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Biomedical subjects

M Smythe

Publications and source records attributed to M Smythe.

10 recordsLinked to original sources
PubMed1994

Patient-controlled analgesia versus intramuscular analgesic therapy.

The pharmacy and nursing time requirements, quality of postoperative pain control, and cost of patient-controlled analgesia (PCA) and intramuscular (i.m.) analgesic therapy were studied. All timings were conducted with a stopwatch on a single nursing unit that primarily receives gynecologic surgery patients. The various work elements involved in each type of therapy were timed individually. Both quality of analgesia and cost were evaluated in a prospective, randomized study in hysterectomy patients. I.M. patients received meperidine hydrochloride 75-100 mg every three to four hours as needed. PCA patients had access to morphine sulfate 1 mg or meperidine hydrochloride 10 mg, with a six-minute lockout period. The patients scored their pain every four hours. Direct costs for PCA were calculated as drug cost plus tubing cost plus form cost plus maintenance cost plus depreciation cost. Direct costs for i.m. therapy consisted of the cost of drugs. The total mean nursing time per patient was 16.9 minutes for PCA and 10.7 minutes for i.m. therapy. Pharmacy time per patient was 5.1 minutes longer for PCA than for i.m. therapy. Thirty-six hysterectomy patients (17 i.m. and 19 PCA) were enrolled in the study of pain control and cost. Among i.m. patients, 64% of the pain scores were mild or worse, compared with 40% for PCA patients. The median pain scores were moderate for i.m. patients and mild for PCA patients. Scores tended to be lower for PCA patients at 16 and 20 hours. Although equal numbers of patients in the two groups experienced nausea, i.m. patients needed more doses of antiemetics than PCA patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Analgesia, Patient-Controlled↗
PubMed1994

Estimating creatinine clearance in elderly patients with low serum creatinine concentrations.

The accuracy of creatinine clearance (CLcr) estimates generated for elderly patients with a low serum creatinine (SCr) concentration when the SCr concentration was rounded to 1.0 mg/dL was evaluated, and daily aminoglycoside dosages calculated with CLcr estimates based on the actual and the rounded SCr concentrations were compared with the actual dosage required as determined by aminoglycoside concentration measurements. Twenty-four-hour urine collections were obtained from elderly hospitalized patients with stable renal function, and CLcr was measured. SCr concentrations were measured at baseline, during urine collection, and after urine collection. CLcr was calculated twice with each of seven methods, once by using the actual SCr concentration and once by rounding the SCr concentration to 1.0 mg/dL. Rounding the SCr concentration to 1.0 mg/dL resulted in significant underestimation of CLcr by all seven methods. The Cockcroft-Gault equation used with ideal body weight and the rounded SCr concentration resulted in the largest bias. For six of the seven methods, bias was greater and precision less when SCr concentrations of < 0.7 mg/dL were rounded than when SCr concentrations of > or = 0.7 mg/dL were rounded. The Bjornsson method used with the actual SCr concentration appeared to offer the best combination of low bias and high precision. The required aminoglycoside dosage was significantly underestimated when the rounded SCr concentration was used. In elderly patients with low SCr concentrations, rounding the SCr concentration to 1.0 mg/dL led to underestimates of both CLcr and the correct aminoglycoside dosage.

Aged↗
PubMed1994

Prospective patient-controlled analgesia quality assurance: one year's experience.

The goal of this project was to develop a prospective patient-controlled analgesia (PCA) quality assurance (QA) program and evaluate its impact on patient care. Initial elements selected for inclusion into the QA were: patient satisfaction, pain relief, clarity of instructions, respiratory rate, and nausea and vomiting. Standards were initially set at 100% with the exception of nausea and vomiting, which was 90%. Preliminary evaluation in 26 patients indicated initial standards were unrealistically high. Standards were revised to 90% for all elements except respiratory rate, which was left at 100%. Nausea and vomiting were eliminated from the QA because it was difficult to establish a cause and effect relationship with narcotic. Data were collected through patient interviews and chart reviews on a bimonthly basis. Cumulative data on 297 patients revealed standards were met in all categories. Two systematic problems identified early in the QA were that there was no recording of respiratory rate and there was a high incidence of unclear instructions. As a result of pharmacist interventions, outcomes improved. Patient outcomes with PCA therapy can be improved using a prospective PCA QA program. Pharmacy Department's without resources for daily monitoring of PCA patients should consider implementing a prospective PCA QA program.

Analgesia, Patient-Controlled↗
PubMed1993

Drug-induced alterations in serum creatinine concentrations.

OBJECTIVE: To provide a comprehensive review of drug-induced alterations in serum creatinine concentrations (SCrs). DATA SOURCES: Information was obtained from a MEDLINE search, reference lists from articles identified in the search, review articles, and abstracts. STUDY SELECTION: Emphasis was placed on clinical studies of direct relevance to clinical practitioners. DATA EXTRACTION: Literature was assessed for its methodology, results, discussion, and conclusion. DATA SYNTHESIS: Two analytical systems to assay SCr are commonly employed in clinical practice--the Jaffé-based and enzymatic methods. Several drugs have been reported to interfere with SCr results obtained with both analytical systems by producing assay interference. In addition, trimethoprim, cimetidine, and salicylates produce elevations in the SCr by altering the normal elimination pathways of creatinine. Phenacemide has been reported to increase creatinine elimination, but the mechanism of this effect is unknown. CONCLUSIONS: Pharmacists should recognize the clinical significance of drug-induced interference with SCr and propose alternative methods of determining concentrations in selected patients.

Aminohydrolases↗
PubMed1993

Comparison of three morphine regimens in postsurgical patients using patient-controlled analgesia.

OBJECTIVE: To compare the efficacy and toxicity of three patient-controlled analgesia (PCA) morphine regimens. DESIGN: A prospective, randomized, pilot study of three PCA morphine regimens: (1) 1 mg with 6-minute lockout (n = 10), (2) 2 mg with 12-minute lockout (n = 12), and (3) 2 mg with 20-minute lockout (n = 12). SETTING: Large teaching institution. PARTICIPANTS: Thirty-four patients undergoing cholecystectomy or hysterectomy. MAIN OUTCOME MEASURES: Pain scores (0 = no pain, 1 = mild pain, 2 = moderate pain, 3 = severe pain), sedation scores, analgesic consumption, and patient attempts (patient activation of PCA device) and injections (doses actually delivered) were evaluated using analysis of covariance. Distribution of pain and sedation scores and adverse effects were assessed using Fisher's exact test. RESULTS: Data on 24 patients were evaluable. Six patients withdrew for poor pain control (2 in group 1, 1 in group 2, and 3 in group 3). Three other patients withdrew because of adverse effects and 1 withdrew because of pump problems. Mean morphine consumption did not differ significantly among the groups. Distribution of pain and sedation scores and the number of patients with nausea were similar across treatment groups. The mean injection to attempt ratio was significantly smaller in group 3 (0.71 +/- 0.11) compared with groups 1 and 2 (0.9 +/- 0.06 and 0.83 +/- 0.09, respectively; p = 0.001). Adverse events occurred similarly among treatment groups. CONCLUSIONS: No significant differences in the efficacy or toxicity of the three morphine PCA regimens were identified.

Adult↗
PubMed1992

Patient-controlled analgesia: a review.

The patient-activated analgesic system was introduced in 1968. Early trials, although uncontrolled, supported the safety and efficacy of patient-controlled analgesia (PCA) in several kinds of pain, such as that relating to surgery, cancer, trauma, and obstetric procedures. In the past decade, prospective, randomized trials have reported several advantages of PCA over conventional analgesia in the early postoperative period. Although not supported by all controlled trials, they include improved pain relief, less sedation, lower level of narcotic consumption, fewer postoperative complications, greater patient satisfaction, and improved pulmonary function. Preliminary results in the management of chronic pain indicate that PCA can lead to significant lifestyle improvements in ambulatory patients with cancer. The most significant, although infrequent, adverse effect is respiratory depression, the majority of cases occurring in patients predisposed secondary to concomitant illness or as a result of human error. The clinical use of PCA will likely see a significant increase among persons with cancer, and an increase in epidural administration. The cost benefit of PCA has yet to be assessed in inpatient and outpatient settings.

Abdomen↗
PubMedDate not supplied

Nabumetone-associated interstitial nephritis.

An 84-year-old woman was admitted to the hospital for progressive edema and decreased urine output. She had been taking nabumetone for 6 months, but had discontinued the agent 2 weeks before admission due to progressive edema. On admission she had 2-3+ pitting edema. Her serum electrolytes were sodium 122 mEq/L, potassium 5.9 mEq/L, chloride 93 mEq/L, and carbon dioxide 19 mEq/L. A urinalysis was significant for protein 3061 mg/dl, ketones 15 mg/dl, blood 2+, leukocytes 26-50/high-power field, and a protein:creatinine ratio 24.9. The serum creatinine and blood urea nitrogen concentrations were 2.7 mg/dl and 70 mg/dl, respectively. Throughout hospitalization the patient underwent aggressive diuresis. She developed congestive heart failure, and hemodialysis was initiated. A renal biopsy specimen on hospital day 9 showed tubular damage with minimal glomerular changes consistent with a diagnosis of nonsteroidal agent-induced nephropathy. On day 13, a 24-hour urine collection had a protein excretion of 3151 mg. Although the patient recovered from her renal failure (creatinine clearance 43 ml/min), the nephrotic syndrome persisted (13 g protein/day). The patient developed infectious complications and died on hospital day 32.

Aged↗
PubMedDate not supplied

Serotonin syndrome secondary to phenelzine-venlafaxine interaction.

A 44-year-old woman accidentally ingested phenelzine along with venlafaxine. Thirty minutes after the ingestion the woman began to feel nauseous and anxious. Approximately 45 minutes later a friend noted that the woman had lower extremity shaking and increasingly rapid respirations. The friend brought the woman to the emergency department and she was subsequently diagnosed with serotonin syndrome. Serotonin syndrome is usually precipitated by combinations of serotonin-potentiating agents and can lead to devastating outcomes. When using combinations of drugs that elevate serotonin levels in the central nervous system, the possibility of serotonin syndrome should be considered.

Adult↗