RELATIONSHIP BETWEEN THE TIME TO BEGINNING OF RECOVERY AFTER THE INITIAL BOLUS OF MUSCLE RELAXANT AND THE INFUSION RATE REQUIREMENTS FOR MIVACURIUM AND SUCCINYLCHOLINE

1988 ◽  
Vol 69 (3A) ◽  
pp. A521-A521
Author(s):  
S. K. Woelfel ◽  
B. W. Brandom ◽  
D. R. Cook ◽  
B. Whitehead ◽  
L. M Borland
Keyword(s):  
Muscle Relaxant ◽  
Infusion Rate ◽  
Initial Bolus

scholarly journals Use of a New Syringe Pump (Springfusor®) for Muscle Relaxant Infusion

1993 ◽  
Vol 21 (4) ◽  
pp. 444-446 ◽  
Author(s):  
C. C. P. Eagle ◽  
D. F. Capes
Keyword(s):  
Muscle Relaxant ◽  
Infusion Rate ◽  
Bolus Dose ◽  
Muscle Relaxants ◽  
Syringe Pump ◽  
Background Infusion ◽  
Continuous Background ◽  
Nominal Rate ◽  
The Mean ◽  
Initial Bolus

A new spring-driven syringe pump (Springfusor 10®, Go Medical Industries, Subiaco, W.A.) was evaluated for infusion of muscle relaxants in 50 surgical cases. After an initial bolus dose, atracurium was given at a rate of 25 to 37.5 mg/hour and vecuronium at a rate of 4 to 6 mg/hour. The mean infusion rate was found to be 4% above the nominal rate of 5 ml/hour and the accuracy in all cases was within ± 20%. The Springfusor was found to be rugged, cheap and easy to use. It lacks dose flexibility but is suitable for continuous background infusion of muscle relaxants during surgery.

scholarly journals Oral Mucosal Injection of a Local Anesthetic Solution Containing Epinephrine Enhances Muscle Relaxant Effects of Rocuronium

2012 ◽  
Vol 59 (1) ◽  
pp. 18-21 ◽  
Author(s):  
Asako Ninomiya ◽  
Yui Terakawa ◽  
Nobuyuki Matsuura ◽  
Tatsuya Ichinohe ◽  
Yuzuru Kaneko
Keyword(s):  
Muscle Relaxant ◽  
Infusion Rate ◽  
Nasotracheal Intubation ◽  
Lidocaine Hydrochloride ◽  
Rocuronium Bromide ◽  
Start Of Injection ◽  
Train Of Four ◽  
Relevant Dose ◽  
Epinephrine Dose ◽  
Hydrochloride Solution

The purpose of this study was to examine how submucosal injection of a clinically relevant dose of a lidocaine hydrochloride solution containing epinephrine affects the muscle relaxant effects of rocuronium bromide. Sixteen patients scheduled for orthognathic surgery participated in this study. All patients were induced with fentanyl citrate, a target-controlled infusion of propofol and rocuronium bromide. Anesthesia was maintained by total intravenous anesthesia. After nasotracheal intubation, an infusion of rocuronium bromide was started at 7 µg/kg/min, and the infusion rate was then adjusted to maintain a train of four (TOF) ratio at 10 to 15%. The TOF ratio just prior to oral mucosal injection of a 1% lidocaine hydrochloride solution containing 10 µg/mL epinephrine (LE) was taken as the baseline. TOF ratio was observed for 20 minutes, with 1-minute intervals following the start of injection. Mean epinephrine dose was 85.6 ± 18.6 µg and mean infusion rate of rocuronium bromide was 6.3 ± 1.6 µg/kg/min. TOF ratio began to decrease 2 minutes after the injection of LE, reached the minimum value at 3.1 ± 3.6% 12 minutes after the injection, and then began to recover. We conclude that oral mucosal injection of LE enhances the muscle relaxant effects of rocuronium bromide.

scholarly journals A Method for Implementing Programmed Infusion of Thiopentone and Methohexitone with a Simple Infusion Pump

1989 ◽  
Vol 17 (4) ◽  
pp. 496-499 ◽  
Author(s):  
D. P. Crankshaw ◽  
F. Karasawa
Keyword(s):  
Infusion Rate ◽  
Infusion Pump ◽  
Drug Efflux ◽  
Syringe Pump ◽  
Plasma Drug ◽  
Drug Concentrations ◽  
Arterial Concentration ◽  
Initial Bolus

We have tabulated the series of steps in infusion rate required to maintain constant arterial levels of thiopentone and methohexitone. The tables are based on multiexponential equations for infusion rate, derived from plasma drug efflux studies. In each table an initial bolus is followed by nine steps in infusion rate over three hours. The tables provide rates suitable for delivery by a standard syringe pump to achieve and maintain an arterial concentration of 10 mg/l of thiopentone and 5 mg/l of methohexitone. Other desired drug concentrations can be derived from the table by simple multiplication.

Evaluation of an Unfractionated Heparin Pharmacy Dosing Protocol for the Treatment of Venous Thromboembolism in Nonobese, Obese, and Severely Obese Patients

2017 ◽  
Vol 51 (9) ◽  
pp. 768-773 ◽  
Author(s):  
Lindsey M. Hosch ◽  
Emily Y. Breedlove ◽  
Lauren E. Scono ◽  
Chad A. Knoderer
Keyword(s):  
Body Weight ◽  
Venous Thromboembolism ◽  
Infusion Rate ◽  
Ideal Body Weight ◽  
Current Data ◽  
Inpatient Setting ◽  
Hospital Inpatient ◽  
Obese Patients ◽  
Severely Obese ◽  
Initial Bolus

Background: Despite large interpatient variability in dose response, heparin is utilized for treatment of venous thromboembolism (VTE). Current data on the optimal heparin dosing in obese patients are conflicting. Objective: The objective was to evaluate the time and dose required to achieve a therapeutic activated partial thromboplastin time (aPTT) in nonobese, obese, and severely obese patients using a pharmacist-directed heparin dosing protocol. Methods: This was a retrospective cohort study in a single-center community hospital inpatient setting. Adult patients receiving heparin for VTE treatment from July 1, 2013, to July 31, 2015, were evaluated. Patients were categorized into 3 groups: nonobese (BMI < 30 kg/m2), obese (BMI = 30-39.9 kg/m2), and severely obese (BMI ≥ 40 kg/m2). Data on height, weight, initial bolus dose, initial infusion rate, time to therapeutic aPTT, and therapeutic infusion rate were collected. Dosing body weight (DBW) was utilized for patients 20% over their ideal body weight (IBW). The primary outcome was time to therapeutic aPTT. Results: Analysis included 298 patients. Median times to therapeutic aPTT (hours:minutes) in the nonobese, obese, and severely obese were 15:00 (interquartile range [IQR] = 8:05-23:21), 15:40 (IQR = 9:22-25:10), and 15:22 (IQR = 7.54-23:40), respectively ( P = 0.506). There was no difference in bleeding among the nonobese (14%), obese (13.9%), or severely obese groups (7.9%; P = 0.453). No adverse thrombotic events occurred during hospitalization. Conclusion: Using a DBW for heparin dosing in patients 20% over their IBW resulted in similar times to therapeutic aPTT and adverse events in the nonobese, obese, and severely obese.

Comparison of two pediatric cases requiring the use of bivalirudin during cardiopulmonary bypass

Perfusion ◽  
2018 ◽  
Vol 33 (7) ◽  
pp. 525-532 ◽  
Author(s):  
Molly E. Bryant ◽  
William L. Regan ◽  
Francis Fynn-Thompson ◽  
David Hoganson ◽  
Viviane G. Nasr ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Infusion Rate ◽  
Clotting Factors ◽  
Ventricular Assist ◽  
High K ◽  
Institutional Experience ◽  
Margin Of Safety ◽  
Bilateral Lung ◽  
Low K ◽  
Initial Bolus

Introduction: Comparison of two pediatric cases at our institution that utilized bivalirudin for anticoagulation on cardiopulmonary bypass (CPB); a bilateral lung transplant (BLT) and a ventricular assist device (VAD) implantation. Methods: The same bivalirudin protocol was utilized in both cases with an initial bolus of 1 mg/kg administered by the anesthesia team, a 50 mg bolus in the pump prime at the time of the initial patient bolus and an initial infusion rate of 2.5 mg/kg/h, with titration as needed during CPB to maintain kaolin-activated clotting time (K-ACT) values >400 s. Results: The BLT experienced high K-ACT levels (>720 s) for the majority of the case despite decreasing the bivalirudin infusion rate to 0.5 mg/kg/h. The VAD implantation case required the bivalirudin infusion rate to be increased to 5.0 mg/kg/h throughout the case due to low K-ACTs. Conclusion: The literature strongly supports a specific infusion rate1–7 (2.5 mg/kg/h) for bivalirudin anticoagulation during extracorporeal circulation. Clinicians must consider the loss of clotting factors and the administration of blood products while adjusting the bivalirudin infusion during bypass. We have now elected to maintain an infusion rate of ≥0.5 mg/kg/h for bivalirudin anticoagulation at our center, based on institutional experience, though consideration for a higher infusion rate for an added margin of safety should be considered. It is imperative to have a well-developed protocol for the management of these cardiopulmonary bypass patients and we offer our one-page timeline of events to help guide other pediatric centers looking to use bivalirudin anticoagulation.

Continuous Estimation of CO2 Production during Exercise

1997 ◽  
Vol 36 (04/05) ◽  
pp. 368-371
Author(s):  
R. Soma ◽  
Y. Yamamoto
Keyword(s):  
Fuzzy Logic ◽  
Steady State ◽  
Infusion Rate ◽  
Feedback System ◽  
Whole Body ◽  
Co2 Production ◽  
Cycle Exercise ◽  
Continuous Estimation ◽  
Breath Measurement ◽  
13Co2 Enrichment

Abstract.A new method was developed for continuous isotopic estimation of human whole body CO2 rate of appearance (Ra) during non-steady state exercise. The technique consisted of a breath-by-breath measurement of 13CO2 enrichment (E) and a real-time fuzzy logic feedback system which controlled NaH13CO3 infusion rate to achieve an isotopic steady state. Ra was estimated from the isotope infusion rate and body 13CO2 enrichment which was equal to E at the isotopic steady state. During a non-steady state incremental cycle exercise (5 w/min or 10 w/min), NaH13CO3 infusion rate was successfully increased by the action of feedback controller so as to keep E constant.

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