ANALYSIS OF THE STUDY OF 2% LIDOCAINE HYDROCHLORIDE SOLUTION HEPATOTOXICITY AT VARIOUS NUMBER OF INJECTIONS IN THE EXPERIMENT

To emphasize the utility of office-based transnasal esophagoscopy (TNE) in the evaluation of patients with swallowing complaints, we present 2 case reports and a review of the literature. The 2 patients both presented with complaints of chronic dysphagia, globus sensation, and a sensation of “food sticking” with swallowing. The patients were counseled to undergo esophagoscopy. Informed consent was obtained. The nasal cavities and pharynx were anesthetized with topical 4% lidocaine hydrochloride solution. Transnasal esophagoscopy was performed. The procedure was well tolerated by the patients. Esophagoscopy revealed diverticuli in various segments of the esophagus, including the midesophageal and distal areas. The cause of the patients' complaints could be well attributed to the endoscopic findings. No morbidity was associated with the TNE examination. A review of the literature concerning office-based TNE was performed. We found no published reports of middle or distal esophageal diverticuli detected on routine office TNE. We conclude that transnasal esophagoscopy is a relatively safe and efficient tool that can be used in the office setting for evaluation of swallowing complaints.

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

Anesthesia Progress ◽

10.2344/10-17.1 ◽

2012 ◽

Vol 59 (1) ◽

pp. 18-21 ◽

Cited By ~ 2

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.

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Buffered Lidocaine Hydrochloride Solution With and Without Epinephrine: Stability in Polypropylene Syringes

The Canadian Journal of Hospital Pharmacy ◽

10.4212/cjhp.v62i5.824 ◽

2009 ◽

Vol 62 (5) ◽

Author(s):

Ronald F Donnelly ◽

Elena Pascuet ◽

Danielle Garceau ◽

Régis Vaillancourt

Keyword(s):

Lidocaine Hydrochloride ◽

Hydrochloride Solution

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Diffusion of lidocaine hydrochloride from lipid microparticles

Chemical Industry and Chemical Engineering Quarterly ◽

10.2298/ciceq0901033p ◽

2009 ◽

Vol 15 (1) ◽

pp. 33-35 ◽

Cited By ~ 4

Author(s):

Rada Pjanovic ◽

Radoslava Stojanovic ◽

Milana Sajber ◽

Jelena Veljkovic ◽

Nevenka Boskovic-Vragolovic ◽

...

Keyword(s):

Drug Release ◽

Diffusion Rate ◽

Drug Carriers ◽

Lidocaine Hydrochloride ◽

Diffusion Cell ◽

Sustained Drug Release ◽

Franz Diffusion Cell ◽

Diffusion Rates ◽

Hydrochloride Solution ◽

Prolonged Drug Release

Lipid particles, as drug carriers, are of increasing research interest, because a sustained drug release and avoidance of side effects could be achieved by using them. Lidocaine hydrochloride is a very efficient local anesthetic, but it has a short effect. The objective was to prolong the effect of the drug by encapsulating lidocaine hydrochloride in phospholipids microparticles. Two different procedures were used for the preparation of phospholipids microparticles. In both cases, phosphatidylcholine and lysophosphatidylcholine were used for the preparation of microparticles in which 5 % w/w lidocaine hydrochloride solution was encapsulated. The standard Franz diffusion cell was used for the experimental diffusion rate determination. The obtained results show that diffusion rate from microparticles is significantly lower than from the lidocaine hydrochloride solution, which means that this kind of microparticles could be used for the prolonged drug release. There was no much difference in diffusion rates from microparticles obtained by different procedures. That indicates that only the composition of the particles membrane has an influence on the lidocaine hydrochloride release rate.

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Relationship between metamorphopsia and inner retinal microstructure following intravitreal ranibizumab injection for branch retinal vein occlusion

Scientific Reports ◽

10.1038/s41598-021-84038-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yoshimi Sugiura ◽

Fumiki Okamoto ◽

Tomoya Murakami ◽

Shohei Morikawa ◽

Takahiro Hiraoka ◽

...

Keyword(s):

Macular Edema ◽

Retinal Vein Occlusion ◽

Branch Retinal Vein Occlusion ◽

Post Treatment ◽

Intravitreal Ranibizumab ◽

Vein Occlusion ◽

Treatment Naïve ◽

Pre Treatment ◽

Number Of Injections

AbstractTo evaluate the effects of intravitreal ranibizumab injection (IVR) on metamorphopsia in patients with branch retinal vein occlusion (BRVO), and to assess the relationship between metamorphopsia and inner retinal microstructure and other factors. Thirty-three treatment-naïve eyes of 33 patients with macular edema caused by BRVO with at least 12 months of follow-up were included. The degree of metamorphopsia was quantified using the M-CHARTS. Retinal microstructure was assessed with spectral-domain optical coherence tomography. Disorganization of the retinal inner layers (DRIL) at the first month after resolution of the macular edema (early DRIL) and at 12 months after treatment (after DRIL) was studied. Central retinal thickness (CRT), and status of the external limiting membrane as well as ellipsoid zone were also evaluated. IVR treatment significantly improved best-corrected visual acuity (BCVA) and CRT, but the mean metamorphopsia score did not improve even after 12 months. Post-treatment metamorphopsia scores showed a significant correlation with pre-treatment metamorphopsia scores (P < 0.005), the extent of early DRIL (P < 0.05) and after DRIL (P < 0.05), and the number of injections (P < 0.05). Multivariate analysis revealed that the post-treatment mean metamorphopsia score was significantly correlated with the pre-treatment mean metamorphopsia score (P < 0.05). IVR treatment significantly improved BCVA and CRT, but not metamorphopsia. Post-treatment metamorphopsia scores were significantly associated with pre-treatment metamorphopsia scores, the extent of DRIL, and the number of injections. Prognostic factor of metamorphopsia was the degree of pre-treatment metamorphopsia.

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Setting up a successful nurse-led intravitreal injections service: pearls from Swindon

British Journal of Nursing ◽

10.12968/bjon.2020.29.20.1178 ◽

2020 ◽

Vol 29 (20) ◽

pp. 1178-1185

Author(s):

Hani Hasan ◽

Sunil Mamtora ◽

Nimish Shah

Keyword(s):

Nurse Practitioners ◽

Positive Impact ◽

Training Model ◽

Training Programme ◽

Intravitreal Injections ◽

Nurse Training ◽

Financial Benefits ◽

Hands On ◽

Number Of Injections

The demand for performing intravitreal injections has increased in recent years, prompting the need for more nurse training in their administration. The Great Western Hospitals NHS Trust in Swindon has developed a structured nurse training programme and now has 8 independent nurse injectors trained to undertake injections independently; nurse practitioners now contribute upwards of 85% of the total number of injections. The authors have also demonstrated the financial benefits of using injection assistant devices and shown the positive impact such devices have on training. In September 2019, the authors organised the first course to offer nurses and doctors hands-on experience in administering injections, using the Swindon training model to provide participants with a structured approach to learn how to perform intravitreal injections safely. Nurses made up 96% of participants; the remainder were doctors and managers; 6% had never performed an intravitreal injection; of units where they had, disposable drapes and a speculum were used in 71% of these. The number of injections performed per session at participants' units at the time they attended the course was: 17 or more injections=46%, 13–14=39%, and 11–12=15%. The course was rated 8.9/10 overall for content, with 85% very likely to recommend it to colleagues. All participants indicated that using the Swindon model made them feel confident to deliver injections safely. The authors demonstrated that using a structured training protocol and intravitreal assistant device improves the quality of nurse training and increases confidence in administering intravitreal injections.

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1400. Physician Attitudes towards Combination Vaccine Use in Infants up to 24 months of age in the United States (US)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1582 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S708-S709

Author(s):

Ya-Ting Chen ◽

Xinyi Ng ◽

Tanaz Petigara ◽

Jyoti Aggarwal ◽

Jenna Bhaloo ◽

...

Keyword(s):

Research Study ◽

Scientific Research ◽

Physician Attitudes ◽

Combination Vaccine ◽

Hexavalent Vaccine ◽

Family Practitioners ◽

Study Investigator ◽

Vaccine Schedule ◽

Combination Vaccines ◽

Number Of Injections

Abstract Background Combination vaccines reduce the number of injections and improve the timeliness of vaccination coverage. US Advisory Committee on Immunization Practices (ACIP) recommendations state that combination vaccines are generally preferred over equivalent individual component vaccines. Healthcare providers strongly influence parental decisions about vaccination. We sought a contemporary understanding of physician’s attitudes towards combination vaccine use in infants. Methods We conducted an online survey of US physicians (70 pediatricians and 30 family practitioners) who administer vaccines to infants aged 0-24 months and spend at least 2 days a week providing patient care. Information was collected on attitudes towards combination vaccines and factors that influence the choice of combination vaccine used in clinical practice. Descriptive analyses were performed. Results Physicians (mean age=50.2 years, range 30.0-70.0; 66% white; 37% women) reported a median of 4 injections (range 2-9) as the maximum that parents would accept at a single visit, and 71% routinely explained what combination vaccines are to parents. When deciding which pentavalent vaccine to use, physicians considered how the brand fits into the current vaccine schedule (71%); upfront purchase costs (64%); and availability as a prefilled syringe (61%). The main reasons for using combination vaccines were to reduce the number of injections (96%); ensure the infant is up-to-date with vaccinations (86%); and reduce the pain that the infant experiences with multiple injections (68%). More than half reported that their institution or practice has a program to incentivize infant vaccination according to schedule. If a hexavalent vaccine-based schedule was available, 76% of physicians said they would choose it over their current schedule comprising pentavalent or equivalent component vaccines. Conclusion Choice of pentavalent combination vaccine among pediatricians and family practitioners was largely dependent on convenience and cost-related factors. Over three-quarters would be inclined to use a hexavalent vaccine schedule if available. Disclosures Ya-Ting Chen, PhD, Merck & Co., Inc. (Employee, Shareholder) Xinyi Ng, PhD, Merck & Co., Inc. (Consultant) Tanaz Petigara, PhD, Merck & Co., Inc. (Employee, Shareholder) Jyoti Aggarwal, MHS, Merck & Co., Inc. (Consultant) Jenna Bhaloo, MPH, Merck & Co., Inc. (Consultant) Michelle Goveia, MD, Merck & Co., Inc (Employee, Shareholder) David Johnson, MD, MPH, Sanofi Pasteur (Employee, Shareholder) Gary S. Marshall, MD, GlaxoSmithKline (Consultant, Scientific Research Study Investigator)Merck (Consultant, Scientific Research Study Investigator)Pfizer (Consultant, Scientific Research Study Investigator)Sanofi Pasteur (Consultant, Grant/Research Support, Scientific Research Study Investigator, Honorarium for conference lecture)Seqirus (Consultant, Scientific Research Study Investigator)

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