A 2021 systematic review evaluated the occurrence of fever or hyperthermia induced by dexmedetomidine in adult patients.. The systematic review identified 488 citations, narrowing down to 17 eligible studies, including 4 retrospective cohort studies, 1 case series, and 12 case reports. The evidence ranged from very low to low quality, with patient-level data indicating the uncommon nature of dexmedetomidine-associated fever. The median Naranjo score was 4, and dexmedetomidine doses varied from 0.1 to 2 μg/kg/h, highlighting obesity and cardiac surgery as potential risk factors. The 2021 review underscored the importance of clinicians considering dexmedetomidine-associated fever when evaluating elevated body temperature in critically ill patients, given that the true incidence remains unclear. Notably, the review revealed that patients receiving dexmedetomidine were significantly more likely to develop hyperthermia compared to those on standard sedatives like propofol. The findings a...

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According to the 2018 Society of Critical Care Medicine (SCCM) Clinical Practice Guidelines for the Management of Pain, Agitation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU, opioids remain a mainstay of pain management in critically ill adults; however, concerns regarding opioid-associated adverse effects, including sedation, delirium, respiratory depression, ileus, and immunosuppression, have led to evaluation of multimodal analgesic strategies incorporating nonopioid agents such as ketamine. The guideline panel generally supported multimodal pharmacotherapy as part of an analgesia-first approach to reduce opioid and sedative exposure. For ketamine specifically, the guideline issued a conditional recommendation based on very low-quality evidence suggesting the use of low-dose ketamine (0.5 mg/kg IV push followed by a continuous infusion of 1-2 mcg/kg/min) as an adjunct to opioid therapy when seeking to reduce opioid consumption in postsurgical adults a...

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A 1998 article explored the efficacy of topical metronidazole gel as an antimicrobial agent for managing malodorous wounds. Wound odors caused by anaerobic bacterial activity are the result of volatile fatty acids produced during the breakdown of lipid by anaerobic bacteria present in devitalized and necrotic tissue. The wounds frequently associated with such malodour include fungating lesions, leg ulcers, pressure sores, and decubitus ulcers. Clinical research over the past two decades has consistently shown that topical application of metronidazole is effective against anaerobic infections, providing notable control of wound-related odors. The piece cites multiple studies, including a notable 1989 investigation by Newman et al. (Table 4), which treated 68 patients with malodorous wounds, achieving complete odor control in 34 patients and reasonable control in 31 others. While systemic metronidazole treatments may present side effects, the topical application in Metrotop has demons...

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A 2016 guidance article on the practical management of direct oral anticoagulants (DOACs) in venous thromboembolism (VTE) treatment describes transition strategies between parenteral anticoagulation and oral factor Xa inhibitors in the context of VTE therapy. While the guidance details approaches to transitioning from unfractionated heparin (UFH) to DOACs, the reverse scenario of initiating UFH in patients already taking a DOAC is not specifically addressed, making the optimal strategy for this situation unclear. [1] There appears to be limited guidance on the optimal strategy for initiating a heparin infusion in patients with acute or worsening VTE who are actively taking an oral factor Xa inhibitor; however, another 2016 review suggests potential approaches when transitioning from a factor Xa inhibitor to UFH. The recommended strategy is to first determine the time of the last DOAC (factor Xa inhibitor) dose, then initiate UFH infusion without a bolus approximately 2 hours be...

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A 2025 review evaluated whether routine QTc screening is necessary before administering intravenous ondansetron to hospitalized adults. Ondansetron is a widely used 5-HT3 receptor antagonist known to prolong the QTc through potassium channel blockade, but evidence linking standard-dose intravenous ondansetron to clinically significant arrhythmias is limited. In 2017, the U.S. Food and Drug Administration (FDA) issued safety communications after identifying dose-dependent QTc prolongation at a 32 mg IV dose, leading to removal of that formulation and restriction of single IV doses to ≤16 mg. The labeling advises avoidance in congenital long QT syndrome and recommends ECG monitoring in patients with specific risk factors such as electrolyte abnormalities, heart failure, bradyarrhythmias, or concomitant QT-prolonging medications. These communications did not alter approved oral dosing or lower IV dosing used for postoperative nausea and vomiting. Observational data suggest baseline QTc...

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