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At least 487 records · Page 27Linked to original sources
PubMed1987

Assessment of alfentanil by intravenous infusion as long-term sedation in intensive care.

The use of an alfentanil infusion for sedation of critically ill patients in intensive care was investigated in 16 patients who were entered consecutively into the study. The mean duration of stay was 8 days. Supplements of Diazemuls and muscle relaxants were administered if required. The success of the technique was judged by nursing and medical staff and, in particular, the wakefulness of patients was noted. No patient could recall events that occurred during their infusion. An outline protocol is described.

Adolescent↗
PubMed1992

Oxyhaemoglobin saturation following elective abdominal surgery in patients receiving continuous intravenous infusion or intramuscular morphine analgesia.

Oxygen saturation was continuously measured using computerised pulse oximetry for 8 h overnight pre-operatively and for the first 24 h postoperatively in 40 patients receiving intermittent intramuscular morphine or continuous infusion of morphine following elective upper abdominal surgery. The proportion of time with an oxygen saturation less than 94% was used as an index of desaturation. Patients receiving continuous infusion analgesia received a larger morphine dose and achieved better analgesia than the intramuscular group. Postoperatively, the duration of desaturation increased 10-fold over pre-operative values, 'intramuscular' patients spending 39.0% (SD, 37.0%) and 'continuous infusion' patients 40.0% (SD, 37.5%) of the time below 94% saturation. Although newer therapies (e.g. epidural analgesia and patient-controlled analgesia) are currently receiving greater attention, the sequelae of these more traditional analgesic techniques warrant further study.

Abdomen↗
PubMed1995

Sedation with intravenous infusions of propofol or thiopentone. Effects on pain perception.

The aim of this study was to investigate pain perception during thiopentone or propofol infusions for sedation. Thirty ASA 1 or 2 patients received a two step infusion of either thiopentone (step 1: 1.25 mg.kg-1 followed by 2.5 mg.kg-1.h-1; step 2: 1.25 mg.kg-1 and 12.5 mg.kg-1.h-1; n = 15) or propofol (step 1: 0.5 mg.kg-1, 1 mg.kg-1.h-1; step 2: 0.5 mg.kg-1, 5 mg.kg-1.h-1; n = 15) for sedation. At control and 10 min after the start of each infusion dosage, reaction times and thermal pain detection thresholds were determined. We found no clinically or statistically significant depression of thermal pain detection thresholds during propofol or thiopentone infusions and these are, therefore, unlikely to be associated with clinically relevant hyperalgesia.

Adolescent↗
PubMed1990

Pharmacokinetics of propofol when given by intravenous infusion.

We have previously shown with i.v. bolus studies that the elimination of propofol is much slower than previously reported. Now we have studied the implications of this for prolonged i.v. infusion of propofol in seven patients who received continuous infusions of propofol for up to 9 h. Values of elimination half-life ranged from 13.1 to 44.7 h, systemic clearance from 1.02 to 1.63 l h-1 and volume of distribution from 1390 to 3940 l and these were similar to those obtained with bolus administration. The large volume of distribution is consistent with the high octanol/blood partition coefficient, which was found to be 72.0. Despite the very long elimination half-life, blood propofol concentrations appeared to approach steady state within 20 min rather than the 4-5 half-lives normally expected. This is because for this drug, which displays multicompartment pharmacokinetics, the rate of initial rise of blood concentrations is governed primarily by the very short distribution half-life of the drug. Therefore, the long elimination half-life of propofol is probably of little significance in designing infusions regimens, but the lower systemic clearance should be taken into account to avoid unwanted accumulation.

Adult↗
PubMed1995

Severe hypotension and bradycardia after continuous intravenous infusion of urodilatin (ANP 95-126) in a patient with congestive heart failure.

The effects of a continuous i.v. infusion of urodilatin at a dose of 30 ng kg-1 min-1 were studied in a patient with congestive heart failure. After 30 min, urodilatin had induced a marked stimulation of plasma cyclic GMP concentrations. In parallel haematocrit increased. No significant diuresis and no change of invasive haemodynamics was observed. After 2 h the patient developed a profuse perspiration. Eighty minutes later he suffered from dizziness due to hypotension (blood pressure 80/40 mmHg) and a sudden bradycardia (50 bpm). Urodilatin was discontinued and symptoms were relieved by bed tilt and rapid infusion of isotonic saline solution. Mechanisms contributing to these adverse effects may be fluid extravasation to the third space and sympathoinhibitory effects known to occur with natriuretic peptide infusion.

Atrial Natriuretic Factor↗
PubMed2005

Plasma and interstitial fluid pharmacokinetics of enrofloxacin, its metabolite ciprofloxacin, and marbofloxacin after oral administration and a constant rate intravenous infusion in dogs.

Enrofloxacin and marbofloxacin were administered to six healthy dogs in separate crossover experiments as a single oral dose (5 mg/kg) and as a constant rate IV infusion (1.24 and 0.12 mg/h.kg, respectively) following a loading dose (4.47 and 2 mg/kg, respectively) to achieve a steady-state concentration of approximately 1 microg/mL for 8 h. Interstitial fluid (ISF) was collected with an in vivo ultrafiltration device at the same time period as plasma to measure protein unbound drug concentrations at the tissue site and assess the dynamics of drug distribution. Plasma and ISF were analyzed for enrofloxacin, its active metabolite ciprofloxacin, and for marbofloxacin by high performance liquid chromatography (HPLC). Lipophilicity and protein binding of enrofloxacin were higher than for marbofloxacin and ciprofloxacin. Compared to enrofloxacin, marbofloxacin had a longer half-life, higher Cmax, and larger AUC(0-infinity) in plasma and ISF after oral administration. Establishing steady state allowed an assessment of the dynamics of drug concentrations between plasma and ISF. The ISF and plasma-unbound concentrations were similar during the steady-state period despite differences in lipophilicity and pharmacokinetic parameters of the drugs.

Administration, Oral↗
PubMed1987

Postoperative water and electrolyte changes in skeletal muscle: a clinical study with three different intravenous infusions.

Twenty-seven patients admitted for cholecystectomy were matched for age and sex in three groups for different perioperative fluid therapies over a period of 3 days. Group I was given an acetated half-isotone "balanced" saline solution with the addition of 2.5% glucose, Group II an acetated Ringer solution and Group III an isotonic glucose solution. Percutaneous muscle biopsies were performed before and on the third day after surgery for the determination of water content and the concentration of sodium, potassium, magnesium and chloride in skeletal muscle. The cumulative balance of sodium and potassium was measured daily during the study. In all three groups a significant increase in the total muscle water content was demonstrated. The concentration of sodium and chloride in skeletal muscle increased significantly in Groups II and III, whereas the concentration of potassium decreased in all groups. The cumulative sodium balance was positive in Groups I and II; the potassium balance was negative in all groups. In conclusion, the patients given the balanced saline solution showed the least change in water content and electrolyte concentrations in skeletal muscle.

Adult↗
PubMed1988

Intravenous infusion of midazolam, propofol and vecuronium in a patient with severe tetanus.

An adult patient with severe tetanus was successfully treated with alternating long-term infusions of propofol (20-80 mg/h, 8 + 3 days) and midazolam (5-15 mg/h, 29 days) for sedation, and with vecuronium infusion (6-8 mg/h, 35 days) for muscle relaxation. In addition, continuous infusion of labetalol (10-20 mg/h, 39 days) was given to control arterial blood pressure. Blood samples were taken daily for assays of propofol, midazolam and vecuronium plasma concentrations. No accumulation of propofol and vecuronium could be detected. There was an increase in liver enzyme activity at the end of the first 8-day propofol infusion. During the 4-week midazolam infusion, there were two marked plasma concentration peaks at times when the infusion rate was fairly stable. These changes coincided with pulmonary infection (C-reactive protein elevated) and ciprofloxacin treatment. The patient awoke rapidly after the last propofol infusion. He was unable to recall anything about his stay in the intensive care unit.

Aged↗
PubMed1991

A comparison between morphine, meperidine and ketobemidone in continuous intravenous infusion for postoperative relief.

Morphine, meperidine and ketobemidone used in continuous i.v. infusion for postoperative pain relief were compared in a double-blind, controlled, prospective study in 81 consecutive consenting adult patients after open-heart surgery, with permission from the hospital ethics committee. During the first postoperative period, the infusion rates were fixed. Later on, when the infusion rate could be regulated according to individual patient needs, the variation in infusion rate was large, in accordance with earlier studies. No significant differences were demonstrated between the three analgesics with respect to efficacy of analgesia or side effects like shivering, nausea or vomiting. Respiratory depression following extubation was not observed. During shivering, there was a significant increase in the arterio-mixed venous difference of oxygen in all groups. The amounts of opioids used were relatively small compared to amounts used in patients following abdominal surgery. When interviewed some days after surgery, 18/74 patients remembered moderate pain and 11 severe pain during the stay in the ICU.

Double-Blind Method↗