Friday March 2, 2007
Vancomycin induced thrombocytopenia
So far Vancomycin was not blamed for thromboctopenia but this week in The New England Journal of Medicine, case series of 34 patients with vancomycin induced thrombocytopenia has been reported. The mean nadir platelet count was 13.6, with severe bleeding reported in 10 patients. Drug-dependent, platelet-reactive antibodies of the IgG class, the IgM class, or both were identified.
Platelet levels returned to baseline after vancomycin was stopped.
Related previous pearl: Vancomycin-induced Stevens-Johnson syndrome
Reference: click to get abstract
Vancomycin-Induced Immune Thrombocytopenia - Volume 356:904-910, The New England Journal of Medicine, March 1, 2007, number 9
Friday, March 2, 2007
Wednesday, February 28, 2007
Thursday March 1, 2007
Regarding Dexmedetomidine (Precedex)
One sedative which has been successfully used in cardiothoracic ICUs but didn't made real penetration in medical ICUs is Dexmedetomidine (Precedex).
The unique property of precedex of no respiratory depression helps in extubating agitated patients and can be continued beyond extubation (which is in contrast to other sedatives) . Another advantage of Precedex is its analgesic property. It minimize the simultaneous use of other analgesics. It possesses anxiolytic, anesthetic, hypnotic, and analgesic properties.
The dose is IV bolus of 1 mcg/kg over a 10-minute period, followed by a continuous IV infusion of 0.2 mcg/kg per hour which can be titarted upto 0.7 mcg/kg. Due to lack of data on this drug some hospitals restrict its use for 24 to 48 hours.
This drug should be avoided with bradycadia and heart blocks. Interestingly, continuous infusion cause hypotension as like propofol but hypertension can occur with loading dose !!
See nice review article: The Role of Dexmedetomidine (Precedex) in the Sedation of Critically Ill Patients (ref: P&T, Vol. 30 No. 3 • March 2005 , 158-161)
Regarding Dexmedetomidine (Precedex)
One sedative which has been successfully used in cardiothoracic ICUs but didn't made real penetration in medical ICUs is Dexmedetomidine (Precedex).
The unique property of precedex of no respiratory depression helps in extubating agitated patients and can be continued beyond extubation (which is in contrast to other sedatives) . Another advantage of Precedex is its analgesic property. It minimize the simultaneous use of other analgesics. It possesses anxiolytic, anesthetic, hypnotic, and analgesic properties.
The dose is IV bolus of 1 mcg/kg over a 10-minute period, followed by a continuous IV infusion of 0.2 mcg/kg per hour which can be titarted upto 0.7 mcg/kg. Due to lack of data on this drug some hospitals restrict its use for 24 to 48 hours.
This drug should be avoided with bradycadia and heart blocks. Interestingly, continuous infusion cause hypotension as like propofol but hypertension can occur with loading dose !!
See nice review article: The Role of Dexmedetomidine (Precedex) in the Sedation of Critically Ill Patients (ref: P&T, Vol. 30 No. 3 • March 2005 , 158-161)
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