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Biomedical subjects

M L Santeiro

Publications and source records attributed to M L Santeiro.

10 recordsLinked to original sources
PubMed1996

Phenoxybenzamine placental transfer during the third trimester.

OBJECTIVE: To report phenoxybenzamine placental transfer in the treatment of maternal hypertension secondary to pheochromocytoma. CASE SUMMARY: A 22-year-old woman diagnosed with pheochromocytoma was medically managed at 33 weeks gestation with oral phenoxybenzamine and labetalol until delivery 26 days later. To determine phenoxybenzamine placental passage, at the time of cesarean section simultaneous samples were obtained from the cord blood, maternal blood, and amniotic fluid. Additional blood samples were obtained from the newborn at 32 and 80 hours of life. Mean concentrations of phenoxybenzamine from cord and maternal plasma and in amniotic fluid were 103.3, 66, and 79.3 ng/mL, respectively; the newborn's plasma concentration at 32 hours of life was 22.3 ng/mL. At the time of delivery, the 2475-g male infant exhibited perinatal depression; mild transient hypotension was also noted for the first few days of life. DISCUSSION: The fetal-maternal plasma accumulation ratio of 1.6:1 indicates that at this gestational age after 26 days of therapy, the placental transfer of phenoxybenzamine occurs and is accompanied by accumulation in the fetal blood. CONCLUSIONS: Because of the placental transfer of phenoxybenzamine, mild perinatal depression and transient hypotension may occur in newborns of mothers receiving this medication. These newborns must be closely monitored during the first few days of life for respiratory depression and hypotension.

Adrenal Gland Neoplasms↗
PubMed1994

Beta-agonist inhaler causing hallucinations.

This report describes a precocious eight-year-old child who presented with hallucinations from excessive use of albuterol inhalers. Shifting the child to a powdered form of albuterol (without the fluorocarbon propellant) controlled his asthma, and his behavior improved rapidly. The potential harmful effects of fluorocarbons used as propellants for inhalers are discussed.

Albuterol↗
PubMed1992

Guidelines for continuous infusion medications in the neonatal intensive care unit.

OBJECTIVE: To present practical guidelines in tabular form for dosage, calculation, preparation, and monitoring of common medications administered by continuous infusion to neonatal intensive care patients. DATA SOURCES: Review articles and clinical trials were identified through a computer literature search with subsequent bibliography scanning. STUDY SELECTION: Articles selected for review were considered important contributions. DATA EXTRACTION: Data from human studies and review articles published in the English language were evaluated. DATA SYNTHESIS: In emergency situations, physicians and other healthcare providers caring for critically ill newborns often perform rapid calculations to determine the dosage and rate of continuous intravenous medication infusions. Because of the crisis situation, there is the potential for calculation errors. We compiled a concise table designed to provide a standardized method for the administration of emergency medications to neonatal intensive care patients. This table must be used in conjunction with clinical judgment and each medication infusion rate must be adjusted to the patient's clinical response and individual parameters. CONCLUSIONS: These guidelines help to minimize the volume of fluid needed for medication administration and facilitate the calculation, preparation, and timely administration of these medications, thus preventing errors that might occur in an emergency situation.

Critical Care↗
PubMed1990

Osmolality of small-volume i.v. admixtures for pediatric patients.

The osmolalities of pediatric i.v. admixtures were measured to identify drug concentrations in selected vehicles that would conserve fluid while maintaining osmolality values of 400 mOsm/kg or less. Test solutions were prepared by diluting appropriate volumes of freshly reconstituted powdered drug products or commercially diluted drug products with 5% dextrose injection, 0.9% sodium chloride injection, or both to provide 5 mL of each admixture at desired drug concentrations. To reduce their osmolalities, trimethoprim-sulfamethoxazole and ampicillin sodium were also diluted in 0.45% sodium chloride injection; ticarcillin disodium was diluted only in 0.45% sodium chloride injection. A vapor pressure osmometer was used to measure osmolalities in triplicate for three solutions prepared for each admixture. Of the 63 different admixtures prepared with 5% dextrose injection or 0.9% sodium chloride injection or both, 47 (75%) had osmolalities of 400 mOsm/kg or less. At least one concentration of each selected drug diluted in these vehicles had an osmolality of less than 425 mOsm/kg, except for trimethoprim-sulfamethoxazole and ampicillin sodium. Selected concentrations of the latter two drugs and ticarcillin disodium in 0.45% sodium chloride injection resulted in acceptable osmolalities. For most drugs diluted to the same concentration in 5% dextrose injection and 0.9% sodium chloride injection, osmolalities were lower in the dextrose solutions. Selection of an appropriate vehicle and drug concentration can control the osmolality of i.v. admixtures when the volume of fluid must be minimized, as for pediatric patients.

Anti-Bacterial Agents↗
PubMed1988

Flucytosine interference with serum creatinine determinations.

A patient receiving intravenous amphotericin B and oral flucytosine was found to have falsely elevated serum creatinine values. Flucytosine has been reported to interfere with serum creatinine determinations when measured by the Kodak Ektachem-700 analyzer but not when the Jaffe reaction is employed. Serum creatinine values were determined by the two methods on six serum samples obtained from this patient at various times throughout her hospitalization. Flucytosine can cause clinically significant false elevations in serum creatinine when measured by the Kodak Ektachem-700 analyzer.

Amphotericin B↗
PubMedDate not supplied

Continuous infusion of insulin in hyperglycemic low-birth weight infants receiving parenteral nutrition with and without lipid emulsion.

The efficiency of a continuous infusion of insulin in improving glucose tolerance was compared in two groups of very low-birth weight infants (mean +/- SEM birth weights 757 +/- 40 vs 828 +/- 80 g and gestational ages 27.6 +/- 0.7 vs. 27.2 +/- 0.5 weeks) receiving total parenteral nutrition with and without the addition of lipid emulsion to the nutrition regimen. The mean +/- SEM cumulative doses of insulin (0.87 +/- 0.1 vs 1.15 +/- 0.3 U/kg) and hours required to decrease the blood glucose level to 120 mg/dL (9.1 +/- 0.8 vs 9.5 +/- 1.0 hours) were similar. Insulin was delivered with a syringe pump used for other routine purposes in the neonatal intensive care unit. Continuous intravenous insulin infusion is an effective, inexpensive, safe method for maintaining glucose homeostasis in low-birth weight infants who develop hyperglycemia as a consequence of total parenteral nutrition.

Birth Weight↗
PubMedDate not supplied

Pharmacokinetics of continuous infusion fentanyl in newborns.

Although fentanyl administration by continuous infusion in newborns during ventilatory support has increased, pharmacokinetic data are lacking. Our objective was to determine the pharmacokinetics of fentanyl continuous infusions for sedation/analgesia in newborns who had undergone mechanical ventilation. Fentanyl was administered per routine care in seven newborns who had undergone mechanical ventilation and had normal hepatic, renal, and cardiac function. Five blood samples were collected from each newborn's umbilical artery catheter. Sample 1 was obtained at > or = 36 hours after constant fentanyl was infused, and sample 2 was collected 12 hours later. Fentanyl was then discontinued and meperidine given. Additional samples were obtained 6, 12, and 24 hours after fentanyl was discontinued. Decanted plasma was stored at -20 degrees C until gas chromatography analysis was performed. Total body clearance (TBC), elimination half-life, and volume of distribution at steady state were determined. Patient weights were 1.88 +/- 1.12 kg (mean +/- SD) with postnatal age 16 +/- 9 days; the mean gestational age was 32 +/- 4 weeks. Mean final fentanyl dosage was 1.28 +/- 0.58 microgram/kg/hr (range 0.53 to 1.9 micrograms/kg/hr). Mean elimination half-life was 9.5 +/- 2.6 hours (range 5.7 to 12.7 hours), and volume of distribution at steady state was 17 +/- 9 L/kg (range 10.1 to 30.3 L/kg). Mean TBC was 1154 +/- 494 ml/kg/hr (range 565 to 2000 ml/kg/hr). Significant correlation between postnatal age and TBC occurred (r = 0.80; p = 0.03). Newborns were hemodynamically stable during the sampling period. We found an increased volume of distribution at steady state and prolonged elimination half-life compared with single-dose administration in newborns. TBC was similar to reported values for infants and young children but was higher than for older patients.

Anesthetics, Intravenous↗