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Biomedical subjects

D T Jolly

Publications and source records attributed to D T Jolly.

11 recordsLinked to original sources
PubMed2003

Comparison of four strategies to reduce the pain associated with intravenous administration of rocuronium.

BACKGROUND: I.V. rocuronium produces intense discomfort at the site of injection in conscious patients. Four strategies to reduce or prevent this discomfort were studied. METHODS: Two hundred and fifty adult patients, ASA I-III, were randomized into five groups of 50 patients in a blinded, prospective study. The control group received rocuronium 10 mg alone. For the remaining four groups, rocuronium 10 mg was mixed with sodium bicarbonate 8.4% 2 ml, fentanyl 100 micro g, lidocaine 2% or normal saline. The pH and osmolality of all mixtures were measured. Patient data were analysed using ordinal logistic regression. Osmolality and pH data were analysed using the Kruskal-Wallis test with Dunn's multiple comparison test. RESULTS: When compared with rocuronium alone, only the addition of saline failed to significantly reduce the pain reported by patients. The addition of fentanyl reduced the complaint of pain by 1.9 times (P<0.049) and the addition of lidocaine 2% reduced it by 3.6 times (P<0.0001). Sodium bicarbonate 8.4% reduced the reporting of pain by 18.4 times (P<0.0001). CONCLUSIONS: Sodium bicarbonate 8.4%, when added to rocuronium, markedly reduces the experience of pain during the i.v. administration of a small dose of rocuronium.

Adjuvants, Anesthesia↗
PubMed1999

Estimation of desflurane concentration using isoflurane channel in optical infrared analyzer.

PURPOSE: To estimate desflurane concentration on the isoflurane channel in an optical infrared analyzer using a simple regression equation. METHODS: Desflurane in concentrations of 0% to 3% in 0.5% increments and 3% to 12% in 1% increments in 2 L.min-1 oxygen was delivered simultaneously to an Ohmeda 5250 RGM desflurane channel, an Ohmeda 5250 RGM isoflurane channel, and a Datex Capnomac Ultima isoflurane channel at room temperature and atmospheric pressure. For each concentration increment, the displayed gas concentrations were recorded. By comparing the readings from the desflurane channel of Ohmeda RGM and the isoflurane channels from Ohmeda RGM and Datex Capnomac Ultima respectively, the linear regression relationship and the slope of the fitted line (conversion factor) between two channels were obtained. Similar measurements were performed using 2 L.min-1 mixture of nitrous oxide 50% and oxygen 50%. The measurements were repeated with different monitors three months later. RESULTS: All four analysers tested were linear (r2 > 0.9) for measuring desflurane using isoflurane channels over the range of concentrations studied on two different days. The accuracy of the estimation using the mean conversion factor of the four monitors was within 10% error from the readings of the commercially available desflurane channel analyzer. There was no noticeable effect on the slope (conversion factor) of the linear regression with O2 100% or 50/50 mixture of N2O and O2. CONCLUSION: The concentration of desflurane can be estimated by a simple conversion factor using an isoflurane channel of an infrared system.

Analysis of Variance↗
PubMed1999

The growth of microorganisms in propofol and mixtures of propofol and lidocaine.

UNLABELLED: Propofol emulsion supports bacterial growth. Extrinsic contamination of propofol has been implicated as an etiological event in postsurgical infections. When added to propofol, local anesthetics (e.g., lidocaine) alleviate the pain associated with injecting it. Because local anesthetics have antimicrobial activity, we determined whether lidocaine would inhibit microbial growth by comparing the growth of four microorganisms in propofol and in mixtures of propofol and lidocaine. Known quanta of Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans were inoculated into solutions of 1% propofol, 0.2% lidocaine in propofol, 0.5% lidocaine in propofol, 0.5% lidocaine in isotonic sodium chloride solution, and 0.9% isotonic sodium chloride solution. All microorganisms were taken from stock cultures and incubated for 24 h. Growth of microorganisms in each solution was compared by counting the number of colony-forming units grown from a subculture of the solution at 0, 3, 6, 12 and 24 h. Propofol supported the growth of E. coli and C. albicans. Propofol maintained static levels of S. aureus and was bactericidal toward P. aeruginosa. The addition of 0.2% and 0.5% lidocaine to propofol failed to prevent the growth of the studied microorganisms. The effect of 0.5% lidocaine in isotonic sodium chloride solution did not differ from the effects of isotonic sodium chloride solution alone. We conclude that lidocaine, when added to propofol in clinically acceptable concentrations, does not exhibit antimicrobial properties. IMPLICATIONS: Local anesthetics such as lidocaine have antimicrobial activity. Propofol supports the growth of bacteria responsible for infection. Bacteria were added to propofol and propofol mixed with lidocaine. The addition of lidocaine to propofol in clinically relevant concentrations did not prevent the growth of bacteria. The addition of lidocaine to propofol cannot prevent infection from contaminated propofol.

Anesthetics, Intravenous↗
PubMed1998

Propofol and thiopental in a 1:1 volume mixture is chemically stable.

UNLABELLED: Propofol and thiopental have been used clinically in combination for induction of anesthesia. Studies suggest that this mixture has synergistic activity, recovery characteristics similar to propofol alone, and bactericidal effects on multiple organisms. It may therefore be both clinically useful and cost-effective. In this study, we examined the chemical stability of this mixture. We used high-performance liquid chromatography to quantify the concentration of both propofol and thiopental in a given sample. This technique allows the detection of loss in total drug mass and of the appearance of breakdown products resulting from drug interaction. Ten samples of a 1:1 mixture by volume were prepared and assayed at Time 0 and Days 1, 3, and 7. Half the samples were incubated at 23 degrees C and the rest were stored at 4 degrees C. Other mixtures were assayed before and after filtration at Time 0 and Days 1 and 7 after storage at 23 degrees C. The assay was able to measure accurately the quantity of drug present in the samples. There was no significant decrease in the quantities of either propofol or thiopental in the mixture over the 7-day period. We conclude that the 1:1 volume mixture of propofol and thiopental is chemically stable for 1 wk at room temperature. IMPLICATIONS: A mixture of propofol and thiopental has been used to induce anesthesia. We investigated the chemical stability of this mixture using high-performance liquid chromatography and found it to be stable for at least 24 h.

Anesthetics, Intravenous↗
PubMed1996

Growth of microorganisms in propofol, thiopental, and a 1:1 mixture of propofol and thiopental.

To assess and compare the growth of four microorganisms in solutions of intravenous anesthetics, known quanta of Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans were inoculated into propofol, thiopental, a 1:1 mixture of propofol and thiopental, and normal saline. All microorganisms were taken from standard stock cultures and incubated for 24 h (48 h for C. albicans). Growth of microorganism in each drug was compared by counting the number of colony forming units (CFUs) grown from a subculture of each inoculated anesthetic at 0, 3, 6, 12, and 24 h. The study shows that propofol strongly supports the growth of E. coli and C. albicans but is bacteriostatic toward S. aureus and weakly bactericidal toward P. aeruginosa. In contrast, both thiopental and the 1:1 mixture of propofol and thiopental behaved differently, exhibiting markedly bactericidal properties toward E. coli, S. aureus, and P. aeruginosa and a bacteriostatic effect on C. albicans. This finding supports recommendations that a strict aseptic technique should be used when handling propofol and that the contents of an ampoule should be used within 6 h of aspirating. The measured high pH of both thiopental and the 1:1 mixture of propofol and thiopental compared to propofol alone suggests pH to be a major factor in determining whether a given drug will support microbial growth.

Anesthetics, Intravenous↗
PubMed1994

Recovery characteristics following induction of anaesthesia with a combination of thiopentone and propofol.

The purpose of this study was to determine the rate and quality of recovery when general anaesthesia was induced with a mixture of thiopentone and propofol, compared with thiopentone or propofol alone. Sixty ASA class I and II women scheduled for out-patient laparoscopic surgery underwent induction of anaesthesia with either (i) thiopentone, (ii) propofol, or (iii) a mixture of the two, in a randomized, double-blind fashion. Anaesthesia was then maintained using nitrous oxide, isoflurane and fentanyl. A psychometric test was administered before and after surgery, and the time taken to reach a series of recovery milestones was noted. Patients were discharged as soon as they were ambulant and had satisfactory control of pain and nausea with oral agents. They were telephoned at 24-48 hr later, and asked to rate their experience of a list of side effects on an ordinal scale. Patient groups were demographically comparable and underwent surgery of the same duration. Those receiving thiopentone were discharged after a mean time of 3 hr 25 +/- 58 min (SD). The corresponding figures for propofol and the thiopentone/propofol mixture were 2 hr 40 min (+/- 49) and 2 hr 48 min (+/- 68) respectively. The recovery time between thiopentone and the other two regimes was different (P < 0.05). All three groups experienced equally frequent and severe nausea, headache, tiredness and other side effects during the next 24 hr. It is concluded that induction with a mixture of thiopentone and propofol leads to a similar rate and quality of recovery to that of propofol above.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗