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OBJECTIVE To explore and establish a long-term mechanism for rational control of intravenous fluids in hospitals. METHODS On the basis of the establishment of rules and regulations， through the exploration and implementation of the core technical strategy of “six-step method”， a new mode of intravenous infusion control was established. The contents of the “six-step method” were as follows： the first step was to sort out the diseases that did not require intravenous infusion； the second step was to sort out the alternative drugs/dosage forms； the third step was to sort out the alternative routes of infusion； the fourth step was to develop drug specifications； the fifth step was to explore the personalized medication needs of clinical departments； the sixth step was to develop a department-specific integrated infusion regimen. The utilization rate of intravenous fluids in inpatients and the average daily amount of intravenous fluids per bed in inpatients were used as the main indicators to evaluate the control effect. RESULTS The comparison of the average values of three months before and after the implementation of the “six-step” management mode in the department of thoracic surgery of our hospital showed that after management and control， the average utilization rate of intravenous fluids in inpatients decreased by 1.74%， the average daily use of intravenous fluids in inpatients per bed decreased by 0.30 bags/bottle， and the per capita use of infusion drugs under key control gradually decreased. CONCLUSIONS The “six-step” management mode can reduce the utilization rate of intravenous fluids in inpatients， and this management mode is practical and feasible.
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PURPOSE: This analysis was done to investigate the optimal regimen for fentanyl-based intravenous patient-controlled analgesia (IV-PCA) by finding a safe and effective background infusion rate and assessing the effect of adding adjuvant drugs to the PCA regimen. MATERIALS AND METHODS: Background infusion rate of fentanyl, type of adjuvant analgesic and/or antiemetic that was added to the IV-PCA, and patients that required rescue analgesics and/or antiemetics were retrospectively reviewed in 1827 patients who underwent laparoscopic abdominal surgery at a single tertiary hospital. RESULTS: Upon multivariate analysis, lower background infusion rates, younger age, and IV-PCA without adjuvant analgesics were identified as independent risk factors of rescue analgesic administration. Higher background infusion rates, female gender, and IV-PCA without additional 5HT3 receptor blockers were identified as risk factors of rescue antiemetics administration. A background infusion rate of 0.38 microg/kg/hr [area under the curve (AUC) 0.638] or lower required rescue analgesics in general, whereas, addition of adjuvant analgesics decreased the rate to 0.37 microg/kg/hr (AUC 0.712) or lower. A background infusion rate of 0.36 microg/kg/hr (AUC 0.638) or higher was found to require rescue antiemetics in general, whereas, mixing antiemetics with IV-PCA increased the rate to 0.37 microg/kg/hr (AUC 0.651) or higher. CONCLUSION: Background infusion rates of fentanyl between 0.12 and 0.67 microg/kg/hr may safely be used without any serious side effects for IV-PCA. In order to approach the most reasonable background infusion rate for effective analgesia without increasing postoperative nausea and vomiting, adding an adjuvant analgesic and an antiemetic should always be considered.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Analgesia, Patient-Controlled/adverse effects , Fentanyl/administration & dosage , Retrospective Studies , Sex FactorsABSTRACT
Objective: To evaluate the hypoglycemic effect of aqueous extract from Taraxaci Herba (AETH) on postprandial blood glucose (PBG) in diabetic rats induced by Streptozotocin (STZ) and to explore the mechanism. Methods: The PBG within 120 min was measured after 7 d ig administration of AETH (400, 200, and 100 mg/kg) in normal rats and diabetic model rats induced by STZ, and ELISA was performed to detect the serum insulin of rats in each group. The euglycemic clamp assay was performed to investigate the effect of AETH (400 mg/kg) on the insulin sensitivity in normal rats, and the glucose infusion rate (GIR) was detected. The 50% inhibiting concentration (IC50) against α-glucosidase was measured in vitro, using pNPG as substrate. Caco-2 cells were preincubated for 72 h with AETH (200 and 100 mg/L), and then the capacities of Caco-2 monolayer on maltose hydrolysis and glucose absorption were measured. Results: The 7 d ig administration of AETH decreased the PBG significantly in diabetic rats induced by STZ, but had no effect on serum insulin level and GIR. AETH inhibited α-glucosidase in vitro, and the IC50 was higher than that of acarbose. AETH (200 mg/L) inhibited the capacities of Caco-2 monolayer on both maltose hydrolysis and glucose absorption. Conclusion: AETH has the hypoglycemic effect on PBG in diabetic rats, and the mechanism is related to the inhibition of maltose hydrolysis and glucose absorption in small bowel.
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@#Objective To investigate the effect of different speed of perioperative fluid infusion on rate of platelet aggregation during percutaneous coronary intervention. Methods 60 patients accepted percutaneous coronary intervention (PCI) were divided into 2 groups. The control group (n=30) accepted fluid infusion in speed of 1.5~2 ml/kg·h, while the trial group (n=30) with the speed of 6~9 ml//kg·h after coronary arteriongraphy. Their blood pressure, heart beat, rate of platelet aggregation and osmotic pressure of plasma were recorded. Results It was not significantly different in rate of platelet aggregation before and 4 h after operation in the control group (P>0.05), and it was significantly lower 4 h and 1 d after operation in the trial group (P<0.05). Conclusion Fast fluid infusion perioperatively can lower the rate of platelet aggregation, which may improve the success of PCI and reduce the acute thrombosis
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BACKGROUND: We used warming fluid for maintenance of body temperature in operating room or intensive care unit. This study was aimed to investigate the effect of infusion rate and catheter length on the temperature of warming fluid. METHODS: Normal saline was used for testing infusion and temperature of infusion was maintained by a warmer as 40degrees C. The temperatures of solution in infusion line were measured at 0, 25, 50, 75, and 100 cm apart from warmer at six different flow rates (100, 200, 300, 700, 1,400, and 2,100 ml/h). We also measured the temperature changes at room temperature (RT) and 5degrees C, 10degrees C, and 15degrees C above RT. RESULTS: The time to maintain solution temperature as 40degrees C was 165, 122, 37, 37, 21, and 19 s at flow rate 100, 200, 300, 700, 1,400, and 2,100 ml/h. The peak temperature was 43.58 +/- 0.58, 44.43 +/- 1.18, 44.37 +/- 0.70, 43.79 +/- 0.61, 42.82 +/- 0.97, and 42.11 +/- 0.92degrees C according to increasing flow rate. The temperature at 100 cm apart from warmer was 23.96 +/- 1.53, 25.46 +/- 2.76, 29.32 +/- 3.47, 31.40 +/- 5.38, 31.39 +/- 6.75, and 38.14 +/- 0.96degrees C according to increasing flow rate. CONCLUSIONS: These results suggested that the decreasing rate of temperature was related inversely to the flow rate and directly to the catheter length. There may be needed a rapid infusion pump with adequate heating system at a high flow rate and to locate the warmer close to patient for reserving a heating effect.
Subject(s)
Humans , Body Temperature , Catheters , Heating , Hot Temperature , Infusion Pumps , Intensive Care Units , Operating RoomsABSTRACT
Objective To find the safe vertical displacement for minimal infusion rate change of syringe pumps as the theoretical guidance for moving pumps. Methods The infusion volume within 1 minute after none and vertically moving 15, 25, 35, 50 cm of the pumps (microinfusion pump WZ-50C、WZ-50C2、BRAUN perfusor compact) at 10 ml/min were weighted and compared by the electronic balance. Results Significant differences of the infusion rate were detected. The difference of average infusion volume within 1 minute after vertically moving 15, 25, 35, 50 cm and non-movement were 0.004 (minimal),0.017, 0.033, 0.046ml. The lowest infusion curve of 15cm displacement stretches slightly above the horizontal plane until the inflexion in the section graph, leading to steeper in accordance with the increasing vertical displacement of the pumps,which implied the following drastic increase in infusion rate. Conclusions The minimal infusion change is obtained at 15cm, thus becomes the safe displacement height and the inflexion point of further soaring changes.
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BACKGROUND:Administration of a rapid or large dose of remifentanil (>1.0microg/kg for 30?60 s) should be avoided due to its association with side effects such as muscle rigidity. The present study determined the infusion rate and dosage of remifentanil administered using target-controlled infusion (TCI) varies with the modality selected and the target concentration. METHODS: Data including the age, sex, weight, and height of 10 patients undergoing elective surgery in a university hospital were randomly used for a 3-min simulation of TCI-remifentanil Minto model. In every simulation, TCI targeting both plasma (Cp) and the effect-site (Ce) was performed repeatedly with varying target concentrations (2, 3, 5, 10, and 20 ng/ml). The rate of administration and the cumulative dosages of remifentanil (per min) in all of the TCI simulations were recorded and analyzed. RESULTS: The rates of Ce TCI were significantly greater than those of Cp TCI using the same concentration. The cumulative dosage in the first-minute TCI simulation with Cp 20 ng/ml, and Ce 3, 5, 10, 20 ng/ml exceeded 1.0microg/kg/min. CONCLUSIONS: The target concentration and the infusion modality should be selected carefully to avoid rapid infusion and an overdose of remifentanil.
Subject(s)
Humans , Muscle Rigidity , Piperidines , PlasmaABSTRACT
BACKGROUND:Administration of a rapid or large dose of remifentanil (>1.0microg/kg for 30?60 s) should be avoided due to its association with side effects such as muscle rigidity. The present study determined the infusion rate and dosage of remifentanil administered using target-controlled infusion (TCI) varies with the modality selected and the target concentration. METHODS: Data including the age, sex, weight, and height of 10 patients undergoing elective surgery in a university hospital were randomly used for a 3-min simulation of TCI-remifentanil Minto model. In every simulation, TCI targeting both plasma (Cp) and the effect-site (Ce) was performed repeatedly with varying target concentrations (2, 3, 5, 10, and 20 ng/ml). The rate of administration and the cumulative dosages of remifentanil (per min) in all of the TCI simulations were recorded and analyzed. RESULTS: The rates of Ce TCI were significantly greater than those of Cp TCI using the same concentration. The cumulative dosage in the first-minute TCI simulation with Cp 20 ng/ml, and Ce 3, 5, 10, 20 ng/ml exceeded 1.0microg/kg/min. CONCLUSIONS: The target concentration and the infusion modality should be selected carefully to avoid rapid infusion and an overdose of remifentanil.
Subject(s)
Humans , Muscle Rigidity , Piperidines , PlasmaABSTRACT
We have determined the infusion rates of rocuronium in the elderly and young adult patients during sevoflurane and nitrous oxide anesthesia. The correlation of some anthropometric predictors with infusion rate of rocuronium was also investigated for both elderly and young adult. Participating patients were assigned to one of two groups: 1) young adult patients aged 20 to 50 years (n = 30) ; 2) elderly patients aged over 65 years (n = 30). The anthropometric variables such as height, weight, ratio of weight to body surface area, subscapularis and suprailiac skin folds, body surface area, body mass index and % ideal body weight were evaluated as predictors for infusion rate. The infusion rate in elderly patients was significantly less compared with that in young adult patients (p < 0.05). In elderly patients, no anthropometric predictor was related to the infusion rate of rocuronium. This suggests that the infusion rate of rocuronium for an elderly patient needs to be individualized by monitoring neuromuscular transmission to avoid excessive dose.
Subject(s)
Middle Aged , Male , Humans , Female , Aged , Adult , Skinfold Thickness , Neuromuscular Nondepolarizing Agents/administration & dosage , Infusions, Intravenous , Body Weight , Body Surface Area , Body Mass Index , Body Height , Anthropometry , Androstanols/administration & dosageABSTRACT
This report presents the effectiveness of 25-gauge Transconjunctival Sutureless Vitrectomy (TSV) for various vitreoretinal disorders. We performed vitreoretinal surgery on 6 patients using 25-gauge TSV. Minimal or no leakage of intraocular fluid or gas was observed at the entry site. No case required a suture to close the conjunctival or scleral opening site, and no complications resulted from the opening site. Median preoperative visual acuity was 0.04 and median postoperative best corrected visual acuity (BCVA) with a mean follow-up of 12 weeks, was 0.45. Median preoperative intraocular pressure was 12.67mmHg, and median intraocular pressure on the first postoperative day was 15.67 mmHg. Because transconjunctival sutureless surgery is minimally invasive, it increases the efficiency of vitrectomy, hastens postoperative recovery, and improves outcomes due to the simplified surgical procedure. We feel that the adoption of the 25-gauge TSV would lead to improved patient comfort, care, and management.
Subject(s)
Adult , Aged , Child, Preschool , Female , Humans , Male , Middle Aged , Follow-Up Studies , Retina/surgery , Retinal Diseases/surgery , Retrospective Studies , Visual Acuity , Vitrectomy/instrumentation , Vitreous Body/surgeryABSTRACT
PURPOSE: This study was performed to compare the effects and side effects of amphotericin B deoxycholate infusion over 6 versus 24 hours in febrile children with cancer. METHODS: Twenty-four children with cancer who were mostly neutropenic, febrile and suspected to have fungal infection and treated with amphotericin B deoxycholate from March 2001 to July 2002 at the Yeungnam University Hospital, Department of Pediatrics were enrolled for a cross-over study. All patients received 0.5 mg/kg amphotericin B deoxycholate infusion for average 7 days by two different infusion rates, one group by continuous infusion over 24 hours and the other by rapid infusion over 6 hours with at least 4 weeks of washout period. The side effects related to the infusion rates, fever, chilling or rigor, vomiting, headache, serum and urine electrolytes, beta2-microglobulin and creatinine clearance were monitored. The effect of amphotericin B deoxycholate infusion were studied by the days required for defervescence. RESULTS: There were no significant differences (P=0.11) in the effects between continuous and rapid infusion. But less side effects of chilling or rigor (P=0.01) were observed when amphotericin B deoxycholate was infused continuously. The serum phosphate (P=0.05) and magnesium (P=0.04) were lower and creatinine clearance was more reduced (P=0.01) when it was infused rapidly. CONCLUSION: Continuous infusion over 24 hours of amphotericin B deoxycholate could reduce the nephrotoxicity, such as hypophosphatemia, hypomagnesemia, low creatinine clearance and chilling reactions related to the rapid infusion without compromising the effects of amphotericin B deoxycholate in children with cancer.
Subject(s)
Child , Humans , Amphotericin B , Creatinine , Cross-Over Studies , Deoxycholic Acid , Electrolytes , Fever , Headache , Hypophosphatemia , Magnesium , Pediatrics , VomitingABSTRACT
To investigate the effect of electro-acupuncture stimulation (EAS) on insulin sensitivity in rats, we performed several stimulations on Otsuka Long Evans Tokushima Fatty (OLETF) rats, during euglycemic clamp. We divided OLETF rats into five groups according to the kind of the stimulation: EAS at vagal innervated region of the auricle (AVA), EAS at non-vagal innervated region of the auricle (ANVA), EAS on the back of the body (AB), pinching on the back of the body (PB), and no stimulation on the body (NS). These procedures were also applied on Long Evans Tokushima Otsuka (LETO) rats as a control study.<br>Furthermore, we performed long-term stimulation (from six to 24 weeks of age) on OLETF rats to assess the preventive effect of those stimulations on the formation of the insulin resistance. EAS of pulse duration 300ms, 1.5V, 1Hz was applied for 10 or 15minutes. As a result, the glucose infusion rate (GIR) showed significantly higher levels during stimulation of PB group in LETO rats. On the other hand, the GIR of AVA group in LETO rats and PB group in OLETF rats were decreased by stimulation. The GIR in AVA group and AB group after long-term stimulation were significantly higher than those of NS group in OLETF rats. These results suggested that EAS at the auricle and the back is useful for the prevention of the formation of insulin resistance when it's applied before onset of the symptoms in OLETF rats.
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BACKGROUND: Cis-atracurium is more potent, and less likely to release histamine and has better autonomic and cardiovascular stability, compared to atracurium. It is eliminated mainly by Hofmann reaction and produces less amounts of laudanosine, the first metabolite which has the CNS stimulating property. However, drug interactions with several ions, such as magnesium that is popular in treating eclampsia have not yet to be known. METHODS: Using sciatic nerve-anterior tibialis preparation in the cat, we tried to find out whether cis-atracurium has the cumulation effect by administering four consecutive 100 microgram/kg of cis-atracurium. After confirming that the cis-atracurium had no cumulation effect, we proceeded the dose-response study to find out the ED50, ED95 and action duration of cis-atracurium in control group(II) and magnesium-pretreated group(III). After cumulative dose -response study, in the half of the group II and III, the infusion rate to maintain 90% twitch depression at least for 20 minutes was obtained, and afterwards, the recovery index was measured after the discontinuation of infusion. In the other half of the group II and III, while maintaining 90% twitch depression at least for 20 minutes through continuous infusion of cis-atracurium, we administered the 10 microgram/kg of neostigmine to measure the onset time, action duration and antagonism effect of the drug. RESULTS: The cis-atracurium did not have the cumulation effect and in group III, ED50 and ED95 were decreased significantly from 234+/-82 microgram/kg to 103+/-18 microgram/kg and from 399+/-123 microgram/kg to 173+/-28 microgram/kg, respectively, compared with group II. The action duration of cis-atracurium ED95 in group III(190+/-52 sec) was significantly longer than in group II(143+/-29 sec). The infusion rate of cis-atracurium to maintain 90% twitch depression was significantly higher in group II in the spontaneous recoveryand the neostigmine-induced antagonism(6.63+/-2.37 and 4.47+/-1.58 microgram/kg/min), respectively. CONCLUSION: The cis-atracurium do not have the cumulation effect. And, the magnesium potentiates the neuromuscular blocking actions of cis-atracurium. However, it has no effect on the antagonism action of neostigmine.