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PubMedDate not supplied

Does continuous intravenous infusion of low-concentration epinephrine impair uterine blood flow in pregnant ewes?

BACKGROUND AND OBJECTIVES: Bolus intravenous injection of epinephrine can decrease uterine blood flow. This study examined the effects of intravenous infusion of epinephrine on uterine blood flow in the gravid ewe. METHODS: Maternal and fetal vascular catheters and a maternal electromagnetic uterine artery flow probe were implanted in 10 near-term gravid ewes. After recovery, saline, 0.125% bupivacaine, 0.125% bupivacaine with 1:200,000 epinephrine, 0.125% bupivacaine with 1:400,000 epinephrine, and 0.125% bupivacaine with 1:800,000 epinephrine were infused into the maternal superior vena cava. Drugs were infused at 10 mL/h for 30 minutes and then at 20 mL/h for an additional 30 minutes. Animals also received an intravenous bolus of epinephrine 15 micrograms. Throughout all infusions, maternal heart rate, systemic and pulmonary blood pressures, uterine blood flow, cardiac output, and acid-base balance were measured, as well as fetal heart rate, blood pressure, and acid-base balance. RESULTS: Epinephrine 15 micrograms decreased uterine blood flow to 68 +/- 14% of baseline (mean +/- SD). Infusion of all solutions had no effect on any measured hemodynamic variable. CONCLUSIONS: In gravid ewes, intravenous infusion of < or = 1.67 micrograms/min epinephrine altered neither maternal hemodynamics nor uterine blood flow. To the extent that sheep data can be extrapolated to humans, these results suggest that continuous intravenous infusion of epinephrine in local anesthetic solutions is safe if the epidural catheter should enter a blood vessel during the infusion.

Anesthesia, Obstetrical↗

PubMed2005

Randomised trial of intravenous infusion of ephedrine or mephentermine for management of hypotension during spinal anaesthesia for Caesarean section.

This study compared the effects of intravenous infusions of ephedrine and mephentermine for maintenance of maternal arterial pressure and neonatal outcome in pregnant women receiving subarachnoid block for lower segment Caesarean section. Sixty patients who developed hypotension following subarachnoid block for Caesarean section were randomly divided into two groups of 30 each to receive an intravenous infusion of ephedrine or mephentermine. Hypotension was defined as a decrease in systolic blood pressure of > or = 20% from the baseline value or an absolute value of <100 mmHg, whichever was higher. The vasopressor infusion was titrated to maintain systolic blood pressure between 'hypotension' and baseline values. Baseline haemodynamic parameters, haemodynamic changes subsequent to the start of vasopressor infusion, duration of hypotension and amount of vasopressor required were statistically similar for both groups. Neonatal APGAR scores and acid-base profiles were also comparable. To conclude, mephentermine can be used as safely and effectively as ephedrine for the management of hypotension during spinal anaesthesia in patients undergoing elective Caesarean section.

Adrenergic Agents↗

PubMed1995

Bloodstream infections associated with a needleless intravenous infusion system in patients receiving home infusion therapy.

OBJECTIVE: To determine risk factors for bloodstream infections (BSIs) in an outbreak among patients receiving home intravenous infusion therapy. DESIGN: Case-control and retrospective cohort studies. SETTING: Home health agency. PATIENTS: Patients receiving home intravenous infusion therapy from Rhode Island Home Therapeutics (RIHT) from January through December 1993. MAIN OUTCOME MEASURE: Development of primary BSI. METHODS: We compared patients with BSI (ie, case patients) with randomly selected noninfected RIHT patients receiving intravenous therapy, conducted a cohort study of all RIHT patients receiving intravenous therapy via a central venous catheter (CVC), and conducted a culture survey of injection cap luminal fluid. RESULTS: Case patients were more likely than controls to have had therapy via a CVC (11/11 vs 14/32; odds ratio [OR] undefined; P < .001) or total parenteral nutrition and intralipid therapy (TPN/IL) (9/11 vs 3/32; OR, 43.5; 95% confidence interval [CI], 4.9 to 510.0). Among RIHT patients with CVCs, risk factors for BSI were receipt of TPN/IL (9/35 vs 2/67; rate ratio [RR], 8.6; 95% CI, 2.0 to 37.7) or use of a needleless infusion system (10/41 vs 1/61; RR, 14.9; 95% CI, 2.0 to 111.8). Only the combination of both exposures was significantly associated with development of a BSI (P < .001). Luminal fluid from injection caps of needleless devices was significantly more likely to be culture positive than fluid from protected-needle devices (5/23 vs 0/18; RR undefined; P = .04). CONCLUSIONS: Our data suggest that a needleless device used for TPN/IL was associated with increased risk of BSI when injection caps were changed every 7 days.

Case-Control Studies↗

PubMed1986

Labetalol by continuous intravenous infusion in severe hypertension.

This study documents our experience with labetalol administered by continuous intravenous infusion for severe hypertension. Infusions were performed in 14 hospitalized patients (15 infusions) with supine diastolic pressure greater than 125 mmHg or supine systolic pressure greater than 200 mmHg. Blood pressures were measured by intra-arterial recording or an Arteriosonde 1225 Doppler instrument standardized with a mercury sphygmomanometer. Patients initially received 2 mg/min continuous infusion; the infusion rate varied between 0.5 and 2.0 mg/min according to the protocol. The infusion was terminated when diastolic pressure decreased 30 mmHg or when 300 mg of the drug had been infused. Goal blood pressure was achieved in all but two infusions. Sedation was the most common adverse reaction, followed by nausea and diaphoresis. No patient required discontinuation or reduction in infusion rate secondary to side effects. We conclude that continuous intravenous infusion of labetalol offers an effective alternative to current parenteral therapy.

Adult↗

PubMed1976

[Renal production and excretion of AMPc after intravenous infusion of salmon calcitonin in man].

Intravenous infusion of salmon calcitonin in man produced an increase in the plasma levels and urinary excretion of cyclic AMP. This study demonstrates a net extraction of cyclic AMP from plasma by the kidneys but salmon calcitonin does not act only on the kidney and stimulates the production of cyclic AMP in extra renal tissues. The excess of cyclic AMP formed is catabolized by the kidneys.

Adult↗

PubMed1994

Phase I study of adozelesin administered by 24-hour continuous intravenous infusion.

BACKGROUND: Adozelesin, a synthetic analogue of the antitumor antibiotic CC-1065, is the first of a class of potent sequence-specific alkylating agents to be brought to clinical trial. In preclinical in vitro testing, it has demonstrated antitumor activity at picomolar concentrations. PURPOSE: We conducted a phase I study of adozelesin to (a) determine a recommended dose for phase II testing using a 24-hour intravenous infusion, (b) characterize the toxic effects of the drug using this schedule, and (c) document any antitumor activity observed. METHODS: Adozelesin was given as a 24-hour continuous intravenous infusion. Treatments were initially scheduled every 3 weeks, but the prolonged myelosuppression observed necessitated a final dosing interval of every 6 weeks. The starting dose of 30 micrograms/m2 was escalated using a modified Fibonacci scheme until dose-limiting toxicity was encountered. RESULTS: Twenty-nine patients were entered in the study. Successive dose levels used were 30, 60, 100, 150, 120, and 100 micrograms/m2. Prolonged thrombocytopenia and granulocytopenia were dose limiting. No antitumor responses were observed. CONCLUSION: We recommend that the phase II dose of adozelesin given as a continuous 24-hour intravenous infusion be 100 micrograms/m2, repeated every 6 weeks. Other potentially less myelosuppressive schedules could be pursued.

Adult↗

PubMed1981

A comparison of the effects of intravenous infusion of individual branched-chain amino acids on blood amino acid levels in man.

1. Intravenous infusions of L-valine (600 mumol/min), L-isoleucine (150 mumol/min), L-leucine (300 mumol/min) and a mixture of the three branched-chain amino acids (70% L-leucine, 20% L-valine, 10% L-isoleucine; 270 mumol/min) were given to four groups of healthy volunteer subjects. Whole-blood concentrations of amino acids and glucose and serum insulin were measured before and during the infusions. 2. Valine and isoleucine infusions resulted in twelve- and six-fold increases in the respective amino acid. During valine infusion, tyrosine was the only amino acid for which a decrease in concentration was seen (25%, P less than 0.05). With isoleucine administration, no significant changes were found. In contrast, leucine infusion (during which the leucine concentration rose about sixfold) was accompanied by significant decreases in tyrosine (35%), phenylalanine (35%), methionine (50%), valine (40%) and isoleucine (55%). The arterial glucose concentration fell slightly (5%) and the insulin concentration increased 20% during leucine infusion. 3. Infusion of the mixture of the three branched-chain amino acids resulted in marked decreases in tyrosine (50%), phenylalanine (50%) and methionine (35%). The decreased amino acid levels remained low for 2 h after the end of the infusion. 4. The present findings demonstrate that intravenous infusion of leucine (not infusion of valine or isoleucine) results in marked reductions in the concentrations of the aromatic amino acids and methionine. Infusion of a mixture of the three branched-chain amino acids gives results similar to those obtained with leucine infusion alone. Thus a mixed branched-chain amino acid solution with leucine as its main constituent seems to be the best alternative in the treatment of patients with hepatic cirrhosis and encephalopathy.

Adult↗

PubMed1998

Accidental, intravenous infusion of a peanut oil-based medication.

OBJECTIVES: To describe a case of fat embolus syndrome with lipoid pneumonia resulting from intravenous infusion of lipid and to illustrate the potential for accidental intravenous administration of vegetable oil-based progesterone preparations in the treatment of oncology patients. CASE REPORT: A patient with recurrent ovarian carcinoma accidentally received approximately 20 mL (0.29 mL/kg) of a peanut oil-based methylprogesterone product intravenously via infusion pump over 24 hours. The patient developed a lipoid pneumonia with dyspnea, cough, hypoxia, radiographic infiltrates, and a pleural effusion. She was hospitalized for 4 days, and signs and symptoms resolved over 2 weeks following steroids and supportive care. DISCUSSION: Experience with accidental or intentional intravenous lipid overdose in humans is limited. Typical findings of fat embolus syndrome are similar to lipid aspiration, with respiratory distress, hypoxia, and pulmonary infiltrates. In contrast to aspiration, however, fat embolus syndrome results in lipogranulomas surrounding blood vessels, rather than air passages, and potentially produces cerebrovascular, accident-like symptoms. Management of fat embolus syndrome is similar to that for lipid aspiration. However, as seen in this case, fat embolus syndrome typically resolves over several weeks as opposed to the 3-month to 1-year period seen with aspiration lipoid pneumonias. CONCLUSIONS: Accidental intravenous infusion of vegetable oil-based products is a potential complication of the increased use of intravenous progesterones.

Antineoplastic Agents, Phytogenic↗

PubMed2002

Control of acute pain after major abdominal surgery in 585 patients given tramadol and ketorolac by intravenous infusion.

The aim of this study was to assess the efficacy and safety of postoperative pain relief using tramadol and ketorolac in continuous intravenous infusion. The 585 patients included in the study underwent major surgery according to a protocol involving the parenteral administration of 100 mg tramadol approximately 40 min before the end of surgery. This was followed by the continuous intravenous infusion of 600 mg tramadol and 180 mg ketorolac diluted with physiological solution to a total volume of 96 ml. Delivery was carried out using an elastomeric pump or a syringe pump and administered over a 48-hour period at a constant rate of 2 ml/h. Any further doses consisted of 100 mg tramadol up to a maximum of 300 mg over a 24-h period. Pain was assessed on a verbal numeric scale (VNS). For each patient the intensity of pain was assessed both at rest and on movement (coughing, deep breathing, movement of lower limbs). At the scheduled times (T0-T72, every 6 h), the following parameters were evaluated: hemodynamic stability; respiratory function; the appearance of any side effects; the level of sedation; and the need for any further doses of analgesic. The analysis of the data obtained showed the good quality of postoperative pain relief achieved: pain intensity at rest was, on average, always below VNS level 3, while during movement it always had an average VNS level of 3-4. The only side effects found with any frequency were nausea (22.6%) and vomiting (8.5%); hemodynamic and respiratory parameters remained stable. The method adopted was of limited cost and was well accepted by both patients and staff. On the basis of the data obtained, it is possible to affirm that the post-operative pain protocol proposed is effective, safe, without significant side effects, and of limited cost. Therefore, it is the first choice protocol for our operating unit after major abdominal surgery.

Abdomen↗

PubMed2001

Volume kinetics of glucose solutions given by intravenous infusion.

Glucose solutions given by intravenous (i.v.) infusion exert volume effects that are governed by the amount of fluid administered and also by the metabolism of the glucose. To understand better how the body handles glucose solutions, two volume kinetic models were developed in which consideration was given to the osmotic fluid shifts that accompany the metabolism of glucose. These models were fitted to data obtained when 21 volunteers who were given approximately 1 litre of glucose 2.5 or 5% or Ringer's solution (control) over 45 min. The maximum haemodilution was similar for all three fluids, but it decreased more rapidly when glucose had been infused. The volume of distribution for the infused glucose molecules was larger (approximately 12 litres) than for the infused fluid, which amounted to (mean (SEM)) 3.7 (0.3) (glucose 2.5%), 2.8 (0.2) (glucose 5%), and 2.5 (0.2) litres (Ringer). Fluid accumulated in a remote (cellular) body fluid space when glucose had been administered (approximately 0.2 and 0.4 litres, respectively), while expansion of an intermediate fluid space (7.1 (1.3) litres) could be demonstrated in 33% of the Ringer experiments. In conclusion, kinetic models were developed which consider the relationship between the glucose metabolism and the disposition of intravenous fluid. One of them, in which infused fluid expands two instead of three body fluid spaces, was successfully fitted to data on blood glucose and blood haemoglobin obtained during infusions of 2.5 and 5% glucose.

Adult↗

PubMed1990

Chemical stabilities of cefuroxime sodium and metronidazole in an admixture for intravenous infusion.

The chemical stabilities of cefuroxime sodium and metronidazole, when mixed together for intravenous infusion, were studied by high-performance liquid chromatography (HPLC). The critical factor in the stability of the admixture was the degradation of cefuroxime sodium. At 25 degrees C, cefuroxime degraded by first-order kinetics with a rate constant of 7.04 x 10(-2)/day and a t90 (time to reach 90% of the original concentration) of 36 h. At 4 degrees C the rate constant was 5.23 x 10(-3)/day with a t90 of 20 days, however, over the time-scale studied, the kinetics approximated to zero-order at this temperature. The mixture was also stable with respect to metronidazole, nitrite ion and appearance. A 7-day storage life at 4 degrees C can be given to the mixture.

Cefuroxime↗

PubMed1993

Influence of intravenous infusion of ethanol on regional blood flow in conscious rats.

The effects of intravenous infusions of ethanol and saline (0.9% NaCl) on mean arterial pressure (MAP), heart rate (HR), total peripheral resistance (TPR), cardiac contractility (dP/dtmax) and systemic haemodynamics were studied in conscious, unrestrained rats by the radioactive microsphere technique. Saline (0.03 and 0.06 mL min-1 kg-1 for 12 min each dose) in the time-control group did not affect MAP, HR, TPR, dP/dtmax or vascular conductances in any organs or beds. While the low dose ethanol (2.4 mg min-1 kg-1) did not alter MAP, HR, TPR, systemic haemodynamics or dP/dtmax, the high dose (4.8 mg min-1 kg-1) slightly reduced MAP and TPR but did not affect HR, cardiac output or dP/dtmax. Both doses of ethanol vasodilated the intestine and spleen, but vasoconstricted the skin. The high dose caused additional vasodilatation in the heart and testes and the low dose also constricted the skeletal muscle bed. Our results show that ethanol, at non-hypotensive or slightly hypotensive doses, has marked vasodilator effects in the heart, intestine, spleen and testes.

Animals↗

PubMed2006

Effect of intravenous infusion of glyceryl trinitrate on gastric and small intestinal motor function in healthy humans.

BACKGROUND: Glyceryl trinitrate is a donor of nitric oxide that relaxes smooth muscle cells of the gastrointestinal tract. Little is known about the effect of glyceryl trinitrate on gastric emptying and no data exist on the possible effect of glyceryl trinitrate on small intestinal transit. AIM: To examine the effect of intravenous infusion of glyceryl trinitrate on gastric and small intestinal motor function after a meal in healthy humans. METHODS: Nine healthy volunteers participated in a placebo-controlled, double-blind, crossover study. Each volunteer was examined during intravenous infusion of glyceryl trinitrate 1 microg/kg x min or saline. A gamma camera technique was used to measure gastric emptying and small intestinal transit after a 1600-kJ mixed liquid and solid meal. Furthermore, duodenal motility was assessed by manometry. RESULTS: Glyceryl trinitrate did not change gastric mean emptying time, gastric half emptying time, gastric retention at 15 min or small intestinal mean transit time. Glyceryl trinitrate did not influence the frequency of duodenal contractions, the amplitude of duodenal contractions or the duodenal motility index. CONCLUSIONS: Intravenous infusion of glyceryl trinitrate 1 microg/kg x min does not induce major changes in gastric or small intestinal motor function after a 1600-kJ meal in healthy volunteers.

Cross-Over Studies↗

PubMed1987

Subcutaneous infusion of bleomycin--a practical alternative to intravenous infusion.

The phase specificity and short half-life of bleomycin make it likely that it would be more effective when administered by continuous infusion. This is supported by studies using cell lines, as well as by animal studies and clinical experience in humans. This study was conducted to compare the pharmacokinetics of intravenous (IV) and subcutaneous infusions of bleomycin. The serum concentrations of bleomycin were measured using a sensitive and specific radioimmunoassay. The results demonstrate similar plasma concentrations and area under the curve for both routes. The subcutaneous infusions were well tolerated, without local discomfort or excoriation. Subcutaneous infusion of bleomycin may thus offer a practical alternative to IV infusions and can be administered to patients who are ambulatory and out of hospital.

Bleomycin↗

PubMed1997

Effect of a 15-minute infusion of DDAVP on the pharmacokinetics and pharmacodynamics of REVASC during a four-hour intravenous infusion in healthy male volunteers.

Plasma pharmacokinetics, effect on coagulation parameters, and safety and tolerability of an intravenous infusion of REVASC before, during and after a DDAVP infusion were investigated. Twelve healthy volunteers were given an intravenous bolus dose followed by a constant rate four-hour infusion of REVASC. Fifteen-minute infusions of 0.9% saline and DDAVP were started two and three hours respectively after the start of the REVASC infusion. Plasma REVASC concentrations were not affected by either the saline or DDAVP infusion. REVASC infusion produced an increase in APTT which plateaued between 0.5 and 3 hours. After the DDAVP infusion there was a tendency towards a new lower plateau whilst the REVASC infusion continued. There were no serious adverse events or bleeding episodes throughout the study. In conclusion, the co-administration of intravenous DDAVP has no effect on the plasma pharmacokinetics of REVASC and partially reverses the REVASC-induced increase in APTT. This may represent a role for DDAVP in the partial reversal of anticoagulation induced by REVASC.

Adult↗

PubMed1992

[Effects of intravenously infused magnesium on renal calcium metabolism and plasma parathyroid hormone in patients with essential hypertension].

This study aimed to elucidate the effects of intravenously infused magnesium on renal calcium and sodium metabolism in patients with essential hypertension. Mean arterial pressure (MAP), heart rate (HR), urine volume (UV), endogenous creatinine clearance (Ccr), urinary excretion of calcium (UCaV) and sodium (UNaV), fractional excretion of calcium (FECa) and sodium (FENa), plasma ionized calcium (pCa2+) and parathyroid hormone(PTH) were measured before and after intravenous infusion of 10% magnesium sulfate (initial dose: Mg 13.5mg/m2.BSA/15 min.: maintenance dose: Mg 2.7mg/m2.BSA/105min) in 6 normotensive subjects (NT) and 13 mild-to-moderate essential hypertensives (EHT). After the magnesium infusion, significant increases of UV, UCaV, UNaV, FECa and FENa, and a significant decrease of PTH were observed in both NT and EHT while MAP and HR did not change in either group. PCa2+ significantly decreased and Ccr tended to increase only in EHT. Although no significant difference was found in the change in Ccr (delta Ccr) or PTH (delta PTH) between NT and EHT, the changes of UCaV (delta UCaV), UNaV (delta UNaV), FECa (delta FECa) and FENa (delta FENa) were greater in EHT than each in NT. A positive correlation was found between delta UCaV and delta FECa, as well as delta UCaV and delta Ccr, but the former was more remarkable in both groups. In addition, delta UCaV was positively correlated with delta FENa in EHT, but not in NT. No significant relationship was observed between delta UCaV and delta PTH in either group.(ABSTRACT TRUNCATED AT 250 WORDS)

Calcium↗

PubMed1982

The pharmacokinetics of oxpentifylline in man when administered by constant intravenous infusion.

Subjects were each given either a 25, 50 or 100 mg intravenous loading dose of oxpentifylline followed by an intravenous infusion at a constant rate of 1.5 mg/min for 3 h. Plasma levels of oxpentifylline were measured to obtain information on its pharmacokinetics and to establish which of the loading doses gave the most rapid attainment of the steady state plasma levels of intact drug. Oxpentifylline kinetics were best described by a two compartment model giving a characteristic dip in the plasma level versus time curves before steady state was reached when either the 50 or 100 mg loading doses, followed by the constant intravenous infusion, were given. The terminal half-life of oxpentifylline was 1.02 +/- 0.86 h, reflecting a very high clearance of the drug (approx. 3 000 to 6 000 ml/min). The high clearance could be attributed to extrahepatic metabolism occurring in blood which was observed in vitro using whole blood but not plasma. The clearance of a reduced metabolite of oxpentifylline was less than that of the intact drug, although the half-life was similar (0.83 +/- 0.18 h). Of the three loading doses tested, only the highest showed any side effects, these being transient and occurring within a 5 to 10 min period after dosing and appeared to correlate with the high initial plasma levels of the drug. The 25 mg loading dose gave initial plasma levels generally below the final steady state levels, whilst the 50 mg loading was the closest to giving immediate steady state plasma levels of oxpentifylline.

Adult↗

PubMed1994

Eating a meal increases the clearance of ethanol given by intravenous infusion.

We studied the effect of eating a meal on the rate of ethanol elimination (clearance) from the blood after giving 0.4 g/kg by intravenous infusion to six female and six male volunteers. Half of the subjects had eaten breakfast whereas the other half had fasted overnight. After the first infusion of alcohol, those who had fasted ate lunch, and all the volunteers received a second infusion with the same dose of ethanol. The blood ethanol concentration was measured repeatedly for up to 180-240 min after the start of each experiment. Intake of food (lunch or breakfast) increased the clearance of ethanol by about 60% (P < 0.001). Alcohol intoxication was less pronounced at the end of the ethanol infusions preceded by eating a meal (P < 0.01). Gender had no significant effect on the rate of ethanol elimination. We conclude that eating a meal increases the rate of ethanol elimination even when alcohol is given by intravenous infusion.

Adult↗