- |||||||||| tranexamic acid oral / Generic mfg.
Serotonin- Like- Syndrome Resulting From Tranexamic Acid Applied to Airways During Flexible Bronchoscopy (San Diego Convention Center, Area I (Hall H, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_6146;
He was sedated with fentanyl and propofol...He was intubated, placed on a midazolam infusion, and ultimately required paralysis with vecuronium infusion to stabilize his temperature and heart rate...There have also been reports of similar neurotoxicity in patients with chronic kidney disease who have received systemic TXA. This case highlights neurologic toxicity from TXA applied locally during flexible bronchoscopy.
- |||||||||| fentanyl citrate / Generic mfg.
Fentanyl-Induced Wooden Chest Syndrome (San Diego Convention Center, Area K (Hall H, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_6010;
She received treatment for aspergillosis and pneumonia caused by clindamycin-resistant Staphylococcus aureus...However, just before extubation, the patient was transferred to our hospital for further evaluation of her SLE and the initiation of cyclophosphamide treatment...As a result, she received vecuronium to facilitate compliance with the ventilator...It underscores the importance of recognizing and managing this condition when administering high doses of fentanyl, especially in critical care settings. Healthcare providers should be vigilant about such complications to ensure the best possible patient care.
- |||||||||| fentanyl citrate / Generic mfg., levetiracetam / Generic mfg.
CHANTER Syndrome: A Rare Neurological Toxidrome (San Diego Convention Center, Area E (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5945;
DESCRIPTIONA 47-year-old lady with seizure disorder, HIV, SLE, depression, suicide attempts, polysubstance use (PCP, meth, cocaine) and metabolic syndrome was evaluated in the ICU after being found unresponsive 3 days after she had used fentanyl...She was treated with aspirin, atorvastatin, Keppra and hypertonic saline...The grey matter of the hippocampus and basal nuclei is often involved. With early aggressive treatment, outcomes are more favorable compared to hypoxic ischemic encephalopathy.
- |||||||||| fentanyl citrate / Generic mfg., midazolam hydrochloride / Generic mfg.
Severe COVID-19 ARDS With Prone Positioning and Lung Protective Ventilation, While Awake and Receiving Early Rehabilitation (San Diego Convention Center, Area E (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5895;
This ICU setting allowed for guideline-concordant clinical practice for managing mechanical ventilation, pain, sedation, delirium, and early rehabilitation despite many challenges of the pandemic and severe ARDS with prone positioning. The pre-existing clinical practice and ICU culture, along with multidisciplinary collaboration, allowed quick adaptations to address new challenges faced during the COVID-19 pandemic.
- |||||||||| fentanyl citrate / Generic mfg.
Sedative Pharmacodynamics in Patients Supported With Extracorporeal Membrane Oxygenation (San Diego Convention Center, Area K (Hall H, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5865;
There was a strong correlation between propofol concentrations and PSI but a weak correlation between propofol concentrations and respiratory effort, with variable respiratory drive observed across the range of sedative plasma concentrations. No significant correlation was found for fentanyl with PSI or respiratory effort.
- |||||||||| fentanyl citrate / Generic mfg., morphine sulphate / Generic mfg., hydromorphone hydrochloride / Generic mfg.
Variation in Opioid Administration Among Patients Mechanically Ventilated With Acute Respiratory Failure (San Diego Convention Center, Room 5A-B (Upper Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_5373;
We demonstrated wide variation in opioid administration among adults receiving MV for ARF, and determined factors associated with administration of higher opioid doses. Ongoing work is evaluating the impact of practices on outpatient opioid related complications.
- |||||||||| fentanyl citrate / Generic mfg., trimethoprim/sulfamethoxazole / Generic mfg., amphetamine / Generic mfg.
Pneumocystis Jirovecii Pneumonia in an Immunocompetent Patient With Inhalation Injury, A Case Report With Literature Review (San Diego Convention Center, Area E (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_3496;
The toxicology screen was positive for amphetamine, opiates, fentanyl, and cocaine...The patient was started on intravenous sulfamethoxazole-trimethoprim and corticosteroids...Notably, the use of glucocorticoids in patients without HIV is controversial10,11. In conclusion, we experienced and added to literature a case of PJP in an immunocompetent state without the identifiable risk factor with a favorable outcome.
- |||||||||| Opdivo (nivolumab) / BMS
Nivolumab Induced Myxedema Coma (San Diego Convention Center, Area L (Hall H, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_3353;
25), urine toxicology screen was positive for fentanyl and benzodiazepines, normal cortisol level of 13...He was supported with bilevel positive airway pressure ventilation, and the hyperkalemia was temporized with furosemide, insulin, and calcium gluconate...He was given hydrocortisone 50 mg every 6 hours and levothyroxine load of 200 mcg with subsequent improvement of acute kidney injury, hypercarbic respiratory failure, and encephalopathy within 24 hours...It carries a high mortality rate of 20-29. 5%, often in part due to delay in diagnosis.
- |||||||||| Culture Negative Infective Endocarditis Secondary to Septic Emboli of Lung (San Diego Convention Center, Area I (Hall H, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_1982;
Case:32-year-old female with underlying DM, HTN,hypothyroidism, IVDU, polysubstance abuse, chronic smoker,medication non-compliance presenting to the ED for right sided chest pain since overdosed on fentanyl 1...UDS: + Amphetamine...The ID team initially recommended Ceftriaxone, metronidazole, vancomycin, Amphotericin B, then switched to Doxycycline and fluconazole...Patients with suspected lung abscess from aspiration, empiric antibiotics that penetrate the lung parenchyma and target both strict anaerobes and facultatively anaerobic streptococci: beta-lactam/beta-lactamase inhibitor for most patients or a carbapenem because of rising penicillin resistance rates among anaerobes, For patients who cannot use beta-lactams, monotherapy with clindamycin, moxifloxacin, or combination therapy with levofloxacin plus metronidazole are reasonable alternatives...Illicit drugs are widely consumed by an increasing number of persons, correct diagnosis and appropriate treatment planning in the presence of respiratory manifestations require familiarity with the wide spectrum of morbidities and pulmonary dangers associated with their abuse. Aspiration pneumonia and CAP probably represent the most common complications
- |||||||||| fentanyl citrate / Generic mfg.
A Rare Case of a Bronchocutaneous Fistula After Xylazine Use (San Diego Convention Center, Area A (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_1707;
Introduction: The concurrent use of xylazine with heroine and/or fentanyl showed a significant increase of 31% in 2019 compared to 2% reported from 2010 to 2015...In this case, conservative wound debridement resulted in some improvement in the fistula. Managing patients with rare complications related of polysubstance use disorders necessitate comprehensive multidisciplinary management to ensure appropriate care.
- |||||||||| fentanyl citrate / Generic mfg.
IVDU, I Can't Hear You: Sudden Hearing Loss After Fentanyl Use (San Diego Convention Center, Area A (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_1705;
Prior cases note that hearing loss is sometime irreversible, depending on the offending agent, duration of exposure, and overall health status. Given the recent rise in both direct fentanyl use, and street drugs tainted with fentanyl, better awareness and understanding of this phenomenon is needed.
- |||||||||| fentanyl citrate / Generic mfg., buprenorphine/naloxone sublingual film / Generic mfg., naloxone nasal spray / Generic mfg.
No-lax-zone: Side Effects That Can Steal Your Breath Away (San Diego Convention Center, Area A (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_1610;
Although left ventricular dysfunction likely played a role, it underscores the importance of recognizing and managing this adverse effect, particularly with the increasing availability of intranasal naloxone. Raising awareness among patients and healthcare providers about the potential complications associated with naloxone is vital to ensure safe and effective opioid overdose management.
- |||||||||| Trevyent (treprostinil PatchPump) / Correvio, United Therapeutics Corp
Beyond the High: The Association Between Cocaine Use and Severe Pulmonary Arterial Hypertension in a 48-year-old Patient (San Diego Convention Center, Area A (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_1609;
Urine toxicology was positive for cannabis, cocaine, and fentanyl...Potential mechanisms include inhibition of sympathetic neurotransmitters (norepinephrine, dopamine and serotonin) reuptake at synaptic junctions, direct stimulation of endothelial cells, and the release of potentvasoconstrictors such as Endothelin-1 augmenting the pulmonary vasculature. The paradoxical equilibrium between severely elevated PA pressures and minor clinical symptoms is an uncommon phenomenon that resolved quickly upon abstinence from cocaine use and therapy with oral Tadalafil.
- |||||||||| fentanyl citrate / Generic mfg.
A Case of Non-cardiogenic Pulmonary Edema Secondary to Fentanyl Overdose (San Diego Convention Center, Area A (Hall A-B2, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_1608;
Although treatment is largely supportive a minority of patients will require mechanical ventilation making prompt diagnosis and management essential. With increasing prevalence of drug overdoses related to ultra-potent opioids like fentanyl ongoing research on their potential complications like NCPE is the need of the day.
- |||||||||| fentanyl citrate / Generic mfg., dexamethasone / Generic mfg.
Elevated Inflammation Sepsis Phenotype as a Potential Risk Factor for Propofol Related Infusion Syndrome: A Case Report (San Diego Convention Center, Area K (Hall H, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_1186;
Her steroids were changed to dexamethasone for severe ARDS...Despite lower than typical cumulative propofol doses, this case illustrates that an elevated inflammatory phenotype along with other additional risk factors may confer an increased risk for PRIS even at lower cumulative doses. Understanding risk factors for PRIS allows for more timely recognition and treatment of this critical complication.
- |||||||||| fentanyl citrate / Generic mfg., midazolam hydrochloride / Generic mfg.
Brugada Syndrome Discovered After Cardiac Arrest (San Diego Convention Center, Area K (Hall H, Ground Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_1171;
Catheter ablation or medications such as quinidine may be considered in patients who have arrhythmic storms or repeated ICD shocks. It is important to avoid medications that can induce Brugada pattern on ECG such as beta blockers, calcium channel blockers, propofol and lithium.
- |||||||||| fentanyl citrate / Generic mfg.
Fentanyl Induced Chest Wall Rigidity Syndrome (San Diego Convention Center, Room 5A-B (Upper Level)) - Feb 20, 2024 - Abstract #ATS2024ATS_764;
This potential adverse effect should remain on the intensive care physician's differential in patients with recent opioid administration who develop high peak and plateau pressures, a rise in delta ETCO2 by capnography, and signs of muscle rigidity without alternative causes. Early management can lead to prevention of severe respiratory compromise or death.
- |||||||||| fentanyl citrate / Generic mfg., methadone / Generic mfg.
Journal: Routes of Drug Use Among Drug Overdose Deaths - United States, 2020-2022. (Pubmed Central) - Feb 19, 2024
Similar trends were observed among deaths with both IMFs and stimulants detected. Strengthening public health and harm reduction services to address overdose risk related to diverse routes of drug use, including smoking and other noninjection routes, might reduce drug overdose deaths.
- |||||||||| morphine sulphate / Generic mfg.
Journal: Morphine exposure and prematurity affect flash visual evoked potentials in preterm infants. (Pubmed Central) - Feb 19, 2024
In our cohort VEP morphology did not predict neurological outcome. Morphine administration should be evaluated according to potential risks and benefits, and dosage individually accustomed, according to pain and comfort scores, considering the possible risk for neurodevelopmental impairment.
- |||||||||| fentanyl citrate / Generic mfg., morphine sulphate / Generic mfg., tramadol hydrochloride / Generic mfg.
NUTRITIONAL TRACKING IN PEDIATRIC BONE MARROW TRANSPLANT RECOVERY (ePoster area) - Feb 14, 2024 - Abstract #EBMT2024EBMT_2110;
The most common cause of malnutrition in transplanted children is the prolonged occurrence of mucositis, necessitating long-term administration of parenteral nutrition. Additionally, the early recognition of total body weight changes, data collection, and monitoring serum protein and albumin values are crucial for timely identification and prevention of malnutrition.
- |||||||||| fentanyl citrate / Generic mfg.
Journal, IO biomarker, Metabolomic study: Untargeted metabolomics yields insight into extramammary Paget's disease mechanisms. (Pubmed Central) - Feb 13, 2024
In the following feature selection analyses, four metabolites, namely, cyclopentyl fentanyl-d5, LPI 17:0, guanosine-3',5'-cyclic monophosphate, kynurenine (KYN, high in EMPD) were identified by both random forest and support vector machine analyses...In conclusion, this study was the first to reveal the metabolome profile of EMPD. Our results demonstrate that IDO1/TDO2-initialized KYN metabolic pathway may play a vital role in the development and progression of EMPD, which may serve as a potential therapeutic target for treating EMPD.
- |||||||||| Sublocade (buprenorphine once-monthly depot) / Indivior
Journal: The Devil's in the Depot Details: Case of Iatrogenic Opioid Intoxication After Buprenorphine Injection Requiring Surgical Excision. (Pubmed Central) - Feb 12, 2024
In the event of adverse medication effects including oversedation, LAI-BUP can be surgically excised up to 14 days after administration (https://www.sublocadehcp.com/dosing-administration)...We report a case of a man with methamphetamine use disorder and multiple unintentional fentanyl overdoses who inadvertently received LAI-BUP for overdose protection...Providers seeking to use LAI-BUP to prevent overdose among those with unintentional opioid exposure must ensure sublingual buprenorphine tolerance before injection to avoid iatrogenic harm. Although manufacturer instructions mention that LAI-BUP can be excised under local anesthesia within 14 days of insertion, ideal excision is best performed in a setting with surgical instruments and cautery-such as the operating room-as the depot can adhere strongly to the surrounding subcutaneous tissue.
- |||||||||| fentanyl citrate / Generic mfg., tramadol hydrochloride / Generic mfg.
Journal, Surgery: Analgaesic Effect of Erector Spinae Plane Block in Coronary Surgery: A Randomised Controlled Trial. (Pubmed Central) - Feb 12, 2024
Despite the shortcomings of the healthcare system in Morocco, our study indicates that the anaesthesia practice at CHUIS remains highly acceptable by adhering to the highest international standards. Preemptive ESP block application in CABG surgery patients reduced postoperative tramadol demand, intraoperative fentanyl demand, and postoperative pain scores.
- |||||||||| ketamine / Generic mfg.
Observational data, Retrospective data, Journal: The Role of Ketamine as a Component of Multimodal Analgesia in Burns: A Retrospective Observational Study. (Pubmed Central) - Feb 10, 2024
Ketamine was an independent predictor of lower intraoperative fentanyl consumption, according to the multivariate regression analysis (p = 0.015). Contrarily, both groups of patients required postoperative tramadol treatment, while intraoperative ketamine administration had no beneficial effects on postoperative pain management.
- |||||||||| fentanyl citrate / Generic mfg.
Journal: Long-acting Injectable PrEP Interest and General PrEP Awareness among People who Inject Drugs in the San Diego-Tijuana Border Metroplex. (Pubmed Central) - Feb 6, 2024
Compared to the odds of being interested in LAI-PrEP only, the odds of being interested in oral PrEP only were lower among those who were stopped by police (AOR?=?0.38, 95% CI: 0.22-0.65), reported past 6-month fentanyl injection (AOR?=?0.33, 95% CI: 0.20-0.56), polydrug use (AOR?=?0.48, 95% CI: 0.27-0.86), injecting multiple times daily (AOR?=?0.26, 95% CI: 0.14-0.46), receptive syringe use (AOR?=?0.30, 95% CI: 0.19-0.49), and higher perceived HIV risk (AOR?=?0.24, 95% CI: 0.15-0.39). Interest in LAI-PrEP was more common among PWID reporting social and structural factors that could interfere with oral PrEP adherence, suggesting LAI-PrEP implementation could increase PrEP coverage among those most vulnerable to HIV.
- |||||||||| fentanyl citrate / Generic mfg.
Journal: Is This Safe? Examining Safety Assessments of Illicit Drug Purchasing on Social Media Using Conjoint Analysis. (Pubmed Central) - Feb 6, 2024
Background: Illicit substance sales facilitated by social media platforms are a growing public health issue given recent increases in overdose deaths, including an alarming rise in cases of fentanyl poisoning...Additionally, those who were younger in age, had higher income, and identified as female were more likely to purchase from a greater number of platforms. These findings can assist in developing more precise content moderation for platforms seeking to address this ongoing threat to public safety.
- |||||||||| fentanyl citrate / Generic mfg., morphine sulphate / Generic mfg., tramadol hydrochloride / Generic mfg.
Journal: Opioids in geriatric units in 14 Belgian hospitals: prevalence, dosage and associated factors. (Pubmed Central) - Feb 4, 2024
It is not clear whether this reflects under- or overtreatment, but these results can serve as a benchmark for geriatric units to guide future pain management practices. The utilization of transdermal fentanyl and buprenorphine, resulting in higher doses of morphine equivalent, poses significant risks for side effects.
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