Can This Natural Hormone Actually Heal Brain Injuries & Strokes?

Why do some females recover from brain injury much faster and more completely than males?

The answer may have far-reaching implications for the treatment of traumatic brain injury, stroke, and other neurological disorders.

Neuroscientist Dr. Donald G. Stein and his colleagues have been investigating this question and have discovered something remarkable -- that the hormone progesterone neuroprotective effects that improve outcomes and reduce mortality following brain injuries. confers profound

Progesterone provides powerful neuroprotection to the fetus, particularly in late pregnancy, when it helps suppress neuronal excitation that can damage delicate new brain tissue. Dr. Stein and his colleagues have found that in addition to protecting the fetal brain, progesterone also protects and heals injured brain tissue.

Lidocaine Reduces Pain and Anxiety From Peripheral IV Cannula Insertion

      Injected buffered lidocaine or lidocaine cream can reduce the pain and anxiety associated with intravenous cannula insertion, according to study findings reported in the August issue of the Annals of Emergency Medicine. Between the two, injected lidocaine is more effective in alleviating pain.         Many patients who present to the emergency department require placement of a peripheral IV line, which frequently causes pain and anxiety, Dr. Candace McNaughton, from Vanderbilt University, Nashville, Tennessee, and colleagues note.        Most IV placements in the ER are done without local anesthesia, the researchers point out. This may be due to "time constraints, difficulty with their application, perceived ineffectiveness, a belief that use of local anesthesia makes it more difficult to place IVs, or a belief by healthcare providers that the pain of IV insertion is insignificant."      Research has shown that both the pain and anxiety of IV insertion can be reduced by pretreatment with local anesthetics, but the best method was unclear. Anesthetic creams are often used to reduce pain during IV insertion. However, in a busy ER setting, their usefulness is limited due to their delayed onset of action, the authors note. By contrast, injected anesthetics have a more rapid onset, but require an additional needle stick.      In a randomized, crossover study, Dr. McNaughton's team compared pin and anxiety in 70 medical students or nurses who had IVs placed after pretreatment with injected buffered lidocaine, lidocaine cream, or no analgesia. A 10-point numeric rating scale was used to assess pain, anxiety, and treatment preference immediately following IV insertion.      The median pain scores with lidocaine cream and injected, buffered lidocaine were 3 and 1, respectively. Without analgesia, the pain was much worse with a median score of 7. Similarly, the median anxiety score with both lidocaine treatments was 2 compared with a score of 4 without analgesia. The pretreatment method had no bearing on the likelihood of success, the report indicates, and most of the IV placement attempts were successful.      When surveyed, 70% of the subjects indicated that they would always request injected, buffered lidocaine for themselves and for their patients undergoing IV insertion. Lidocaine cream was the preferred treatment for 26% of subjects and no analgesia for 4%. Ann Emerg Med. 2009;54:214-220. News Author: Anthony J. Brown, MD CME Author: Laurie Barclay, MD

Ketamine May Be Useful for Intubation in Critically Ill Patients

Ketamine is a safe, valuable alternative to conventional etomidate for use as a sedative during intubation in critically ill patients, according to the results of a randomized controlled, single-blind trial reported online in the July 1 issue of The Lancet. "Critically ill patients often require emergency intubation," write Patricia Jabre, MD, and colleagues from the KETASED Collaborative Study Group. "The use of etomidate as the sedative agent in this context has been challenged because it might cause a reversible adrenal insufficiency, potentially associated with increased in-hospital morbidity. We compared early and 28-day morbidity after a single dose of etomidate or ketamine used for emergency endotracheal intubation of critically ill patients." At 12 emergency medical services or emergency departments and 65 intensive care units in France, 655 patients requiring sedation for emergency intubation were prospectively enrolled and randomly assigned by a computerized random-number generator list to receive 0.3 mg/kg of etomidate (n = 328) or 2 mg/kg of ketamine (n = 327) for intubation. Group assignment was known to only the emergency medicine physician enrolling patients. The main outcome measure was the maximal score of the sequential organ failure assessment (SOFA) during the first 3 days in the intensive care unit. Analysis was by modified intent-to-treat, with exclusion from analysis of patients who died before reaching the hospital and those discharged from the intensive care unit earlier than 3 days. Data were analyzed for 234 patients in the etomidate group and 235 in the ketamine group. Both groups had statistically similar mean maximal SOFA scores (10.3 ± 3.7 for etomidate vs 9.6 ± 3.9 for ketamine; mean difference, 0.7; 95% confidence interval [CI], 0.0 - 1.4; P = .056). Both groups had a median intubation difficulty score of 1 (interquartile ratio, 0 - 3; P = .70) suggesting similar intubation conditions. Compared with the ketamine group, the etomidate group had a significantly higher percentage of patients with adrenal insufficiency (odds ratio, 6.7; 95% CI, 3.5 - 12.7). No serious adverse events occurred with either study drug. "Our results show that ketamine is a safe and valuable alternative to etomidate for endotracheal intubation in critically ill patients, and should be considered in those with sepsis," the study authors write. Limitations of this study include possibly insufficient power to show a significant increase in morbidity rates associated with etomidate use in patients with sepsis. In an accompanying comment, Dr. Volker Wenzel and Dr. Karl H. Lindner, from Innsbruck Medical University in Innsbruck, Austria, note that successful emergency intubation of critically ill patients depends on pharmacologic knowledge as well as manual skills and clinical experience. Unfortunately, tightening regulations of the European Union hinder trials of commercially noninteresting pathology such as multiple trauma. "We should be lobbying our parliamentary representatives to help with non-commercial research, otherwise industry lobbyists will continue pushing for rules that only global drug companies can comply with," Drs. Wenzel and Lindner write. "Should that occur, our fate would be similar to physicians in developing countries, who have many questions about optimising health care but cannot do clinical trials to find valid answers." The French Ministry of Health supported this study. The study authors and editorialists have disclosed no relevant financial relationships.  Lancet. Published online July 1, 2009.

Cardiac Arrest Picu Kematian Michael Jackson

BINTANG pop Michael Jackson meninggal di usia 50 tahun akibat cardiac arrest. Stasiun TV Los Angeles KTLA melaporkan bahwa Los Angeles fire officials sempat merespon panggilan 911 dari rumah Jackson. Tapi, Jakson sudah tidak bernafas lagi saat petugas tiba di sana. Para medis melakukan prosedur darurat medis (Cardiopulmonary resuscitation/CPR) dan melarikannya ke UCLA Medical Center. Meskipun rumah sakit tidak membeberkan detail kondisi Jackson, dia dinyatakan meninggal akibat cardiac arrest. Apa beda cardiac arrest dengan serangan jantung? Menurut Douglas Zipes, MD, MACC, seorang profesor dari Indiana University School of Medicine, dalam cardiac arrest, jantung berhenti bekerja dengan benar. Cardiac arrest, menurut Zipes, berbeda dengan serangan jantung, tapi bisa terjadi akibat serangan jantung. Cardiac arrest, merupakan gangguan ritme jantung saat bilik jantung bagian bawah, berdetak sangat cepat, 4-600 kali dalam semenit. Ritme jantung ini, lantut Zipes, mencegah kontraksi bilik jantung bagian bawah dan menghambat pemompaan darah ke otak dan ke seluruh bagian tubuh. Dan, jika tidak segera diatasi bisa mengakibatkan kematian dalam waktu 4-5 menit. Saat terjadi gangguan ritme jantung, terang Zipes, bilik jantung bagian bawah sama seperti sekantung cacing yang sudah tidak lagi efektif menekan. Akibatnya tidak ada darah yang dipompa ke seluruh bagian tubuh. Dan jika tidak ada oksigen dalam pembuluh darah yang bisa dipompa ke otak, maka otak akan segera mati. CPR, menurut Zipes, bisa membantu agar darah tetap mengalir. Tapi diperlukan kejutan listrik ke jantung, baik dari alat penyalur listrik dari luar maupun peralatan internal jantung, untuk mengejutkan jantung agar kembali ke ritme normal."Beberapa aliran darah harus distimulusi, baik dengan CPR atau dengan alat pengejut untuk mengembalikan jantung ke fungsi normal," ujar Zipes, seperti dikutip situs webmd. Menurut Zipes, 30-50% kasus cardiac arrest merupakan manifestasi dari penyakit jantung yang belum kelihatan. Jadi, Anda mungkin tidak akan merasakan rasa sakit di dada, sulit bernapas. Anda mungkin tidak merasakan gejala apapun.

Infants With Fetal Distress Are Most Affected by General Anesthesia for Cesarean Delivery

The infants most affected by general anesthesia for cesarean delivery are those who are already compromised in utero, according to the results of a study reported in the April 29 Online First issue of BMC Medicine. Anaesthesia guidelines recommend regional anaesthesia for most caesarean sections due to the risk of failed intubation and aspiration with general anaesthesia," write Charles S. Algert, from Kolling Institute of Medical Research, University of Sydney in Sydney, Australia, and colleagues. However, general anaesthesia is considered to be safe for the foetus, based on limited evidence, and is still used for caesarean sections. The study cohort consisted of 50,806 infants delivered by cesarean delivery from 1998 to 2004 for indications of planned subsequent cesarean delivery, failure to progress, or fetal distress. The investigators compared outcomes of neonatal intubation and 5-minute Apgar scores of less than 7 for deliveries performed with the mother under general anesthesia vs those performed with the mother under spinal or epidural anesthesia. For all 3 indications and across all levels of hospital, the risk for adverse outcomes was increased for cesarean deliveries performed with the patient under general anesthesia. Low-risk, planned subsequent cesarean deliveries had the largest relative risks for resuscitation with intubation (relative risk, 12.8; 95% confidence interval [CI], 7.6 - 21.7), and for Apgar scores of less than 7 (relative risk, 13.4; 95% CI, 9.2 - 19.4). Unplanned cesarean deliveries because of fetal distress had the largest absolute increase in risk (5 extra intubations per 100 deliveries and 6 extra Apgar scores <>

The Australian National Health and Medical Research Council supported this study. The study authors have disclosed no relevant financial relationships. BMC Med. Published online April 29, 2009.

Incidence of and risk factors for awareness during anaesthesia.

Explicit recall of events during general anaesthesia is detected by direct questioning, as patients may not report awareness spontaneously or if they are questioned non-specifically. More than one interview is needed and credibility of reports should always be verified. The overall incidence of awareness has decreased over the last 40 years and is now 0.1-0.2%. Prospective study of patients who undergo general anaesthesia is the only valid method for determining the incidence of awareness. Studies of patients recruited through referrals by colleagues or advertisements, studies of compensation claims and those carried out through quality improvement systems are inadequate. Several factors increase the risk of awareness, including light anaesthesia, some types of surgery, a history of awareness, chronic use of central nervous system depressants, younger age, obesity, inadequate or misused anaesthesia delivery systems, insufficient knowledge about awareness, and ignoring the use of electroencephalographic monitors when the risk is otherwise increased.

Ghoneim MM. Department of Anesthesia, University of Iowa, Iowa City, IA 52244, USA. mohamed-ghoneim@uiowa.edu

Kapan transfusi sel darah merah dilakukan?

• Transfusi sel darah merah hampir selalu diindikasikan pada kadar Hemoglobin (Hb) <7 g/dl, terutama pada anemia akut. Transfusi dapat ditunda jika pasien asimptomatik dan/atau penyakitnya memiliki terapi spesifik lain, maka batas kadar Hb yang lebih rendah dapat diterima. (Rekomendasi A) • Transfusi sel darah merah dapat dilakukan pada kadar Hb 7-10 g/dl apabila ditemukan hipoksia atau hipoksemia yang bermakna secara klinis dan laboratorium. (Rekomendasi C) • Transfusi tidak dilakukan bila kadar Hb ≥10 g/dl, kecuali bila ada indikasi tertentu, misalnya penyakit yang membutuhkan kapasitas transport oksigen lebih tinggi (contoh: penyakit paru obstruktif kronik berat dan penyakit jantung iskemik berat). (Rekomendasi A) • Transfusi pada neonatus dengan gejala hipoksia dilakukan pada kadar Hb ≤11 g/dL; bila tidak ada gejala batas ini dapat diturunkan hingga 7 g/dL (seperti pada anemia bayi prematur). Jika terdapat penyakit jantung atau paru atau yang sedang membutuhkan suplementasi oksigen batas untuk memberi transfusi adalah Hb ≤13 g/dL. (Rekomendasi C)