Thrombophlebitis junge Propofol - Wikipedia
N Engl J Med ; The efficacy and safety of anticoagulant treatment for patients with acute, symptomatic superficial-vein thrombosis in the legs, Thrombophlebitis junge, but without concomitant deep-vein thrombosis or symptomatic pulmonary embolism Thrombophlebitis junge presentation, have not been established.
Full Text of Background In a randomized, double-blind trial, we assigned patients to receive either fondaparinux, administered subcutaneously at a dose of 2. The primary efficacy outcome was a composite of death from any cause or symptomatic pulmonary embolism, symptomatic deep-vein thrombosis, Thrombophlebitis junge, or symptomatic extension to the saphenofemoral junction or symptomatic recurrence of Kältewickel Cellulite, Krampfadern thrombosis at day The main safety outcome was major bleeding.
The patients were followed until day Full Text of Methods The primary efficacy outcome occurred in 13 of patients 0. The incidence of each component of the primary efficacy outcome was significantly reduced in the fondaparinux group as compared with the placebo group, Thrombophlebitis junge, except for the outcome of death 0. Similar risk reductions were observed at day A total of 88 patients would need to be treated to prevent one instance of pulmonary embolism or deep-vein thrombosis.
Major bleeding occurred in one patient in each group, Thrombophlebitis junge. The incidence of serious adverse events was Thrombophlebitis junge. Full Text of Results Fondaparinux at a dose of 2. Full Thrombophlebitis junge of Discussion Superficial-vein thrombosis of the legs is a common condition, 1,2 with an estimated incidence that may exceed that of deep-vein thrombosis.
The treatment of this Thrombophlebitis junge has not been adequately addressed in randomized trials, Thrombophlebitis junge. Accordingly, the recommendations in various guidelines are weak, and in practice, therapeutic strategies vary, ranging from no treatment to the use of Thrombophlebitis junge agents or anticoagulant drugs or surgery, Thrombophlebitis junge. We conducted the Comparison of Arixtra in Lower Limb Superficial Vein Thrombosis with Placebo CALISTO trial to evaluate the efficacy and safety of fondaparinux, a specific factor Xa inhibitor, in reducing symptomatic venous thromboembolic complications or death from any cause in patients with acute, isolated superficial-vein thrombosis of the legs, Thrombophlebitis junge.
For the active treatment, we selected the prophylactic dose of 2. Hospitalized or nonhospitalized patients 18 years of age or older, with acute, symptomatic lower-limb superficial-vein thrombosis at least 5 cm long, as confirmed by standardized compression ultrasonography, were eligible to undergo randomization, Thrombophlebitis junge.
Patients were excluded if the interval between the onset of their symptoms and planned randomization was more than 3 weeks; if they had been treated for cancer within the previous 6 months; if they presented with symptomatic or asymptomatic deep-vein thrombosis, symptomatic documented pulmonary embolism, or superficial-vein Thrombophlebitis junge associated with sclerotherapy or placement of an intravenous catheter or located Thrombophlebitis junge 3 cm of the saphenofemoral junction; or if they had a documented history of superficial-vein thrombosis within the previous 3 months or deep-vein thrombosis or pulmonary embolism within the previous 6 months.
Other exclusion criteria were major surgery within the previous 3 months Thrombophlebitis junge conditions that could confer a predisposition to bleeding, including severe hepatic impairment, a creatinine clearance of less than 30 ml per minute, and a platelet count of less thanper cubic millimeter.
Finally, women of childbearing age were excluded if they were pregnant or were not using a reliable contraceptive method. Verschwörung von venösen Ulzera trial was Thrombophlebitis junge international, multicenter, Thrombophlebitis junge, randomized, double-blind, placebo-controlled study; the protocolincluding the statistical analysis plan, is available with the full text of this article at NEJM.
With the use of a central telephone system and a computer-generated randomization list, consecutive patients were randomly assigned, in a 1: Randomization was performed in blocks of four without any stratification.
The maximum interval allowed between the qualifying ultrasonographic study and randomization was 48 hours. The day of randomization was defined as day 1, Thrombophlebitis junge. No routine ultrasonographic examinations were required during the follow-up period, Thrombophlebitis junge. The study was conducted according to the ethical principles stated in the Declaration of Thrombophlebitis junge and local regulations. The protocol was approved by an independent ethics committee, and written informed consent was obtained from all patients before they underwent randomization.
The study was funded by GlaxoSmithKline. A steering committee, including one nonvoting member representing the sponsor, was responsible for the design, Thrombophlebitis junge, conduct, and reporting of the study.
Data were collected and analyzed by the study sponsor. The database of adjudicated outcomes was managed by an independent central adjudication committee, Thrombophlebitis junge. The members of the writing committee wrote the first draft of the manuscript and made the decision to submit the manuscript for publication. All the authors contributed to the writing of subsequent drafts of the manuscript, had full access to Thrombophlebitis junge data and analyses, and vouch for the accuracy and completeness of the report, Thrombophlebitis junge, as well as the fidelity of the study to the protocol and statistical analysis plan.
Fondaparinux and placebo were packaged in identical boxes containing visually identical, Thrombophlebitis junge, prefilled 0, Thrombophlebitis junge. Each patient received one box containing 45 single-dose syringes 1 per day for 45 days of either 2. At the time of randomization, patients were provided with an injection diary. The investigators were encouraged to teach the patients to administer the study drugs themselves, but the final decision about self-administration was left to the investigator's discretion.
Patients were encouraged to use graduated compression stockings and were allowed to take Thrombophlebitis junge or topical nonsteroidal antiinflammatory drugs as needed. The primary efficacy outcome was the composite of death from any cause, Thrombophlebitis junge, symptomatic pulmonary embolism confirmed by ventilation—perfusion scanning, helical computed tomography, Thrombophlebitis junge, pulmonary angiography, Thrombophlebitis junge, or autopsysymptomatic deep-vein thrombosis confirmed by ultrasonography or venographyor symptomatic extension to the saphenofemoral junction or symptomatic recurrence of superficial-vein thrombosis confirmed by ultrasonography up to day For definitions of recurrence and extension of superficial-vein thrombosis, see the Supplementary Appendixavailable at NEJM.
Secondary efficacy outcomes were the composite primary efficacy outcome up to day 77 and the following outcomes up to day 47 and day Analyses of safety outcomes were performed with data obtained until day 47 or until 4 days after the last injection of the study drug whichever was longerwith data obtained until 4 days after the last injection of the study treatment on-treatment analysisThrombophlebitis junge, and with data obtained until day Other safety outcomes were clinically relevant nonmajor, minor, Thrombophlebitis junge, and total any bleeding definitions provided in the Supplementary Appendix and arterial thromboembolic events.
All other adverse events that occurred while the patient was receiving treatment were reported. If a thromboembolic or bleeding complication occurred during the course of the study, management of the condition was left to the investigator's discretion.
All symptomatic outcomes were reviewed by the central adjudication committee, whose members were unaware of the patients' group assignments. Patient safety was monitored by an independent data and safety monitoring committee. As planned, the independent steering committee, whose members were unaware of the group assignments, monitored the overall event rate for Großmutter Behandlung von Thrombophlebitis primary efficacy outcome.
On November 5,on the basis of an observed rate of the primary efficacy outcome of 3. Efficacy analyses were performed on data from the intention-to-treat population, Thrombophlebitis junge, which included all the patients who had undergone randomization, Thrombophlebitis junge.
Patients for whom a primary efficacy assessment was lacking i. Safety analyses were performed on Thrombophlebitis junge from the as-treated population, which comprised all patients who had undergone randomization and who had received at least one dose of the study drug, Thrombophlebitis junge. Time-to-event outcomes estimated by means of the Kaplan—Meier method were compared with Thrombophlebitis junge use of the log-rank test.
A prespecified sensitivity analysis was performed in which patients with Thrombophlebitis junge data on the primary efficacy outcome were excluded. Zelen's exact test was used to verify the consistency of the treatment effect across 16 prespecified sets of subgroups and 1 set of subgroups that was defined post hoc.
Between March and Maya total of patients were enrolled at centers in 17 countries see the Supplementary Appendix — in the fondaparinux group and in the placebo group, Thrombophlebitis junge.
Of the patients who underwent randomization, 18 patients in the fondaparinux group 1. Overall, patients in the fondaparinux group Of the patients who underwent randomization, 4 patients in the fondaparinux group and 11 in the placebo group received no study drug as a result of the patient's decision, in each Thrombophlebitis jungeand 1 patient who was randomly assigned to the placebo group received at least one dose of fondaparinux in error; thus, Thrombophlebitis junge, patients in the fondaparinux group The demographic and clinical characteristics of the patients, the medications and interventions the patients received before their entry into the study Table 1 Table 1 Baseline Characteristics of the Study Patients, Thrombophlebitis junge.
In addition, the treatments other than the study drugs that patients received during the course of the study were well balanced between the two groups, with two exceptions: This result was confirmed in the sensitivity analysis in which patients with a missing primary efficacy assessment were excluded data not shown.
The incidence of each component of the primary efficacy outcome was significantly reduced in the fondaparinux group as compared with the placebo group including the incidence of pulmonary embolism [number needed to treat to prevent one pulmonary embolism was ]except for the incidence of death, which did not differ significantly between the two groups.
The primary efficacy outcome was a composite of death from any cause, Thrombophlebitis junge, symptomatic pulmonary embolism, symptomatic deep-vein thrombosis, or symptomatic extension to the saphenofemoral junction or symptomatic recurrence of superficial-vein thrombosis. Data from patients who were lost to follow-up were censored at the time of the last contact. The size of each square is in proportion to the number of patients in the comparison.
Thrombophlebitis junge analysis of subgroups according to the distance of thrombus from the saphenofemoral junction included only subjects who had a thrombosis involving the great saphenous vein.
No adjustment for multiple Thrombophlebitis junge was made, since subgroup analyses were performed for exploratory purposes only. None of the P values for interaction were less than 0. Results for 12 of the 16 prespecified subgroups are presented; the treatment effect was also consistent within each of the 4 other prespecified subgroups defined according to country and status with respect to receipt of graduated compression stockings, use of nonsteroidal antiinflammatory drugs, and use of aspirin or other antiplatelet agents at baselineThrombophlebitis junge, as well as the subgroup defined post hoc defined according to whether the index superficial-vein thrombosis was in a varicose vein on ultrasonographic examination.
The body-mass index is the weight in kilograms divided by the square of the height in meters. ND denotes not determined. Finally, more patients in the placebo group than in the fondaparinux group underwent surgery for superficial-vein thrombosis Table 3including ligation of the saphenofemoral junction, which by day 77 had been performed in 52 patients in the placebo group 3.
By day 47, major bleeding had occurred in one patient 0, Thrombophlebitis junge. The rates of clinically relevant nonmajor, minor, and total bleeding and arterial thromboembolic complications did not differ significantly between the two groups Table 4 Table 4 Safety Outcomes up to Day Safety results were similar in on-treatment analyses and in analyses at day 77 Table 4 in the Supplementary Appendix. There were no clinically relevant between-group differences in the incidence of any other adverse events Table 5 and Table 6 wie Krampfadern in den Eiern zu behandeln the Supplementary Appendix, Thrombophlebitis junge.
The only serious adverse event that was reported in more than one patient in either study group was coronary artery disease, Thrombophlebitis junge, which was reported in two patients in the placebo group 0.
No episodes of thrombocytopenia were reported in the fondaparinux group. In this study, we investigated the effect of anticoagulant therapy as compared with placebo on symptomatic outcomes in patients with isolated superficial-vein thrombosis. Treatment with Thrombophlebitis junge at a dose of 2. The number needed to treat to prevent one event of the primary efficacy outcome was 20, whereas the number needed to treat to prevent deep-vein thromboembolism or a pulmonary embolism was The study was placebo-controlled, since no standard treatment has been established in this clinical setting.
The patients in our study are representative of those encountered in routine practice 1,2,8: The rate of symptomatic thromboembolic complications in the placebo group at day 47 5, Thrombophlebitis junge. However, this rate and the corresponding rate at day 77 6. This benefit was evident within the first days after treatment was initiated Figure 1supporting the adequacy of the prophylactic dose of 2. The number needed to treat to prevent one episode Thrombophlebitis junge pulmonary embolism with fondaparinux as compared with placebo in the patients with superficial-vein thrombosis in our study is similar to the number needed Thrombophlebitis junge treat with low-molecular-weight heparin as compared with placebo or no Thrombophlebitis junge in trials of thromboprophylaxis in acutely ill medical patients In addition, more patients in the placebo group than in the fondaparinux group required therapeutic Thrombophlebitis junge of anticoagulant therapy, Thrombophlebitis junge.
A Thrombophlebitis junge limitation of our study is the difficulty Thrombophlebitis junge applying the data to clinical practice, Thrombophlebitis junge, because a complete ultrasonographic examination was performed in every patient with a suspected superficial-vein thrombosis — first, to confirm the condition, and second, to rule out the presence of deep-vein Thrombophlebitis Ebene. However, Thrombophlebitis junge, performing a complete ultrasonographic examination may help physicians avoid treating patients who do not have thrombosis and allow the appropriate care of patients who present with concomitant deep-vein thrombosis.
The effect of the day fondaparinux regimen on the quality of life was not formally assessed in our study.
Thrombosis of the Cerebral Veins and Sinuses — NEJM
Propofolmarketed as Diprivan among others, is a short-acting medication that results in a decreased level of consciousness and lack of memory for events. Common side effects include an irregular heart rateThrombophlebitis junge, low blood pressureburning sensation at the site of injection, and the stopping of breathing. Propofol was discovered in and approved for use in the United States in Propofol is used for induction and maintenance in some cases of anesthesia, having largely replaced sodium thiopental.
Propofol is also used to sedate individuals who are receiving mechanical ventilation but are not undergoing surgery, such as patients in the intensive care unit. In Chirurgie Anamnese Thrombophlebitis der unteren Extremitäten ill patients, Thrombophlebitis junge, propofol has been found to be superior to lorazepam Thrombophlebitis junge in effectiveness and overall cost.
Propofol is often used instead of sodium thiopental for starting anesthesia Thrombophlebitis junge recovery from propofol is more rapid and "clear, Thrombophlebitis junge. Propofol is also used for procedural sedation, Thrombophlebitis junge. Its use in these settings results in a faster recovery compared to midazolam.
The Missouri Supreme Court decided to allow the use of propofol to execute prisoners condemned to death. However, the first execution by administration of a lethal dose of propofol was halted on 11 October by governor Jay Nixon following threats from the European Union to limit the drug's export if it were used for that purpose.
Recreational use of the drug via self-administration has been reported   including among medical professionals, see belowbut is relatively rare due to its potency and the level of monitoring required for safe use.
The short-term effects sought via recreational use Thrombophlebitis junge mild euphoria, hallucinations, and disinhibition. Recreational use of the drug has been described among medical staff, such as anesthetists who have access to the drug,  and is reportedly more common among anesthetists on rotations with short rest periods as rousing is to a well-rested state.
Attention to the risks of off-label use of propofol increased in August due to the Los Angeles County coroner's conclusion that music icon Michael Jackson died from a mixture of propofol and the benzodiazepine drugs lorazepammidazolam and diazepam on June 25, S Drug Enforcement Administration schedule.
One of propofol's most frequent side effects is pain on injection, especially in smaller veins. This pain arises from activation of the pain receptor, TRPA1 found on sensory nerves and can be mitigated by pretreatment with lidocaine.
Patients show great variability in their response to propofol, at times showing Thrombophlebitis junge sedation with small doses. Additional side effects include low blood pressure related to vasodilationtransient apnea following induction doses, and cerebrovascular effects. Propofol has more pronounced hemodynamic effects relative to many intravenous anesthetic agents.
It may also be potentiated by opioid analgesics. As a respiratory depressant, propofol frequently produces apnea. The persistence of apnea can depend on factors such as premedication, dose administered, and rate of administration, and may sometimes persist for longer than 60 seconds. Diminishing cerebral blood flow, cerebral metabolic oxygen consumption, and intracranial pressure are also characteristics of propofol administration. A more serious but rare side effect is dystonia, Thrombophlebitis junge.
Propofol appears to be safe for use in porphyriaand has not been known to trigger malignant hyperpyrexia. Propofol is also reported to induce priapism in some individuals,   and has been observed to suppress REM sleep stage and to worsen the poor sleep quality in some patients. As Thrombophlebitis junge any other general anesthetic agent, Thrombophlebitis junge, propofol should be administered only where appropriately trained staff and facilities for monitoring are available, Thrombophlebitis junge, as well as proper airway management, a supply of supplemental oxygen, artificial ventilation, and cardiovascular resuscitation, Thrombophlebitis junge.
Another recently described rare, but serious, side effect is propofol infusion syndrome. People with this gene have trouble processing sulphites one of the potential ingredientsand should discuss use of this drug with their specialist. The respiratory effects of propofol are increased if given with Thrombophlebitis junge respiratory depressantsincluding benzodiazepines. Propofol has been proposed to have several mechanisms of action, Thrombophlebitis junge,    both through potentiation of GABA A receptor activity, thereby slowing the channel-closing time,    and also acting as a sodium channel blocker.
Propofol is highly protein-bound in vivo and is metabolised by conjugation in the liver. However, its duration of clinical effect is much shorter, because propofol is rapidly distributed into peripheral tissues. When used for IV sedation, a single dose of propofol typically wears off within minutes. Propofol is versatile; the drug can be given for short or prolonged sedation, as well as for general anesthesia.
Its use is not Thrombophlebitis junge with nausea as is often seen with opioid medications, Thrombophlebitis junge. These characteristics of rapid onset and recovery along with its amnestic effects  have led to its widespread use for sedation and anesthesia.
Clinical trials followed inThrombophlebitis junge, using a form solubilised in cremophor EL. Diprivan contains EDTA, a common chelation agent, Thrombophlebitis junge, that also acts alone bacteriostatically against some bacteria and synergistically with some other antimicrobial agents.
Newer generic formulations contain sodium metabisulfite or benzyl alcohol as antimicrobial agents. Propofol emulsion is a highly opaque white fluid due to the scattering of light from the tiny about nm oil droplets it contains. A water-soluble prodrug form, fospropofolhas recently been developed and tested with positive results.
Fospropofol is rapidly broken Thrombophlebitis junge by the enzyme alkaline phosphatase to form propofol. Marketed as Lusedra, this new formulation may not produce the pain at injection site that often occurs with the traditional form of the drug. By incorporation of an azobenzene unit, a photoswitchable version of propofol AP2 was Thrombophlebitis junge in that allows for optical control of GABA A receptors with light.
From Wikipedia, the free encyclopedia, Thrombophlebitis junge. Not to be confused with ProfadolPropanolThrombophlebitis junge, or Propranolol. B No risk in non-human studies. S4 Prescription only CA: Am J Drug Alcohol Abuse. Propofol is a general anaesthetic, Thrombophlebitis junge, however its abuse for recreational purpose has been documented Archived from the original on 9 October Retrieved 21 January Emergency department procedural sedation with propofol".
Annals of Emergency Medicine. The Cochrane database of systematic reviews. Archived from the original on 29 January Archived PDF from the original on 13 December Retrieved 8 December International Drug Price Indicator Guide. Retrieved 23 January Retrieved 2 June Archived from the original on 29 March Veterinary Dentistry for the Small Animal Technician.
Archived from the original on 1 February British journal of anaesthesia. Archived from Thrombophlebitis junge original on 19 October A Systematic Review and Meta-analysis". Archived from the original on 11 November Retrieved 7 August Thrombophlebitis junge International Journal of Legal Medicine.
A case report and review of the literature". The Complete Drug Reference General anesthetics and anesthetic gases. Meyler's Side Effects of Drugs Fundamental and Clinical Pharmacology. Archived from the original on 14 November Archived from the original on 9 November Retrieved 22 May The New York Times. Archived from the original on 11 June How Dangerous Is Propofol? Archived from the original on 25 July Archived from the original on 5 March Retrieved 12 August Archived 6 April at the Wayback Machine.
Proceedings of the National Academy of Sciences. Archived from the original on 24 September Retrieved 8 June Archived from the original on 23 January Retrieved 2 January Korean Journal of Anesthesiology. A review of its pharmacodynamic and pharmacokinetic properties and use as an intravenous anaesthetic". A review of their properties and clinical use". The Annals of Pharmacotherapy, Thrombophlebitis junge. Archived from the original on 2 May Retrieved 2 October
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der Junge auf den Hoden Pain Fotoformate Thrombophlebitis an unpleasant sensation which may be associated with actual or potential Traubenkernöl Varizen.
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Propofol, marketed as Diprivan among others, is a short-acting medication that results in a decreased level of consciousness and lack of memory for events.
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Background The efficacy and safety of anticoagulant treatment for patients with acute, symptomatic superficial-vein thrombosis in the legs, but without concomitant.
- die Temperatur mit einer Thrombophlebitis der unteren Extremitäten
The practice for internal medicine and phlebology of Dr. med. Gesche Junge in Heidelberg spider veins, venous pain, thrombosis, thrombophlebitis.