Influence of acute normovolemic hemodilution on the pharmacokinetics of Cisatracurium Besylate.

BACKGROUND: Acute normovolemic hemodilution (ANH) is an efficacious blood conservation strategy for avoiding or reducing allogeneic blood transfusion. In a previous publication, on a different cohort of patients, we demonstrated that cisatracurium's potency and duration of action were not influenced by ANH, but we could not establish which role, if any, pharmacokinetics played. METHODS: Forty patients were randomly allocated to the ANH or control groups. Patients received cisatracurium single 100 µg kg-1 bolus dose, serial arterial blood samples were collected and assayed for pharmacokinetic analysis. RESULTS: Central and steady state apparent volumes of distribution (V1, Vdss) and slope factor (γ) were larger, effect-compartment concentration at 50% neuromuscular block was lower in the ANH (90.8±41.6 mL kg-1, 159.1±39.2 mL kg-1, 6.0±0.9 and 136.4±29.1 ng·mL-1) compared with the control group (65.5±26.1 mL kg-1, 134.8±31.8 mL kg-1, 5.5±0.8 and 158.5±26.0 ng·mL-1) respectively. Elimination half-life (t1/2 ß) and mean residence time (MRT) were longer in the ANH (37.2±20.9, 23.5±13.2 min) than the control group (26.8±9.8, 16.9±6.2 min), albeit not statistically significant (P=0.051, P=0.051). There were no significant differences in distribution half-life (t1/2 α), effect-compartment equilibration rate-constant (keo), central and total clearances (Clc, Cl) between the ANH (2.4±1.2 min, 0.070±0.013 min-1, 6.1±1.9 mL kg-1 min-1 and 7.7±2.3 mL kg-1 min-1) and control group (1.9±1.2 min, 0.063±0.008 min-1, 7.0±1.8 mL kg-1 min-1 and 8.5±2.1 mL kg-1 min-1) respectively. CONCLUSION: ANH altered some pharmacokinetic parameters such as significantly larger volumes of distribution. Other parameters such as elimination half-life were considerably longer albeit not statistically significant.

No regional difference in cisatracurium dose-response and time-course-of-action between patients in China and Bosnia.

BACKGROUND: Variability in drug response could result from a variety of genetic and environmental factors that are often hard to define or quantify. A number of studies demonstrated regional geographic variations in potency of neuromuscular blocking agents (NMBAs). The aim of our study was to compare dose-response and time-course-of-action of cisatracurium besylate, an NMBA eliminated via the Hoffman degradation, in two countries with different life habits, diet, and ambient conditions; being Han Chinese in China and Caucasians in Bosnia. METHODS: Neuromuscular block of cisatracurium 20 µg kg(-1), followed by four incremental 10 µg kg(-1) doses, and the remainder of 100 µg kg(-1) was evaluated using the Relaxometer mechanomyograph (Groningen University, Groningen, The Netherlands). Dose-response curves were created using log-dose-probit-response transformation. RESULTS: There were no significant differences in cisatracurium mean (95% confidence intervals) ED(50), ED(90), and ED(95) (effective doses for 50%, 90%, and 95% first twitch depression) in Caucasian [39.1 (35.7-42.3), 50.6 (45.5-54.3), and 54.4 (49.8-58.9) µg kg(-1)] compared with Chinese patients [39.2 (35.1-43.1), 52.4 (47.9-56.8), and 56.9 (52.8-61.9) µg kg(-1)], respectively. There were no significant differences in mean (sd) Dur(25) and Dur(0.9) (time until 25% first twitch and 0.9 train-of-four ratio recoveries) in Caucasian [47.1 (6.4) and 77.5 (9.1) min)] compared with Chinese patients [(45.9 (4.7) and 72.3 (9.1) min)], respectively. CONCLUSIONS: Cisatracurium dose-response relationship and time-course-of-action were not influenced by geographic location. Thus, cisatracurium would not require dose adjustments between patients living in the two geographic locations.

[Trends in resistant bacteria isolated from a tube smear in intubated patients in intensive care]. / Kretanje rezistencije bakterija izoliranih brisom tubusa kod intubiranih pacijenata na intenzivnoj njezi.

Long standing antibiotics therapy has resulted in growing bacteria resistance. We took a tube smear and prepared culture with antibiogram from the fifty intubated patients in the Intensive care unit in the war period. Gram-negative germs were the dominant ones in total sum, and among them the Acinetobacter calcoaceticus (No 21), Pseudomonas aeruginosa (No 18), Klebsiella pneumoniae (No 18), were isolated most frequently. Pseudomonas aeruginosa showed high resistance to Gentamicin (64%), Amikacin (35%), Trimethoprim (66%), Pefloxacin (20%), Ofloxacin (25%), Ciprofloxacin (25%). Klebsiella pneumoniae is resistant to Gentamicin (68%), Amikacin (22%), Cephalosporin (100%), Trimethoprim (31%), but it showed no resistance to chinolones. Acinetobacter calcoaceticus is resistant to Gentamicin (73%), Amikacin (36%), Cephalosporin (100%), Trimethoprim (63%), Pefloxacin (33%), Ofloxacin (67%), Ciprofloxacin (46%). Staphylococcus aureus was the most frequent among Gram-positive germs and it was resistant to Penicillin (100%), Gentamicin (40%), Lincocin (18%), Trimethoprim (5%), Pefloxacin (13%), Methicillin (21%), Cephalosporin (8%). The appearance of resistance on the antibiotics demands attentive follow-up aiming to influence the empirical application of antibiotics schemes depending on resistance.

[Aerobic wound infections during the war]. / Aerobne infekcije rana u ratnom periodu.

We presented the results of causative agents of wounds aerobic infections obtained during the first three months of third war year in Bosnia. We isolated mostly Staphylococcus aureus (54%), Pseudomonas aeruginosa (25%) and Serratia marcensens (20%). Other aerobic causative agents of wounds were established in less percent. The most frequent infections were detected in swaba specimens received from Orthopaedic, Traumathological, Plastical, Vasculary and Clinic for Pulmonary Diseases. In discussion we compared our results to data from 1st and 2nd world war and wars in Algeria, Corea, Vietnam and Israel.

[Internal diseases with special emphasis on endocrine disorders during war conditions]. / Internisticka oboljenja sa specificnostima i posebnim osvrtom na endokrina oboljenja u ratnim uslovima.

Presented here is our own experience acquired in the course of one war-year in the Republic of Bosnia and Herzegovnia. Numerous factors that have altered the picture of a number of diseases, their frequency, character and intensity, and as a result, their diagnostica and therapy, have been noticed. Most frequent factors are the following: poorer personal and general states of hygiene, lower standard of living with general lack of food of all kinds, physical strains, exposure to psychotraumas, temperature and climatic changes, life in collective centres and siege, constant migrations of the population, captivity molesting and stay in prisoners camps. The problems, that the health service has, and that are greater than those of the population, have been pointed out. The following diseases have been registered: "common colds" which affect respiratory tract, peptic ulcers, dyspeption, gastritis, malnutrition, enterocolytis and TBC. The most frequent diseases of endocrine glands are: diabetes mellitus, thyreotoxicosis and hypertension. The prolonged hospital stay of the wounded and the patients, as long as 6-7 months, because of their waiting to be transported abroad, or to their homes, is criticized, because as a result of that hospitalisation of the acute patients has been impossible.