52 research outputs found
The bookseller and the basketball player: tales from the French Polonia
No full textAuthor has checked copyrightAD 09/01/201
Impact of physical incompatibility on drug mass flow rates: example of furosemide-midazolam incompatibility.
No full textInternational audienceABSTRACT: BACKGROUND: Patients in intensive care units receive many drugs simultaneously but through limited venous accesses. Several intravenous therapies have to be administered through the same catheter, thus increasing the risk of physicochemical incompatibility. The purpose of this work was to assess and to quantify the impact of physical incompatibility on the mass flow rates of drugs infused simultaneously to the patient, through an in vitro study. METHODS: Furosemide-midazolam incompatibility was used to assess the impact of physical incompatibility on drug mass flow rates. Furosemide, midazolam, and saline were simultaneously infused. A filter was added at the end of the infusion line to retain visible particles. Two infusion conditions were tested with and without visible particles. A partial least square method on UV spectra was used to determine simultaneously the concentrations of the two drugs at the egress of the terminal extension line. The drug mass flow rate (expressed as mg/h) was calculated as the product of drug concentration versus total flow rate. Observed/theoretical mass flow rate ratios for each drug (%) were determined per infusion condition. RESULTS: Even in the absence of visible particles, precipitation of furosemide led to a drug loss estimated at between 10 % and 15 %. Furosemide is more impacted by interaction because the pH of the mixture is acid and this form is poorly soluble in an aqueous solution. CONCLUSIONS: Physical incompatibility between furosemide and midazolam leads to a significant reduction in drug delivered to the patient and may result in treatment failure
The Impact on Drug Mass Flow Rate of Interrupting and Resuming Carrier Fluid Flow
No full textInternational audienc
Monitoring the Onset of Neuromuscular Block at the Orbicularis Oculi Can Predict Good Intubating Conditions During Atracurium-Induced Neuromuscular Block
No full textInfluence of real-time Bayesian forecasting of pharmacokinetic parameters on the precision of a rocuronium target-controlled infusion
No full textInternational audienc
Prevention of drug delivery disturbances during continuous intravenous infusion: an in vitro study on a new multi-lumen infusion access device
No full textInternational audienceObjectiveStopping and restarting carrier fluid flow and performing simultaneous drug infusions can lead to hazardous disturbances in drug delivery. The present study was designed to assess in vitro whether using a multi-lumen infusion access device could prevent noradrenaline disturbances.Study designIn vitro laboratory work.MethodsTwo infusion devices were studied: a standard device with a four-port manifold and a 150 cm extension line and a nine-lumen infusion device (Edelvaiss-Multiline®) with eight accesses connected to nine separate lumens in a single tube of 150 cm: seven accesses connected to seven peripheral lumens and one for the carrier fluid access connected to two lumens. Two experimental protocols of noradrenaline infusion were made: (a) drug flow rate change and (b) stop-and-go carrier fluid flows. Two parameters were studied: drug mass flow rate and flow change efficiency (FCE) calculated from the ratio of the area under the experimental mass flow rate curve to the area under the theoretical instantaneous mass flow rate curve.ResultsVariations in noradrenaline mass flow rate were more rapid with the Edelvaiss-Multiline® when the noradrenaline infusion rate was increased or decreased. FCE was significantly different from one infusion device to the other during both noradrenaline flow rate increase (standard vs. nine-lumen: 58% vs. 84%; P = 0.008) and decrease (175% vs. 108%; P = 0.008). Decreased drug delivery after stopping carrier fluid flow (standard vs. nine-lumen: 21% vs. 98%; P = 0.008) and sudden temporary increases on resumption (253% vs. 103%; P = 0.008) were reduced in magnitude and duration when using the Edelvaiss-Multiline® with a significant difference in FCE between the two infusion devices.ConclusionsUsing the nine-lumen infusion device reduces drug delivery disturbances during continuous intravenous infusion.ObjectifL’arrêt/reprise du débit de l’hydratation et la réalisation de perfusions simultanées de médicaments peuvent conduire à des perturbations hasardeuses en termes de quantité de médicament délivrée. La présente étude a été réalisée pour évaluer in vitro comment l’utilisation d’un dispositif de perfusion multi-lumières peut prévenir les perturbations de noradrénaline.Conception de l’étudeTravail de laboratoire in vitro.MéthodesDeux dispositifs de perfusion ont été étudiés : un dispositif standard composé d’une rampe de quatre robinets et d’un prolongateur de 150 cm et un dispositif de perfusion à neuf lumières (Edelvaiss-Multiline®) avec huit accès connectés à neuf lumières séparées en un seul tube de 150 cm : sept accès connectés à sept lumières périphériques et une pour l’accès de l’hydratation connecté lui-même à deux lumières. Deux protocoles expérimentaux de perfusion de la noradrénaline ont été réalisés : (1) avec changement du débit du médicament et (2) avec arrêt/reprise du débit de l’hydratation. Deux paramètres ont été étudiés : débit massique du médicament et l’efficacité du changement de débit (flow change efficiency [FCE]) calculé à partir du rapport de l’aire sous la courbe du débit massique expérimental par l’aire sous la courbe du débit massique théorique.RésultatsLes variations en termes de débit massique de noradrénaline étaient plus rapides avec l’Edelvaiss-Multiline® lorsque le débit de perfusion de la noradrénaline étaient augmentée ou diminué. Le FCE était significativement différent d’un dispositif de perfusion à l’autre au cours de l’augmentation et de la diminution du débit de noradrénaline (dispositif standard vs à neuf lumières : 58 % vs 84 % ; p = 0,008 et 175 % vs 108 % ; p = 0,008, respectivement). La diminution de la quantité de médicament délivrée après un arrêt de l’hydratation (dispositif standard vs à neuf lumières : 21 % vs 98 % ; p = 0,008) et son augmentation soudaine à sa reprise (253 % vs 103 % ; p = 0,008) ont été réduites en magnitude et en durée par l’utilisation de l’Edelvaiss-Multiline® avec une différence significative en termes de FCE entre les deux dispositifs de perfusion.ConclusionsL’utilisation du dispositif de perfusion à neuf lumières réduit les perturbations de quantité de médicament délivrée au cours d’une perfusion intraveineuse en continu
Visual Estimation of Onset Time at the Orbicularis Oculi After Five Muscle Relaxants: Application to Clinical Monitoring of Tracheal Intubation
No full textComparison of sugammadex or neostigmine for reversal of mild rocuronium paralysis using repetitive 100-Hz tetanic fade
No full textTrain-of-four ratio (TOFR) values from 0.9 to 11 are generally regarded as the ‘gold standard of the absence of residual paralysis’.2–4 In rocuronium-induced paralysis, despite ‘gold standard’ accelerometry TOFR recordings (0.9), relevant fade was detected by isometric mechanographic signals elicited by 5 s of 100-Hz or 200-Hz tetanic stimulations.5,6 This situation fully justifies the design of the present trial, which used tetanic signals for studying the effects of reversal agents. The aim of the present work was to document the reversal effects of sugammadex 2 mg kg−1 or neostigmine/atropine 40/15 μg kg−1 boluses with repetitive 5-s 100-Hz stimulations5 using strictly standardised conditions
100 Hz-5 s tetanic stimulation to illustrate the presence of “residual paralysis” co-existing with accelerometric 0.90 train-of-four ratio—A proof-of-concept study
No full textAn acceleromyographic train-of-four (TOF) ratio of 0.90 at extubation does not prevent postoperative pulmonary complications in surgical patients receiving non-depolarising muscle relaxants. This recent observation suggests that a more selective neuromuscular transmission monitoring parameter is mandatory to detect more precisely any remaining residual paralysis. The aim of our proof-of-concept study was to evaluate, in patients receiving rocuronium, the degree of 100-Hz, 5-s tetanic fade present when the acceleromyographic TOF ratio has recovered to 0.90. Twenty adult patients scheduled for surgery under general anaesthesia were included. Before anaesthesia induction, a TOF-Watch SX™ and a VISUAL-ITF© (a prototype monitor for recording isometric force) were positioned on both hands. After induction but before rocuronium injection, a 100-Hz, 5-s tetanus (TET0) was delivered to both ulnar nerves. Thereafter, TOF stimulations every 15 s were delivered to both arms until a TOF ratio > 0.90 was recorded; then, a 100-Hz, 5-s tetanus (TET1) was recorded on the VISUAL-ITF© monitor. The values of the tetanic parameters (force) recorded at TET0 and TET1 were compared using a Wilcoxon rank sum test. Compared to TET0, tetanic parameters of TET1 were significantly lower (median [range]): maximal force 36.4 [19.2−82.6] vs. 25.5 [5.0−42.4] Newton (p < 0.005); residual force 36.2 [18.2−82.0] vs. 5.5 [0.20–38.3] Newton (p < 0.0001) and residual force/maximal force ratio 0.98 [0.89−0.99] vs. 0.17 [0.03−0.90] (p < 0.0001). Our results confirm that even when the acceleromyographic TOF ratios have recovered to above 0.90, the contralateral 100-Hz, 5-s tetanic stimulus may show tetanic fade characteristic of residual neuromuscular block, and may help improve the safety of tracheal extubation
- …
