Background Ciprofol is a novel 2, 6-disubstituted phenolic derivative anesthetic that binds to the gamma-aminobutyric acid-A receptor. Aim To determine the equally potent dose of ciprofol compared with propofol as an induction agent for general anesthesia in patients undergoing selective surgery, and to assess its safety. Method A total of 109 patients undergoing selective non-emergency, non-cardiothoracic or non-neurosurgical surgery requiring tracheal intubation for general anesthesia were enrolled. Ten patients per group were assigned to ciprofol-0.3, 0.4 and 0.5 mg/kg, and propofol-2.0 or 2.5 mg/kg groups, respectively to receive an intravenous bolus dose. An additional 20 patients were enrolled in the ciprofol-0.3, 0.5 or propofol-2.0 mg/kg groups. The primary outcome was the success rate of induction defined as a Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) ≤ 1 after the initial bolus dose. The secondary outcomes included the time to reach MOAA/S ≤ 1, the time to loss of the eyelash reflex, the incidences and severity of adverse events (AEs). Results The success rates were 100% for all 5 groups. The mean time to MOAA/S ≤ 1 and the time to loss of the eyelash reflex were not different among the 5 groups, regardless of whether a top-up dose was needed. There were no significant differences in the incidences and severity of AEs in the dose ranges investigated of ciprofol vs. propofol. Conclusion The efficacy and safety of a single bolus dose of ciprofol-0.5 mg/kg for the general anesthesia induction in selective surgery patients was comparable to that of propofol-2.0 mg/kg. Trial registration Clinicaltrials.gov, NCT03698617, retrospectively registered.

Introduction of structured competency-based training for specialty registrars and implementation of European Working Time Directives (EWTD) have affected the quality of maternity care. In York District Hospital, consultant resident on-call (CRO) without registrar cover was introduced in July 2010 to address the long-standing problem of middle-grade out-of-hours coverage. To examine the impact of introducing out-of-hours consultant resident on-call on maternity care, data from 486 deliveries including 59 CRO and 59 registrar shifts were collected retrospectively, from July 2010 to April 2011. Main outcome measures include mode of delivery, second-stage management, maternal and neonatal outcomes. Feedback from consultants, junior trainees and midwives on the impact of CRO were collated through semi-structured interviews. More normal vaginal deliveries (71.8% vs 63.0%) and fewer emergency caesarean sections (12.5% vs 20.6%) were performed in the CRO shifts compared with registrar on-call. Instrumental delivery rates in labour rooms vs theatre were higher when compared with the registrar group. Overall, good patient and staff experience was reflected during interviews. Our work shows that introduction of CRO in out-of-hours settings is acceptable among staff and is associated with fewer obstetric interventions. However, improved job descriptions may be needed in order to make the CRO post more attractive.

Background and ObjectiveAegis Sciences Corporation developed a test (InterACT Rx™) that objectively and definitively identifies substances known to interact with drug–drug interaction-prone medications commonly prescribed in the treatment of chronic pain and behavioral health disorders. The objective of this study was to assess the severity of identified drug–drug interactions, the reduction in the frequency and severity of identified drug–drug interactions, and the impact of the test on healthcare utilization.MethodsPatients with chronic pain, behavioral health disorders, or both who had one or more drug–drug interaction tests and one or more drug–drug interactions identified in the study period were included. Drug–drug interaction test results described the number and severity of interactions and detected substances involved in drug–drug interactions. Patients’ electronic medical records were obtained to analyze outpatient visits and prescription medications. The cost of outpatient visits was based on the Medicare Physician Fee Schedule. Outcomes were compared between the pre- and post-study index periods to determine the impact of the drug–drug interaction test on patient care.ResultsA total of 262 patients were included. The majority of drug–drug interactions detected (77.9%) at index were of moderate severity. The number of monthly all-cause and pain-related outpatient visits was reduced in the post-index period compared with the pre-index period (0.74–0.54 and 0.69–0.49, respectively). Associated costs were reduced from US$64.92 to US$51.20, and from US$62.42 to US$47.62, (p < 0.0001 for both) for all-cause and pain-related outpatient visits, respectively. Follow-up drug–drug interaction testing for 43 patients revealed that previously reported drug–drug interactions at the index test were no longer identified in the subsequent test for 39.5% of patients.ConclusionsEmploying a definitive test to detect substances whose interactions may cause adverse drug events can enhance a provider’s insights, drive clinical decision making, and improve patient outcomes.Electronic supplementary materialThe online version of this article (10.1007/s40801-018-0143-z) contains supplementary material, which is available to authorized users.

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Background Propofol improves rodent pulmonary injury after intestinal ischemia-reperfusion (IIR). However, its effect and underlying mechanisms in large animals remain unclear. Here, we examined whether pretreatment with propofol could relieve lung injury during IIR in pigs, then investigated the underlying mechanism. Material/Methods A porcine model of IIR-induced lung injury was built by clamping the super mesenteric artery for 2 h and loosening the clamp for 4 h. Randomized grouping was used, and pigs were assigned to a sham-operated group, an IIR with saline pretreatment group, and an IIR with propofol pretreatment group. Pulmonary histopathologic changes, permeability, and oxygenation were assessed to evaluate the effect of propofol. We assessed levels of methane dicarboxylic aldehyde (MDA), superoxide dismutase (SOD), myeloperoxidase (MPO), high-mobility group box 1 protein (HMGB1), Toll-like receptor 4 (TLR4), and double-stranded RNA activated protein kinase R (PKR) to investigate the underlying mechanism. Results IIR caused severe lung damage, including morphological changes, high permeability, airway resistance, low static compliance, hypoxemia, and acidemia. Pulmonary and plasma MDA content and MPO activity increased, whereas SOD activity decreased. The HMGB1/TLR4/PKR signaling pathway was activated following IIR. Pretreatment with propofol markedly attenuated lung injury (such as reducing the lung edema and permeability), increased MDA content and MPO activity, and restored SOD activity induced by IIR, accompanied by inhibiting the effect of the HMGB1/TLR4/PKR signaling pathway. Conclusions IIR caused acute lung injury in pigs. Pretreatment with propofol alleviated the lung injury, which was related to its suppression of the HMGB1/TLR4/PKR signaling pathway.