Pharmacotherapy
-
Increased activity or inadequate inhibition of the autonomic nervous system is often the cause of perioperative hypertension. The goal of treatment is to maintain an adequate balance between myocardial oxygen supply and demand. ⋯ The cost:benefit ratio of therapy with these newer agents must also be considered. Despite the fact that perioperative hypertension is aggressively treated, there are no long-term, large-scale study data indicating that this treatment affects long-term patient outcomes.
-
The discovery of ether anesthesia made modern surgery possible. Successive improvements produced today's inhaled anesthetics, compounds that allow precise control over the anesthetic state without compromising safety. Such control extends to induction and maintenance of, and recovery from, anesthesia. ⋯ Important among these is molecular stability that permits elimination of the unchanged anesthetic molecule in expired air and provides resistance to degradation by metabolism and by carbon dioxide absorbents. Halogenation with fluorine produces more stable, safer anesthetics. Greater stability, lower solubility, and rapid recovery can decrease direct and indirect costs.
-
Comparative Study
Vancomycin pharmacokinetics in neonates receiving extracorporeal membrane oxygenation.
Vancomycin is administered as both prophylaxis and treatment in neonates receiving extracorporeal membrane oxygenation (ECMO), typically after surgery. An open-label, retrospective study was conducted to determine dosing strategies in all neonates who received vancomycin during ECMO and compare pharmacokinetic values with those of matched controls not receiving ECMO. Fifteen neonates receiving ECMO were given vancomycin infused into the circuit, with dosages based on weight and gestational age. ⋯ Volume of distribution and clearance were not significantly different in controls (0.39 +/- 0.12 L/kg, 0.79 +/- 0.41 ml/min/kg), but half-life was shorter (6.53 +/- 2.05 hrs, p = 0.02). Based on long volume of distribution in neonates receiving ECMO, we recommend that empiric vancomycin regimens incorporate a longer dosing interval than the 6-8 hours commonly recommended for term infants. The effects of severity of illness on drug elimination require additional study.