Pharmacokinetics and outcome of tazobactam/piperacillin in Japanese patients undergoing low-flow continuous renal replacement therapy: dosage considerations.

BACKGROUND: Tazobactam/piperacillin (TAZ/PIPC), which is often combined with continuous renal replacement therapy (CRRT), induces renal excretion and is thought to have a high component removal rate for blood purification. CRRT procedures vary depending on the country, region, and institution. It is not clear whether the dose of TAZ/PIPC for use in Japan can be determined based on studies conducted in other countries. Therefore, in this study, we examined the suitability of recommended dose in Japan. METHODS: The study subjects consisted of 10 patients who received TAZ/PIPC during CRRT in the intensive care unit of Hyogo College of Medicine, Nishinomiya, Japan. We used a one-compartment model to characterize and parameterize the pharmacokinetics of TAZ/PIPC because their blood levels were eliminated monoexponentially. RESULTS: Compared with the data of healthy adults, the half-lives (t1/2) of both PIPC and TAZ were prolonged while their clearance rates decreased. CONCLUSION: For the continuous hemodiafiltration procedure adopted in Japan, we concluded that the dose and frequency were appropriate because the patients who received PIPC/TAZ 2.25 g twice a day during continuous hemodiafiltration maintained appropriate blood levels of both PIPC and TAZ.

Simulation analysis of three intubating supraglottic devices during infant chest compression.

Current guidelines for pediatric cardiopulmonary resuscitation suggest that supraglottic devices are alternatives for tracheal intubation with minimal interruption of chest compression. We examined the utility of three intubating supraglottic devices, air-Q® (air-Q), Ambu® aura-i (aura-i), and i-gel® (i-gel), utilizing manikin simulation. Twenty-two novice physicians performed securing of airway on an infant manikin with the three devices. We measured the rate of success on ventilation and the insertion time with or without chest compression. Successful ventilation rate did not significantly decrease with chest compression in the three devices (without chest compression: air-Q, 21/22; aura-i, 20/22; i-gel, 20/22, during chest compression: air-Q, 20/22; aura-i, 20/22; i-gel, 18/22). The insertion time with air-Q and aura-i did not extend significantly for chest compression. In contrast, the insertion time with i-gel was significantly extended in chest compression (P < 0.05). Air-Q and aura-i are more useful for airway management during chest compression than i-gel.

Utility of the Pentax-AWS Airwayscope and Macintosh laryngoscope for airway management during chest compressions in 27° left-lateral tilt: a manikin simulation study of maternal cardiopulmonary resuscitation.

PURPOSE: American Heart Association (AHA) 2010 cardiopulmonary resuscitation guidelines recommend high-quality chest compressions (minimum interruption, a pace >100 compressions/min, and a depth more than 5 cm). They propose minor changes for pregnant women: manual left deviation of the uterus or a left-lateral incline of 27°-30° to alleviate pressure on the inferior vena cava. We examined the performance of the Pentax-AWS Airwayscope (AWS) and Macintosh laryngoscope (McL) for airway management during chest compressions on a 27° left-lateral tilt (27 LLT) operating table. METHODS: The study included 18 novice doctors in our anesthesia department. They performed tracheal intubation on a manikin positioned on a 27 LLT operating table using the AWS or McL with or without chest compressions. We measured the intubation time and success rate for tracheal intubation. RESULTS: Intubation success rate with the McL decreased with chest compressions compared to without chest compressions (12/18 vs. 18/18, P < 0.05). Intubation time with the McL was lengthened with chest compressions compared to without chest compressions (18.9 ± 4.0 s vs. 11.1 ± 1.0 s, P < 0.05). Intubation success rate was the same for the AWS with and without chest compressions (18/18 in both cases), and intubation time did not increase significantly without compressions compared to with compressions (11.6 ± 1.4 s vs. 12.6 ± 1.2 s, NS). CONCLUSIONS: The AWS is an effective tool for airway management during chest compressions in 27 LLT in a manikin, suggesting that the AWS may be a useful device for airway management during maternal resuscitation.

[Anesthetic machine leakage from vaporizer by external force derived from keyboard of electronic medical records].

We experienced the leakage from the vaporizer of the anesthetic machine despite the normalities on performing the initial leak test. The vaporizer of the anesthetic machine was compressed by computer keyboard of EMR which caused a leak from vaporizer. After computer keyboard and the vaporizer were set at normal position, the leak stopped.

Addition of a video camera system improves the ease of Airtraq(®) tracheal intubation during chest compression.

Recent resuscitation guidelines for cardiopulmonary resuscitation emphasize that rescuers should perform tracheal intubation with minimal interruption of chest compressions. We evaluated the use of video guidance to facilitate tracheal intubation with the Airtraq (ATQ) laryngoscope during chest compression. Eighteen novice physicians in our anesthesia department performed tracheal intubation on a manikin using the ATQ with a video camera system (ATQ-V) or with no video guidance (ATQ-N) during chest compression. All participants were able to intubate the manikin using the ATQ-N without chest compression, but five failed during chest compression (P < 0.05). In contrast, all participants successfully secured the airway with the ATQ-V, with or without chest compression. Concurrent chest compression increased the time required for intubation with the ATQ-N (without chest compression 14.8 ± 4.5 s; with chest compression, 28.2 ± 10.6 s; P < 0.05), but not with the ATQ-V (without chest compression, 15.9 ± 5.8 s; with chest compression, 17.3 ± 5.3 s; P > 0.05). The ATQ video camera system improves the ease of tracheal intubation during chest compressions.

Comparison of Pentax-AWS Airwayscope video laryngoscope, Airtraq optic laryngoscope, and Macintosh laryngoscope during cardiopulmonary resuscitation under cervical stabilization: a manikin study.

PURPOSE: The 2010 American Heart Association or European Resuscitation Council guidelines for cardiopulmonary resuscitation emphasize that rescuers should minimize interruption of chest compressions, even for endotracheal intubation. Cervical stabilization should also be maintained during traumatic cardiac arrest. The utility of the Pentax-AWS Airwayscope (AWS) video laryngoscope and Airtraq (ATQ) optic laryngoscope for airway management has been reported under cervical stabilization. We first evaluated ATQ utility during chest compression with or without cervical stabilization and then compared the AWS, ATQ, and Macintosh laryngoscope (McL) during chest compressions under cervical stabilization in a manikin. METHODS: In the first trial, 19 novice doctors performed tracheal intubation with ATQ during chest compression with or without cervical stabilization. In the second trial, 21 novice doctors performed tracheal intubation on a manikin with cervical stabilization using AWS, ATQ, and McL with or without chest compression in a manikin. The rate of successful intubation, time to intubation, and subjective difficulty of use (visual analog scale) were recorded. RESULTS: In the first trial, intubation time during chest compression was significantly shortened under cervical stabilization compared to without cervical stabilization (P < 0.05). In the second trial, using McL, 3 participants failed to perform tracheal intubation without chest compression and 11 failed during chest compression (P < 0.05). Using ATQ, all intubations were successful without chest compression, but 5 failed during chest compression (P < 0.05). Intubation time was significantly prolonged by chest compression using McL or ATQ (P < 0.05). All participants successfully secured the airway with AWS regardless of chest compression, and chest compression did not prolong intubation time. Chest compression worsened the score on the visual analog scale of laryngoscopy in the McL trial (P < 0.05), but not in ATQ or AWS trials. Difficulty of tube passage through the glottis increased with chest compression with the McL and ATQ (P < 0.05) but not with AWS. CONCLUSION: The AWS was superior to McL and ATQ for endotracheal intubation during simulated cervical stabilization and chest compression.

Comparison of Supreme(®) and Soft Seal(®) laryngeal masks for airway management during cardiopulmonary resuscitation in novice doctors: a manikin study.

PURPOSE: In the 2005 American Heart Association (AHA) guidelines, the laryngeal mask (LMA) was proposed as an alternative to tracheal intubation for cardiopulmonary resuscitation (CPR). We compared the utility of a newly developed LMA, the Supreme(®) (Supreme), with a conventional LMA, the Soft Seal(®) (Soft Seal). METHODS: A total of 19 novice doctors in our anesthesia department performed insertion of the Supreme or Soft Seal on a manikin with or without chest compression. Insertion time and number of attempts for successful ventilation were measured. After successful ventilation, the amount of air entering the stomach and maximum ventilation pressure were measured. The subjective difficulty of using the devices was also measured. RESULTS: The ventilation success rate of first insertion did not differ between the Supreme and Soft Seal without chest compression. However, the success rate was significantly lower with the Soft Seal than the Supreme during chest compression. Insertion time was lengthened by chest compression with the Soft Seal, but not with the Supreme. Maximum ventilation pressure was higher with the Supreme than the Soft Seal. The amount of air entering the stomach was significantly lower with the Supreme than the Soft Seal. The Supreme also scored better than the Soft Seal on a visual analog scale of subjective difficulty in insertion. CONCLUSIONS: The Supreme is an effective device for airway management during chest compression.