Pharmacotherapy
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Case Reports
Cross-resistance to both atracurium- and vecuronium-induced neuromuscular blockade in a critically ill patient.
A previously healthy 33-year-old woman received neuromuscular blocking agents during treatment of severe adult respiratory distress syndrome secondary to pneumococcal pneumonia and septic shock. Atracurium infusion rates were progressively increased, preceded by repeated loading doses up to a maximum of 3.57 mg/kg/hour, but produced inadequate neuromuscular blockade as assessed by clinical and ventilatory parameters as well as train-of-four (TOF) monitoring. Atracurium was discontinued and vecuronium infusions of 2.3 mg/kg/hour finally produced adequate paralysis for 7 days. ⋯ Atracurium was reinstituted 2 days later because of worsening pulmonary function. Infusion rates of 3.04 mg/kg/hour were again required, together with high-dose midazolam and fentanyl, to achieve adequate oxygenation with acceptable airway pressures; however, TOF monitoring showed an unacceptable level of paralysis. Cross-resistance among chemically dissimilar neuromuscular blocking agents poses a difficult patient management problem and supports a pharmacodynamic basis of resistance to these agents.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Evaluation of the safety and efficacy of ketorolac versus morphine by patient-controlled analgesia for postoperative pain.
To compare ketorolac tromethamine with morphine for pain management after major abdominal surgery. ⋯ Ketorolac may be effective when administered by PCA device, and has a clear morphine-sparing effect.
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Randomized Controlled Trial Comparative Study Clinical Trial
Pharmacoeconomic analysis of sevoflurane versus isoflurane anesthesia in elective ambulatory surgery.
This study investigated the economic aspects of sevoflurane and isoflurane anesthesia in 47 healthy women undergoing elective ambulatory surgery, as part of a randomized, prospective clinical trial. Patient records were analyzed for anesthetic; duration of surgery, anesthesia, and recovery room stay; and associated charges. ⋯ A minor decrease in recovery room charges ($15) associated with earlier discharge was observed with sevoflurane (p>0.05), but the agent was not associated with lower hospital charges. Larger trials and assessment of other patient populations may show sevoflurane to be more pharmacoeconomically advantageous than isoflurane.
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Review Comparative Study
Comparative clinical pharmacology of cisplatin and carboplatin.
The platinum compounds cisplatin and carboplatin are active against a wide range of adult and pediatric malignancies. Whereas both exert their cytotoxic effect by incorporating into DNA, they have substantially different systemic and cellular pharmacology. ⋯ Substantial interpatient pharmacokinetic variability and narrow therapeutic indexes of the two agents led to the development of several dosing strategies. Although these strategies reduce pharmacokinetic variability, their effect on improving patient outcome remains to be determined.
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Benzocaine-induced methemoglobinemia is a rare but life-threatening event. The use of topical benzocaine spray in a 77-year-old woman during endoscopic retrograde cholangiopancreatogram produced marked cyanosis and methemoglobin levels consistent with methemoglobinemia. Immediate recognition and prompt treatment of the disorder are essential to decrease morbidity and mortality.