES and the laboratory tests needed to support the diagnosis are highlighted.
Aged, 80 and over ; Anaphylaxis ; Anesthesia ; Anesthesia, Spinal ; Colloids ; Dexamethasone ; Diagnosis ; Dihydroergotamine ; Exanthema ; Humans ; Hydrocortisone ; Hypersensitivity ; Hypotension ; Hypovolemia ; Immunoglobulin E ; Immunoglobulins ; Phenylephrine ; Plasma ; Starch ; Tryptases ; Vital Signs

Cardiovascular and central nervous system (CNS) toxicity, including tachydysrhythmia, agitation, and seizures, may arise from cocaine or bupropion use. We report acute toxicity from the concomitant use of cocaine and bupropion in a 25-year-old female. She arrived agitated and uncooperative, with a history of possible antecedent cocaine use. Her electrocardiogram demonstrated tachycardia at 130 beats/min, with a corrected QT interval of 579 ms. Two doses of 5 mg intravenous metoprolol were administered, which resolved the agitation, tachydysrhythmia, and corrected QT interval prolongation. Her comprehensive toxicology screen returned positive for both cocaine and bupropion. We believe clinicians should be aware of the potential for synergistic cardiovascular and CNS toxicity from concomitant cocaine and bupropion use. Metoprolol may represent an effective initial treatment. Unlike benzodiazepines, metoprolol directly counters the pharmacologic effects of stimulants without respiratory depression, sedation, or paradoxical agitation. A lipophilic beta-blocker, metoprolol has good penetration of the CNS and can counter stimulant-induced agitation.
Adult ; Benzodiazepines ; Bupropion ; Central Nervous System ; Cocaine ; Dihydroergotamine ; Electrocardiography ; Female ; Humans ; Metoprolol ; Respiratory Insufficiency ; Seizures ; Tachycardia ; Toxicology

BACKGROUND AND PURPOSE: Cluster headache (CH) is frequently either not diagnosed or the diagnosis is delayed. We addressed this issue by developing the self-administered Cluster Headache Screening Questionnaire (CHSQ). METHODS: Experts selected items from the diagnostic criteria of CH and the characteristics of migraine. The questionnaire was administered to first-visit headache patients at nine headache clinics. The finally developed CHSQ included items based on the differences in responses between CH and non-CH patients, and the accuracy and reliability of the scoring model were assessed. RESULTS: Forty-two patients with CH, 207 migraineurs, 73 with tension-type headache, and 18 with primary stabbing headache were enrolled. The CHSQ item were scored as follows: 3 points for ipsilateral eye symptoms, agitation, and duration; 2 points for clustering patterns; and 1 point for the male sex, unilateral pain, disability, ipsilateral nasal symptoms, and frequency. The total score of the CHSQ ranged from 0 to 16. The mean score was higher in patients with CH than in non-CH patients (12.9 vs. 3.4, p < 0.001). At a cutoff score of >8 points, the CHSQ had a sensitivity, specificity, positive predictive value, and negative predictive value of 95.2%, 96%, 76.9%, and 99.3%, respectively. CONCLUSIONS: The CHSQ is a reliable screening tool for the rapid identification of CH.
Cluster Headache* ; Diagnosis ; Dihydroergotamine ; Headache ; Headache Disorders, Primary ; Humans ; Male ; Mass Screening* ; Migraine Disorders ; Prevalence ; Sensitivity and Specificity ; Tension-Type Headache

PURPOSE: The purpose of this study was to evaluate the antimicrobial effects of a toothbrush with light-emitting diodes (LEDs) on periodontitis-associated dental biofilm attached to a zirconia surface by static and dynamic methods. MATERIALS AND METHODS: Zirconia disks (12 mm diameter, 2.5 mm thickness) were inserted into a 24-well plate (static method) or inside a Center for Disease Control and Prevention (CDC) biofilm reactor (dynamic method) to form dental biofilms using Streptococcus gordonii and Fusobacterium nucleatum. The disks with biofilm were subdivided into five treatment groups-control, commercial photodynamic therapy (PDT), toothbrush alone (B), brush with LED (BL), and brush with LED+erythrosine (BLE). After treatment, the disks were agitated to detach the bacteria, and the resulting solutions were spread directly on selective agar. The number of viable bacteria and percentage of bacterial reduction were determined from colony counts. Scanning electron microscopy (SEM) was performed to visualize alterations in bacterial morphology. RESULTS: No significant difference in biofilm formation was observed between dynamic and static methods. A significant difference was observed in the number of viable bacteria between the control and all experimental groups (P < 0.05). The percentage of bacterial reduction in the BLE group was significantly higher than in the other treated groups (P < 0.05). SEM revealed damaged bacterial cell walls in the PDT, BL, and BLE groups, but intact cell walls in the control and B groups. CONCLUSION: The findings suggest that an LED toothbrush with erythrosine is more effective than other treatments in reducing the viability of periodontitis-associated bacteria attached to zirconia in vitro.
Agar ; Bacteria ; Biofilms ; Cell Wall ; Centers for Disease Control and Prevention (U.S.) ; Dihydroergotamine ; Erythrosine ; Fusobacterium nucleatum ; In Vitro Techniques ; Microscopy, Electron, Scanning ; Photochemotherapy ; Streptococcus gordonii ; Toothbrushing

PURPOSE: The purpose of this study is to identify the effects of aromatherapy on agitation in patients with dementia using a meta-analysis and systemic literature review. METHODS: The EMBASE, CINAHL, MEDLINE, and other databases were searched up to November 2017. RESULTS: Of 419 publications identified, 12 met inclusion criteria, and 9 studies were used to estimate the effect size of aromatherapy. A total of 837 participants across all studies were included. The commonly applied methods were massage (50%), type of oil lavender (75%), and instrument Cohen-Mansfield Agitation Inventory (75%). A medium effect size of aromatherapy on agitation was identified (d=−0.56, I2=65.0%, p=.001). The massage group has lower effect size than the other group (d=−0.98, I2=0.0%, p=.001). CONCLUSION: Aromatherapy appears to be effective in improving agitation in patients with dementia. However, further studies for home-dwelling patients with dementia and with different types of aroma oil should be conducted in the future. In addition, research with well-designed are needed to assess the effects or aromatherapy on agitation.
Aromatherapy ; Dementia ; Dihydroergotamine ; Humans ; Lavandula ; Massage ; Psychomotor Agitation

PURPOSE: The feasibility and differential effects of two music therapy methods (interventions with preferred music vs. classical relaxation music) were done to examine the effects on agitation and anxiety in patients weaning off mechanical ventilation. METHODS: This pilot study was conducted using a crossover design. Six patients listened to preferred music choices and classical relaxation music. Anxiety scores were measured using the Richmond Agitation Sedation Scale (RASS), State-Trait Anxiety Inventory (STAI), and visual analog scale (VAS). RESULTS: Patients showed a significant decrease in agitation and anxiety after both the preferred and classical relaxation music interventions. The difference in the effects of preferred music and that of classical relaxation music was not significant. As for feasibility, patients exhibited a change in agitated behaviors after the music interventions by not trying to take off medical devices and quietly listening to the music, and by smiling and moving lips along with the lyrics while listening. CONCLUSION: Music interventions which centered on either patients' preferences or classical relaxation music to enhance relaxation, helped reduce agitation and anxiety during the mechanical ventilation weaning process.
Anxiety ; Cross-Over Studies ; Dihydroergotamine ; Humans ; Lip ; Methods ; Music Therapy ; Music ; Pilot Projects ; Relaxation ; Respiration, Artificial ; Smiling ; Ventilation ; Visual Analog Scale ; Weaning

BACKGROUND: Despite well-known advantages, propofol remains off-label in many countries for general anesthesia in children under 3 years of age due to insufficient evidence regarding its use in this population. This study aimed to evaluate the efficacy and safety of propofol compared with other general anesthetics in children under 3 years of age undergoing surgery through a systematic review and meta-analysis of existing randomized clinical trials. METHODS: A comprehensive literature search was conducted of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to find all randomized clinical trials comparing propofol with another general anesthetic that included children under 3 years of age. The relative risk or arcsine-transformed risk difference for dichotomous outcomes and the weighted or standardized mean difference for continuous outcomes were estimated using a random-effects model. RESULTS: A total of 249 young children from 6 publications were included. The children who received propofol had statistically significantly lower systolic and diastolic blood pressures, but hypotension was not observed in the propofol groups. The heart rate, stroke volume index, and cardiac index were not significantly different between the propofol and control groups. The propofol groups showed slightly shorter recovery times and a lower incidence of emergence agitation than the control groups, while no difference was observed for the incidence of hypotension, desaturation, and apnea. CONCLUSION: This systematic review and meta-analysis indicates that propofol use for general anesthesia in young healthy children undergoing surgery does not increase complications and that propofol could be at least comparable to other anesthetic agents.
Anesthesia, General ; Anesthetics ; Anesthetics, General ; Apnea ; Child ; Dihydroergotamine ; Heart Rate ; Humans ; Hypotension ; Incidence ; Infant ; Propofol ; Stroke Volume