Comparison of cosyntropin versus caffeine for post-dural puncture headaches: A randomized double-blind trial
Journal Title: World Journal of Emergency Medicine - Year 2012, Vol 3, Issue 3
Abstract
BACKGROUND: Cosyntropin has been reported to be effective in the treatment of post-dural puncture headaches, but there is a lack of data on its effectiveness. We compared the efficacy of cosyntropin with that of caffeine in the treatment of post-dural puncture headaches. METHODS: We performed an interim analysis of a prospective, double blinded, trial of adult patients presenting to the emergency department with a post-dural puncture headache. Patients were randomized to receive either intravenous caffeine or intravenous cosyntropin. Values on a 100-mm visual analog scale (VAS) were recorded at 0, 60, and 120 minutes to assess pain. Rescue therapy was documented on the study data forms. Its effectiveness was determined by the need for this therapy. RESULTS: Thirty-seven patients were included and four patients were excluded from the analysis because of protocol violations or incomplete data. Analysis was based on intention-to-treat. Caffeine was 80% (95% CI 60–100%) effective and cosyntropin was 56% (95% CI 33–79%) effective in treating post-dural puncture headaches. The group's VAS scores at 0, 60, and 120 minutes were 80 mm, 41 mm, 31 mm for caffeine and 80 mm, 40 mm, 33 mm for cosyntropin, respectively (P=0.66). CONCLUSION: Caffeine was not more effective than cosyntropin in treating patients with postdural puncture headaches, and there was no difference in the degree of pain relief on VAS assessment.
Ventilator management for acute respiratory distress syndrome associated with avian influenza A (H7N9) virus infection: A case series
BACKGROUND: Data on the mechanical ventilation (MV) characteristics and radiologic features for the cases with H7N9-induced ARDS were still lacking. METHODS: We describe the MV characteristics and radiologic features of...
Pre-recorded instructional audio vs. dispatchers’ conversational assistance in telephone cardiopulmonary resuscitation: A randomized controlled simulation study
BACKGROUND: To assess the effectiveness of the telephone chest-compression-only cardiopulmonary resuscitation (CPR) guided by a pre-recorded instructional audio when compared with dispatcher-assisted resuscitation. METHO...
Passive leg raising as an indicator of fluid responsiveness in patients with severe sepsis
BACKGROUND: In the management of critically ill patients, the assessment of volume responsiveness and the decision to administer a fluid bolus constitute a common dilemma for physicians. Static indices of cardiac preload...
Effect of Zhenwu Tang Granule on pressure-overloaded left ventricular myocardial hypertrophy in rats
BACKGROUND: In the perspective of traditional Chinese medicine, few studies have focused on the compound preparations though there are many investigations. The present study was undertaken to investigate the effect of Zh...
Neutrophil-to-lymphocyte ratio in occlusive vascular diseases: the literature review of the past 10 years
BACKGROUND: This study aims to evaluate the results of studies investigating neutrophilto- lymphocyte ratio (NLR) and to identify the prognostic and diagnostic value of NLR in occlusive vascular diseases. METHODS: With t...