Continuous Optimization of Drug Storage Position Management in Automatic Dispensing Machine by Or-bital Utilization Rate Algorithm / 中国药房

OBJECTIVE:To optimize the drug storage position management in automatic dispensing machine,and improve the dispensing efficiency. METHODS:The orbital utilization rate of drugs in automatic dispensing machine was calculated,the opti-mum value of orbital utilization rate was set up to adjust the drug varieties and numbers of storage tracks for continually optimizing the storage position management. Dispensing rates of automatic dispensing machines and real-time dispensing windows with fully automated deployment before (Mar.-Jun. 2016) and after (Jul.-Oct. 2016) optimization were statistically analyzed and compared. RESULTS:The optimum value of orbital utilization rate was set up as 67%. Drugs more than the value were increased the num-bers of storage tracks,while drugs less than the value was decreased the numbers of storage tracks or removed out of dispensing machines. From Mar. to Oct. 2016,2 dispensing machines in our hospital adjusted 75 varieties and 127 orbits in total,storage num-bers was increased by 158 boxes. Compared with before optimization (Mar.),dispensing rate of automatic dispensing machines was increased from 73.7% to 81.3% after optimization(Oct.),dispensing rate of real-time dispensing window was increased from 39.8% to 51.8%(P<0.05). CONCLUSIONS:Applying the orbital utilization rate algorithm for adjusting drug variety and track number in machine can effectively and continually optimize the drug storage position,increase the storage capacity in machine, make full use of automatic equipments and improve the dispensing efficiency.

Continuous Optimization of Drug Storage Position Management in Automatic Dispensing Machine by Or-bital Utilization Rate Algorithm / 中国药房

OBJECTIVE:To optimize the drug storage position management in automatic dispensing machine,and improve the dispensing efficiency. METHODS:The orbital utilization rate of drugs in automatic dispensing machine was calculated,the opti-mum value of orbital utilization rate was set up to adjust the drug varieties and numbers of storage tracks for continually optimizing the storage position management. Dispensing rates of automatic dispensing machines and real-time dispensing windows with fully automated deployment before (Mar.-Jun. 2016) and after (Jul.-Oct. 2016) optimization were statistically analyzed and compared. RESULTS:The optimum value of orbital utilization rate was set up as 67%. Drugs more than the value were increased the num-bers of storage tracks,while drugs less than the value was decreased the numbers of storage tracks or removed out of dispensing machines. From Mar. to Oct. 2016,2 dispensing machines in our hospital adjusted 75 varieties and 127 orbits in total,storage num-bers was increased by 158 boxes. Compared with before optimization (Mar.),dispensing rate of automatic dispensing machines was increased from 73.7% to 81.3% after optimization(Oct.),dispensing rate of real-time dispensing window was increased from 39.8% to 51.8%(P<0.05). CONCLUSIONS:Applying the orbital utilization rate algorithm for adjusting drug variety and track number in machine can effectively and continually optimize the drug storage position,increase the storage capacity in machine, make full use of automatic equipments and improve the dispensing efficiency.

Optimization of Intelligent Workflow in Outpatient Pharmacy to Reduce Patient Waiting Time for Drugs / 中国药房

OBJECTIVE:To reduce patient waiting time for drugs by improving work efficiency via the optimization of the in-telligent workflow of outpatient pharmacy. METHODS:The problems existing in each link in the workflow after the adoption of au-tomated drug dispensing machine in the outpatient pharmacy of our hospital were analyzed. Measures were developed and imple-mented,on the basis of the factors affecting each link including adding drugs,making up a prescription and dispensing drugs,to optimize the workflow. The effect after the optimization was evaluated,with the time it takes to make up a prescription and to dis-pense drugs and patient waiting time for drugs as the indexes. RESULTS:The averaged time it takes a pharmacist to make up a pre-scription and to dispense drugs and patient waiting time for drugs significantly reduced from 3.4 min,9.3 min and 12.7 min to 1.0 min,6.1 min and 7.1 min respectively,after taking measures such as adjusting the number of the drug types,tracks and positions in the machine,adding the contrasting pictures of the drugs which were similar on the system interface for adding drugs,standardiz-ing the process of adding drugs,improving and allocating information labels,adjusting the process of dispensing drugs and adding new small packages of drugs within 6 months. CONCLUSIONS:The optimized intelligent workflow in the pharmacy can reduce pa-tient waiting time for drugs,increase patient satisfaction and promote the development of intelligent pharmacy.

Effects of selective lobar ventilation on intrapulmonary shunt and inflammatory response in patients with pulmonary dysfunction during thoracotomy / 中华麻醉学杂志

Objective To investigate the effects of selective lobar ventilation on intrapulmonary shunt and inflammatory response in patients with pulmonary dysfunction during thoracotomy.Methods Thirty-four ASA Ⅱ or Ⅲ patients,aged 64-79 years,weighing 50-85 kg,with moderate or severe impaired pulmonary function,scheduled for esophageal cancer radical correction,were randomly divided into two groups (n =17 each):one-lung ventilation group (group A) and selective lobar ventilation group (group B).In group A,an endobronchial blocker tube was used to obstruct the bronchus principalis and practice one-lung ventilation.In group B,an endobronchial blocker tube was used to obstruct the bronchi Iobares and practice selective lobar ventilation.Blood samples were taken from the arteria radialis and the internal jugular vein for blood gas analysis and determination of plasma concentrations of tumor necrosis factor-alpha (TNF-α),interleukin-6 (IL-6) and IL-8 by enzyme linked immunosorbent assay (ELISA) before anesthesia induction (T0),30 minutes following two-lung ventilation at the lateral position (T1),60 minutes following one-lung ventilation or selective lobar ventilation (T2) and at the end of surgery (T3).Peak airway pressure (Ppeak) and plateau airway pressure (Pplat) were recorded at the same time.Results The incidence of hypoxemia was significantly lower in group B (0) than in group A (18％,P ＜ 0.05).Compared with group A,Pliat and Ppeak at T1-3,the intrapulmonary shunt rate (Qs/Qt) at T2,TNF-α,IL-6 and IL-8 concentrations at T2-3 were significantly decreased in group B (P ＜ 0.05).Conclusion Selective lobar ventilation can reduce intrapulmonary shunt and inhibit inflammatory responses to help lessen mechanical ventilation-related lung injuryduring thoracotomy in patients with pulmonary dysfunction.

Effect of remote ischemic preconditioning combined with dexmedetomidine on lung injury during one-lung ventilation in patients undergoing thoracic surgery / 中华麻醉学杂志

Objective To investiga~ the effect of remote ischemic preconditioning (RIPC) combined with dexmedetomidine on the lung injury during one-lung ventilation (OLV) in the patients undergoing thoracic surgery.Methods Thirty ASA physical status Ⅰ or Ⅱ patients,aged 45-70 yr,weighing 51-69 kg,scheduled for elective radical operation for esophageal cancer,were randomly divided into 2 groups (n =15 each) using a random number table:control group (group C) and RIPC combined with dexmedetomidine group (group ORD).In ORD group,at 10 min after endotracheal intubation,RIPC was induced by 3 cycles of 5 min lower extremity ischemia followed by 5 min reperfusion,and at the same time a loading dose of dexmedetomidine 1.0 μg/kg was infused intravenously over 15 min and then dexmedetomidine was infused at a rate of 0.5 μg· kg-1 · h-1 until the end of operation.At 0,30 min,1 h and 2 h of OLV (T1-4),blood samples were obtained from the radial artery for blood gas analysis and determination of plasma concentrations of tumor necrosis factor-α (TNF-α),interleukin-1β (IL-1β) and IL-10.Oxygenation index and respiratory index were calculated.Exhaled breath condensate was collected at T1,T3 and T4,and the pH value was measured.Results Compared with group C,oxygenation index was significantly increased,and respiratory index was decreased at T2-4,the plasma concentrations of TNF-α and IL-1β were decreased,and the pH value of exhaled breath condensate was increased at T3-4,and the plasma concentration of IL-10 was increased at T4 in group ORD.Conclusion RIPC combined with dexmedetomidine can inhibit inflammatory responses and reduce airway acidification,thus attenuating the lung injury during OLV in the patients undergoing thoracic surgery.

Feasibility of using corrected body weight to set tide volume for mechanical ventilation during general anesthesia in obese patients / 中华麻醉学杂志

Objective To evaluate the feasibility of using corrected body weight to set the tide volume (VT) for mechanical ventilation during general anesthesia in obese patients.Methods Sixty ASA physical status Ⅰ or Ⅱ obese patients,with a body mass index of 28-44 kg/m2,scheduled for elective extremity surgery under general anesthesia,were randomly divided into 3 groups (n =20 each):VT based on actual body weight group (group A),VT based on ideal body weight group (group Ⅰ),and VT based on corrected body weight group (group C).The pulmonary function of all patients was normal.The patients were endotracheally intubated and mechanically ventilated after induction of anesthesia.According to the corresponding body weight,the initial VT was set based on 8 ml/kg in each group (RR 15 bpm,I ∶ E =1 ∶ 2,FiO2 =100％).At 10 min after start of mechanical ventilation,peak airway pressure (Ppeak),airway plateau pressure (Pplat),airwayresistance (Raw) were recorded.Arterial blood samples were collected at 30 min of mechanical ventilation for blood gas analysis and PaO2,PaCO2 and the patients requiring readjustment of VT (PaCO2 ＞ 45 mm Hg or ＜ 35 mm Hg) were also recorded.Results Compared with group A,PaCO2 was significantly increased and Ppeak,Pplat and Raw were decreased in I and C groups (P ＜ 0.01).PaCO2 was significantly lower and Ppeak,Pplat and Raw were higher in group C than in group Ⅰ(P ＜ 0.01 or 0.05).There were no patients requiring readjustment of VT in group C,however,95％ patients required readjustment of V+ in group A and 80％ in group B.The percentage of patients requiring readjustment of VT was significantly higher in A and B groups than in group C (P ＜ 0.01).Conclusion Corrected body weight based on 8 ml/kg can be used to set the Vr for mechanical ventilation during general anesthesia in obese patients with normal pulmonary function.

Median effective target plasma concentration of remifentainil inhibiting body movement evoked by puncture during brachial plexus block in pediatric patients / 中华麻醉学杂志

Objective To determine the median effective target plasma concentration (Cp50) of remifentainil inhibiting body movement evoked by puncture during brachial plexus block in pediatric patients.Methods Pediatric patients of both sexes,aged 5-12 yr,who grown normally,scheduled for elective forearm or hand surgery,were enrolled in this study.Children were premedicated with oral midazolam 0.2 mg/kg at 30 min before anesthesia.The initial target Cp of remifentainil was 5.0 ng/ml.The target Cp was determined by up-and-down sequential method.Each time Cp increased/decreased by 20％ in the next patient depending on the response of the previous patient to puncture.The ratio between the two successive concentrations was 1.2.The puncture was performed after the target effect-site and plasma concentrations were balanced.Body movement was defined as puncture-induced movement of truncus,limbs and/or head and neck.The Cp50 and 95 ％ confidence interval of remifentainil were calculated by Dixon method.Results Cp50 of remifentainil inhibiting body movement evoked by puncture during brachial plexus block was 3.9 ng/ml,and 95 ％ confidence interval was 3.6-4.2 ng/ml.Conclusion Cp50 of remifentainil inhibiting body movement evoked by puncture during brachial plexus block is 3.9 ng/ml in pediatric patients.

Efficacy of ventilation with selective lobar collapse for thoracic surgery in elderly patients with chronic obstructive pulmonary disease / 中华麻醉学杂志

Objective To investigate the efficacy of ventilation with selective lobar collapse for thoracic surgery in elderly patients with chronic obstructive pulmonary disease (COPD).Methods Thirty ASA Ⅱ or Ⅲ patients with COPD,aged 65-80 yr,with a body mass index of 16-28 kg/m2,undergoing radical resection of esophagus cancer,were randomly divided into 2 groups (n=15 each):one-lung ventilation (OLV) group and ventilation with selective lobar collapse group (group SLC).In group OLV,OLV was performed,while in group SLC,the balloon of the blocker was placed at 0.5 cm below the opening of the upper lobe bronchus and the lower lobe was collapsed when chest was open.The patients were mechanically ventilated (VT =7-8 ml/kg,RR =14-16 bpm,I∶E=1∶1.5-2.0,FiO2 =100％).Peak pressure (Ppeak),plateau pressure (Pplat),airway resistance (Raw),and dynamic lung compliance (Cd) were measured at 10 min of two-lung ventilation in supine position (T0),at 5,45 and 90 min of OLV or selective lobar collapse (T1-3) and at 10 min of two-lung ventilation in lateral position after the end of operation (T4).Arterial blood samples were obtained at To,T3 and T4 for blood gas analysis.Oxygenation index (OI),alveolar-arterial oxygen gradiant (P(A-a)O2),and respiratory index (RI) were calculated.Results Ppeak,Pplat and Raw were significantly lower at T2-4,while Cd was significantly greater at T1-4,OI was significantly higher at T3,4,and P(A-a)O2 and RI were significantly lower at T3,4 in group SLC than in group OLV.Conclusion The thoracic operation can be completed safely using ventilation with selective lobar collapse and OLV,however,ventilation with selective lobar collapse can improve oxygenation and provides better ventilatory efficacy than OLV in elderly patients with COPD.

Effects of selective lobar ventilation on intrapulmonary shunt and inflammatory response in patients with pulmonary dysfunction during thoracotomy / 中华麻醉学杂志

ObjectiveTo investigate the effects of selective lobar ventilation on intrapulmonary shunt and inflammatory response in patients with pulmonary dysfunction during thoracotomy.MethodsThirty-four ASA Ⅱ or Ⅲ patients,aged 64-79 yr,weighing 50-85 kg,with moderate and severe impaired pulmonary function,scheduled for esophageal cancer radical correction,were randomly divided into 2 groups( n =17 each): one-lung ventilation group (group A) and selective lobar ventilation group (group B).In group A,endobronchial blocker tube was used to obstruct bronchus principalis and practice one-lung ventilation.In group B,endobronchial blocker tube was used to obstruct bronchi lobares and practice selective lobar ventilation.The blood samples were taken from arteria radialis and internal jugular vein for blood gas analysis and determination of the plasma concentrations of TNF-α,IL-6 and IL-8 by ELISA before anesthesia induction(T0 ),at 30 min following two-lung ventilation at lateral position (T1),at 60 min following one-lung ventilation or selective lobar ventilation (T2) and at the end of surgery (T3).Ppeak and Plat.were recordeded at the same time.ResultsThe incidence of hypoxemia was significantly lower in group B (0) than in group A(18％ )( P ＜0.05).Compared with group A,Pplat and Ppeak at T1-3,Qs/Qt at T2,TNF-α,IL-6 and IL-8 concentrations at T2-3 were significantly decreased in group B( P ＜ 0.05 ).Conclusion The selective lobar ventilation can reduce intrapulmonary shunt,inhibit inflammatory response to help lessen mechanical ventilation related lung injury during thoracotomy in patients with pulmonary function.