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At least 595 records · Page 33Linked to original sources
PubMed1994

An anaesthetic drug error: minimizing the risk.

A medication error caused a near fatal cardiac arrest in a previously healthy patient undergoing elective surgery. Inadvertent epinephrine injection induced ventricular dysrhythmias, hypertension, hypotension and pulmonary oedema. The case was investigated using critical-incident technique and was reviewed by the Risk Management Team of the Department of Anaesthesia. The purpose of this report is to present the recommendations resulting from the investigation. These include: improved resident training in intravenous drug management, the use of anaesthetic drug ampoules with distinct labels, and the development of a standardized colour code system for labels on anaesthetic drug ampoules. Furthermore, it is recommended that all anaesthetic drug errors be reported to the Canadian agencies responsible for drug packaging in order to identify patterns in anaesthetic drug errors, and to facilitate the implementation of effective drug identification systems.

Adult↗
PubMed1994

Drug errors.

Explore the source record for details and available documents.

Canada↗
PubMed1996

Failure of neuromuscular blockade reversal after rocuronium in a patient who received oral neomycin.

PURPOSE: Because the aminoglycoside antibiotics and nondepolarizing muscle relaxants have interactions that vary, it is necessary to update the potential for such interactions when new drugs are introduced clinically. Rocuronium is a newly released steroidal nondepolarizing muscle relaxant with an intermediate duration of action. The following report is the first description of prolonged neuromuscular blockage after rocuronium in a patient who had received oral neomycin in anticipation of open bowel resection. CLINICAL FEATURES: A 71-yr-old woman with a two week history of bleeding pr was scheduled for exploratory laparotomy and right hemicolectomy. She received two standard bowel preparations consisting of oral erythromycin and neomycin over a two day period. Rocuronium was used to facilitate tracheal intubation and maintain muscle relaxation during a two hour operation. Despite clinical appearance of reversal of neuromuscular blockade after neostigmine and glycopyrolate, the patient complained of dyspnoea and weakness upon tracheal extubation and required reintubation twice. The reason for prolonged muscle relaxation was thought to be secondary to a rocuronium and neomycin interaction. CONCLUSION: Rocuronium, a new nondepolarizing muscle relaxant, has potential interactions with other drugs including the aminoglycoside antibiotics. This clinical report describes the failure of neuromuscular blockade reversal in a patient who received oral neomycin in anticipation of open bowel resection.

Administration, Oral↗
PubMed2004

Cardiovascular autonomic function in patients with hemodynamic instability at induction of capnoperitoneum: a case-control study.

BACKGROUND: This study hypothesized that patients in whom bradycardia and hypotension develop with induction of positive-pressure capnoperitoneum have an underlying autonomic cardiovascular dysfunction. METHODS: A case-control study was conducted to examine the baseline autonomic function of patients in whom bradycardia and hypotension develop with induction of positive-pressure capnoperitoneum. The control group consisted of patients who maintained normal cardiac rhythm and blood pressure during the same procedure. Two groups of tests were performed: bedside stress tests of cardiovascular autonomic function (response graded 1 (normal) to 4 (severely abnormal) and heart rate variability analysis (spectral and time domain components). RESULTS: The study evaluated 6 patients in the bradycardia group and 10 in the control group. The group in whom bradycardia had developed scored significantly worse on the bedside stress tests than the control group (for grades I to IV: chi2 = 6.5, p = 0.022; for trend: chi2 = 5.6, p = 0.018). In contrast, both groups had similar baseline autonomic tone, as measured by heart rate variability. CONCLUSIONS: Patients in whom bradycardia and hypotension develop with induction of positive-pressure capnoperitoneum have cardiovascular autonomic dysfunction, which is identifiable by bedside stress tests of autonomic function.

Autonomic Nervous System↗
PubMed1989

Intravenous physostigmine increases cerebrospinal fluid neuropeptide-Y.

The ability to measure directly central nervous system (CNS) neurotransmitter changes after an acute pharmacological challenge would be a useful clinical tool in psychiatric research. As one approach to this possibility, we attempted to measure cerebrospinal fluid (CSF) neuropeptide changes produced by an intravenous infusion of the indirect cholinergic agonist physostigmine. Six rhesus monkeys, with indwelling CSF catheters, had serial CSF samples removed before and after a 15 micrograms/kg physostigmine infusion. Five of six monkeys studied showed at least a 50% increase in CSF neuropeptide-Y (NPY) levels. Normal human subjects (n = 27) had CSF sampled before and 15, 30, and 45 min after an acute intravenous infusion of physostigmine (either 0, 5, or 15 micrograms/kg). An Analysis of Variance revealed a significant (p = 0.04) dose-time interaction, suggesting that physostigmine increased CSF NPY at the 15 micrograms/kg dose. CSF levels of seven other neuropeptides remained unchanged. These results suggest that the pharmacological challenge paradigm can be adapted to CSF neuropeptides, providing new measures of CNS stimulus-induced response beyond the peripheral plasma determinations usually employed.

Animals↗
PubMed1990

Effect of central cholinergic stimulation on regional cerebral blood flow in Alzheimer disease.

Patients with Alzheimer disease (AD) had reduced regional cerebral blood flow (rCBF) in the posterior parietotemporal region compared with controls, as determined with technetium-99m hexamethyl propyleneamine oxime and single photon emission tomography. Central cholinergic stimulation with physostigmine produced a focal increase in rCBF in the posterior parietotemporal region in the patients with AD but not in controls.

Aged↗
PubMed1980

A simplified method for assessing drug effects on gastric emptying in rats.

A method is described to determine the effects of experimental compounds on gastric emptying in rats. The technique, using a methylcellulose-based test meal, is simple, versatile and reliable. Data are presented to show the utility of the method in demonstrating both enhancement and inhibition of gastric emptying.

Animals↗
PubMed1983

Behavioral, physiological, and neuroendocrine responses to arecoline in normal twins and "well state" bipolar patients.

Cholinergic supersensitivity has been postulated to be an etiologic factor in affective disorder. After several pilot dose-response studies, we administered 8 mg of the cholinergic agonist arecoline subcutaneously to eight pairs of normal volunteer identical twins and eight bipolar patients currently euthymic and unmedicated. During the hour following arecoline administration, the Profile of Mood States (POMS) showed an increase in total mood disturbance in both patient and control groups. Mean systolic blood pressure, pulse, plasma cortisol, prolactin, and growth hormone also increased. Anger and elation scores on the POMS showed significant concordance in identical twins, as did change in prolactin, implying that these are the components of drug response possibly influenced by genetic factors. None of these responses differentiated well state patients from controls. Thus, mood, behavioral, and neurochemical responses to arecoline, which appears to have nonspecific neurochemical effects at the dose employed, are not markers of vulnerability to affective illness.

Arecoline↗
PubMed1990

Cholinergic-adrenergic balance: Part 1. Relationship between central and peripheral sensitivities.

Eight healthy volunteers were studied under double-blind conditions after acute challenge with the peripheral beta 2-agonist reproterol, either alone or combined with the peripheral indirect cholinomimetic neostigmine. Their responses were also studied after administration of the centrally active indirect cholinomimetic physostigmine. The beta-adrenergic rise in heart rate was cholinergically suppressed. The beta-adrenergic rise of plasma cyclic adenosine monophosphate (cAMP) was not cholinergically modulated, while that of plasma glucose tended to be cholinergically suppressed. Physostigmine induced an anergic-anhedonic syndrome accompanied by physiological, metabolic, and neuroendocrine stress phenomena. The beta-adrenergic and cholinergic sensitivities, respectively, of the various parameters investigated tended to be nonsignificantly intercorrelated. Only a limited portion of the variance was explained by drug effects. Sensitivity to neostigmine was completely unrelated to sensitivity to physostigmine. Thus, cholinergic sensitivity seems not to be decisive for the fine tuning of the highly complex regulatory systems studied and peripheral sensitivity not to be representative for the central one, at least if unselective drugs like neostigmine and physostigmine are used.

Adult↗
PubMed1990

Cholinergic-adrenergic balance: Part 2. Relationship between drug sensitivity and personality.

Sensitivity to the centrally active cholinomimetic physostigmine varies dramatically among healthy individuals. The elucidation of the reasons for this variability could contribute to the understanding of the pathophysiology of affective disorders where a cholinergic supersensitivity has been demonstrated. Therefore, personality characteristics and habitual stress-coping strategies were related to sensitivity to physostigmine in eight healthy male volunteers. Cardiovascular and behavioral responses tended to be positively correlated with irritability and emotional liability. Passive, "helpless" strategies for coping with stress were positively related to these responses. The metabolic and neuroendocrine responses to physostigmine were generally unrelated to personality. In view of putative beta-adrenergic disturbances in depression, the responses to the peripheral beta 2-adrenergic agonist reproterol were studied. Irritability and emotionality tended to be positively correlated with cardiovascular responses to reproterol as well as with reductions of heart rate by the peripheral cholinomimetic neostigmine.

Adult↗
PubMed1990

A new strategy of iontophoresis for hyperhidrosis.

We used a modified iontophoretic method with an anticholinergic agent and aluminum chloride to treat hyperhidrosis. The strategy behind this combination was to shift gradually from inhibition of sweat gland secretion to blockage of the sweat duct. In a double-blind study in which we compared our method with tap water iontophoresis, the results were comparable. A second study revealed an 87% response rate, with an average remission period of 32 days. Our data indicate that patients who were older at onset, had a family history negative for the disorder, had an early response, or underwent treatment in cool weather had the most favorable results.

Aluminum↗
PubMed1989

Continuous infusion of methohexital and alfentanil hydrochloride for general anesthesia in outpatient third molar surgery.

Three anesthetic techniques were compared in this study: 1) Intermittent Brevital boluses supplemented with fentanyl and midazolam all titrated to patient movement, 2) constant infusion of Brevital supplemented with fentanyl and midazolam all delivered in calculated mg/kg doses based on total body weight, and 3) constant infusion of methohexital (Brevital) and alfentanil (Alfenta) supplemented by midazolam (Versed), droperidol, and glycopyrolate (Robinul) delivered in calculated mg/kg doses based on lean body mass. Nitrous oxide was delivered in all cases via nasal mask in a 30% to 50% concentration. The mean total dose of Brevital in group 1 (intermittent Brevital bolus) was 0.17 mg/kg/min (SD = 0.07), group 2 (Brevital infusion) was 0.23 mg/kg/min (SD = 0.06), and group 3 (alfentanil/Brevital infusion) was 0.12 mg/kg/min (SD = 0.07). Mean total dose of alfentanil in group 3 equaled 1.58 mcg/kg/min (SD = 0.73). In group 1, 94% of the patients experienced moderate to severe movement intraoperatively. Twenty-three percent of the patients in group 2, and only 7% of group 3 exhibited moderate to severe movement. Emergence in group 3 averaged 4.5 minutes (SD = 1.6). Three patients (7%) in group 3 had postoperative nausea. Additional subjective findings in group 3 included easier airway maintenance during administration of the anesthetic, lack of unpleasant emergence phenomena such as crying, and prompt readiness for discharge. It was concluded that continuous alfentanil and Brevital infusion satisfied the objectives of safety, stability, predictability, and rapid recovery, while improving operating conditions (less patient movement) when compared with more traditional anesthetic techniques.

Adult↗
PubMed1994

Rapid infusion of magnesium sulfate obviates need for intubation in status asthmaticus.

Rapid infusion of intravenous magnesium sulfate (MgSO4) was given to two young adults with impending respiratory failure caused by status asthmaticus. The infusion of 2 g of MgSO4 during a 2-minute period was associated with an immediate, dramatic reversal of their severe bronchospasm. This treatment obviated the need for intubation. Continuous beta 2-agonist therapy was performed simultaneously, taking advantage of the MgSO4-induced bronchodilation to deliver the beta 2-agonist to the target tissues. Rapid infusion of intravenous MgSO4 has been documented as safe in standard obstetric literature. Previous reports of MgSO4 therapy for acute asthma have used slow infusion. This is the first report of rapid infusion of MgSO4 for the emergency department management of asthma. In both cases, this therapy obviated the need for endotracheal intubation and mechanical ventilation.

Administration, Inhalation↗