Use Of Pharmacological Adjuncts Research Articles

(417) Erectile Function after Treatment for Non-ischemic Priapism

Abstract Introduction Non-ischemic priapism (NIP) is a rare subtype of priapism that typically arises from a straddle injury leading to the formation of an arterial-sinusoidal fistula, which results in partial penile tumescence. NIP can be managed conservatively, with selective arterial embolization, or, rarely, with surgical arterial ligation. These treatments have varying rates of success and post-treatment erectile dysfunction (ED), but there is a paucity of studies that include long-term outcomes. We present long term follow up of 23 three patients in a large centre offering all interventions. Objective Follow up 23-patients presenting with non-ischemic priapism, evaluating long term erectile function in both those who did and didn’t require intervention in the form of embolization. Methods We conducted a single-centre retrospective cross-sectional study looking at erectile function (EF) in a cohort of 23 patients over a median follow-up of 61 months. Patients’ EF was assessed using the erectile function domain (IIEF-EF) of the British Association of Urological Surgeons (BAUS) International Index of Erectile Function (IIEF) questionnaire, and ED was defined as a score ≤ 25 and/or the use of pharmacological adjuncts to assist EF. This is the largest and longest study in this field of its type. Results o Our cohort had a median IIEF-EF score of 28, and 4 patients (17.4%) reported using adjuncts. 21 patients were treated with embolization, and 2 were managed conservatively. o 91.3% required treatment with embolization, 17.4% needed adjunctive agents o 4.3% reported suffering a further episode of priapism (single iatrogenic episode) o 0% ED in conservative management group, 47.6% ED in embolization group. Conclusions We had a higher ED rate with embolization compared to the literature (47.6% vs 15-22%). Although no patients treated conservatively had ED at follow-up, there were only 2 patients in this group. Our study’s validity is negatively affected by many factors: its retrospective nature, a small sample size, and confounding from a heterogeneous group of patients. Ultimately, NIP is a rare condition with good treatment outcomes which are constantly improving and evolving. Disclosure No

Placenta Accreta Spectrum Disorders: Knowledge Gaps in Anesthesia Care.

Placenta accreta spectrum (PAS) disorder is a potentially life-threatening condition that can occur during pregnancy. PAS puts pregnant individuals at a very high risk of major blood loss, hysterectomy, and intensive care unit admission. These patients should receive care in a center with multidisciplinary experience and expertise in managing PAS disorder. Obstetric anesthesiologists play vital roles in the peripartum care of pregnant patients with suspected PAS. As well as providing high-quality anesthesia care, obstetric anesthesiologists coordinate peridelivery care, drive transfusion-related decision making, and oversee postpartum analgesia. However, there are a number of key knowledge gaps related to the anesthesia care of these patients. For example, limited data are available describing optimal anesthesia staffing models for scheduled and unscheduled delivery. Evidence and consensus are lacking on the ideal surgical location for delivery; primary mode of anesthesia for cesarean delivery; preoperative blood ordering; use of pharmacological adjuncts for hemorrhage management, such as tranexamic acid and fibrinogen concentrate; neuraxial blocks and abdominal wall blocks for postoperative analgesia; and the preferred location for postpartum care. It is also unclear how anesthesia-related decision making and interventions impact physical and mental health outcomes. High-quality international multicenter studies are needed to fill these knowledge gaps and advance the anesthesia care of patients with PAS.

Pharmacological Tests in Atrial Fibrillation Ablation.

The invasive management of atrial fibrillation (AF) has been considerably changed by the identification of major sites of AF initiation and/or maintenance within the pulmonary vein antra. Percutaneous catheter ablation of these targets has become the standard of care for sustained maintenance of sinus rhythm. Long-term failure of ablation is related to an inability to create a durable transmural lesion or to identify all of the non-pulmonary vein arrhythmia triggers. Pharmacological challenges during catheter ablation have been suggested to improve outcomes in both paroxysmal and persistent AF. Herein we review the mechanism and evidence for the use of pharmacological adjuncts during the catheter ablation of AF.

Pharmacological adjuncts to stop bleeding: options and effectiveness.

Severe trauma and massive haemorrhage represent the leading cause of death and disability in patients under the age of 45 years in the developed world. Even though much advancement has been made in our understanding of the pathophysiology and management of trauma, outcomes from massive haemorrhage remain poor. This can be partially explained by the development of coagulopathy, acidosis and hypothermia, a pathological process collectively known as the “lethal triad” of trauma. A number of pharmacological adjuncts have been utilised to stop bleeding, with a wide variation in the safety and efficacy profiles. Antifibrinolytic agents in particular, act by inhibiting the conversion of plasminogen to plasmin, therefore decreasing the degree of fibrinolysis. Tranexamic acid, the most commonly used antifibrinolytic agent, has been successfully incorporated into most trauma management protocols effectively reducing mortality and morbidity following trauma. In this review, we discuss the current literature with regard to the management of haemorrhage following trauma, with a special reference to the use of pharmacological adjuncts. Novel insights, concepts and treatment modalities are also discussed.

Pulmonary Rehabilitation and Pharmacotherapy

Though pulmonary rehabilitation can have potent effects on exercise capacity and quality of life in chronic obstructive pulmonary disease (COPD), not all patients benefit to the same degree. Enabling patients to achieve higher training intensities may improve exercise capacity. Adding pharmacological agents to target the abnormal ventilatory mechanics or skeletal muscle dysfunction may enhance the effects of exercise training. This review discusses the rationale and clinical evidence supporting the use of pharmacological adjuncts during the course of pulmonary rehabilitation.

Pharmacological adjuvants during infertility surgery: A systematic review of evidence derived from randomized controlled trials

The aim of this study was to evaluate systematically the role of pharmacological agents used as adjuvants during infertility surgery to prevent or reduce postoperative adhesion formation and improve pregnancy rates. Meta-analyses were performed of the ten randomized controlled trials identified that evaluated the use of pharmacological adjuvants at infertility surgery. The administration of steroids, dextran 70, noxytioline, heparin, or promethazine have all been investigated for their adjuvant role in preventing adhesion formation during pelvic surgery for infertility. Outcome measures were taken as: pregnancy rates after infertility surgery; number of patients with absent, improved or deteriorated adhesions at second look laparoscopy (dichotomous outcomes); and changes in adhesion score from initial surgery to second look laparoscopy (ordinal outcome). None of the pharmacological adjuncts investigated in a randomized controlled fashion was shown to improve postoperative pregnancy rates. There was some evidence that steroids reduced the incidence or severity of postoperative adhesion formation; there was little evidence to support the use of dextran. The routine use of pharmacological adjuncts during infertility surgery cannot be recommended on the basis of the available evidence derived from randomized controlled trials. Dextran appears to offer no advantage. The evidence with regard to steroids is far from conclusive but tentatively indicates that they may be beneficial.

The Use of Pharmacological Adjuncts in the Psychotherapy of Alcoholics

The Use of Pharmacological Adjuncts in the Psychotherapy of Alcoholics