Reducing cocaine solution use by promoting the use of a lidocaine-phenylephrine solution.

A program to reduce the use of cocaine solution in a university teaching hospital by promoting the use of a lidocaine-phenylephrine solution is described. To reduce the use of cocaine solution, pharmacists promoted the use of a mixture of lidocaine 3% and phenylephrine 0.25% in place of cocaine solution for nasotracheal intubation procedures. Because initial clinical use of the lidocaine-phenylephrine solution by the anesthesia service was successful, the pharmacy department began in December 1986 to actively promote use of the solution to the bronchoscopy service, the emergency service, and select inpatient nursing units. Educational measures included an article in the pharmacy and therapeutics newsletter detailing the safety and efficacy of the solution, pharmacist description of the program to physicians and nurses, and designation of the solution as a free floor stock item on nursing units. By 1988, total cocaine solution use had decreased by 66% from the 1984 average of 145.7 doses per month to an average of 50.0 doses per month; overall use of topical anesthetics remained constant. The nursing staff supported the use of the lidocaine-phenylephrine solution because it eliminated the extensive record keeping necessary for the cocaine solution. The program to decrease the amount of cocaine solution used was successful and will be expanded to other areas of the hospital.

Preparation and release characteristics of tobramycin-impregnated polymethylmethacrylate beads.

Preparation of tobramycin-impregnated polymethylmethacrylate (PMMA) bone cement beads and release of tobramycin from the beads in vitro and after implantation in a patient are described. Tobramycin sulfate powder 1.2 g was mixed with Palacos PMMA bone cement 40 g in a custom-made mold to produce 25 beads containing 3.26 mg tobramycin (as the sulfate salt) per bead. Chains of the beads, strung on stainless-steel suture, were sterilized with ethylene oxide. Three single beads were each placed in multiple-electrolyte solution (pH 7.4); the solution was removed and replaced with fresh solution every 24 hours for 28 days. The tobramycin content of each day's solution was determined by fluorescence polarization immunoassay. After day 28, solution was removed weekly for assay until day 84. Tobramycin concentrations were measured in drainage from the surgical wound after six chains of tobramycin-PMMA bone cement beads were implanted in the right acetabulum and femur of a patient whose hip prosthesis had been removed because of infection. Tobramycin concentrations in the dissolution medium averaged 34.3 micrograms/mL initially, and 7.5 micrograms/mL on day 2, gradually decreasing to 0.6 microgram/mL on day 28. Release of tobramycin followed a predictable pattern, and variation among samples was small. Over 12 weeks, less than 20% of the theoretically available tobramycin from a single bead was released. Tobramycin concentration in wound drainage was 90.0 micrograms/mL during the first 24 hours after surgery, while serum tobramycin concentrations were less than 0.5 microgram/mL. Extemporaneously prepared beads of bone cement are effective for delivering high concentrations of tobramycin to an infection site.(ABSTRACT TRUNCATED AT 250 WORDS)