Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2006
Case ReportsAccidental epidural administration of succinylcholine.
We report a case of accidental epidural of succinylcholine injection. A prolonged onset and a longer duration of neuromuscular blockade were observed compared with IV administration. No neurological or cardiovascular side effects or other symptoms of local or systemic toxicity were observed.
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Anesthesia and analgesia · Apr 2006
The role of anesthesiologists in the selection and administration of perioperative antibiotics: a survey of the American Association of Clinical Directors.
The importance of timely administration of antibiotics for prophylaxis of surgical site infections has led to pressure on anesthesiologists to administer antibiotics. We present a survey of members of the American Association of Clinical Directors designed to evaluate the role of the anesthesiologist in the selection and administration of perioperative antibiotics. ⋯ Based on the responses received, anesthesiologists appear to be integrally involved with the administration, but not selection, of perioperative antibiotics, despite what respondents perceive as inadequate training in antibiotic therapy. Furthermore, perioperative antibiotic therapy in general appears to be poorly monitored, and responsibility for selection and administration of perioperative antibiotics appears to be poorly defined.
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Anesthesia and analgesia · Apr 2006
Randomized Controlled Trial Comparative StudyA prospective evaluation of opioid weaning in opioid-dependent pediatric critical care patients.
Critically ill children are treated with opioid medication in an attempt to decrease stress and alleviate pain during prolonged pediatric intensive care. This treatment plan places children at risk for opioid dependency. Once dependent, children need to be weaned or risk development of a withdrawal syndrome on abrupt cessation of medication. ⋯ Children exposed to opioids for an average of 3 wk showed no difference in the number of agitation events requiring opioid rescue (3 consecutive neonatal abstinence scores >8 every 2 h) in either wean group. Most of the events requiring rescue occurred on day 5 and 6 of the wean in both treatment groups. Patients may be able to be weaned successfully in 5 days once converted to oral methadone, with a follow-up period after medication wean to observe for a delayed withdrawal syndrome.
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Anesthesia and analgesia · Apr 2006
Randomized Controlled Trial Comparative StudyPrevention of postoperative nausea and vomiting with granisetron and dolasetron in relation to CYP2D6 genotype.
We investigated the efficacy of granisetron and dolasetron in preventing postoperative nausea and vomiting. Because the metabolism of the various antiemetic 5-hydroxytryptamine type 3 (5-HT3) antagonists involves different isoforms of the hepatic cytochrome P450 system, we examined the relationship between the clinical efficacy of these drugs and polymorphic cytochrome P450 2D6 (CYP2D6) genotype. This prospective, randomized, double-blind study involved 150 adult patients with a moderate to high risk for postoperative nausea and vomiting. ⋯ A complete response was more frequent in the granisetron group (54.7%) compared with the dolasetron group (38.7%, P < 0.05). In subjects receiving dolasetron, carriers of the duplication of the CYP2D6 allele predicting ultrarapid metabolizer status had more frequent vomiting episodes (P < 0.05) than patients in the granisetron group. It is postulated that the difference in the antiemetic efficacy between two investigated 5-HT3 receptor antagonists may be associated with differences in the carrier status for the duplication of the CYP2D6 allele.
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Anesthesia and analgesia · Apr 2006
Randomized Controlled Trial Comparative StudyPopulation pharmacokinetics of milrinone in neonates with hypoplastic left heart syndrome undergoing stage I reconstruction.
We performed a blinded, randomized pharmacokinetic study of milrinone in 16 neonates with hypoplastic left heart undergoing stage I reconstruction to determine the impact of cardiopulmonary bypass and modified ultrafiltration on drug disposition and to define the drug exposure during a continuous IV infusion of drug postoperatively. Neonates received an initial dose of either a 100 or 250 microg/kg of milrinone into the cardiopulmonary bypass circuit at the start of rewarming. Postoperatively, milrinone was infused to clinical needs. ⋯ A constant infusion of 0.5 microg x kg(-1) x min(-1) resulted in drug accumulation during the initial 12 h of drug administration. Postoperatively, milrinone clearance was significantly impaired (0.4 mL x kg(-1) x min(-1)), improved by the 12th postoperative hour, and approached steady-state clearance (2.6 mL x kg(-1) x min(-1)) by postoperative day 4. In the postoperative setting of markedly impaired renal function, an infusion rate of 0.2 microg x kg(-1) x min(-1) should be considered.