ABSTRACT
Aminoglycoside antibiotics can be used successfully in the treatment of otologic infections caused by gram-negative bacteria. They can be particularly valuable, sometimes in combination with a beta-lactam antibiotic such as carbenicillin, in malignant external otitis, acute middle ear infections caused by gram-negative organisms, and central nervous system complications of cholesteatomas. On the basis of susceptibility tests and of the pharmacology of these drugs, we administer appropriate therapeutic doses of one of the following antibiotics: kanamycin, gentamicin, tobramycin, or amikacin. All of these drugs may be ototoxic and nephrotoxic.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacterial Infections/drug therapy , Cholesteatoma/drug therapy , Otitis Media/drug therapy , Aminoglycosides/adverse effects , Aminoglycosides/metabolism , Aminoglycosides/therapeutic use , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/metabolism , Brain Abscess/etiology , Cholesteatoma/complications , Cochlea/drug effects , Humans , Injections, Spinal , Kidney/drug effectsSubject(s)
Anesthesia, Inhalation/methods , Halothane/blood , Models, Biological , Computers, Analog , Drug Administration Schedule , Halothane/administration & dosage , Halothane/metabolism , Humans , Kinetics , Lung/physiology , Nitrous Oxide/administration & dosage , Pharmacology , Pulmonary Alveoli/metabolism , Respiratory Dead Space , Tissue DistributionABSTRACT
It is appropriate to consider dose-regulated or quantitative closed-circuit anesthesia in terms of uptake of inhalation anesthetics from a reservoir bag which is never allowed to fill completely. The method which the authors have used routinely for 8 years requires reduction of the dose as a function of the inverse square root of elapsed anaesthesia time. Nitrogen does not accumulate because there is an inevitable loss of 20 to 100 ml/min between cuff and trachea. A simpler method, which has been well received, is that of "minimal flow" anesthesia (Virtue) with a constant fresh gas flow of 300 ml/min O2 and 200 ml/min N2O. "Low-flow" techniques typically entail use of 500 ml each of O2 and N2O per min.