Dexmedetomidine versus propofol for prolonged sedation in critically ill trauma and surgical patients.

BACKGROUND: and Purpose: Currently, dexmedetomidine versus propofol has primarily been studied in medical and cardiac surgery patients with outcomes indicating safe and effective sedation. The purpose of this study was to assess the efficacy of dexmedetomidine versus propofol for prolonged sedation in trauma and surgical patients. METHODS: This was a single-center prospective study conducted in the Trauma/Surgical Intensive Care Unit (ICU) at a Level I academic trauma center. It included patients 18 years of age or older requiring mechanical ventilation who were randomly assigned based on unit bed location to receive either dexmedetomidine or propofol. The primary outcome was duration of mechanical ventilation. Secondary outcomes included mortality; proportion of time in target sedation; incidence of delirium, hypotension, and bradycardia; and ICU and hospital length of stay (LOS). RESULTS: A total of 57 patients were included. Baseline characteristics were similar between groups. There was no significant difference in duration of mechanical ventilation (median [IQR]) between the dexmedetomidine (78.5[125] hours) and propofol (105[130] hours; p = 0.15) groups. There was no difference between groups in ICU mortality, ICU and hospital LOS, or incidence of delirium. Safety outcomes were also similar. Patients in the dexmedetomidine group spent a significantly greater percentage of time in target sedation (98[8] %) compared to propofol group (92[10] %; p = 0.02). CONCLUSIONS: Our results suggest that, similar to medical and cardiac surgery patients, dexmedetomidine and propofol are safe and effective sedation agents in critically ill trauma and surgical patients; however, dexmedetomidine achieves target sedation better than propofol for this specific population.

One-male harems and female social dynamics in Guinea baboons.

Little is known about the mating system and social organization of Guinea baboons. This study investigated whether Guinea baboons have a harem-based mating system similar to that of hamadryas and gelada baboons and whether one-male mating units also correspond to social units. Ten adult females in a captive multi-male multi-female group of Guinea baboons were focally observed 2 h per week for 12 weeks, and all observed copulations within the group were recorded. Some males copulated with a single female while others had harems of 2-4 females. All females copulated with a single male except 1 female that switched harems early in the study. The focal females had higher rates of social interaction with their harem members, especially their harem male, than with individuals outside the harem. Females appeared to be subordinate to the harem male but little or no physical aggression or herding behavior from the male was observed. Variation in female social interactions within the harem was not accounted for by their sexual interactions with the male or their genetic relatedness with the females. Females, however, appeared to maintain social relationships with their female relatives in other harems. Taken together, the results of this study show that both mating and affiliative interactions in Guinea baboons are concentrated within one-male units and that the social dynamics within and between these units share some similarities as well as differences with those of hamadryas and gelada baboons.

AANA journal course. Update for nurse anesthetists. 2. Anticoagulation and spinal and epidural anesthesia.

An increasing number of surgical patients preoperatively are taking anticoagulant medications. These patients are at an increased risk for development of epidural hematoma with spinal or epidural anesthesia. It is the responsibility of the anesthesia provider to understand and anticipate this risk and to alter the anesthetic plan accordingly. The purpose of this AANA Journal course is to update anesthesia providers regarding the common anticoagulants used for surgical patients, the risks associated with epidural and spinal anesthesia in conjunction with anticoagulation, and recommendations for the use of epidural and spinal anesthesia in anticoagulated patients. Antiplatelet drugs, oral anticoagulants, heparin, low-molecular-weight heparin, other new anticoagulants, and herbal medications are reviewed. When spinal or epidural anesthesia is considered for a patient who has been taking anticoagulant medications, the risk of epidural hematoma vs the benefits of regional anesthesia must be weighed carefully. Appropriate management of the patient extends well into the postoperative period and should include anesthesia providers, attending physicians, and nurses.