Daniel Agustin Godoy; Pablo David Guerrero Suarez; Luis Rafael Moscote-Salazar; Mario Di Napoli
Volume 5, Issue 3 , July 2017, , Pages 143-151
Abstract
Intracranial hypertension (IH) is one of the final pathways of acute brain injury. In severe traumatic brain injury (sTBI), it independently predicts poor outcomes. Its control represents a key aspect of the management. Lack of response to conventional therapies signals a state of ‘’refractory ...
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Intracranial hypertension (IH) is one of the final pathways of acute brain injury. In severe traumatic brain injury (sTBI), it independently predicts poor outcomes. Its control represents a key aspect of the management. Lack of response to conventional therapies signals a state of ‘’refractory IH’’, with an associated mortality rate of 80-100%. In such cases, hypothermia, barbiturates at high doses (BBT), decompressive craniectomy (DC), and extreme hyperventilation are utilized. However, none of them has proven efficacy. Indomethacin (INDO), a non-steroidal anti-inflammatory drug, may be an option with an acceptable safety profile and easy to administer. Reported series showed encouraging results. We herein present a case of refractory IH after sTBI in which INDO was utilized. In refractory IH, INDO can help to decrease ICP and improve cerebral perfusion pressure. However, it requires administration under strict protocol since it’s not free of adverse effects after withdrawal.
Mehdi Shirazi; Mehdi Salehipour; Mohammad Amin Afrasiabi; Alireza Amin Sharifi
Volume 3, Issue 2 , April 2015, , Pages 41-45
Abstract
Objective: To compare the efficacy of desmopressin (DDAVP), tramadol and indomethacin on pain intensity of patients with acute renal colic caused by urolithiasis.Methods: This prospective, randomized clinical trial was conducted between July 2005 and July 2006 including120 patients (70 men and 50 women, ...
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Objective: To compare the efficacy of desmopressin (DDAVP), tramadol and indomethacin on pain intensity of patients with acute renal colic caused by urolithiasis.Methods: This prospective, randomized clinical trial was conducted between July 2005 and July 2006 including120 patients (70 men and 50 women, mean age 38.2±5.8 years) referring to emergency room of Shahid Faghihi hospital with renal colic caused by urolithiasis without any previous treatment. The patients were randomly assigned to three groups: group A received tramadol 50mg intramuscularly (n=40), group B received desmopressin40 µg intranasally (n=40) and group C received indomethacin 100mg rectally (n=40). The pain was assessed both on admission and 30 minutes after the intervention. The pain intensity and the side effects were compared between two study groups.Results: There was no significant difference between two study groups regarding the baseline characteristics. The intensity of pain of presentation was almost similar in all groups. In group A, 30 patients (75%), in group B, 15 patients (37.5%) and in group C, 19 patients (47.5%) had complete pain relief. The pain intensity decreased significantly after the intervention within all three groups ( p<0.001).Conclusion: According to the results of the current study, rectal indomethacin, intramuscular tramadol and intranasal desmopressin are effective and safe routs of controlling pain in acute renal colic secondary to urolithiasis. Tramadol was the most effective agent in controlling the pain.Clinical Trial Registry: The current study is registered with Iranian Registry for Clinical Trials (www.irct.ir; IRCT2015030919470N18)
