Eric Chan, PhD’s Post

🔎 💊 European Medicines Agency safety committee, the #PRAC, at its July meeting has recommended new measures to minimise the risk of aspiration with GLP-1 medicines during anaesthesia and deep sedation. Patients treated with GLP-1 medicines should inform the doctor involved if they have a planned surgery. The PRAC also agreed a direct healthcare professional communication (DHPC) for glatiramer acetate, a medicine authorised for the treatment of relapsing forms of multiple sclerosis. Following an EU-wide review of all available data, the PRAC concluded that the medicine is associated with anaphylactic reactions which may occur even after months up to years after initiation of treatment. Cases with a fatal outcome have been reported. The DHPC will inform healthcare professionals about this risk and recommend that patients and/or caregivers be advised of the signs and symptoms and to seek emergency care in the event of an anaphylactic reaction. Read more: https://lnkd.in/eKPBbPFf

In cases of abnormal uterine bleeding and hormonal dysfunction, medical treatment is done using hormonal drugs. But in case of not responding to drug treatment by rejecting other pathological conditions, diagnostic curettage is suggested. 👩🏻 In this method, the gynecologist surgeon takes a piece from the inner layer of the uterus in the operating room under sterile conditions and under general anesthesia and sends the sample to the laboratory for diagnosis. Diagnostic curettage (D / C) is a diagnostic-therapeutic method used in cases of abnormal bleeding in women. Sometimes, for better evaluation of the uterine cavity, diagnostic curettage can be performed under hysteroscopy instead of blind curettage.

What is diagnostic curettage? In cases of abnormal uterine bleeding and hormonal dysfunction, medical treatment is done using hormonal drugs. But in case of not responding to drug treatment by rejecting other pathological conditions, diagnostic curettage is suggested. 👩🏻 In this method, the gynecologist surgeon takes a piece from the inner layer of the uterus in the operating room under sterile conditions and under general anesthesia and sends the sample to the laboratory for diagnosis. Diagnostic curettage (D / C) is a diagnostic-therapeutic method used in cases of abnormal bleeding in women. Sometimes, for better evaluation of the uterine cavity, diagnostic curettage can be performed under hysteroscopy instead of blind curettage.

45 years ago, Viby-Morgensen et al. shed light on the startling rate of residual neuromuscular block in the recovery room and called for routine neuromuscular monitoring! • • • “Our results emphasize three points: First, that residual curarization in the recovery room remains a problem in patients not monitored with a nerve stimulator; Second, that anesthetists tend toward the use of high dosages of relaxants and are giving insufficient attention to the problem of residual curarization; Third, that in the face of such relatively high relaxant dosages, a total dosage of neostigmine of 2.5 mg is insufficient for reversing neuromuscular blockade in about 40 percent of patients. We recommend that neuromuscular monitoring be used more extensively during anesthesia, as well as postoperatively, for titrating reversal with anticholinesterase drugs.” • • • In celebration of these authors, let’s bring more light to the under-appreciated and dangerous condition of residual neuromuscular blockade! Learn more about how TwitchView can help prevent residual neuromuscular blockade at www.blinkdc.com/twitchview #TwitchView #ResidualNeuromuscularBlockade #PatientSafety

Perioperative Management of Anticoagulant and Antiplatelet Therapy

What is the best approach for a glenohumeral hydrodilatation procedure? . . I have been doing glenohumeral hydrodilatation (GH HD) for close to a decade now, and I have revised my technique and approach numerous times. When I perform this procedure now I will start with a suprascapular nerve block (anterior approach), then I will inject a few cc of anesthetic in the posterior GH joint under US guidance, in-plane. After that I will do a "ligament release" of the CHL at its insertion on the coracoid, while having an assistant progressively provide more glenohumeral ER to help loosen the ligament (which I find is often thickened and "contracted" in adhesive capsulitis (AC)). At this point I will then perform the actual GH HD, and this is where my approach can vary; anterior or posterior. Finally I perform aggressive OMT while the anesthetic and nerve blocks are still active, and typically I can break up a good amount of the adhesions while they are still on my table in my office. . So let's talk about the GH HD approach: I learned this through the posterior approach, and this has worked well for ~90% of the cases I have performed this on. The remaining 10% of cases I have to come back and do an anterior approach on them, and this seems to be the final step. I recently did a case of bilateral AC, and did both sides with the posterior approach. The right side, which was the patient's worse side, did profoundly well. The left side did well, but still had deficits. After a couple of weeks of very active PT and a diligent HEP we came back and did the anterior approach on this shoulder, and that did the job! . So what factors should we look at on a patient's history, physical exam, and/or imaging that could influence whether the anterior, posterior, or a combination approach, is needed? I get subtle clues from the physical exam, notably in testing where the capsular restriction is when performing PROM and AAROM. I have seen thickened anterior capsules and CHL's on MRI and US that still responded to posterior GH HD, so not sure if imaging is the answer. . What are your thoughts?! #adhesivecapsulitis #frozenshoulder #shoulderpain #hydrodilatation #brisement https://lnkd.in/g6xUYUxz

Two common corticosteroids that you will encounter in clinical practice are methylprednisolone acetate (MPA) and triamcinolone acetonide (TA). For many years, The Society of Musculoskeletal Medicine have advocated the use of TA. This decision would seem to be supported by the results of the recent, prospective study ⬇ for shoulder injections. This study concluded that TA injections resulted in a >5-fold reduction in steroid flare reactions, with statistically superior 6-month efficacy rates, compared with MPA injections. This study supports TA as a more viable corticosteroid option for shoulder injection. https://lnkd.in/diw3yJq9

Perioperative Management of Anticoagulant and Antiplatelet Therapy.

⭐️Using Steroids in an Insulin Pump ⭐️ I just did my first device training using Solu-Cortef in a pod for a lady struggling with Addison’s disease & it’s complications. The current steroid medications on the market have a hard time matching up with the physiology & timing to replace the work of the adrenal glands. But a few Endo’s have started using OFF-LABEL Solu-Cortef in a sub-cutaneous infusion through an insulin pump, which mimics the ups & downs of cortisol & the delicate sleep wake cycles. This pt is already seeing improvements, esp with energy & sleep, after only a few weeks of infusion. ➡️ She uses a 2:1 diluted solution of Solu-Cortef, which seems to help with crystallization and occlusions, plus helps with site absorption/ scar tissue. (~50 units total daily dose/ 25mg) ➡️ She has a “sick day” basal program ⬆️ 240% to offset stressors like with surgery or illness. 🎉 It’s AMAZING how all this medical technology can really change lives! 💕 WATCH MY IG VIDEO here: https://lnkd.in/gg59RKUc ** these statements have not been approved by the FDA. Consult your physician about changes in your treatment & administration.

1.7% or less causes minimal irritation and can be applied to the conjunctiva without prior anesthetic agent; we switched to 1.7% PI more than 2 years ago without any PIE in more than 10,000 intravitreal injections ( below article) I flush with 1.67% 1/3 of 5% 1 part 5% 2 parts BSS Then apply gel for 10 minutes inferior Patient closes both eyes Then bladed speculum Flush with 5% inject in inferior temporal Then rinse with speculum in