Propofol for Procedural Sedation in the Emergency Department: A Qualitative Systematic Review (June).

Propofol for Procedural Sedation in the Emergency Department: A Qualitative Systematic Review (June).

Ann Pharmacother. 2013 May 21;
Black E, Campbell SG, Magee K, Zed PJ

OBJECTIVE:To evaluate the efficacy and safety of propofol compared to other agents for procedural sedation of adults in the emergency department (ED) and to review the use of opioids in conjunction with propofol for procedural sedation in the ED.DATA SOURCES:PubMed (1949-December 2012) and EMBASE (1980-December 2012) were searched using combinations of the following search terms: (procedural sedation or conscious sedation [MESH]) and propofol. A manual search of references was also performed.STUDY SELECTION AND DATA EXTRACTION:English-language, full reports of randomized controlled trials (RCTs) and observational studies evaluating propofol use in adults undergoing procedural sedation in the ED were included if they reported efficacy or safety outcomes. Two reviewers independently assessed each article for inclusion, data extraction, and study limitations.DATA SYNTHESIS:Thirteen RCTs and 20 observational studies meeting our inclusion criteria were retrieved. Regardless of the agent used for sedation, procedural success was greater than 80% and most trials demonstrated no statistically significant difference in the incidence of respiratory depression with propofol compared to alternatives. One RCT showed a significantly greater percent decrease in systolic blood pressure from baseline in those who received propofol compared to ketamine. Where reported, no significant difference was found in patient recall, pain, and satisfaction when opioids were added to propofol compared to propofol alone; the addition of opioids may have resulted in a higher incidence of respiratory adverse events.CONCLUSIONS:Propofol for procedural sedation is a reasonable alternative for use in the ED, with comparative efficacy and safety to other alternatives. Use of opioids in addition to propofol may not provide added benefit but does contribute to increased rates of adverse events. HubMed – depression


Role of Dexmedetomidine for the Prevention and Treatment of Delirium in Intensive Care Unit Patients (June).

Ann Pharmacother. 2013 May 21;
Mo Y, Zimmermann AE

OBJECTIVE:To review recent clinical studies regarding the role of dexmedetomidine for prevention and treatment of delirium in intensive care unit (ICU) patients.DATA SOURCES:MEDLINE and PubMed searches (1988-Feburary 2013) were conducted, using the key words delirium, dexmedetomidine, Precedex, agitation, ?-2 agonists, critical care, and intensive care. References from relevant articles were reviewed for additional information.STUDY SELECTION AND DATA EXTRACTION:Clinical trials comparing dexmedetomidine with other sedatives/analgesics or with antipsychotics for delirium were selected. Studies that evaluated the use of dexmedetomidine for sedation for more than 6 hours were included in this review.DATA SYNTHESIS:Dexmedetomidine is a highly selective ?-2 receptor agonist that provides sedation, anxiolysis, and modest analgesia with minimal respiratory depression. Its mechanism of action is unique compared with that of traditional sedatives because it does not act on ?-aminobutyric acid receptors. In addition, dexmedetomidine lacks anticholinergic activity and promotes a natural sleep pattern. These pharmacologic characteristics may explain the possible anti delirium effects of dexmedetomidine. Eight clinical trials, including 5 double-blind randomized trials, were reviewed to evaluate the impact of dexmede to midine on ICU delirium.CONCLUSIONS:Currently available evidence suggests that dexmedetomidine is a promising agent, not only for prevention but also for treatment of ICU-associated delirium. However, larger, well-designed trials are warranted to define the role of dexmedetomidine in preventing and treating delirium in the ICU. HubMed – depression


Resilience, depressed mood, and menopausal symptoms in postmenopausal women.

Menopause. 2013 May 20;
Pérez-López FR, Pérez-Roncero G, Fernández-Iñarrea J, Fernández-Alonso AM, Chedraui P, Llaneza P,

OBJECTIVE: This study aims to assess resilience, depressed mood, and menopausal symptoms in postmenopausal women. METHODS: In this cross-sectional study, 169 postmenopausal women aged 48 to 68 years were asked to fill out the Wagnild and Young Resilience Scale (WYRS), the Center for Epidemiologic Studies Depression Scale (CESD-10), the Menopause Rating Scale (MRS), and a questionnaire containing personal and partner sociodemographic data. RESULTS: The median [interquartile range] age of participating women was 54 [10.0] years. Among the women, 55.6% had increased body mass index, 76.9% had a partner, 17.8% were current smokers, 14.2% had hypertension, 25.4% used psychotropic drugs, and 13.0% used hormone therapy. Forty-five percent of the women had depressed mood (CESD-10 scores ?10), and 34.9% had severe menopausal symptoms (total MRS scores ?17). Less resilience (lower WYRS scores) correlated with depressed mood (higher CESD-10 scores) and severe menopausal symptoms (higher total, psychological, and urogenital MRS scores). Multiple linear regression analysis determined that WYRS scores positively correlated with exercising regularly and inversely correlated with CESD-10 scores (depressed mood). CESD-10 scores positively correlated with somatic and psychological MRS subscale scores and inversely correlated with WYRS scores (less resilience). CONCLUSIONS: In this postmenopausal sample, depressed mood and participation in regular exercise correlate with lower and higher resilience, respectively. Depressed mood is associated with the severity of menopausal symptoms (somatic and psychological). HubMed – depression


Effect of escitalopram on mental stress-induced myocardial ischemia: results of the REMIT trial.

JAMA. 2013 May 22; 309(20): 2139-49
Jiang W, Velazquez EJ, Kuchibhatla M, Samad Z, Boyle SH, Kuhn C, Becker RC, Ortel TL, Williams RB, Rogers JG, O’Connor C

Mental stress can induce myocardial ischemia and also has been implicated in triggering cardiac events. However, pharmacological interventions aimed at reducing mental stress-induced myocardial ischemia (MSIMI) have not been well studied.To examine the effects of 6 weeks of escitalopram treatment vs placebo on MSIMI and other psychological stress-related biophysiological and emotional parameters.The REMIT (Responses of Mental Stress Induced Myocardial Ischemia to Escitalopram Treatment) study, a randomized, double-blind, placebo-controlled trial of patients with clinically stable coronary heart disease and laboratory-diagnosed MSIMI. Enrollment occurred from July 24, 2007, through August 24, 2011, at a tertiary medical center.Eligible participants were randomized 1:1 to receive escitalopram (dose began at 5 mg/d, with titration to 20 mg/d in 3 weeks) or placebo over 6 weeks. MAIN OUTCOMES AND MEASURES: Occurrence of MSIMI, defined as development or worsening of regional wall motion abnormality; left ventricular ejection fraction reduction of 8% or more; and/or horizontal or down-sloping ST-segment depression of 1 mm or more in 2 or more leads, lasting for 3 or more consecutive beats, during 1 or more of 3 mental stressor tasks.Of 127 participants randomized to receive escitalopram (n = 64) or placebo (n = 63), 112 (88.2%) completed end point assessments (n = 56 in each group). At the end of 6 weeks, more patients taking escitalopram (34.2% [95% CI, 25.4%-43.0%]) had absence of MSIMI during the 3 mental stressor tasks compared with patients taking placebo (17.5% [95% CI, 10.4%-24.5%]), based on the unadjusted multiple imputation model for intention-to-treat analysis. A significant difference favoring escitalopram was observed (odds ratio, 2.62 [95% CI, 1.06-6.44]). Rates of exercise-induced ischemia were slightly lower at 6 weeks in the escitalopram group (45.8% [95% CI, 36.6%-55.0%]) than in patients receiving placebo (52.5% [95% CI, 43.3%-61.8%]), but this difference was not statistically significant (adjusted odds ratio; 1.24 [95% CI, 0.60-2.58]; P = .56).Among patients with stable coronary heart disease and baseline MSIMI, 6 weeks of escitalopram, compared with placebo, resulted in a lower rate of MSIMI. There was no statistically significant difference in exercise-induced ischemia. Replication of these results in multicenter settings and investigations of other medications for reducing MSIMI are Identifier: NCT00574847. HubMed – depression