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Gag Reflex

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181. Cardiopulmonary Syndromes

and obtund the gag reflex, and anaphylactic reactions to preservatives in these solutions have been documented. Opioid and nonopioid antitussives, such as dextromethorphan, may act synergistically, but further studies are required to confirm this hypothesis.[ ] Gabapentin was found to be efficacious compared with placebo for chronic refractory cough, although this study did not specifically include cancer patients.[ ] In cases of increased sputum production, expectorants and mucolytics have been employed

2012 PDQ - NCI's Comprehensive Cancer Database

182. Cadaveric donation: brain stem death

maintained on mechanical ventilators. Brain stem death is diagnosed by performing, on two separate occasions, five simple tests which verify that: (1) the pupils are fixed and dilated and do not react to light; (2) there is no eye movement; (3) there is no ear reflex; (4) there is no pain response; and, (5) there is no gag reflex. Globally, brain death is clinically adjudged as the death of an individual. It is a clinical declaration of death whereby an individual’s life is clinically considered to have (...) their cardio-respiratory system is continuously maintained on mechanical ventilators. Brain stem death is diagnosed by performing, on two separate occasions, five simple tests which verify that: (1) the pupils are fixed and dilated and do not react to light; (2) there is no eye movement; (3) there is no ear reflex; (4) there is no pain response; and, (5) there is no gag reflex. Globally, brain death is clinically adjudged as the death of an individual. It is a clinical declaration of death whereby

2015 Evidence-Based Nursing blog

183. Jeffrey Aronson: When I use a word . . . Medical onomatopoeia

borborygmi in the chest have been reported in . To gag is to strangle or suffocate, imitating the sound made in choking. Hence, the gag reflex. By transference, a gag is something used to stop up the mouth or to keep the jaws open during surgery. Gagging for air is choking, but, in case you thought we’d worked back up the body again, gagging for it is being desperate for something altogether different. Jeffrey Aronson is a clinical pharmacologist, working in the Centre for Evidence Based Medicine

2015 The BMJ Blog

184. Determining brain death in adults

of the temporomandibular joints and deep pressure at the supraorbital ridge should produce no grimacing or facial muscle movement. Absence of the pharyngeal and tracheal reflexes. The pharyngeal or gag reflex is tested after stimulation of the posterior pharynx with a tongue blade or suction device. The tracheal reflex is most reliably tested by examining the cough response to tracheal suctioning. The catheter should be inserted into the trachea and advanced to the level of the carina followed by 1 or 2 suctioning (...) integrity ensured) □ Oculovestibular reflex absent □ No facial movement to noxious stimuli at supraorbital nerve, temporomandibular joint □ Gag reflex absent □ Cough reflex absent to tracheal suctioning □ Absence of motor response to noxious stimuli in all 4 limbs (spinally mediated reflexes are permissible) Apnea testing (all must be checked) □ Patient is hemodynamically stable □ Ventilator adjusted to provide normocarbia (PaCo 2 34–45 mm Hg) □ Patient preoxygenated with 100% FiO 2 for > 10 minutes

2010 American Academy of Neurology

185. The AMA acts to try to rein in doctors spreading misinformation

being "muzzled" or "gagged" is utter nonsense. Medical professional societies have the right—no, the duty—to uphold professional standards, and this is all that the AMA is trying to do. In the overall scheme of things, the AMA's action probably won't do much by itself. But if it serves as a start, an action that inspires other professional societies and—dare I dream it?—even state medical boards to follow suit, it could have a real impact. Imagine, for instance, not just Dr. Oz facing professional (...) about vaccines. And if that jibes with any of a number of different confirmation biases you might have, your guard goes up without thinking too much about it: Maybe there's something to this! I don't want to take a chance with my kid! Nobody gets measles anymore anyway! Better safe than sorry... As long as this mental process stays in the background, it can proliferate. Pull it all up to the front of consciousness, really look into it past the reflex phase, and it's a very different story. Too often

2015 Respectful Insolence

186. Bupivacaine Lozenge Compared with Lidocaine Spray as Topical Pharyngeal Anesthetic before Unsedated Upper Gastrointestinal Endoscopy: A Randomized, Controlled Trial. Full Text available with Trip Pro

Bupivacaine Lozenge Compared with Lidocaine Spray as Topical Pharyngeal Anesthetic before Unsedated Upper Gastrointestinal Endoscopy: A Randomized, Controlled Trial. Unsedated upper gastrointestinal endoscopy (UGE) can induce patient discomfort, mainly due to a strong gag reflex. The aim was to assess the effect of a bupivacaine lozenge as topical pharyngeal anesthetic compared with standard treatment with a lidocaine spray before UGE. Ninety-nine adult outpatients undergoing unsedated (...) diagnostic UGE were randomized to receive either a bupivacaine lozenge (L-group, n = 51) or lidocaine spray (S-group, n = 42). Primary objective was assessment of patient discomfort including acceptance of the gag reflex during UGE. The L-group assessed the discomfort significantly lower on a visual analog scale compared with the S-group (P = 0.02). There was also a significant difference in the four-point scale assessment of the gag reflex (P = 0.03). It was evaluated as acceptable by 49% in the L-group

2014 Clinical medicine insights. Gastroenterology Controlled trial quality: uncertain

187. Predictors of extubation failure in neurocritical patients identified by a systematic review and meta-analysis. Full Text available with Trip Pro

to close the eyes, thick secretion, and no intact gag reflex. Meanwhile, the following were not predictive for extubation failure: sex, secretion volume, coughing upon suctioning, and the inability to follow one command among showing two fingers, wiggling the toes, or coughing on command. Additionally, some traditional weaning parameters were shown to poorly predict extubation failure in neurocritical patients.Besides pneumonia, atelectasis, and the duration of mechanical ventilation, other factors (...) that should be taken into consideration in the prediction of extubation failure when neurocritical patients are weaned from tracheal intubation include neurologic abilities (Glasgow Coma Scale score and following commands), the secretion texture, and the presence of a gag reflex.

2014 PloS one

188. Safety and Efficacy of CDFR0612 and CDFR0613 for Bowel Cleansing Before Colonoscopy

) disturbance Severe dehydration risk (e.g., rhabdomyolysis, ascites) Dialysis or renal disorder (creatinine clearance <15ml/min) Suspected pulmonary aspiration or gag reflex disorder History of hypersensitivity of drug or others Alcohol or drug abuse within 6 months Clinically significant underlying disease or medical history at investigator's discretion Inability in written/verbal communication Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study

2014 Clinical Trials

189. The effect of chewing lidocaine soaked gauze on intubation conditions during awake videolaryngoscopy: a randomised controlled trial in the morbidly obese. (Abstract)

The effect of chewing lidocaine soaked gauze on intubation conditions during awake videolaryngoscopy: a randomised controlled trial in the morbidly obese. The increasing utilisation of the videolaryngoscope for awake tracheal intubation requires development and assessment of methods to decrease the gag reflex. We hypothesised that chewing gauze soaked with lidocaine would decrease the gag reflex during awake videolaryngoscope tracheal intubation. Twenty four morbidly obese patients assessed (...) as having a potential difficult tracheal intubation were randomised to chew gauze soaked with 20 ml of 2% lidocaine or saline for 3 minutes. All patients then received 20 ml of aerosolised 2% lidocaine and underwent awake videolaryngoscope assisted tracheal intubation. Gagging scores, heart rate and blood pressure were assessed when best laryngeal view was obtained, when the tracheal tube was positioned at the cords, and when the tube was advanced into the trachea. In addition, serum lidocaine levels

2014 Acta anaesthesiologica Belgica Controlled trial quality: uncertain

190. An analysis of moderate sedation protocols used in dental specialty programs: a retrospective observational study. (Abstract)

, and other information that was recorded.The reasons for the use of moderate sedation were anxiety (54%), local anesthesia failures (15%), fear of needles (15%), severe gag reflex (8%), and claustrophobia with the rubber dam (8%). The most common medical conditions were hypertension (17%), asthma (15%), and bipolar disorder (8%). Most patients were classified as American Society of Anesthesiologists class II. More women (63.1%) were treated than men (36.9%). The mean age was 45 years. Monitoring

2014 Journal of Endodontics

191. Incident and Extent of Pulse Alteration During Local Anesthesia in Children

aberrant event which may occur during alteration of the pulse rate such as gag reflex, coughing, or pain related disruptive behavior will be documented on the computer in real time by another person that is not the treating dentist. All types of local anesthesia delivery will be performed by the computerized-controlled local anesthesia delivery system - Single-Tooth-Anesthesia which connected to a computer and documents continuously the amount and velocity of the local anesthetic delivered

2014 Clinical Trials

192. Clinical impact of gastroenterologist-administered propofol during esophagogastroduodenoscopy: a randomized comparison at a single medical clinic. Full Text available with Trip Pro

and four levels of the gag reflex, respectively. For safety purposes, endoscopists and nurses were trained in administering propofol and an anesthesiologist was on call at all times.No statistically significant differences were found between the two groups in sedation level and patient tolerability. Full recovery time in the propofol group (4.7 min) was significantly shorter than that in the midazolam group (24 min, P < 0.01).Regarding post-procedure management of patients in a medical clinic, propofol

2014 Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association Controlled trial quality: uncertain

193. Risk factors for unsuccessful prehospital laryngeal tube placement. (Abstract)

in 15.1% of first attempts and 9.9% of cases overall. The majority (79.2%) of first attempts occurred as a rescue airway after unsuccessful endotracheal intubation attempt(s), in patients with non-traumatic complaints (70.9%) and in cardiac arrest (60.8%). Gag reflex (OR 4.08, 95% CI 1.72-9.67), ground (versus air) EMS agency (OR 2.49, 95% CI 1.07-5.79), and male gender (OR 1.90, 95% CI 1.04-3.46) were associated with unsuccessful LT placement in our multivariable model.The laryngeal tube (...) is an effective airway management tool for both advanced life support and critical care prehospital providers. Gag reflex, ground (versus air) EMS agency, and male gender were associated with unsuccessful laryngeal tube placement by prehospital personnel.Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

2014 Resuscitation

194. Vertebrobasilar Stroke (Overview)

the central venous pressure and the pulmonary capillary wedge pressure. This approach would improve monitoring of the intravascular volume to avoid overload. Respiratory management Early assessment and management of the airway are critical due to the frequent involvement of lower cranial nerves and the impairment of consciousness in patients with brainstem ischemia. Assessment of the respiratory drive, gag reflex, and ability to handle secretions with a forceful cough also is of great importance (...) prognosis with reasonable functional recovery. See the images below regarding vertebrobasilar stroke. Lesion of the medial longitudinal fasciculus (MLF) resulting in internuclear ophthalmoplegia (INO). (Courtesy of BC Decker Inc.) Illustration of afferent (CN V) and efferent (CN VII) limbs of the blink reflex. (Courtesy of BC Decker Inc.) Visceral motor component of CN III and pathways involved in pupillary constriction. (Courtesy of BC Decker Inc.) Note the horizontal eye movement. Also note


195. Brain Death in Children (Overview)

brainstem function - Fixed and dilated or midposition pupils; absent spontaneous and oculocaloric/oculovestibular eye movements; absent movement of facial and oropharyngeal muscles; and bsent corneal, gag, cough, sucking, and rooting reflexes Spinal cord reflex withdrawal not included Consistent examination throughout the observation period (see Table 1, below) Table 1. Age-Dependent Observation Period Age Hours Between 2 Examinations Recommended Number of EEGs 7 days-2 months 48 2 2 months-1 year 24 2 (...) of the remaining patients; therefore, generalizations concerning age could not be made. The report concluded that ECS together with complete unresponsiveness, apnea, absent cephalic reflexes, and the inability to maintain circulation without artificial means is strongly presumptive of irreversible coma (ie, cerebral death). [ , ] The term electrocerebral inactivity (ECI) is often used instead of ECS. Previous Next: Harvard Medical School Ad Hoc Committee In 1968, a consensus report of the Ad Hoc Committee


196. Botulism (Overview)

, dysphagia, and/or suppressed gag reflex Additional neurologic manifestations include symmetrical descending paralysis or weakness of motor and autonomic nerves Respiratory muscle weakness may be subtle or progressive, advancing rapidly to respiratory failure The autonomic nervous system is also involved in botulism, with manifestations that include the following: Paralytic ileus advancing to severe constipation Gastric dilatation Bladder distention advancing to urinary retention Orthostatic hypotension (...) Reduced salivation Reduced lacrimation Other neurologic findings include the following: Changes in deep tendon reflexes, which may be either intact or diminished Incoordination due to muscle weakness Absence of pathologic reflexes and normal findings on sensory and gait examinations Normal results on mental status examination See for more detail. Diagnosis A mouse neutralization bioassay confirms botulism by isolating the botulinum toxin. Toxin may be identified in the following: Serum Stool Vomitus


197. Gynecologic Pain (Overview)

of the causes of gynecologic pain with links to other Medscape Drugs & Diseases articles is included at the end of this article. Next: Acute Pelvic Pain Associated Symptoms and Differentiation Acute pain due to ischemia or injury to a viscus is accompanied by autonomic reflex responses such as nausea, vomiting, restlessness, and sweating. The following is a discussion of some of the important gynecologic causes of acute abdominal pain. Culdocentesis can still be a useful diagnostic aid for differentiating (...) improvement in patients with IC who were treated with amitriptyline. [ ] Corticosteroids are not widely used because of adverse effects such as fluid retention and osteoporosis. However, a study reported improved pain control and overall satisfaction with oral prednisone in a cohort of women with severe refractory IC. [ ] Pentosan polysulfate sodium (PPS) (Elmiron) is claimed to restore the depletion in the glycosaminoglycan (GAG) layer. A double-blind placebo-controlled trial revealed subjective


198. Assessment of Neuromuscular Transmission (Overview)

weakness, which is exacerbated by exertion. Frequently, the pupillary light reflex is slowed (or even absent), and ophthalmoparesis may be present. Scoliosis or lordosis may also be present. The severity of the different symptoms varies considerably from patient to patient. The disease is caused by an autosomal recessive gene ( COLQ ; 603033) that codes for the collagen-like tail of endplate acetylcholinesterase. Histochemical stains show that acetylcholinesterase is absent from the nerve terminals


199. Lung Abscess (Overview)

the following risk factors: Periodontal disease Seizure disorder Alcohol abuse Dysphagia Other patients at high risk for developing lung abscess include individuals with an inability to protect their airways from massive aspiration because of a diminished gag or cough reflex, caused by a state of impaired consciousness (eg, from alcohol or other CNS depressants, , or encephalopathy). Infrequently, the following infectious etiologies of pneumonia may progress to parenchymal necrosis and lung abscess


200. Hypopharyngeal Cancer (Overview)

examination is important to attempt to localize and stage the primary tumor. Because of the patient's gag reflex, a flexible fiberoptic examination is the preferred examination technique and often allows the mucosa of the hypopharynx to be well examined. Hypopharyngeal cancer is typically advanced at presentation, and an obvious abnormality is usually present in either the pharynx or the neck. Occasionally, only subtle signs such as submucosal fullness or unilateral pooling of saliva are present. Typical (...) in Clinical. The flexible fiberoptic examination is the preferred examination to determine the mucosal anatomy because of the location of the hypopharynx and the patient's gag reflex. This examination is complementary to imaging studies, which permit an evaluation of deeper anatomic structures but do not allow an adequate view of the mucosal anatomy. Imaging studies should be not be considered as a replacement for a flexible fiberoptic examination. See related CME at . Differentials Differential diagnoses


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