Why hasn’t dad woken up after his heart surgery?

January 26, 2008

Sedation helps patients tolerate the uncomfortable bodily invasions of high tech intensive care. But when dad isn’t “waking up”, or just “isn’t himself”, many family members want to know whether sedatives are responsible for the prolonged problems with wakefulness, memory, and cognition seen in a significant number of patients who have received care in the Intensive Care Unit (ICU).

Benzodiazepines like lorazepam (Ativan)(cousin:Valium) are inexpensive, effective and safe sedatives for this purpose, with very little impact on organ systems other than the brain (that’s a good thing).Flowers

Dexmedetomidine is a new sedative drug marketed as the more easily pronounceable Precedex™. It is cousin to clonidine, a blood pressure medicine that’s been around for many years, which also has sedative properties. Precedex has pain-relieving properties and can cause the heart to slow and the blood pressure to drop in some patients.

Because Precedex works in a different way to the standard sedatives (it blocks alpha-adrenergic receptors) there is hope that it represents a better option for some conditions and procedures. Could it have less long term effect than other drugs on the brain?

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How to Avoid (One Type of) Hospital Infection

January 24, 2008

Peter Pronovost is a different kind of medical hero. An anesthesiologist who is making an impact on hospital care far greater than almost any new pharmaceutical or high-tech surgical technique.

Implementation of Pronovost’s simple checklist for prevention of catheter-related bloodstream infection – the infection that can arise from intravenous lines inserted into the central circulation – has resulted in a dramatic reduction in these infections in a large group of Michigan hospitals. In many hospitals, the incidence, quite astonishingly, dropped to ZERO, sustained over a period of months.

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