PubMed Health⌕ Search

Biomedical subjects

M J Iribarren

Publications and source records attributed to M J Iribarren.

9 recordsLinked to original sources
PubMed2000

Cost analysis of neuromuscular blocking agents in the operating room: cisatracurium, atracurium, vecuronium and rocuronium.

Cisatracurium (C), Atracurium (A), Rocuronium (R) and Vecuronium (V) are four neuromuscular blockers (NMB) used in the operating room with similar efficacy, defined as adequate muscle relaxation, but different pharmacokinetics. C and A have organ-independent elimination, A is associated with histamine release and R has a shorter onset time. The objective of this study was to economically compare these four NMB from the hospital point of view in order to facilitate drug selection. A cost analysis was performed. Only direct costs were considered and data were collected through a retrospective chart review. A total of 151 patient charts were randomly selected. Differences between patients receiving one of the four NMB were evaluated by ANOVA or Kruskal-Wallis tests. Then a multiple linear regression analysis was conducted. In the chart review, no significant difference was observed between the four groups of patients in age, weight or surgery duration (p > 0.05). Multiple regression analysis revealed that atracurium was on average PTA 237 (1 Euro = PTA 166) cheaper per surgery than any other NMB after adjusting for other factors (p < 0.01) and there is no significant difference in cost between the other three NMBs (p > 0.1). We recommend the use of rocuronium when a quick onset is needed and the patient does not have hepatic failure, cisatracurium when a haemodynamic instability is possible and atracurium in the remaining cases. If just one NMB can be included in the drug formulary we would select cisatracurium due to its pharmacological advantages over atracurium with a small increment in cost.

Adult↗
PubMed2000

A comparative study with oral nifedipine, intravenous nimodipine, and magnesium sulfate in postoperative analgesia.

UNLABELLED: We tested the ability of two L-type calcium channel blockers (nifedipine and nimodipine) and the N-methyl D-aspartate natural antagonist magnesium to decrease morphine requirements and pain in the postoperative period in 92 patients undergoing elective colorectal surgery. In a randomized, double-blinded study, patients were assigned to one of four groups. The control group received placebo. The nifedipine group received 60 mg of oral nifedipine. The magnesium group received an initial dose of 30 mg/kg followed by 10 mg x kg(-1) x h(-1) of magnesium sulfate over 20 h. The nimodipine group received 30 microg x kg(-1) x h(-1) of nimodipine over 20 h. Postoperative morphine consumption was assessed for 48 h. Pain at rest and pain on movement were assessed up to the fifth day postsurgery. There were no differences among groups in postoperative morphine consumption at 12 and 24 h. The nifedipine group consumed more morphine than the control and nimodipine groups during 24-48 h. Pain at rest scores were higher at 16 and 24 h in the nifedipine group than in the other three groups. Pain on movement scores were lower at 72 h in the nimodipine group than in the control and nifedipine groups. In conclusion, the perioperative application of oral nifedipine, IV nimodipine, or IV magnesium sulfate failed to decrease postoperative morphine requirements after colorectal surgery. IMPLICATIONS: The increase of intracellular calcium plays a key role in spinal transmission of pain and in the establishment of central sensitization. We examined the effects of nifedipine, nimodipine, and magnesium sulfate in postoperative analgesia after colorectal surgery. We found no differences in morphine consumption with the administration of each drug alone.

Administration, Oral↗
PubMed1996

Combination of ondansetron and droperidol in the prophylaxis of postoperative nausea and vomiting.

The aim of this study was to compare the efficacy and safety of ondansetron plus droperidol with each drug alone or placebo in the prevention of postoperative nausea and vomiting (PONV). One hundred females, aged 18-65 yr, ASA physical status I-II, undergoing general anesthesia for elective abdominal surgery were included in a prospective, double-blind, placebo-controlled, randomized study. A standardized anesthetic technique and postoperative analgesia (ketorolac plus patient-controlled analgesia [PCA] with morphine) were used in all patients. Patients were randomly assigned to receive placebo (Group 1, n = 25), droperidol 2.5 mg with induction of anesthesia and 1.25 mg 12 h later (Group 2, n = 25), ondansetron 4 mg with induction (Group 3, n = 25), and ondansetron plus droperidol at the same doses as Groups 3 and 2, respectively (Group 4, n = 25). A complete response, defined as no PONV in 48 h, occurred in 28% of patients in Group 1, 60% in Group 2 (P < 0.05 vs Group 1), 56% in Group 3 (P < 0.05 vs Group 1), and 92% in Group 4 (P < 0.01 vs Groups 1, 2, and 3). Sedation was significantly greater with droperidol (Groups 2 and 4) for 12 h postoperatively. In conclusion, the combination of ondansetron plus droperidol was more effective than each antiemetic alone or placebo in the prevention of PONV in women undergoing elective abdominal surgery.

Adolescent↗
PubMed1995

[Reduction of the need for blood derivatives in liver transplantation using aprotinin].

OBJECTIVES: To evaluate the efficacy of aprotinin in reducing the need for blood products in orthotopic liver transplantation. PATIENTS AND METHODS: Blood product needs and coagulation test results were studied in 42 adults with cirrhosis of the liver who received orthotopic liver transplants. The first 16 liver transplants carried out without aprotinin (control group) were compared with the next 26 consecutive transplant patients who received aprotinin. Each of the first 9 received a loading dose of 2 million units that was followed by the infusion of half a million units per hour until the end of surgery. The next 17 received the same infusion dose at the same rate but no loading dose. RESULTS: Patients who received aprotinin required fewer transfusions of blood products (5.3 units of packed red blood cells as opposed to 13 units; 9 units of fresh frozen plasma versus 14.6 units; 1.7 units of platelets versus 4.2 units; and 3.8 units of cryoprecipitates versus 8.8 units). We observed a marked reduction of fibrinolysis (less increase in D dimers after removal of the liver when aprotinin was used. CONCLUSIONS: Prophylactic use of aprotinin during surgery has a beneficial effect on hemostatic mechanisms, reducing the need for blood products. A reduction in fibrinolysis seems to contribute to this effect.

Adult↗
PubMed1986

The effect of labetalol on urinary prostacyclin secretion during surgery.

The effects of labetalol on the secretion of prostacyclin and plasma-renin activity (PRA) were evaluated, relative to a control group in 24 patients undergoing hip osteotomy. They were randomly assigned to two groups (G-I and G-II) with 12 patients each. Patients allocated to both groups received standard anaesthesia (thiopentone, pancuronium, fentanyl and nitrous oxide). Patients belonging to Group II were given labetalol at a dose of 0.8 mg kg-1. The stable metabolite of PGI2, 6-keto-PGF1 alpha was quantified from urine samples by radioimmunoassay (RIA). Cortisol, PRA and aldosterone were determined from blood samples. A significant increase in 6-keto-PGF1 alpha elimination was observed in G-I. Labetalol administration partially but significantly inhibited this increase. We believe that prostacyclin is involved not through the beta 1 but through the alpha 1 receptors in the secretion of renin.

6-Ketoprostaglandin F1 alpha↗
PubMed1985

The effects of epidural analgesia and conventional anaesthesia on renal excretion of PGE2 during orthopaedic surgery.

The effect of standard anaesthesia (G-I) and epidural analgesia (G-II) on urinary synthesis of PGE2 was compared in two groups of 12 patients each undergoing orthopaedic surgery. This study demonstrates a significant elevation of renal PGE2 in patients undergoing standard anaesthesia during surgery. In marked contrast, with epidural analgesia, the inhibition of renal secretion of PGE2 is apparent. These findings strongly suggest the important role of the sympathetic nervous system in the synthesis of PGE2.

Adult↗