Nesiritide is a recombinant formulation of brain-type natriuretic factor. Preliminary experience in the adult population suggests that nesiritide may be an effective agent in the treatment of decompensated congestive heart failure. Given its physiologic effects, it may be an effective agent in the pediatric population; however, to date, there are no reports regarding its use in infants and children. The authors retrospectively review their experience with nesiritide in 5 pediatric patients. The cohort of 5 patients included a diverse population with 2 patients who were status postcardiothoracic surgery, 2 with adult respiratory distress syndrome, and 1 in the recovery phase from septic shock. Although no direct measurement of cardiac output was feasible as none of the patients had a pulmonary artery catheter, other indicators of increased cardiac output were noted. These included improved peripheral perfusion with warming of the extremities and improvement of peripheral pulses in all of the patients, increased venous saturation in 2 of the patients, and maintenance of or increased urine output despite weaning or discontinuation of diuretics. In 3 of the patients, nesiritide was started as the primary agent to provide a decrease in systemic vascular resistance and augment cardiac output, while in the other 2 patients, nesiritide was used when other vasoactive agents failed to provide the desired effect or resulted in adverse effects.
Objective-To present the legal and professional issues related to nurse administration of drugs according to protocols, and describe the implementation and initial audit findings of such a scheme. Setting-Accident and emergency (A&E) department of a district general hospital. Methods-Analysis of legal and professional opinion. Protocols acceptable to the medical, nursing, and pharmacy professions were developed across a wide range of drugs appropriate for administration by accident and emergency nurse practitioners (ENPs). The first six months ofthe scheme were audited. Audit initially addressed general compliance with protocols and later the specific areas of tetanus immunisation and emergency contraception.Results-ENPs assessed 2925 patients in six months (10.9% of all new patients); 455 patients (15.5% of the ENP patients) were given drugs according to protocols. There were no breaches of the protocols. Subsequent audit of tetanus immunisation showed 94-100% compliance with protocol standards and 71-100% compliance for emergency contraception. Conclusions-There are no legal or professional obstacles to the development of protocols for the administration of drugs to patients by nurses without reference to a doctor, providing the protocols meet all the requirements of the UKCC and have the support of consultant medical staff. Such a system must be subject to regular audit to promote a dynamic approach to protocols and training. The system safely enhanced the quality of care of patients treated by ENPs in A&E.
Kearns Sayre syndrome (KSS) is a rare mitochondrial myopathy that is associated with progressive impaired ventilatory drive, heart block, and peripheral neuropathy. Charcot-Marie-Tooth disease (CMT) is a rare chronic motor and sensory peripheral neuropathy which includes muscle weakness and restrictive pulmonary impairment. Patients with either condition having anesthesia can have postoperative respiratory failure. We report a 52-year-old man diagnosed with variants of KSS and CMT presenting for supraventricular tachycardia (SVT) ablation. This is the first report of successful perioperative management of a general anesthetic in a patient with both KSS and CMT.
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