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PubMed1998

Comparing ease of intraosseous needle placement: Jamshidi versus cook.

In a sample of 34 study subjects, Cook and Jamshidi intraosseous (IO) needles were compared for ease of insertion into turkey bones. The averaged lapsed time of insertion was significantly shorter using the Jamshidi needle (25.5 v 56.2 seconds, P < .0001). The mean difficulty of insertion score was lower using the Jamshidi needle (3.0 v 7.1 on a 10-cm visual analog scale, P < .0001). The less costly Jamshidi needle is easier to use in IO insertion in this turkey bone model.

Animals↗
PubMed1996

[Intraosseous puncture as vascular access in pediatric emergency and intensive care medicine].

In paediatric resuscitation scenarios, emergency physicians have sufficient skills in endotracheal intubation. They are successful in about 80% of the cases as US studies indicate. However, vascular access is much more of a critical problem and emergency physicians succeed in only 50%. Therefore, intraosseous access has become an internationally widely used and accepted method for venous access. In Germany, however, only case reports concerning this technique have been published. Based on the authors' experience shared with Sussmane and Raszynski in the US, we used the technique of intraosseous access in 18 paediatric resuscitative situations. Eleven patients survived who would not have done so without quick intravenous access. As complications we recorded a minor fracture, one compartment syndrome, which did not require surgical intervention, and a postmortally discovered minor fat embolism, which was of no clinical significance. Courses teaching this method should be offered in Germany to spread knowledge of this life-saving technique.

Catheters, Indwelling↗
PubMed1995

Circumferential pressure as a rapid method to assess intraosseous needle placement.

This study was done to determine whether the application of circumferential pressure about an intraosseous (IO) site can be used as a rapid method to detect incorrect placement of an IO needle. We used a prospective, randomized, controlled canine tibial IO model. According to random assignment, IO needles were placed either intramedullary (correct placement) or extramedullary (incorrect placement) in the anteromedial tibias of 12 euthanized mongrel dogs. Neonatal blood pressure cuffs were placed contiguously above and below the IO needles. One-liter bags of solution were connected to the IO needles via blood tubing. The gravity-dependent rate of flow at each site was measured with and without the blood pressure cuffs inflated to 120 mmHg. Eleven IO needles were correctly placed and 13 were incorrectly placed. Following inflation of the blood pressure cuffs, the mean percent decrease in flow was 48% for the correctly placed IO needles, and 95% for the incorrectly placed IO needles. A two-way repeated measure of analysis of variance was significant between groups (P = 0.006), and a significant interaction was found between groups and flow rates over time (P = 0.043). We conclude that circumferential pressure about an IO infusion site can be used as a rapid method to detect incorrect placement of the IO needle.

Animals↗
PubMed2002

A new animal model of femoral head necrosis induced by intraosseous injection of ethanol.

There is no reliable animal model of the early stages of osteonecrosis of the femoral head (ONFH) for the evaluation of new therapeutic approaches. In this study, we propose a new animal model of femoral head osteonecrosis. Pure ethanol was injected into the centre of the femoral head in adult Merino sheep under fluoroscopic control. After 3, 6 and 12 weeks the animals were killed and the femoral heads were harvested. Microradiographic and histological changes were analysed and recorded. Partial necrosis was documented over a period of 12 weeks in all animals. The appearance of necrosis in combination with intact macrotexture, macrocirculation and joint cartilage is similar to the features described in early ONFH in humans. Due to its efficacy and its similarity to the early stages of ONFH in humans, this model may be suitable to evaluate new therapeutic techniques in the treatment of ONFH.

Animals↗
PubMed2006

The pharmacokinetic behaviour of marbofloxacin in Eurasian buzzards (Buteo buteo) after intraosseous administration.

This study reports on the administration of a single dose of marbofloxacin (2 mg/kg) to five adult Eurasian buzzards (Buteo buteo) by the intraosseous (IO) route, which has been proposed as a rapid and efficient means for the parenteral delivery of antimicrobial drugs. The drug was rapidly absorbed. Peak marbofloxacin concentration (C(max)) in plasma and area under the concentration-time curve (AUC) of 1.92+/-0.78 microg/mL and 8.53+/-2.73 microg h/mL, respectively. The time marbofloxacin remained in the plasma after IO administration was relatively short (elimination half-life, t(1/2beta)=4.91+/-0.65 h; mean residence time (MRT)=5.38+/-0.57 h). Single dose marbofloxacin gave values for C(max)/minimum inhibitory concentration (MIC) of 19.2 and an AUC/MIC value of 85.3h after IO administration. The IO route appears to be practical and effective for the rapid delivery of marbofloxacin to buzzards.

Animals↗
PubMed2000

Osteoreflectory treatment of alcohol abstinence syndrome and craving for alcohol in patients with alcoholism.

Osteoreflexotherapy is used alone as a treatment used for alcohol abstinence syndrome and for alcohol craving by intraosseal stimulation of the processus styloideus ulnae of the patient's left and right hands as well as the processus spinosus of the seventh cervical vertebra and the manubrium sterni osteoreceptors. This is done by intraosseal injection of 0.5 to 1.0 ml of 0.9% NaCl solution during a period of 3 to 5 seconds. Craving for alcohol and depressed mood, strongly manifested Alcohol Abstinence Syndrome (AAS) symptoms before osteoreflexotherapy, were reduced in a most convenient and fast manner under the influence of two sessions of osteoreceptive stimulation. The withdrawal symptoms caused by alcohol abstinence decreased markedly during the first two hours after the first osteoreflexotherapy treatment, continued to decrease in the next 24 hours and by the time the second osteoreflexotherapy session was given, the withdrawal symptoms completely disappeared in 72 hours. The most slowly and least reduced AAS symptoms were asthenia and disturbances of postular equilibrium. Based on clinical observations, it is speculated that osteoreceptive stimulations destroy ethanol dependent functional systems and restore the neurophysiological and neuromediatorial integration of the brain in alcoholismpatients. Primarily because of these two cited factors, the patient can be freed of the craving for alcohol for several years, and he or she also does not suffer from depression.

Adult↗
PubMed1998

Cardiopulmonary and anesthetic effects of propofol administered intraosseously to green iguanas.

OBJECTIVE: To determine cardiopulmonary effects of intraosseous administration of propofol in green iguanas (Iguana iguana). DESIGN: Prospective study. ANIMALS: 14 green iguanas. PROCEDURE: Anesthesia was induced in 4 iguanas with propofol (10 mg/kg [4.5 mg/lb] of body weight, intraosseously). Heart and respiratory rates, functional hemoglobin oxygen saturation (SpO2), end-tidal CO2 concentration, and cloacal temperature were recorded. Ten additional iguanas were given propofol intraosseously for induction (5 mg/kg [2.3 mg/lb] and maintenance (0.5 mg/kg/min [0.23 mg/lb/min], q 30 min) of anesthesia. Heart and respiratory rates, cloacal temperature, and SpO2 were recorded. RESULTS: Mean induction time for the first 4 iguanas was 1.2 minutes. A significant decrease in heart rate was seen 1 minute after induction of anesthesia. All iguanas were apneic, but spontaneous ventilation resumed within 5 minutes. End-tidal CO2 concentration decreased from 46 mm of Hg 4 minutes after induction of anesthesia to 32 mm of Hg 30 minutes after induction of anesthesia. Mean duration of anesthesia was 27 minutes. Mean induction time for the other 10 iguanas was 3 minutes. A significant decrease in heart rate was detected 35 minutes after induction of anesthesia and persisted until 120 minutes. Mean SpO2 value decreased from 79% 5 minutes after induction of anesthesia to 64% 30 minutes after induction of anesthesia. Mean recovery time was 57 minutes. CLINICAL IMPLICATIONS: Propofol is an effective anesthetic agent for use in green iguanas. It is recommended that iguanas be intubated, provided oxygen, and given assisted ventilation after administration of propofol to prevent hypoxemia and hypercapnia.

Anesthesia↗
PubMed2000

Intraosseous is faster and easier than umbilical venous catheterization in newborn emergency vascular access models.

The purpose of this study is to compare the speed and ease of establishing newborn emergency vascular access using intraosseous (IO) versus umbilical venous catheterization (UVC). The study is an experimental design. A total of 42 medical students, without prior IO and UVC experience, were recruited as study subjects. All subjects performed the UVC procedure and were randomized (by a coin flip) to perform the IO procedure in one of two models: (1) turkey bone or (2) plastic infant leg. Each subject performed an initial trial for both the IO and UVC procedures without practice ("Inexperienced attempt") and a second trial in both procedures after practice ("Experienced attempt"), such that in total, each subject completed four attempts (two IO and two UVC). IO and UVC placement times were measured, and placement difficulty scores for IO and UVC were measured using a 10 cm visual analog scale (VAS). The averaged elapsed time to successful access was significantly shorter for the IO procedure on both the initial "inexperienced" attempt (52 versus 134 seconds, P < .001) as well as the "experienced" attempt (45 versus 95 seconds, P = .011). Procedure difficulty scores were lower in the IO procedure for both "inexperienced" and "experienced" attempts (3.5 versus 5.5, P = .001 and 2.6 versus 4.7, P < .001) as measured on a 10 cm VAS. Although UVC may be preferred by neonatologists, this model suggests that IO results in easier and more rapid vascular access in those who do not frequently perform newborn resuscitation. As such, the benefit of teaching UVC in pediatric resuscitation courses should be reconsidered. The recommended method of emergency newborn vascular access should be reconsidered pending further studies on this subject.

Animals↗
PubMed1995

Hematologic safety of intraosseous blood transfusion in a swine model of pediatric hemorrhagic hypovolemia.

OBJECTIVE: To assess the risk of hemolysis, disseminated intravascular coagulation (DIC), or fat embolism syndrome (FES) with pressurized intraosseous (IO) blood transfusion following hemorrhage. METHODS: A controlled, repeated-measures, randomized animal study with blinded pathologic evaluations was conducted. Sixteen pentobarbital-anesthetized, instrumented immature swine underwent a 20-mL/kg hemorrhage into citrate-phosphate-dextrose bags, then received autologous blood transfusion via a 16-ga i.v. catheter (eight), or via a 15-ga IO needle in the proximal tibia (eight) under maximal manual pressure using a 30-mL syringe. At baseline and at one hour and 48 hours posttransfusion, blood samples were assayed for hemoglobin (Hb), schistocytes, free Hb in plasma, bilirubin, lactate dehydrogenase, platelets, fibrinogen, and alveolar-arteriolar O2 gradient. Lung sections were examined for inflammation after hematoxylin/eosin stain, and for fat emboli after oil red-O-stain. Kidney sections were examined for inflammation using hematoxylin/eosin stain. RESULTS: Though the IO transfusion rate of 21 +/- 6 mL/min was slower than the i.v. rate of 35 +/- 5 mL/min (p = 0.0012), all the animals returned to baseline blood pressure within 15 minutes and survived. The presence of schistocytes and mildly elevated free Hb in plasma was noted in both groups at baseline and each time period, and was presumed to be due to sampling from the arterial catheter. All other laboratory values remained within normal limits and without intergroup differences at any time period. No fat embolus was noted, and all lung and kidney specimens were free of inflammation. CONCLUSIONS: In this model, pressurized IO blood transfusion appears to be hematologically safe, i.e., without risk of appreciable hemolysis, DIC, or FES.

Animals↗
PubMed2000

Anesthetic efficacy and heart rate effects of the intraosseous injection of 1.5% etidocaine (1:200,000 epinephrine) after an inferior alveolar nerve block.

OBJECTIVE: The purpose of this study was to determine the anesthetic efficacy and heart rate effects of an intraosseous (IO) injection of 1.5% etidocaine with 1:200,000 epinephrine after an inferior alveolar nerve block. STUDY DESIGN: In a repeated-measures designed study, 48 subjects randomly received 2 combinations of injections at 2 separate appointments. The combinations were an inferior alveolar nerve (IAN) block (with 3% mepivacaine) + IO injection with 1.8 mL of 1.5% etidocaine hydrochloride containing 1:200,000 epinephrine, and an IAN + mock IO injection. The first molar was blindly tested with a pulp tester at 2-minute cycles for 60 minutes after the injection. Anesthesia was considered successful when 2 consecutive 80 readings (no subject response) were obtained. Heart rate (pulse rate) was measured with a pulse oximeter. RESULTS: Lip numbness occurred in 100% of the subjects with both the techniques. For the first molar, anesthetic success for the IAN + mock IO and the IAN + IO etidocaine hydrochloride groups, respectively, were 81% and 100%. The differences were significant (P <.05) when the IAN + IO etidocaine hydrochloride technique was compared with the IAN + mock IO. A mean increase in heart rate of 32 beats/min occurred in 90% of the subjects with the IO injection of the etidocaine hydrochloride solution. In 89% of these subjects, the heart rate returned to within 5 beats of baseline values 4 minutes or less after solution deposition. CONCLUSIONS: The IO injection of 1.8 mL of 1.5% etidocaine hydrochloride with 1:200,000 epinephrine, when used to augment an inferior alveolar nerve block, significantly increased anesthetic success in the first molar. The majority of subjects receiving the IO injection of the etidocaine hydrochloride solution had a transient increase in heart rate.

Adult↗
PubMed1999

Cardiovascular effects of intraosseous injections of 2 percent lidocaine with 1:100,000 epinephrine and 3 percent mepivacaine.

BACKGROUND: Because a number of patients have reported an increase in heart rate with the intraosseous, or i.o., injection, it is important to evaluate changes in the cardiovascular system with this injection technique. The purpose of this study was to determine the cardiovascular effects of an i.o. injection of 2 percent lidocaine with 1:100,000 epinephrine and 3 percent mepivacaine. METHODS: With the use of a repeated-measures design, the authors randomly assigned 42 subjects to receive i.o. injections of 1.8 milliliters of 2 percent lidocaine with 1:100,000 epinephrine or 1.8 mL of 3 percent mepivacaine in a double-blinded manner at two appointments. At each appointment the authors monitored electrocardiographic findings, cardiac rate, systolic and diastolic blood pressure, and mean arterial pressure before, during and after administration of anesthetic solutions. RESULTS: With the 2 percent lidocaine with 1:100,000 epinephrine solution, 28 (67 percent) of 42 subjects experienced an increase in heart rate that might be attributed to the effect of the epinephrine. In 22 (79 percent) of these subjects, the heart rate returned to within 5 beats of baseline values within four minutes after solution deposition. The authors found no significant increase in heart rate in subjects receiving the 3 percent mepivacaine. No significant differences (P > .05) were found in mean diastolic, mean systolic or mean arterial blood pressure values between the subjects receiving 2 percent lidocaine with 1:100,000 epinephrine and those receiving 3 percent mepivacaine. CONCLUSIONS: The majority of subjects receiving the i.o. injection of the 2 percent lidocaine-epinephrine solution experienced a transient increase in heart rate. No significant increase in heart rate was seen with the i.o. injection of 3 percent mepivacaine. CLINICAL IMPLICATIONS: While patients would likely notice the heart rate increase with the lidocaine-epinephrine solution, it would not be clinically significant in most healthy patients. In patients whose medical condition, drug therapies or epinephrine sensitivity suggests caution, 3 percent mepivacaine is a good alternative for i.o. injections.

Adolescent↗
PubMed2003

Local infusion of FGF-2 enhances bone ingrowth in rabbit chambers in the presence of polyethylene particles.

Osseointegration of porous-coated implants during revision arthroplasty procedures is often impeded due to the presence of residual granuloma, particulate debris, and a sclerotic, dysvascular bone bed. We hypothesized that local infusion of recombinant fibroblast growth factor (FGF-2) would increase bone ingrowth in an in vivo model of tissue differentiation in the rabbit tibia in the presence of phagocytosable polyethylene particles. A drug test chamber (DTC) was implanted in the proximal medial tibial metaphysis of mature rabbits unilaterally. The chamber contained a 1x 1 x 5-mm tunnel for tissue ingrowth, and was connected to an osmotic diffusion pump. FGF-2 was infused at dosages of 0, 0.5, 5, 50, or 500 ng/day for a 3-week period, with subsequent harvesting of the ingrown tissue after each 3-week treatment. The effects of ultrahigh molecular weight polyethylene particles (0.5-microm diameter) on tissue ingrowth were determined by adding particles to the chamber at concentrations of 5.8 x 10(11) (low dose) or 1.7 x 10(12) (high dose) particles/mL, with and without infusion of 50 ng/day of FGF for 3 weeks. The tissue forming in the chamber was harvested after each treatment for histologic processing and morphometric analysis of bone ingrowth. Statistical analysis was performed using parametric tests (ANOVA), nonparametric tests (Kruskal-Wallis test) and post hoc tests. In the absence of particles, infusion of 50 ng FGF-2 per day yielded the greatest amount of bone ingrowth. The high dose of particles suppressed bone ingrowth into the chamber, but the low dose particles did not (p = 0.0002, 95% confidence limits = 9.19-18.80). Infusion of 50 ng FGF-2 per day significantly increased net bone formation in the presence of high-dose UHMWPE particles (p = 0.039, 95% confidence limits = 1.41-6.79). There was a trend for decreased numbers of vitronectin-receptor positive (osteoclast-like) cells with the addition of FGF-2, compared to particles alone (p = 0.08). Local delivery of FGF-2 may prove useful in mitigating the adverse effects of wear debris (e.g., in treating early osteolytic lesions), and facilitating osseointegration of revision total joint replacements in situations where the bone bed is suboptimal and residual particles and granulomatous tissue are present.

Animals↗
PubMed1994

Chronic intramedullary infusion of interleukin-1 alpha increases bone mineral content in rats.

Interleukin-1 (IL-1) is known to have a potent bone-resorbing activity in vitro, however, results from in vivo studies are conflicting. We performed experiments with the continuous infusion of recombinant IL-1 alpha directly into the femoral bone marrow of rats for 2 weeks and examined its effects on bone by soft X-ray photographs, bone mineral assessment, and histological examination. Infusion of IL-1 alpha at doses greater than 1 microgram/ml (0.6 ng/hour) caused sclerosis around the infusion site on soft X-ray photographs, and the bone mineral content of IL-1 alpha infused femora was increased significantly. Histologically, extensive periosteal bone formation was observed around the infusion site and small mononuclear cells replaced the normal fat tissue. Infusion of prostaglandin E2 alone produced intramedullary bone formation more extensively. Simultaneous infusion of IL-1 alpha and indomethacin (10(-3) M; 179 ng/hour) inhibited the increase of bone mineral content (BMC) induced by IL-1 alpha. Thus, the chronic intramedullary administration of IL-1 alpha stimulates bone formation, especially in the periosteum, and increases BMC in intact rats.

Animals↗
PubMed2005

[Invasive techniques in emergency medicine. III. Intraosseous punction--an alternative vascular access in paediatric emergencies].

There can be few more daunting challenges for the emergency physician than an infant or small child in shock or cardiac arrest. At the best of times, the combination of small veins and abundant subcutaneous tissue makes vascular access difficult or impossible, even in experienced hands. For these situations, the intraosseous vascular access is an easy, rapid and safe alternative. The intraosseous route is recommended for children < or =6 years of age, where conventional vascular access cannot be timely established. The preferred sites are the medial aspect of the proximal end of the tibia, just below the tibial tuberosity. Access should be obtained with a commercially available intraosseous needle. All emergency drugs and infusion fluids for intravenous usage can safely be infused via the intraosseous route (except hypertonic solutions) and it is not necessary to adjust drug dosage compared to the intravenous route. To avoid complications caused by the intraosseous needle, such as osteomyelitis, it should be replaced within 2 h by a conventional vascular access.

Anesthesia, General↗
PubMed2004

Transient femoral neuropathy after harvest of bone from the iliac crest.

A 31-year-old woman had bone harvested from the left anterior iliac crest as a graft for an augmentation genioplasty. For postoperative analgesia, she was given a bupivacaine infusion into the iliac wound. She developed a temporary left femoral mononeuropathy from which she recovered completely.

Adult↗
PubMed2002

Recent advances in emergency life support.

With additional international input, recent changes in emergency life support are reflected in updated guidelines for Advanced Cardiac Life Support (ACLS) from the American Heart Association and new technology in the arena of vascular access and emergency airway management. These changes will expand nurses' ability to provide advanced levels of care, even in the prehospital situation, and represent a more rigorous evidence-based approach than ever before. As early morbidity and mortality in emergency situations are frequently associated with complications associated with airway management and vascular access, recent development in these areas are reviewed along with evolution in ACLS guidelines.

Adult↗
PubMed1992

Comparison of intraosseous and intravenous delivery of hypertonic saline/dextran in anesthetized, euvolemic pigs.

STUDY OBJECTIVES: With renewed interest in intraosseous (IO) infusion, the present study examined if sternal IO infusion provided vascular entry of 7.5% NaCl/6% dextran-70 (HSD) as efficiently as IV infusion. DESIGN, SETTING, TYPE OF PARTICIPANTS, INTERVENTIONS: Twelve anesthetized pigs were catheterized for measurement of cardiovascular parameters. Six pigs were given a 4-mL/kg IO infusion of HSD under pressure over two to six minutes; each pig was paired with another that had been given HSD IV over the same time course. Rapid arterial blood sampling was used to evaluate vascular entry of NaCl and dextran with monitoring continued for two hours after infusion. MEASUREMENTS AND MAIN RESULTS: Complete vascular entry of infused sodium and dextran was generally complete within one minute after infusion in all experiments. Increases in mean arterial pressure, cardiac output, and other cardiovascular parameters were indistinguishable between IO and IV infusions. Plasma volume expansion was about 20% above baseline in both groups of pigs. Histologic examination showed minimum pathology to the sternum and no significant pulmonary complications. CONCLUSION: 1O vascular delivery of HSD is a viable alternative in emergency scenarios in which vascular access is compromised.

Analysis of Variance↗