Anestesia total intravenosa en la cirugía oncológica de mama / Total intravenous anesthesia in oncologist breast surgery

Introducción: El cáncer es la principal causa de muerte. Cada año se diagnostican millones de mujeres con cáncer de mama que necesitan tratamiento quirúrgico, para lo cual la anestesia total intravenosa parece ser una excelente opción. Objetivo: Describir los resultados de la aplicación de la anestesia total intravenosa en las pacientes a las que se les efectuó cirugía oncológica de mama. Métodos: Se realizó un estudio observacional, descriptivo, longitudinal, prospectivo, en el Servicio de Anestesiología del Hospital General Docente "Abel Santamaría Cuadrado" en el período comprendido entre enero de 2013 y enero de 2015. Se estudió una población accesible de 111 pacientes seleccionados mediante criterios de inclusión y exclusión. Para el análisis estadístico se utilizaron distribuciones de frecuencias, cálculo de medidas de tendencia central y de dispersión. Algunas de las variables fueron tensión arterial, frecuencia cardíaca, saturación de oxígeno, complicaciones, tiempo de recuperación, nivel de sedación, respuesta analgésica. Resultados: Se logró gran estabilidad hemodinámica en más del 95 por ciento de las pacientes. Se detectó superficialidad anestésica en 1,80 por ciento de los casos. El 92,80 por ciento de los casos se recuperaron entre 10 y 20 min. Se presentó sedación adecuada en 106 pacientes. Las principales complicaciones fueron las náuseas y los vómitos en 9,01 por ciento. Existió una adecuada respuesta analgésica en 93,69 por ciento de los casos. Conclusiones: La aplicación de la anestesia total intravenosa para cirugía oncológica de mama arrojó resultados muy satisfactorios como método anestésico(AU)

Introduction: Cancer is the leading cause of death worldwide. Every year millions of women are diagnosed with breast cancer and they need surgical treatment, for which total intravenous anesthesia seems to be an excellent option. Objective: Describe the results of the application of total intravenous anesthesia in patients undergoing oncological breast surgery. Methods: An observational, descriptive, longitudinal, prospective study was conducted in the Anesthesiology Service of "Abel Santamaría Cuadrado" Hospital in the period between January 2013 and January 2015. An accessible population of 111 patients selected using inclusion and exclusion criteria was studied. For the statistical analysis, frequency distributions, calculation of measures of central tendency and dispersion were used. Some of the variables were blood pressure, heart rate, oxygen saturation, complications, recovery time, level of sedation, analgesic response. Results: High hemodynamic stability was achieved in more than 95 percent of the patients. Anesthetic superficiality was detected in 1.80 percent of cases. 92.80 percent of the cases recovered after 10 to 20 minutes. Adequate sedation was present in 106 patients. The main complications were nausea and vomiting in 9.01 percent There was an adequate analgesic response in 93.69 percent of the cases. Conclusions: The application of total intravenous anesthesia for oncological breast surgery yielded very satisfactory results as an anesthetic method(AU)

Comparison of pharmacokinetics characteristics of vancomycin in cerebrospinal fluid after administration by continuous and interim intravenous infusion / 中国中西医结合急救杂志

Objective To compare the difference in pharmacokinetics characteristics of vancomycin in cerebrospinal fluid between administration by continuous infusion and interim infusion.Methods Twenty postoperative patients in the Department of Neurosurgery of Beijing Tiantan Hospital, Capital Medical University admitted into intensive care unit (ICU) to receive vancomycin for prophylaxis of intracranial infection were enrolled, and they were randomly distributed to a continuous intravenous infusion group and a interim intravenous infusion group, each group 10 cases. In continuous intravenous infusion group, the patients received a loading dose of vancomycin (15 mg/kg) by continuous intravenous pump infusion for 1 - 2 hours followed by 30 mg/kg vancomycin in a constant pump infusion rate for 24 hours; while in interim intravenous infusion group, the patients received 15 mg/kg vancomycin administered by intravenous pump infusion for 1 - 2 hours, once every 12 hours. The concentration of vancomycin in the cerebrospinal fluid at different time points was measured by two-dimensional liquid chromatography (2D-LC) method, the parameters of pharmacokinetics were calculated in the two groups, and the adverse reaction was observed.Results The comparison between the ratio of areas under the concentration-time curves (AUC) and minimum inhibitory concentration (MIC) of the continuous and interim groups showed no significant difference (19.7±14.0 vs. 16.1±6.4,P > 0.05). However, in the continuous intravenous infusion group, the drug concentration reached the peak value (0.96± 0.77)μg/mL at 12 hours, and later revealed a plateau concentration 0.91-0.93μg/mL for 12 hours; while in the intravenous infusion interim group, the drug concentration reached the peak value (0.92±0.47)μg/mL at 16 hours, in the later 2 hours declined to (0.84±0.45)μg/mL, and afterwards still had a tendency of persistent declination. In all the patients, no any adverse reaction related to the drug occurred.Conclusion Continuous intravenous infusion and interim intravenous infusion of vancomycin for the postoperative neurosurgical patients without intracranial infection have the similar efficacy of medication, but the former can achieve the peak concentration faster and later the fluctuation of drug concentration in cerebrospinal fluid is smaller than those in the latter.

The comparison of the treatment effect of continuous intravenous infusion and sequential therapy in pneumonia in children / 中国基层医药

Objective To investigate the clinical effects and significance of continuous intravenous infusion and sequential therapy in pneumonia in children.Methods 90 patients with pneumonia were randomly divided into the observation group and the control group,with 45 patients in each group,observation group received continuous intravenous infusion,the control group received sequential therapy.The expectoration and rales disappear time,chest X-ray and body temperature return to normal time,clinical efficacy were observed.Results The expectoration and rales disappear time,chest X-ray and body temperature return to normal time were longer than control group,which were significantly different (x2 =6.21,P ＜ 0.05),the total effective rate of observation group was 77.8％,the total effective rate of control group was 97.8％,the differences were statistically significant (t =3.58,4.62,6.18,7.01,all P ＜ 0.05).Conclusion The sequential therapy treatment pneumonia in children has better clinical effect,shorter hospital stay and worthy of clinical application.

Dose conversion ratio for continuous intravenous infusion of fentanyl and fentanyl transdermal patches (reservoir-type)

Objectives: At present, the dose conversion ratio for a continuous intravenous infusion of fentanyl (CIV) and fentanyl transdermal patches (TP), which are widely used in Japan, is not based on the results of clinical studies in Japanese patients. Studies comparing serum fentanyl concentrations in patients with cancer pain treated by TP showed large differences between Japanese patients and those in other countries. We therefore studied the dose conversion ratio in Japanese patients. Methods: From October 2003 through October 2008, we extracted information on all patients with gastrointestinal cancer who underwent rotation from CIV to TP in the gastrointestinal ward of Kitasato University East Hospital. We selected patients in whom the daily dose of CIV or TP (i.e., the basic dose) was unchanged for 10 days after rotation and the difference in the number of rescue doses (per day) as compared with immediately before rotation was 1 or less on at least 3 consecutive days. All TP preparations used in this study were reservoir-type. Regression lines were plotted on the basis of the relation of “the basic released dose of TP” to “the basic prescribed dose of CIV,” and the dose conversion ratio was calculated. Results: 47 patients underwent opioid rotation, and 11 of them satisfied the eligibility criteria. Eleven patients were studied. The following regression equation was obtained: Y=1.0227X+1.0103, r²=0.9188, indicating a strong correlation. The dose conversion ratio of CIV to TP (released dose) derived by regression analysis was 1:1. Conclusions: Our results obtained in Japanese patients will allow dose conversion at the time of opioid rotation from CIV to TP to be more appropriately performed.

Continuous intravenous infusion of fentanyl for pain due to stomatitis, pharyngitis, and esophagitis after hematopoietic stem cell transplantation

<b>Purpose</b>: The effectiveness of continuous intravenous infusion of fentanyl for pain due to stomatitis, pharyngitis, and esophagitis after hematopoietic stem cell transplantation (HSCT) was investigated. <b>Methods</b>: Subjects included 15 HSCT patients with pain due to mucosal damage. Continuous intravenous infusion of fentanyl was commenced at a dose of 12.5 μg/hour. Pain was controlled through an increase or decrease in volume as needed. Grade of oral mucosal damage, pain scale, and QOL index such as the number of tooth brushing or gargles were measured at the start of administration of fentanyl and at the time of maximum dosage. <b>Results</b>: The median time to start of fentanyl administration was day 7 after transplantation. The median duration of administration was 12 days. The median maximum dosage of fentanyl was 980 (range, 243.8∼3,010) μg/day, and it was reached at a median of day 5 after administration of fentanyl was started. Compared to that observed at the start of fentanyl administration, the grade of oral mucosal damage was significantly increased at the time of maximum administration. However, pain scale was significantly decreased and QOL index was maintained. <b>Conclusion</b>: Continuous intravenous infusion of fentanyl suppressed the increase of pain when mucosal damage increased, maintained QOL, and possibly contributed to selfcare. Palliat Care Res 2011; 6(2):246-252

Continuous vs intermittent infusion of fluorouracil in advanced colorectal cancer / 中国癌症杂志

Purpose:To compare the therapeutic and adverse effects between continuous and intermittent infusion of fluorouracil(5-FU) in advanced colorectal cancer.Methods:17 patients of advanced colorectal cancer were treated with continuous intravenous infusion of 5-FU 2.5g in 100 ml of 5% glucose in a continuous infusions pump,for 120 h (Group A).16 patients of similar severity were treated with 5-FU 500 mg in 500 ml of 5% glucose 2 h iv daily for 5 d (Group B). Total of 33 patients were treated with calcium folinate (CF) 200 mg in 100 ml of 5% glucose 1 h iv daily for 5 d and HCPT 10 mg in 250 ml of 5% glucose 2 h iv daily for 6d.The therapeutic and adverse effects were evaluated according to the cri- teria recommended by WHO.Results:Effectiveness was noted in 9 patients in Group A and 3 patients in group B.(x~2 test P

Anestesia em cães utilizando éter glicerol guaiacol, quetamina e fentanil em infusão contínua intravenosa / Anaesthesia in dogs using continuous intravenous infusion of guaiphenesin, ketamine and fentanyl

Onze cães, sem raça definida, receberam como medicação pré-anestésica a anestesia induzida e mantida por infusão contínua intravenosa de quetamina e fentanil em solução de éter gliceril guaiacol a 5% em glicose a 5%, através de bomba de infusão. Em seis animais foram mensuradas frequência cardíaca e respiratória, ventilometria (volume corrente e volume minuto), pressão arterial (sistólica, média e diastólica), temperatura retal, hemogasometria arterial, saturação de 02 na hemogoblina, anion residual, osmolalidade sérica, concentração sérica total de 02, hematócrito, hemoglobina, glicose e eletrólitos. Avaliou-se também a analgesia através de pinçamento da pele da região glabra. Em outro grupo de cinco animais, onde foram realizadas três ovários-salpingo-histerectomias e duas osteossínteses, foram mensuradas a frequência cardíaca e respiratória e a resposta ao estímulo cirúrgico. Em ambos os grupos observou-se, principalmente, depressão respiratória dose-dependente, agravada com o uso de velocidade de infusão elevada, no caso de manobras cirúrgicas muito cruentas, como manipulação de periósteo.

Eleven mongrel dogs were premedicated with methotrimeprazine. Anaesthesia was induced and main-tained by continuous intravenous infusion of a 5% glucose solution containing guaiphenesin, ketamine and fentanyl. Heart and respiratory rates, tidal and minute volume, systolic, mean and diastolic blood pressure, temperature, arterial blood gases, hemoglobin oxygen saturation, anion gap, serum osmolality, serum oxygen concentration, packed cell volume, hemoglobin, glucose and electrolytes were measured in six dogs. Analgesia was investigated usind a forceps in the skin. In the other five dogs heart and respiratory rates and response to surgical stimulus were investigated. Respiratory acidosis, hypoximia and hypoventilation were observed. Respiratory depression was proportional to the infusion rate, particulary when high infusion rates were used for bone repair.

The Effects of Midazolam and Propofol by Continuous Intravenous Infusion to provide Sedation in Patients who receive Spinal Anesthesia / 대한마취과학회지

Midazolam and propofol by continuous intravenous infusion produce excellent and easily controllable sedation as an adjunct to spinal anesthesia. The purpose of the present study is to compare the cardiovascular and respiratory effect, degree of sedation and recovery of midazolam and propofol, and then determines the mean infusion rate of both groups. Forty patients of ASA class 1 or 2 scheduled to lower extremities surgery under spinal anesthesia were classified randomly into 2 groups. Group 1 were infused with midazolam 0.1-0.2mg/kg/h and group 2 propofol 2-3mg/kg/h. The results were as follows: 1) The mean induction dose of midazolam was 0.29+/-0.03mg/kg/h and propofol was 5.56+/-0.78mg/kg/h and the mean infusion rate of midazolam was 0.09+/-0.02mg/kg/h and propofol was 2.13+/-0.41mg/kg/h, which resulted in easily controllable sedation during operation. 2) The quality of sedation was assessed as good in 19 patients but 1 patient showed excitatory movements after midazolam infusion. Good sedation was provided in 16 patients but 2 patients showed excitatory movements and 2 patients complained pain on injection after propofol infusion. 3) The mean arterial pressure was more significantly decreased in propofol than midazolam group. 4) The heart rate was more decreased than control in both groups. 5) Airway maintenance was excellent and side effects were rare. 6) Recovery, judged by ability to open the eyes and recall date of birth, was significantly more rapid after propofol than after midazolam infusion.