A comprehensive review on pharmacotherapy optimization for rapid sequence intubation (RSI) in the emergency department highlights important considerations regarding weight-based dosing (see Table 1). RSI medications in obese patients are often underdosed, particularly etomidate and succinylcholine, although the clinical consequences of this underdosing remain unclear. Given the critical importance of achieving full induction and paralysis during RSI, underdosing may carry greater risk than overdosing. In emergent settings, total body weight (TBW) can be used for dosing when calculating ideal or adjusted body weight is not feasible, with suggested maximum doses considered to avoid excessive exposure. However, for induction agents that predispose to hypotension, dosing based on adjusted body weight may be appropriate. Additionally, clinicians should anticipate a potentially prolonged duration of paralysis when large doses of neuromuscular blocking agents are required in obese patients...

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A search of the published medical literature revealed 2 studies investigating the researchable question:

Level of evidence
C - Multiple studies with limitations or conflicting results  

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A 2014 meta-analysis of neuraxial dexmedetomidine identified 16 randomized, double-blind, placebo-controlled trials, of which four evaluated dexmedetomidine administered via the epidural route. Within the description of included-study characteristics, the reported epidural dexmedetomidine dose range was 1 to 2 mcg/kg; the main text does not provide additional study-level detail on exact epidural bolus versus infusion regimens, and the authors state that different dosages from the included studies were pooled without dose-stratified analysis. Within the epidural subgroup, the pooled analysis showed a reduction in postoperative pain intensity in 1 trial (n= 50; standardized mean difference [SMD] −1.23; 95% confidence interval [CI] −1.58 to −0.88) and a prolongation of postoperative analgesia duration in 1 trial (n= 36; weighted mean difference [WMD] 2.00 hours; 95% CI 0.65 to 3.35); epidural dexmedetomidine was also associated with no difference in onset of sensory block in 1 trial (n...

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Cannabis hyperemesis syndrome is characterized by cyclic episodes of nausea, vomiting, and abdominal pain in the setting of chronic cannabis use, driven by dysregulation of the endocannabinoid system and gut–brain axis. Clinically, it progresses through three phases: a prodromal phase lasting months with mild morning nausea, a hyperemesis phase lasting several days marked by severe, frequent vomiting (up to multiple episodes per hour) and autonomic symptoms, and a recovery phase in which symptoms resolve after cessation of cannabis. Acute treatments such as benzodiazepines, haloperidol, droperidol, and topical capsaicin can provide relatively rapid symptomatic relief—often within hours; for example, capsaicin has demonstrated meaningful nausea reduction within 60 minutes, and benzodiazepines or antipsychotics can improve symptoms during emergency care. However, standard antiemetics alone are often insufficient. Temporary relief may also occur with hot showers. Definitive and sustain...

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A 2025 systematic review evaluated the efficacy and safety of intravenous immunoglobulin (IVIg) in the treatment of acute viral myocarditis in children by exploring randomized controlled trials (RCTs). A literature search was conducted across five databases, including PubMed, EMBASE, the Cochrane Library, Scopus, and Web of Science, along with trial registries and grey literature sources. Despite identifying 9,524 records initially, none met the eligibility criteria as RCTs focusing on the pediatric population with acute viral myocarditis. The review underscored the urgent need for well-designed prospective randomized trials to substantiate the role of IVIg in managing acute viral myocarditis in children; previous reviews and studies included in broader analyses had methodological limitations, such as combining adult and pediatric data or relying on quasi-randomized designs, which do not provide the rigorous evidence necessary for clinical recommendations. [1] A 2020 Cochrane rev...

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