[Tocolysis with calcium-channel blockers and intraventricular hemorrhage]. / Tocolyse par les inhibiteurs calciques et hémorragies intraventriculaires.

OBJECTIVE: To determine the possible association between intraventricular hemorrhage (IVH) in very premature infants and calcium-channel blockers used as tocolytics. MATERIALS AND METHODS: We performed a case-control study (from October 1999 to December 2002) including 51 premature infants under 30 weeks with IVH (all grade) and 112 premature infants under 30 weeks without IVH. In this study only premature infants issued from spontaneous prematurity were included. The exposure frequency to calcium-channel blockers and to other tocolytics were compared between the two groups by univariate analysis and by logistic regression analysis. RESULTS: Calcium-channel blockers were used in monotherapy before birth in 16% of infants without IVH and in 20% of infants with IVH (P=0.55). An exposure to a bitherapy or a tritherapy with a calcium-channel blocker and one or several other tocolytics has been found in 43% of infants with IVH and in 26% of infants without IVH (P<0.05). However this association disappears after adjustment for gestational age. CONCLUSION: We did not find a significant association between calcium-channel blockers used as tocolytics and an increased risk of intraventricular hemorrhage in premature infants less than 30 weeks.

[Auditing of drug use practices in anesthesia]. / Audit des pratiques médicamenteuses en anesthésie.

OBJECTIVES: Internal pharmaceutical practice guidelines were produced in a department of anaesthesia of a University hospital in 1995, after a preliminary evaluation showing controversial and expensive practices. After approval, these recommendations were circulated to all members of the department. Phase I of this study was started 18 months later, to evaluate the compliance of anaesthetists with these guidelines. STUDY DESIGN: Prospective survey. METHOD: An audit was performed by a research assistant pharmacist, previously trained, who compared anaesthetic agents and fresh gas flows used during anaesthetics with those recommended in the internal guidelines. RESULTS: Implementation of guidelines was observed in more than 90% of cases for all agents studied, except for non-depolarizing neuromuscular relaxants. Relaxants of intermediate duration were used in 52% of cases with an expected surgery duration of more than 90 min, in opposition to the guidelines stating that pancuronium should have been administered in such circumstances. These results were presented and discussed. Slight changes in the guidelines (especially concerning monitoring of neuromuscular blockade) were made and evaluated again, using the same method (Phase II). A small but significant improvement was seen with induction agents (use of propofol in non-approved situations: 5 versus 0%, P = 0.03), while a non significant trend toward better implementation of guidelines was seen with non-depolarizing agents (use of pancuronium in surgery of expected duration > 90 min: phase I vs phase II = 47 vs 52%, NS; use of pancuronium in surgery of expected duration < 90 min: phase I vs phase II = 3.5 vs 0%, NS). CONCLUSION: This study suggests that implementation of internal guidelines is easy when clinical indications of the agents are not controversial.

Audit of ketoprofen prescribing after orthopedic and general surgery.

PURPOSE: In 1994, we developed a practice guideline which stated that ketoprofen should be used in every adult patient after surgical procedures for which at least moderate pain was anticipated. The dose recommended was 50 mg every six hours i.v. in the operating room followed by oral administration as soon as possible for three days. The purpose of this study was to evaluate the success of the guideline implementation. METHODS: In 1995, an audit performed by a research pharmacist assistant under the supervision of the authors analysed prospectively the files of patients scheduled for orthopedic or general surgery during a one-month period. The compliance of the nurses was also recorded. RESULTS: Of 185 patients operated upon during the period, seven were transferred to the ICU and were not evaluated. Ketoprofen was not prescribed to 112 (63%) of the 177 remaining patients, either because minor pain was expected (n = 55) or because one or several contra-indications to its use were detected. In cases where ketoprofen was used although theoretically contraindicated (11%), review of the medical records and interviews of anesthesiologists showed that prescription was guided by a risk/benefit analysis. In 18% of cases, nurses did not administer at least one dose of ketoprofen although medical prescription requested regular administration. CONCLUSION: Although the use of NSAIDs is still controversial, implementation by anesthesiologists of a practice guideline introducing ketoprofen for postoperative analgesia was successful and the nursing non-compliance rate to follow written orders was modest.

Stability of epinephrine in alkalinized solutions.

STUDY OBJECTIVE: Increasing the pH of an epinephrine solution favors its oxidation and may result in a decrease in its biological activity. It is therefore generally assumed that epinephrine and sodium bicarbonate should not be infused in the same IV line during CPR. The aim of this study was to determine the validity of this widely accepted proposition. DESIGN AND SETTING: Two different commercial solutions of epinephrine differing only in the concentration of sodium metabisulfite (0.46% and 0.02%) were studied. Two dosages of each solution type (1 mg/1 mL and 10 mg/10 mL) were diluted in 250 mL of 8.4% sodium bicarbonate. MEASUREMENTS AND MAIN RESULTS: The concentration of epinephrine was measured at different times for two weeks. It was found that the concentration of epinephrine decreased slowly to zero after two weeks, and was approximately at 70% and 100% of control values at 30 minutes after alkalinization. CONCLUSION: It was concluded that epinephrine in an alkaline solution is effectively oxidized but has a slow reaction that may not be clinically relevant over short periods of time.

Chemical stability of bupivacaine in pH-adjusted solutions.

Recent clinical studies have suggested that alkalinization of bupivacaine may shorten the time to onset and lengthen its duration of action. However, addition of sodium bicarbonate to commercially manufactured bupivacaine can rapidly produce precipitation. This study was performed to study the stability and precipitation of bupivacaine solutions 0.25% and 0.50% with and without epinephrine 1:200,000 after alkalinization. The results indicate that alkalinization does not increase precipitation above recommended limits and that the concentration of bupivacaine in solutions is maintained at least 6 h after alkalinization.

Chemical stability of lignocaine (lidocaine) and adrenalin (epinephrine) in pH-adjusted parenteral solutions.

Recent clinical studies have shown that alkalinizing lignocaine (lidocaine) solutions is an effective way of shortening the time of onset and increasing the duration of anaesthesia. However, alkalinizing lignocaine solutions raises the problem of the stability of these preparations. Moreover, the adrenalin usually associated with it is unstable in alkalinized solutions designed for peridural injection. This study was performed to define the range of pH over which lignocaine and adrenalin in commercial solution is stable. The results indicate that it is possible to alkalinize lignocaine solutions and that the solutions prepared are stable for at least 6 h.

[Use of thyrocalcitonin by the trans-dentinopulpal route as a means of stabilizing and preventing rejection of human teeth homografts. Results and radiological changes (author's transl)]. / Essai d'une thérapeutique anti-rejet dans le cas d'une homogreffe de dent humaine: la thyrocalcitonine par voie trans-dentino-pulpaire. Résultats et évolution radiologique; une méthode de stabilisation du rejet? (author's transl)]

Clinical and radiological results of an antirejection therapy based on the local action of a thyroid hormone, thyrocalcitonin, were studied. A double action was noted as it may stop the rhyzalase, and, more particularly, it reestablishes normal alveolodental relationships. Immunological factors are discussed. The therapeutic mode of action is emphasized as being a new method of local treatment.