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Savage R.,Lions Gate Hospital
Journal of the Canadian Academy of Child and Adolescent Psychiatry | Year: 2010

Objective: To review the background and mechanisms behind how certain psychotropic medications cause adverse drug reactions. Methods: A literature review pertaining to several interesting and unusual adverse drug reactions attributed to selected psychotropic medications was conducted. These include: 1) QTc interval prolongation secondary to ziprasidone, pimozide, and other antipsychotic agents. 2) Nephrogenic diabetes insipidus and hypernatremia secondary to lithium. 3) Hypothyroidism secondary to lithium. 4) Erectile dysfunction secondary to selective serotonin and serotonin/norepinephrine reuptake inhibitors (SSRIs/SNRIs). Results: Biochemical mechanisms of how certain psychotropic medications cause adverse drug reactions were reviewed. Specific interventions and monitoring recommendations to prevent or reduce the impact of these adverse reactions are discussed briefly. Conclusion: Knowledge of risk factors and mechanisms of adverse drug reactions with psychotropic medications can help to guide medication prescribing, monitoring and interventions to prevent or mitigate these reactions. Source


Andolfatto G.,University of British Columbia | Abu-Laban R.B.,University of British Columbia | Abu-Laban R.B.,Center for Clinical Epidemiology and Evaluation | Zed P.J.,University of British Columbia | And 4 more authors.
Annals of Emergency Medicine | Year: 2012

Study objective: We determine whether a 1:1 mixture of ketamine and propofol (ketofol) for emergency department (ED) procedural sedation results in a 13% or more absolute reduction in adverse respiratory events compared with propofol alone. Methods: Participants were randomized to receive either ketofol or propofol in a double-blind fashion. Inclusion criteria were aged 14 years or older and American Society of Anesthesiology class 1 to 3 status. The primary outcome was the number and proportion of patients experiencing an adverse respiratory event as defined by the Quebec Criteria. Secondary outcomes were sedation consistency, efficacy, and time; induction time; and adverse events. Results: A total of 284 patients were enrolled, 142 per group. Forty-three (30%) patients experienced an adverse respiratory event in the ketofol group compared with 46 (32%) in the propofol group (difference 2%; 95% confidence interval -9% to 13%; P=.80). Three ketofol patients and 1 propofol patient received bag-valve-mask ventilation. Sixty-five (46%) patients receiving ketofol and 93 (65%) patients receiving propofol required repeated medication dosing or progressed to a Ramsay Sedation Score of 4 or less during their procedure (difference 19%; 95% confidence interval 8% to 31%; P=.001). Six patients receiving ketofol were treated for recovery agitation. Other secondary outcomes were similar between the groups. Patients and staff were highly satisfied with both agents. Conclusion: Ketofol for ED procedural sedation does not result in a reduced incidence of adverse respiratory events compared with propofol alone. Induction time, efficacy, and sedation time were similar; however, sedation depth appeared to be more consistent with ketofol. © 2011 American College of Emergency Physicians. Source


Andolfatto G.,Lions Gate Hospital | Willman E.,University of British Columbia
Academic Emergency Medicine | Year: 2010

Objectives: This study evaluated the effectiveness, recovery time, and adverse event profile of intravenous (IV) ketofol (mixed 1:1 ketamine-propofol) for emergency department (ED) procedural sedation and analgesia (PSA) in children. Methods: Prospective data were collected on all PSA events in a trauma-receiving, community teaching hospital over a 3.5-year period, from which data on all patients under 21 years of age were studied. Patients receiving a single-syringe 1:1 mixture of 10 mg?mL ketamine and 10 mg?mL propofol (ketofol) were analyzed. Patients received ketofol in titrated aliquots at the discretion of the treating physician. Effectiveness, recovery time, caregiver and patient satisfaction, drug doses, physiologic data, and adverse events were recorded. Results: Ketofol PSA was performed in 219 patients with a median age of 13 years (range = 1 to 20 years; interquartile range [IQR] = 8 to 16 years) for primarily orthopedic procedures. The median dose of medication administered was 0.8 mg?kg each of ketamine and propofol (range = 0.2 to 3.0 mg?kg; IQR = 0.7 to 1.0 mg?kg). Sedation was effective in all patients. Three patients (1.4%; 95% confidence interval [CI] = 0.0% to 3.0%) had airway events requiring intervention, of which one (0.4%; 95% CI = 0.0% to 1.2%) required positive pressure ventilation. Two patients (0.9%; 95% CI = 0.0% to 2.2%) had unpleasant emergence requiring treatment. All other adverse events were minor. Median recovery time was 14 minutes (range = 3 to 41 minutes; IQR = 11 to 18 minutes). Median staff satisfaction was 10 on a 1-to-10 scale. Conclusions: Pediatric PSA using ketofol is highly effective. Recovery times were short; adverse events were few; and patients, caregivers, and staff were highly satisfied. © 2010 by the Society for Academic Emergency Medicine. Source


Rezazadeh S.,University of British Columbia | Co S.J.,University of British Columbia | Bicknell S.,Lions Gate Hospital
Canadian Association of Radiologists Journal | Year: 2014

Purpose The purpose of this study was to determine whether low-kilovoltage (80 or 100 kV) computed tomography (CT)-guided interventions performed in a community-based hospital are feasible and to compare radiation exposure incurred with conventional 120 kV potential.Materials and Methods Effective doses (ED) received by patients who underwent CT-guided intervention were analysed before and after a low-dose kilovoltage protocol was instituted in our department. We performed CT-guided procedures of 93 consecutive patients by using conventional 120-kV tube voltage (50 patients) and a low voltage of 80 or 100 kV for the remainder of this cohort. Automatic tube current modulation was enabled to obtain the best image quality. Procedure details were prospectively recorded and included examination site and type, slice width, tube voltage and current, dose length product, volume CT dose index, and size-specific dose estimate. Dose length product was converted to ED to account for radiosensitivity of specific organs. Statistical comparisons with test differences in the ED, volume CT dose index, size-specific dose estimate, and effective diameter (patient size) were made by using the Student t test.Results All but 6 of the procedures performed at 80 kV were successful, for a success rate of 86%. At lower voltages, the ED was significantly (P <.01) reduced, on average, by 57%, 73%, and 65% for the pelvic, chest, and abdomen procedures, respectively.Conclusion A low-dose radiation technique by using 80 or 100 kV results in a high technical success rate for pelvic, chest, and abdomen CT-guided interventional procedures, although dramatically decreasing radiation exposure. There was no significant difference in effective diameter (patient size) between the conventional and the low-dose groups, which would suggest that dose reduction was indeed a result of kVp change and not patient size. © 2014 Canadian Association of Radiologists. Source


Dewar C.L.,Lions Gate Hospital | Sigler L.,University of Alberta
Clinical Rheumatology | Year: 2010

Mycoleptodiscus indicus is a recognized plant pathogen which has very rarely been reported as a cause of human infection. It is a tropical or subtropical fungus which is difficult to culture and identify from clinical specimens. This is the first report of septic arthritis with this fungus in a healthy Canadian male. The fungal infection was contracted on a vacation in Costa Rica, probably through direct inoculation through injured skin. The fungus was isolated from synovial fluid and identification was confirmed by DNA sequencing. There has only been one previous case of septic arthritis of the knee and one skin infection reported with this fungus; both cases involved immunocompromised hosts. Both septic arthritis patients required joint surgery and lavage to eradicate the fungus, however, only the immunocompromised patient required antifungal medications. In the future, it is very likely that the number of patients identified with M. indicus infection will rise due to increasing awareness of this pathogen as well as increasing exposure. Many immunocompromised patients on anti-retroviral or biologic therapy are healthy enough to travel, thereby exposing themselves to exotic and infected plants which increase the risk of unusual fungal infections. © 2010 Clinical Rheumatology. Source

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