INJECTION PAIN OF PROPOFOL IN CHILDREN WITH MEDIUM PLUS LONG CHAIN TRIGLYCERIDES AND LONG CHAIN PROPOFOL MIXED WITH LIGNOCAINE

2019 ◽  
Vol 3 (11) ◽  
Author(s):  
Jitendra Punamchand Mehta
Keyword(s):  
Severe Pain ◽  
Recovery Period ◽  
Medium Chain Triglyceride ◽  
Postoperative Nausea And Vomiting ◽  
Life Time ◽  
Injection Pain ◽  
Significant Difference ◽  
Long Chain Triglycerides ◽  
Long Chain ◽  
Long Chain Triglyceride

Introduction: Propofol is widely accepted drug because of its rapid and smooth induction, short context-sensitive time, rapid terminal half-life time and low incidence of postoperative nausea and vomiting. It is used for sedation and anaesthesia for almost all types of surgeries. During a propofol injection, pain due to the long-chain triglyceride (LCT) emulsion is experienced by 70% of adults and up to 85% of children. Despite various strategies to reduce propofol injection pain, this still poses a clinical problem in adults and children, and the incidence reported to be 30–90%. A medium-chain triglyceride/long-chain triglyceride (MCT/LCT) emulsion has been advised to reduce injection pain as compared to propofol LCT in adults and teenagers Material and Methods: 100 children aged 5–13 years, in American Society Anaesthesiologists (ASA) class I or II, undergoing elective general anaesthesia without any contraindication to propofol anaesthesia were included in the study. Injection pain following injection propofol was assessed in all patients, but the anaesthetist was blinded for which formula was being used. Results: The demographic characteristics like age, sex, weight, amount of propofol given, ASA physical status and recovery period was calculated. No statistically significant difference was observed in both the groups. Incidence of pain and severe pain in LCT group was 24 (48%) and 7 (14%) respectively while incidence of pain and severe pain in MCT/LCT group was 15 (30%) and 1 (2%) respectively. Pain score was found less in group MCT / LCT. Conclusion: Medium plus long chain triglycerides and long chain propofol along with lignocaine significantly reduces the incidence as well as the severity of injection pain in the paediatric age group and can be used in children for sedation or induction of anaesthesia.

Absorption of triglycerides in the absence of lipase

1990 ◽  
Vol 68 (4) ◽  
pp. 519-523 ◽  
Author(s):  
B. P. C. Chow ◽  
E. A. Shaffer ◽  
H. G. Parsons
Keyword(s):  
Molecular Weight ◽  
Pancreatic Lipase ◽  
Medium Chain Triglyceride ◽  
Sprague Dawley ◽  
Medium Chain Triglycerides ◽  
Medium Chain ◽  
Molecular Weights ◽  
Long Chain Triglycerides ◽  
Long Chain ◽  
Long Chain Triglyceride

Medium chain triglycerides are considered to be readily absorbed intact in the absence of pancreatic lipase, unlike long chain triglycerides. Commercial medium chain triglyceride oils comprise various medium chain fatty acids from 6 to 12 carbons in length resulting in triglyceride molecules of different sizes and molecular weights. The effect of molecular weight and hence fatty acid chain length on the efficiency of intact medium chain triglyceride absorption is unknown. Therefore, this study measured, using a single-pass marker perfusion technique, intestinal jejunum absorption of five medium chain and one long chain triglycerides in anesthetized Sprague–Dawley rats. The molecular weights of the five medium chain triglycerides were 470.7, 498.8, 526.8, 554.9, 639.0, and the long chain triglyceride, 885.4. Residual luminal pancreatic lipase was removed prior to lipid perfusion. This study demonstrated that medium chain triglycerides were absorbed in the absence of lipase whereas long chain triglyceride was not. There was no significant variation in the absorption of the five different medium chain triglycerides perfused. The molecular weight of the medium chain triglyceride did not affect its intact absorption by the small intestine.Key words: triglycerides, intestinal absorption, molecular weight, pancreatic lipase, fat.

Gastric Lipolysis and Fat Absorption in Preterm Infants: Effect of Medium-Chain Triglyceride or Long-Chain Triglyceride-Containing Formulas

PEDIATRICS ◽  
1989 ◽  
Vol 83 (1) ◽  
pp. 86-92 ◽  
Author(s):  
Margit Hamosh ◽  
Joel Bitman ◽  
Teresa H. Liao ◽  
N. R. Mehta ◽  
R. J. Buczek ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Fatty Acid ◽  
Weight Gain ◽  
Preterm Infants ◽  
Lipase Activity ◽  
Medium Chain Triglyceride ◽  
Fat Absorption ◽  
Medium Chain ◽  
Long Chain ◽  
Long Chain Triglyceride

The extent of gastric lipolysis, fat absorption, and infant weight gain was studied in 12 preterm infants (gestational age 28.75 ± 0.50 weeks, postnatal age 6.08 ± 0.81 weeks) fed medium-chain triglyceride or long-chain triglyceride formula for 1 week in a crossover design. The former formula contained 42% of 8:0 and 10:0 and 19% of 12:0, 14:0, and 16:0; the latter formula contained only 7% of 8:0 and 10:0 and 46% of 12:0, 14:0, and 16:0. Gastric aspirates were obtained on the second and third day of formula feeding for quantitation of lipase activity and of the extent of gastric lipolysis. Fat balance studies were conducted during the last three days of each feeding regimen. The study showed that (1) there was marked hydrolysis of formula fat in the stomach during feeding of either medium-chain triglyceride formula or long-chain triglyceride formula (20% and 16%, respectively); (2) lipase activity in the gastric aspirates was less during feeding of medium-chain triglyceride formula than before the meal, which suggested stimulation of lipase secretion by long-chain fatty acid released from long-chain triglyceride formula fat or more rapid binding of lipase to ingested lipid in the medium-chain triglyceride formula; (3) fatty acid distribution in glycerides and free fatty acids showed preferential release of medium-chain (8:0, 10:0) and long-chain unsaturated (18:1, 18:2) fatty acids in the stomach. The low content of 8:0 and 10:0 in gastric triglyceride and free fatty acids suggested that medium-chain fatty acids were absorbed directly in the stomach. (4) fat balance studies showed almost identical absorption rates (84.6% ± 3.1% and 82.8% ± 4.0%) and weight gain (23.0 ± 1.5 g/d and 20.8 ± 1.8 g/d) during feeding of either medium-chain triglyceride or long-chain triglyceride formula. In this study, in which each infant was fed either formula alternately, it was shown that although the extent of fat digestion varied among infants, medium-chain and long-chain triglyceride were absorbed to the same extent by most infants.

scholarly journals A Mixed (Long- and Medium-chain) Triglyceride Lipid Emulsion Extracts Local Anesthetic from Human Serum In Vitro  More Effectively than a Long-chain Emulsion

2012 ◽  
Vol 116 (2) ◽  
pp. 334-339 ◽  
Author(s):  
Weiming Ruan ◽  
Deborah French ◽  
Alicia Wong ◽  
Kenneth Drasner ◽  
Alan H. B. Wu
Keyword(s):  
Human Serum ◽  
Local Anesthetics ◽  
Lipid Emulsion ◽  
Life Support ◽  
Medium Chain Triglyceride ◽  
In Vitro Study ◽  
Current Data ◽  
Long Chain Triglycerides ◽  
Long Chain

Background Lipid emulsion infusion reverses cardiac toxicity of local anesthetics. The predominant effect is likely creation of a "lipid sink." This in vitro study determined the extent to which Intralipid® (Fresenius Kabi, Uppsala, Sweden) and Lipofundin® (B. Braun Melsungen AG, Melsungen, Germany) sequester anesthetics from serum, and whether it varies with pH. Methods Bupivacaine, ropivacaine, and mepivacaine were added to human drug-free serum (pH 7.4) at 10 μg/ml. The lipid emulsions were added, and the mixture shaken and incubated at 37°C. Lipid was removed by ultracentrifugation and drug remaining in the serum measured. Additional experiments were performed using 100 μg/ml bupivacaine and at pH 6.9. Results Lipofundin® extracted all three anesthetics to a greater extent than Intralipid® (34.7% vs..22.3% for bupivacaine, 25.8% vs..16.5% for ropivacaine, and 7.3% vs..4.7% for mepivacaine). By increasing either concentration of bupivacaine or lipid, there was an increase in drug extraction from serum. Adjusting the pH to 6.9 had no statistically significant effect on the percentage of bupivacaine sequestered. Conclusions Bupivacaine, ropivacaine, and mepivacaine were sequestered to an extent consistent with their octanol:water partition constants (logP). In contrast with previous studies of extraction of lipids from buffer solutions, an emulsion containing 50% each of medium- and long-chain triglycerides extracted local anesthetics to a greater extent from human serum than one containing exclusively long-chain triglycerides, calling into question recent advanced cardiac life support guidelines for resuscitation from anesthetic toxicity that specify use of a long-chain triglyceride. The current data also do not support recent recommendations to delay administration until pH is normalized.

Effect of a 0.5% Dilution of Propofol on Pain on Injection during Induction of Anesthesia in Children

2007 ◽  
Vol 106 (1) ◽  
pp. 80-84 ◽  
Author(s):  
Stefan Soltész ◽  
Malte Silomon ◽  
Gerhard Gräf ◽  
Thomas Mencke ◽  
Sabiha Boulaadass ◽  
...  
Keyword(s):  
Adverse Events ◽  
Medium Chain Triglyceride ◽  
Serum Triglyceride ◽  
Double Blind ◽  
Serum Triglycerides ◽  
Medium Chain ◽  
Pain On Injection ◽  
Pain Reaction ◽  
Long Chain ◽  
Long Chain Triglyceride

Background Pain on injection of propofol in children has been reported to be as high as 30-80%. The reason for the pain is assumed to be the aqueous phase of the propofol emulsion. Therefore, for the first time, this study tested the hypothesis that dilution of propofol to a 0.5% emulsion might reduce the incidence of pain during propofol injection. Methods The study design was prospective, monocenter, double-blind, and randomized. Sixty-four children aged 2-6 yr were scheduled to receive 0.5% or 1.0% propofol in a medium-chain-triglyceride/long-chain-triglyceride emulsion. Incidence and intensity of pain were assessed by spontaneous expressions of pain and withdrawal of the arm. In a subgroup of 21 children, serum triglyceride levels were measured before and 3 and 20 min after induction. Adverse events were recorded. Results Amounts of propofol required until loss of eyelash reflex were 4.40+/-1.01 mg/kg for 0.5% propofol and 4.31+/-0.86 mg/kg for 1.0% propofol. Percentages of children who showed at least one pain reaction were 23.3% in the 0.5% propofol group and 70.0% in the 1.0% propofol group (P<0.001). Serum triglycerides were higher in the 0.5% propofol group 3 and 20 min after injection (251.7 vs. 148.8 mg/dl; P=0.001 and 135.5 vs. 75.5 mg/dl; P=0.03). Adverse events or complications did not occur. Conclusions Dilution of propofol to a 0.5% medium-chain-triglyceride/long-chain-triglyceride emulsion reduced pain effectively during injection in children aged 2-6 yr. Cumulative doses until 4-5 mg/kg propofol led to moderate increases of triglyceride levels and did not result in significant adverse events.

Studies of the absorption and enterohepatic circulation of 7,12-dimethylbenz[a]anthracene in the rat

1983 ◽  
Vol 61 (11) ◽  
pp. 1368-1373 ◽  
Author(s):  
J. M. Laher ◽  
G. A. Chernenko ◽  
J. A. Barrowman
Keyword(s):  
Biliary Excretion ◽  
Plasma Levels ◽  
Enterohepatic Circulation ◽  
Medium Chain Triglyceride ◽  
Systemic Availability ◽  
Safflower Oil ◽  
Medium Chain ◽  
Physiological Conditions ◽  
Long Chain ◽  
Long Chain Triglyceride

This study was undertaken to examine intraluminal factors which might alter the bioavailability of an orally ingested hydrocarbon carcinogen, 7,12-dimethylbenz[a]anthracene, and to assess the extent of its enterohepatic circulation. Rats with biliary and duodenal fistulae were administered radiolabelled hydrocarbon dissolved in olive oil, safflower oil, or medium-chain triglyceride only or with exogenous bile. Subsequent biliary excretion and plasma levels of radiolabel were monitored. Luminal bile significantly enhanced biliary recovery of radiolabel following instillation in both long-chain triglyceride vehicles, but did not affect the recovery from the medium-chain oil. In the presence of luminal bile, plasma levels and biliary recovery of radiolabel using the medium-chain triglyceride were significantly less than with either long-chain triglyceride. Following intraduodenal infusions of the radiolabelled biliary products of the carcinogen, 33% of the administered radiolabel was subsequently reexcreted in the bile within 24 h. This study, therefore, demonstrates that, while bile is not absolutely necessary for the uptake of this orally ingested hydrocarbon carcinogen, it significantly facilitates absorption from a long-chain triglyceride vehicle. Under physiological conditions, a long-chain triglyceride vehicle will provide greater systemic availability than a medium-chain vehicle for the hydrocarbon, which then undergoes extensive biliary excretion and recycling.

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