A COMPARATIVE STUDY ON THE TOTAL DOSE REQUIREMENTS AND HEMODYNAMIC ALTERATIONS WITH AND WITHOUT THE APPLICATION OF PRIMING PRINCIPLE AMONG PATIENTS INDUCED WITH PROPOFOL

2021 ◽  
pp. 71-73
Author(s):  
Radhika Nair ◽  
Saramma Abraham ◽  
Reji S. Varghese
Keyword(s):  
Total Dose ◽  
Haemodynamic Instability ◽  
Priming Principle ◽  
Induction Dose ◽  
Haemodynamic Stability ◽  
Minute Post ◽  
Calculated Dose ◽  
Blood Pressures ◽  
Group 3 ◽  
Group 2

Background:- Propofol given at standard induction dose, is known to produce haemodynamic instability, especially hypotension. Application of “priming principle” helps to reduce the total dose of propofol. Objectives:- To study the total dose requirements of propofol and peri-intubation haemodynamic stability in patients undergoing surgery under GACV when priming principle is applied. Methodology:- This was an observational study among 54 ASA I and II patients undergoing surgery under GACV, who were randomly divided into three groups of 18 patients each. All patients received fentanyl 1 mcg/kg over 30 seconds followed by propofol. Group 1 patients received the total (100%) calculated dose of propofol. Group 2 and 3 patients received 20% and 40% of the dose respectively as priming dose, and the remaining was given 30 seconds later, until there was loss of eyelash reex. The total dose of propofol given, the heart rate, systolic and diastolic blood pressures, mean arterial pressures at various time intervals before, during and after induction and intubation, and complications observed were compared and statistically analysed using SPSS 2.0. Results:- The mean induction dose of propofol was signicantly lower in the priming groups (71.7 ± 17.2mg in group 2 and 80.0 ± 17.1mg in group 3) compared to group1 (107.9 ± 8.0mg). The fall in mean arterial pressure was signicantly lower in groups 2 and 3 (p<0.05) compared to group1 at one minute post-induction. Conclusion:-Application of priming principle reduces the induction dose of propofol and is associated with better peri-intubation haemodynamic stability.

Multi-Center Phase II Study of CAMPATH-1H Dose De-Escalation Prior to Nonmyeloablative HLA-Identical Sibling Transplantation.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1055-1055
Author(s):  
Ronjon Chakraverty ◽  
Nilusha Manji ◽  
Richard Clark ◽  
Charles Crawley ◽  
Peter Johnson ◽  
...  
Keyword(s):  
Total Dose ◽  
Chronic Gvhd ◽  
Conditioning Regimen ◽  
Significant Risk ◽  
Post Transplantation ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Inclusion of CAMPATH-1H as part of a Fludarabine/Melphalan conditioning regimen is effective at preventing GVHD and reducing non-relapse mortality (NRM)following allogeneic stem cell transplantation. However, these benefits are offset by high rates of infection and potentially a loss of graft-versus-tumor effects. When used at a total dose of 100mg, CAMPATH-1H antibody can still be detected at levels in excess of those required to induce ADCC for several weeks. We reasoned that a reduction in the dose of CAMPATH-1H would permit improved immune reconstitution post-transplantation. We report here the analysis of a national, multi-center trial in which the total dose of CAMPATH-1H was reduced step-wise in separate cohorts from 60mg to 20mg prior to HLA-identical sibling transplantation (n=106). Eligibility criteria included patients with haematological malignancies who were aged 18–65, who had a life expectancy >3 months and who were not suitable for standard myeloablative conditioning. Primary endpoints included PK data, chimerism, NRM and incidence of GVHD or infection. The study received IRB approval and all patients gave informed consent. Four total doses of CAMPATH-1H were tested in consecutive cohorts: group 1, 60mg split between d-2 and d-1 (n=26); group 2, 40mg split between d-2 and d-1 (n=27); group 3, 30mg d-1 (n=28); and group 4, 20mg on day -1 (n=25). 97/106 patients recruited to the study are evaluable with a median follow up of 12 months. Median age was 50 (range 19–64). No major differences were identified in patient characteristics between each cohort. 1-year OS and PFS for the whole population was 80.8% and 67.2% respectively. Peak CAMPATH-IH levels (ug/ml) measured by ELISA on day 0 (n=5 each group) were 7.7 ±1.1 in group 1, 4.3 ±0.7 in group 2, 4.9 ±0.8 in group 3 and 2.7± 0.7 in group 4 (p<0.05 groups 1 vs. each group 2–4). By day 28, CAMPATH-1H levels had fallen substantially in all groups, but especially groups 3/4: 1.1 ±0.4 in group1, 0.6 ±0.1 in group 2, 0.1 ±0.06 in group 3 and 0.1 ±0.06 in group 4 (p<0.05 group 1 vs. each group 3 and 4). In groups 3 and 4, 40% of patients had undetectable CAMPATH-1H levels by day 28. Chimerism data was available in 78 patients and of these, 1 patient showed autologous reconstitution, 52 were mixed chimeras and 25 were full chimeras, with no differences between the groups. Day 100 NRM was 4% in group 1, 8% in group 2, 0% in group 3 and 12% in group 4. Grade III-IV GVHD was 0% in group 1, 4% in group 2, 0% in group 3 and 11% in group 4 (p=0.09 group 1 vs. 4). It is noteworthy that 2 patients in group 4 died of complications secondary to grade IV GVHD, although no patients died of this complication in any of the other cohorts. There were no significant differences in the rates of initial CMV reactivation between the groups, or in the rates of CD4 reconstitution. Cumulative incidences of chronic GVHD at 1-year were 55% and 30% in groups 1 and 2, although further follow up is required in later cohorts. We conclude that significant de-escalation of the CAMPATH-1H dose prior to HLA-identical sibling transplantation is feasible without increasing NRM, although reductions below 30mg are associated with a clinically significant risk of severe acute GVHD. Further studies are warranted to determine whether reductions in CAMPATH-1H dosage will translate into improvements in progression-free survival.

Increased intensification and total dose of cyclophosphamide in a doxorubicin-cyclophosphamide regimen for the treatment of primary breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-22.

1997 ◽  
Vol 15 (5) ◽  
pp. 1858-1869 ◽  
Author(s):  
B Fisher ◽  
S Anderson ◽  
D L Wickerham ◽  
A DeCillis ◽  
N Dimitrov ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Total Dose ◽  
Primary Breast Cancer ◽  
National Surgical Adjuvant Breast ◽  
Significant Difference ◽  
Bowel Project ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

PURPOSE The National Surgical Adjuvant Breast and Bowel Project (NSABP) initiated a randomized trial (B-22) to determine if intensifying but maintaining the total dose of cyclophosphamide (Cytoxan, Bristol-Myers Squibb Oncology, Princeton, NJ) in a doxorubicin (Adriamycin, Pharmacia, Kalamazoo, MI)-cyclophosphamide combination (AC), or if intensifying and increasing the total dose of cyclophosphamide improves the outcome of women with primary breast cancer and positive axillary nodes. PATIENTS AND METHODS Patients (N = 2,305) were randomized to receive either four courses of standard AC therapy (group 1); intensified therapy, in which the same total dose of cyclophosphamide was administered in two courses (group 2); or intensified and increased therapy, in which the total dose of cyclophosphamide was doubled (group 3). The dose and intensity of doxorubicin were similar in all groups. Disease-free survival (DFS) and overall survival were determined using life-table estimates. RESULTS There was no significant difference in DFS (P = .30) or overall survival (P = .95) among the groups through 5 years. At 5 years, the DFS of women in group 1 was similar to that of women in group 2 (62% v 60%, respectively; P = .43) and to that of women in group 3 (62% v 64%, respectively; P = .59). The 5-year survival of women in group 1 was similar to that of women in group 2 (78% v 77%, respectively; P = .86) and to that of women in group 3 (78% v 77%, respectively; P = .82). Grade 4 toxicity increased in groups 2 and 3. Failure to note a difference in outcome among the groups was unrelated to either differences in amount and intensity of cyclophosphamide or to dose delays and intervals between courses of therapy. CONCLUSION Intensifying or intensifying and increasing the total dose of cyclophosphamide failed to significantly improve either DFS or overall survival in any group. It was concluded that, outside of a clinical trial, dose-intensification of cyclophosphamide in an AC combination represents inappropriate therapy for women with primary breast cancer.

Lung Function in Adolescents Receiving High-Dose Methotrexate

PEDIATRICS ◽  
1979 ◽  
Vol 63 (5) ◽  
pp. 741-746
Author(s):  
Michael A. Wall ◽  
Mary Ellen B. Wohl ◽  
Norman Jaffe ◽  
Denise J. Strieder
Keyword(s):  
Pulmonary Function ◽  
Total Dose ◽  
Osteogenic Sarcoma ◽  
Young Patients ◽  
High Dose ◽  
Diffusing Capacity ◽  
Group 3 ◽  
Group 2 ◽  
Restrictive Defect ◽  
Group 1

Methotrexate (MTX) has been implicated as a cause of interstitial pneumonitis and/or fibrosis, but the mechanism by which the drug causes these processes is not known. The purpose of this study was to determine whether patients receiving high-dose MTX developed a consistent decrease in pulmonary function, which would implicate a role for total dose of MTX received in the pathogenesis of the lung toxicity. Pulmonary function studies, including spirometry, plethysmography, and diffusing capacity at two levels of alveolar Po2, were performed in 38 adolescents treated for osteogenic sarcoma. The patients were divided into three groups including 12 patients (group 1) studied before and during therapy, 15 patients (group 2) studied during therapy, and 11 patients (group 3) studied after completion of treatment. While total dose received at the time of the study varied from 0 to 256 gm/sq m, pulmonary function showed no change, with one exception. A mild restrictive defect and decrease in diffusing capacity due to unilateral pleural and diaphragmatic disease, whose relationship to MTX therapy is uncertain, developed in one patient. MTX, when administered in high dose to young patients by the described protocol, causes no dose-related decrease in pulmonary function.

scholarly journals Use of priming principle in the induction dose requirement of propofol and its hemodynamic stability- A cross sectional study

2021 ◽  
Vol 8 (3) ◽  
pp. 367-372
Author(s):  
P Ramesh Kumar ◽  
S Suganya ◽  
A Mohanhariraj ◽  
P Jothianand ◽  
R Shankar
Keyword(s):  
Blood Pressure ◽  
Total Dose ◽  
Control Group ◽  
Induction Agent ◽  
Hemodynamic Parameters ◽  
Dose Requirement ◽  
Hemodynamic Stability ◽  
Priming Principle ◽  
Induction Dose ◽  
The Mean

In anesthesia propofol induction is administered at a dose of 2mg/kg as a single bolus and when given at this dose the commonest problem faced by the anesthetist is the sudden drop in the blood pressure, as the hypotensive effect of propofol is proportional to the dose and rate of administration.To study the effect of auto co-induction (priming principle) in the requirement of induction dose of propofol and the resulting hemodynamic parameters. A prospective randomized double blinded study was conducted for a period of one year in the department of anesthesia at a government medical college hospital in TamilNadu. A total of 60 patients were selected for our study and were randomly allocated into two groups of 30 each. Group A is the study group (priming) and group B is the control group (non-priming group). In the priming group, three minutes after premedication the co induction agent was administered (25% of the calculated dose of propofol) and two minutes later the patient received propofol at a rate of 30mg/10 sec until loss of vocalization was achieved. The hemodynamic parameters along with the total dose requirement of propofol and BIS values were monitored at regular intervals after induction.The mean total dose of propofol required among the priming group patients was 78.2 mg compared to the total dose requirement in the non-priming group which was 92.5 mg and the mean difference was found to be statistically significant. A statistically significant fall in the heart rate and blood pressure was observed at 1 min and 3 mins after induction in non priming group compared to priming group. By applying priming principle the induction dose of propofol was reduced by 14.25% with a good hemodynamic stability.

scholarly journals A Comparative Study on Three Different Combinations of Ketofol for Induction of General Anaesthesia

2021 ◽  
Vol 10 (7) ◽  
pp. 430-434
Author(s):  
Bijaya Chingtham ◽  
Langpoklakpam Chaoba Singh ◽  
Saraswathi Ramakrishna ◽  
Rahul Jain ◽  
Anita Gurung
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
General Anaesthesia ◽  
Induction Time ◽  
Time Intervals ◽  
Haemodynamic Stability ◽  
Group 3 ◽  
Group 2 ◽  
Post Operative Nausea ◽  
Group 1

BACKGROUND Ketamine and propofol are one of the commonly used drugs for induction of general anaesthesia. Ketofol, is the combination of ketamine and propofol in varying concentrations. Due to the paucity of information in the literature regarding comparison of different combinations of ketofol for use as an induction agent, we intend to study the various doses of propofol ketamine combination in view of its haemodynamic stability and its relevance to speed of induction as well as side effect profile. METHODS This is a double blinded randomised controlled trial study. 60 patients posted for elective surgery under general anaesthesia were selected. They were randomly allotted to three groups with 20 patients in each group. Group 1 received ketofol in the ratio of 1:1, group 2 in the ratio of 1:2, group 3 in the ratio of 1:3. The time from the start of injection till the loss of verbal command, induction time, was noted. Mean arterial pressure, incidence of apnoea, awareness, hallucinations and post-operative nausea and vomiting (PONV) were noted. RESULTS Induction time was fastest in group 3 followed by group 2 followed by group 1. It was statistically significant. Mean arterial pressure (MAP) was comparable in all the three groups at different time intervals except at 5 minutes after induction, the fall in group 3 was significant. The change in MAP as compared to baseline in group 1 and 2 in different time intervals was not significant. But the fall in MAP was significant as compared to baseline in all the different time intervals in group 3. There was no reported incidence of apnoea, awareness and hallucinations in all the three groups. There were two reported cases of PONV in group 1, one in group 2 and zero in group 3. CONCLUSIONS Ketofol with the maximum propofol and least ketamine combination has the fastest induction time. Ketofol in the combination of 1:1 and 1:2 offers more haemodynamic stability as compared to 1:3 combination and ketofol has minimal side effects. KEY WORDS Ketofol, Different Combinations, Induction Time, Haemodynamic Stability

scholarly journals Effects of Exposure to Mixed Organic Solvents on Blood Pressure in Non-Smoking Women Working in a Pharmaceutical Company

2012 ◽  
Vol 63 (2) ◽  
pp. 161-169 ◽  
Author(s):  
Saber Mohammadi ◽  
Majid Golabadi ◽  
Yasser Labbafinejad ◽  
Fatemeh Pishgahhadian ◽  
Mirsaeed Attarchi
Keyword(s):  
Blood Pressure ◽  
Pharmaceutical Company ◽  
Organic Solvents ◽  
Mixed Solvents ◽  
Control Group ◽  
Significant Difference ◽  
Blood Pressures ◽  
Group 3 ◽  
Group 2 ◽  
Comprehensive Programs

Effects of Exposure to Mixed Organic Solvents on Blood Pressure in Non-Smoking Women Working in a Pharmaceutical CompanySome studies suggest that exposure to industrial solvents can affect blood pressure. The objective of this study was to investigate the effect of a mixture of organic solvents on blood pressure in women working in a pharmaceutical company in Iran. Four hundred and thirty-three women were included in the study. Women working in packing units (group 1) were not exposed to the mixture of organic solvents, women in new laboratory units (group 2) were exposed to the mixture within the permitted range and women working in old laboratory units (group 3) were exposed to the mixture above the permitted limit. We compared systolic and diastolic blood pressures (SBP & DBP) and prevalence of hypertension and pre-hypertension among groups. The results revealed a significant difference in SBP and pre-hypertension (p<0.001) and hypertension (p<0.05) prevalence between the exposed and the control group, but DBP did not differ significantly. Logistic regression analysis showed a significant association between hypertension and exposure to mixed solvents. Odds ratio for hypertension in the group 2 and group 3 (exposed) workers was 2.36 and 3, respectively, compared to controls. Our results suggest that exposure to a mixture of organic solvents may increase SBP and hypertension and pre-hypertension prevalence in drug manufacture workers. Therefore, more attention should be paid to workers that work in such settings by periodically measuring blood pressure and implementing accurate and comprehensive programs to reduce exposure to organic solvents.

scholarly journals Efficacy of Priming Principle in Propofol Induction-A Randomised Controlled Trial

2021 ◽  
Author(s):  
Sri Sowmiya Dhanapalan ◽  
Manisha B Vyas
Keyword(s):  
Blood Pressure ◽  
Total Dose ◽  
Controlled Trial ◽  
Control Group ◽  
Chi Square ◽  
Priming Principle ◽  
Induction Dose ◽  
Elective Surgical Procedures ◽  
Student’S T ◽  
Randomised Controlled

Introduction: Priming refers to administration of a small calculated dose of a drug before giving the total induction dose. Priming principle is well-documented with the use of non-depolarising muscle relaxants. Over the years, propofol has emerged as an effective alternative to thiopentone for intravenous induction. Aim: To evaluate whether priming with propofol reduces the total induction dose of propofol. Materials and Methods: Fifty patients with American Society of Anaesthesiologists (ASA) I and II grades, aged 18-55 years, and undergoing elective surgical procedures under general anaesthesia were randomly allocated into two groups; with 25 patients each. Patients in Control Group (CG) received calculated induction dose of injection propofol 2 mg/kg whereas patients in Study Group (SG) received 20% of total calculated induction dose of propofol 2 mg/kg as a priming dose and remaining dose after 30 seconds titrated till the loss of the eyelash reflex. The total induction dose and the associated haemodynamic parameters were noted. The data thus obtained was then analysed using Chi-square test and Student’s t-test. Results: The CG required a higher dose of inj. propofol (2.15 mg/kg) as compared with the SG (1.77 mg/kg), i.e., there was 17.43% reduction of the total dose in the SG. The preoperative baseline vitals {Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP)} in both the groups were comparable. The changes in HR, at 1 minute and 3 minutes after induction were higher in CG than SG, which was statistically significant. The MAP at 1 minute and 3 minutes after induction was higher in SG than CG and was statistically significant. Conclusion: The priming principle when applied to induction with propofol reduces the total dose requirements of propofol and reduces the hypotension that it causes, thereby proving a stable haemodynamic state.

Morphological Changes in the Rat Granulosa Cell Surface During Differentiation Induced by Estradiol and Gonadotropins

1977 ◽  
Vol 35 ◽  
pp. 484-485
Author(s):  
P. Bagavandoss ◽  
JoAnne S. Richards ◽  
A. Rees Midgley
Keyword(s):  
Cell Surface ◽  
Granulosa Cell ◽  
Morphological Changes ◽  
Follicular Development ◽  
Female Rats ◽  
Functional Changes ◽  
Group 4 ◽  
Group 3 ◽  
Group 5 ◽  
Group 2

During follicular development in the mammalian ovary, several functional changes occur in the granulosa cells in response to steroid hormones and gonadotropins (1,2). In particular, marked changes in the content of membrane-associated receptors for the gonadotropins have been observed (1).We report here scanning electron microscope observations of morphological changes that occur on the granulosa cell surface in response to the administration of estradiol, human follicle stimulating hormone (hFSH), and human chorionic gonadotropin (hCG).Immature female rats that were hypophysectcmized on day 24 of age were treated in the following manner. Group 1: control groups were injected once a day with 0.1 ml phosphate buffered saline (PBS) for 3 days; group 2: estradiol (1.5 mg/0.2 ml propylene glycol) once a day for 3 days; group 3: estradiol for 3 days followed by 2 days of hFSH (1 μg/0.1 ml) twice daily, group 4: same as in group 3; group 5: same as in group 3 with a final injection of hCG (5 IU/0.1 ml) on the fifth day.

Correlation of γ-radioactivity and Scanning Electron Microscopy in measurement of retention of 111Indium-labeled canine endothelial cells on synthetic vascular grafts

1989 ◽  
Vol 47 ◽  
pp. 886-887
Author(s):  
E.J. Prendiville ◽  
S. Laliberté Verdon ◽  
K. E. Gould ◽  
K. Ramberg ◽  
R. J. Connolly ◽  
...  
Keyword(s):  
Blood Flow ◽  
Ex Vivo ◽  
Vascular Grafts ◽  
Retention Data ◽  
Vascular Prostheses ◽  
Group 4 ◽  
Human Fibronectin ◽  
Insufficient Time ◽  
Group 3 ◽  
Group 2

Endothelial cell (EC) seeding is postulated as a mechanism of improving patency in small caliber vascular grafts. However the majority of seeded EC are lost within 24 hours of restoration of blood flow in previous canine studies . We postulate that the cells have insufficient time to fully develop their attachment to the graft surface prior to exposure to hemodynamic stress. We allowed EC to incubate on fibronectin-coated ePTFE grafts for four different time periods after seeding and measured EC retention after perfusion in a canine ex vivo shunt circuit.Autologous canine EC, were enzymatically harvested, grown to confluence, and labeled with 30 μCi 111 Indium-oxine/80 cm 2 flask. Four groups of 5 cm x 4 mm ID ePTFE vascular prostheses were coated with 1.5 μg/cm.2 human fibronectin, and seeded with 1.5 x 105 EC/ cm.2. After seeding grafts in Group 1 were incubated in complete growth medium for 90 minutes, Group 2 were incubated for 24 hours, Group 3 for 72 hours and Group 4 for 6 days. Grafts were then placed in the canine ex vivo circuit, constructed between femoral artery and vein, and subjected to blood flow of 75 ml per minute for 6 hours. Continuous counting of γ-activity was made possible by placing the seeded graft inside the γ-counter detection crystal for the duration of perfusion. EC retention data after 30 minutes, 2 hours and 6 hours of flow are shown in the table.

In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection – does cyanoacrylate increase the severity of infection?

VASA ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 281-284
Author(s):  
Atıf Yolgosteren ◽  
Gencehan Kumtepe ◽  
Melda Payaslioglu ◽  
Cuneyt Ozakin
Keyword(s):  
Vascular Graft ◽  
Graft Infection ◽  
Vascular Graft Infection ◽  
Group 4 ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Prosthetic Vascular Graft Infection ◽  
Group 1

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.

Sign in / Sign up

Export Citation Format

Share Document