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Canadian Journal of Anaesthesia =... Jun 2022Carbetocin, an oxytocin analog, given as a postpartum hemorrhage prophylaxis in elective Cesarean deliveries, frequently causes tachycardia and hypotension.... (Randomized Controlled Trial)
Randomized Controlled Trial
Comparison of carbetocin as a bolus or an infusion with prophylactic phenylephrine on maternal heart rate during Cesarean delivery under spinal anesthesia: a double-blinded randomized controlled trial.
PURPOSE
Carbetocin, an oxytocin analog, given as a postpartum hemorrhage prophylaxis in elective Cesarean deliveries, frequently causes tachycardia and hypotension. Phenylephrine infusion has been shown to prevent spinal anesthesia-induced hypotension. The goal of this study was to evaluate if a slow infusion of carbetocin would reduce maternal heart rate variation and hemodynamic disturbances compared with a rapid bolus in parturients receiving a prophylactic phenylephrine infusion during elective Cesarean delivery.
METHODS
In this double-blinded randomized controlled trial, 70 healthy parturients were allocated to either a bolus group or an infusion group. At cord clamping, participants in the bolus group received carbetocin 100 µg as a rapid intravenous bolus, while participants in the infusion group received carbetocin 100 µg over 10 min. The primary outcome was the variation in maternal heart rate from baseline during the 20 min following cord clamping. Secondary outcomes included blood pressure, cardiac output, and stroke volume variations during the study period, measured with the ClearSight™ hemodynamic monitor.
RESULTS
Maximum heart rate variation was not different between the groups: bolus group, mean (standard deviation) 29.8 (25.2)% vs infusion group, 27.2 (23.3)%; P = 0.67. The increase in heart rate occurred significantly earlier in the bolus group than in the infusion group (median [interquartile range] time, 105 [69-570] sec vs 485 [255-762] sec; P = 0.02; group × time interaction: two-way repeated measures ANOVA, P = 0.04). There was no significant difference in maximum variations for the other hemodynamic parameters between the groups.
CONCLUSION
Carbetocin infused over ten minutes did not reduce the magnitude of maternal heart rate variation but delayed its occurrence. This finding could be relevant to the anesthesiologist caring for parturients in whom a slight increase in maternal heart rate is clinically undesirable.
STUDY REGISTRATION
www.
CLINICALTRIALS
gov (NCT03404544); registered 19 January 2018.
Topics: Anesthesia, Spinal; Double-Blind Method; Female; Heart Rate; Humans; Hypotension; Infusions, Intravenous; Oxytocin; Phenylephrine; Pregnancy; Vasoconstrictor Agents
PubMed: 35352277
DOI: 10.1007/s12630-022-02227-y -
European Journal of Anaesthesiology Apr 2019The analgesic benefits of programmed intermittent bolus infusion for thoracic paravertebral block remain unknown. (Comparative Study)
Comparative Study Randomized Controlled Trial
Programmed intermittent bolus infusion versus continuous infusion of 0.2% levobupivacaine after ultrasound-guided thoracic paravertebral block for video-assisted thoracoscopic surgery: A randomised controlled trial.
BACKGROUND
The analgesic benefits of programmed intermittent bolus infusion for thoracic paravertebral block remain unknown.
OBJECTIVE
The aim of this study was to compare the analgesia from intermittent bolus infusion with that of a continuous infusion after thoracic paravertebral block.
DESIGN
A randomised controlled study.
SETTING
A single centre between December 2016 and November 2017. Seventy patients scheduled for video-assisted thoracoscopic surgery were included in the study.
INTERVENTION(S)
Patients were randomly assigned to receive 0.2% levobupivacaine via continuous infusion (5 ml h, continuous group) or programmed intermittent bolus infusion (15 ml every 3 h, bolus group) after an initial 15-ml bolus injection of 0.2% levobupivacaine.
MAIN OUTCOME MEASURES
The main outcome was the amount of rescue fentanyl (per kg of body weight) consumed within 24 h after surgery. Secondary outcomes were postoperative pain scores, plasma levobupivacaine concentrations and the number of dermatomes anaesthetised.
RESULTS
There was no significant difference between the continuous and bolus groups in the postoperative consumption of fentanyl (median [interquartile range] 5.5 [4 to 9.5] μg kg versus 6 [3.5 to 9] μg kg respectively, P = 0.45) and postoperative pain scores within 24 h. At 20 h after initiating the infusions, there was no statistically significant difference between the two groups in terms of the plasma levobupivacaine concentration. The number of dermatomes anaesthetised to pinprick and cold testing was significantly greater in the bolus group.
CONCLUSION
Our findings suggest that postoperative pain and opioid usage are similar with either programmed intermittent bolus infusion or continuous infusion after thoracic paravertebral block. Programmed intermittent bolus infusion provides a wider sensory blockade and could benefit patients requiring a wider extent of anaesthesia.
TRIAL REGISTRATION
UMIN Clinical Trials Registry (UMIN-CTR; URL: http://umin.ac.jp/ctr/, ID: UMIN000023378).
Topics: Aged; Analgesics, Opioid; Anesthetics, Local; Female; Fentanyl; Humans; Infusion Pumps; Infusions, Parenteral; Levobupivacaine; Male; Middle Aged; Nerve Block; Pain Management; Pain Measurement; Pain, Postoperative; Prospective Studies; Spinal Nerves; Thoracic Surgery, Video-Assisted; Thoracic Vertebrae; Treatment Outcome; Ultrasonography, Interventional
PubMed: 30664012
DOI: 10.1097/EJA.0000000000000945 -
American Journal of Clinical Oncology Oct 19855-Fluorouracil (5-FU) remains the standard chemotherapy for gastrointestinal cancer, particularly colorectal cancer, with response rates of 8% to 33% and median... (Clinical Trial)
Clinical Trial Comparative Study Review
5-Fluorouracil (5-FU) remains the standard chemotherapy for gastrointestinal cancer, particularly colorectal cancer, with response rates of 8% to 33% and median survivals of 24 to 44 weeks. The schedule of delivery for 5-FU has been addressed in a number of clinical trials over the past two decades, but the optimal schedule based upon more recent studies is not clear. The prospective comparative trial by Ansfield et al., investigated bolus delivery in four schedules and the daily X 5 loading regimen was superior to the less intensive regimens. However, two randomized trials of bolus 5-day vs. continuous 5-day infusions have indicated that the infusion schedule is superior: in colorectal cancer, the study by Seifert et al. demonstrated a response rate of 42% for infusion vs. 21% for bolus; and in head and neck cancers 5-FU administered in conjunction with cisplatin achieved a response rate of 76% for infusion vs. 20% for bolus delivery. Further support for the superiority of the infusion schedule is provided by the comparative trials of hepatic arterial infusion (HAI) and systemic venous infusion, in which response rates are equivalent regardless of the route of delivery. In order to definitively establish an improved therapeutic effect for the infusion schedule, additional prospective trials comparing standard bolus schedules to infusion schedules are necessary, and should address other issues, such as the optimal duration of infusion and relative cost-effectiveness.
Topics: Clinical Trials as Topic; Colonic Neoplasms; Fluorouracil; Humans; Infusions, Intra-Arterial; Infusions, Parenteral; Rectal Neoplasms
PubMed: 3904399
DOI: No ID Found -
Critical Care (London, England) Jun 2022Fluid challenges are widely adopted in critically ill patients to reverse haemodynamic instability. We reviewed the literature to appraise fluid challenge... (Review)
Review
INTRODUCTION
Fluid challenges are widely adopted in critically ill patients to reverse haemodynamic instability. We reviewed the literature to appraise fluid challenge characteristics in intensive care unit (ICU) patients receiving haemodynamic monitoring and considered two decades: 2000-2010 and 2011-2021.
METHODS
We assessed research studies and collected data regarding study setting, patient population, fluid challenge characteristics, and monitoring. MEDLINE, Embase, and Cochrane search engines were used. A fluid challenge was defined as an infusion of a definite quantity of fluid (expressed as a volume in mL or ml/kg) in a fixed time (expressed in minutes), whose outcome was defined as a change in predefined haemodynamic variables above a predetermined threshold.
RESULTS
We included 124 studies, 32 (25.8%) published in 2000-2010 and 92 (74.2%) in 2011-2021, overall enrolling 6,086 patients, who presented sepsis/septic shock in 50.6% of cases. The fluid challenge usually consisted of 500 mL (76.6%) of crystalloids (56.6%) infused with a rate of 25 mL/min. Fluid responsiveness was usually defined by a cardiac output/index (CO/CI) increase ≥ 15% (70.9%). The infusion time was quicker (15 min vs 30 min), and crystalloids were more frequent in the 2011-2021 compared to the 2000-2010 period.
CONCLUSIONS
In the literature, fluid challenges are usually performed by infusing 500 mL of crystalloids bolus in less than 20 min. A positive fluid challenge response, reported in 52% of ICU patients, is generally defined by a CO/CI increase ≥ 15%. Compared to the 2000-2010 decade, in 2011-2021 the infusion time of the fluid challenge was shorter, and crystalloids were more frequently used.
Topics: Critical Illness; Crystalloid Solutions; Fluid Therapy; Hemodynamic Monitoring; Hemodynamics; Humans; Shock, Septic
PubMed: 35729632
DOI: 10.1186/s13054-022-04056-3 -
European Journal of Anaesthesiology Mar 2019Minimising rocuronium administration during paediatric surgery helps to reduce the incidence of residual muscular blockade. (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Minimising rocuronium administration during paediatric surgery helps to reduce the incidence of residual muscular blockade.
OBJECTIVE
To determine whether intermittent bolus injection (Bolus group) or continuous infusion (group) requires the lesser amount of rocuronium.
DESIGN
A randomised, single-blind controlled trial.
SETTING
A single university hospital from March to June 2017.
PATIENTS
Sixty-six children undergoing general anaesthesia.
INTERVENTIONS
Dose of rocuronium for maintenance of muscle relaxation in either Bolus or continuous infusion group. Train-of-four (TOF) count of two was maintained during surgery. When TOF count reached three, 0.1 mg kg of rocuronium was administered in Bolus group or infused at an increased rate of 0.1 mg kg h in continuous infusion group.
MAIN OUTCOME MEASURES
Primary outcome was the dose of rocuronium given (μg kg min). The recovery time from the TOF count four to TOF 0.7 (RT0.7), and 0.9 (RT0.9) were recorded. All adverse events were recorded up to 30 min after extubation.
RESULTS
Mean (SD) rocuronium dose in the Bolus group was 6.1 (0.9), [95% confidence interval (95% CI) 5.7 to 6.4] μg kg min and 4.9 (1.0), (95% CI 4.6 to 5.3) μg kg min in the continuous infusion group (P = 0.001). RT0.7 was 24.0 (13.7), 95% CI 19.3 to 28.7) min in the Bolus group, and 25.7 (16.0), (95% CI 20.2 to 31.2) min in the continuous infusion group (P = 0.73). RT0.9 was 30.7 (17.1), (95% CI 24.9 to 36.5) min in the Bolus group, and 30.0 (17.6), (95% CI 24.0 to 36.0) min in the continuous infusion group (P = 0.91). The incidence of adverse events was not significantly different between two groups.
CONCLUSION
In children undergoing general anaesthesia, the dose of rocuronium given by continuous administration was less than that with intermittent bolus.
TRIAL REGISTRATION
ClinicalTrials.gov (identifier: NCT03060707).
Topics: Child; Child, Preschool; Delayed Emergence from Anesthesia; Dose-Response Relationship, Drug; Female; Humans; Infusions, Intravenous; Injections, Intravenous; Male; Muscle Relaxation; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Postoperative Complications; Rocuronium; Single-Blind Method
PubMed: 30540640
DOI: 10.1097/EJA.0000000000000934 -
Journal of Cerebral Blood Flow and... Sep 1992The approaches hitherto used for measuring the kinetic constants Kd and Bmax of neuroreceptors in vivo all violate the steady state of the system. This complicates the... (Review)
Review
The approaches hitherto used for measuring the kinetic constants Kd and Bmax of neuroreceptors in vivo all violate the steady state of the system. This complicates the kinetic analysis as approximations must be made, introducing errors of unknown magnitude. The present study presents the theory for designing experiments in which the steady state is preserved. It is based on maintaining a constant degree of receptor binding (occupancy) throughout the experiment. This is achieved by administering by prolonged intravenous infusion the non-radioactive ligand one wishes to study. The fraction of receptors sites not occupied by the "cold" ligand is measured by using trace amounts of a radioactive ligand binding to the same receptor. A minimum of two studies at different occupanies must be performed. In this presentation it is proposed to make the second study at essentially zero receptor occupancy by administering the tracer alone. The pair of tracer studies, the one without and the other with infusion of cold ligand, allows calculation of the cold ligand's equilibrium dissociation constant Kd. In the special case when tracer and cold ligands are chemically identical, then Bmax can also be calculated. Two different modes of tracer administration can be used. If the tracer is also infused at a constant rate for a long time, then the occupancy of receptor sites by the cold ligand can be calculated by measuring the equilibrium tracer concentrations in brain and plasma. If the tracer is administered as an intravenous bolus injection, then the area under the brain and plasma radioactivity curves or compartmental analysis must be used.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Animals; Brain; Humans; Infusions, Intravenous; Injections, Intravenous; Kinetics; Models, Chemical; Radioisotopes; Radioligand Assay; Sensory Receptor Cells
PubMed: 1506439
DOI: 10.1038/jcbfm.1992.101 -
Journal of Dental Anesthesia and Pain... Sep 2016Dentists often sedate patients in order to reduce their dental phobia and stress during dental treatment. Sedatives are administered through various routes such as oral,... (Review)
Review
Dentists often sedate patients in order to reduce their dental phobia and stress during dental treatment. Sedatives are administered through various routes such as oral, inhalation, and intravenous routes. Intravenous administration has the advantage of rapid onset of action, predictable duration of action, and easy titration. Typically, midazolam, propofol or dexmedetomidine are used as intravenous sedatives. Administration of these sedatives via infusion by using a syringe pump is more effective and successful than infusing them as a bolus. However, during intravenous infusion of sedatives or opioids using a syringe pump, fatal accidents may occur due to the clinician's carelessness. To prevent such risks, smart syringe pumps have been introduced clinically. They allow clinicians to perform effective sedation by using a computer to control the dose of the drug being infused. To ensure patient safety, various alarm features along with a drug library, which provides drug information and prevents excessive infusion by limiting the dose, have been added to smart pumps. In addition, programmed infusion systems and target-controlled infusion systems have also been developed to enable effective administration of sedatives. Patient-controlled infusion, which allows a patient to control his/her level of sedation through self-infusion, has also been developed. Safer and more successful sedation may be achieved by fully utilizing these new features of the smart pump.
PubMed: 28884149
DOI: 10.17245/jdapm.2016.16.3.165 -
Journal of Pediatric Surgery Jun 1998Stimulation of gallbladder contraction in patients receiving total parenteral nutrition (TPN) may be beneficial in preventing cholestatic jaundice associated with TPN....
BACKGROUND/PURPOSE
Stimulation of gallbladder contraction in patients receiving total parenteral nutrition (TPN) may be beneficial in preventing cholestatic jaundice associated with TPN. Bolus intravenous administration of either amino acids or fat promotes gallbladder contraction in normal adult volunteers after a period of starvation. This phenomenon has not been investigated in patients receiving continuous TPN. The aim of this study was to test the hypothesis that bolus intravenous infusion of amino acids or fat produces gallbladder contraction in neonates receiving TPN.
METHODS
Twenty-eight studies of gallbladder contraction were performed in 18 neonates receiving continuous TPN (median weight, 2.3 kg; range, 1.3 to 7.3; gestational age, 37 weeks; range, 28 to 40; age, 6.5 days; range, 2 to 180). Different types of experiments were performed: (1) bolus intravenous infusion of amino acid or fat for 60 minutes at twice the normal infusion rate; (2) bolus intravenous infusion of amino acid or fat for 15 minutes at four times the normal infusion rate. Gallbladder volume was measured by real-time ultrasonography by a single investigator. Measurements were made before starting the bolus infusion and every 15 minutes for 1 hour.
RESULTS
The volume of the gallbladder before bolus intravenous infusion was not significantly different between experiments (median, 985; range, 603 to 1,802 mm3). These volumes are consistent with an enlarged and atonic gallbladder as previously reported in infants receiving parenteral nutrition. In all experiments there was no significant decrease in gallbladder volume after bolus infusion of either amino acids or fat.
CONCLUSIONS
Contrary to their effects in adults, bolus infusions of amino acids or fat did not induce gallbladder contraction in neonates on TPN. This may have been because of lack of starvation in the neonates and/or the effect of continuous glucose infusion.
Topics: Amino Acids; Fat Emulsions, Intravenous; Gallbladder; Humans; Infant, Newborn; Infusions, Intravenous; Parenteral Nutrition, Total; Ultrasonography
PubMed: 9660204
DOI: 10.1016/s0022-3468(98)90649-2 -
Journal of Cardiothoracic and Vascular... Feb 1999In the present study, the authors compared continuous infusion to bolus administration of sufentanil and midazolam in patients undergoing mitral valve surgery. The... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
OBJECTIVE
In the present study, the authors compared continuous infusion to bolus administration of sufentanil and midazolam in patients undergoing mitral valve surgery. The purpose of the study was to evaluate the hemodynamic variability, total dose, effective plasma drug concentrations, and simplicity of the two anesthetic techniques.
DESIGN
Prospective, randomized study.
SETTING
University hospital.
PARTICIPANTS
Thirty patients scheduled for elective mitral valve surgery.
INTERVENTIONS
Induction of anesthesia was similar in both groups and consisted of sufentanil, up to 2 microg/kg, and midazolam, 0.05 to 0.15 mg/kg, followed by atracurium, 0.5 mg/kg. Anesthesia was maintained in the bolus group with predetermined boluses of sufentanil, 2 microg/kg, and midazolam, 0.03 mg/kg. Boluses were not administered if blood pressure was within 20% of baseline. The continuous-infusion group received sufentanil, 3.6 microg/kg/h, and midazolam, 0.08 mg/kg/h, started immediately after induction. The infusion rate was reduced to sufentanil, 1.8 microg/kg/h, and midazolam, 0.04 mg/kg/h, after sternotomy and was discontinued at skin closure. Atracurium was infused at a rate of 0.5 mg/kg/h up to sternal closure in both groups. No inhalation agents were used.
MEASUREMENTS AND MAIN RESULTS
Hemodynamic variability between the groups was not significant. Total sufentanil dose was 773 +/- 186 microg in the continuous-infusion group and 610 +/- 184 microg in the bolus group (p = 0.01). Total midazolam dose was 14.4 +/- 3 mg and 11.2 +/- 3 mg in the continuous-infusion and bolus groups, respectively. There were 3.46 (range, 0 to 7) additional bolus injections in the bolus group and 0.31 (range, 0 to 1) in the continuous-infusion group (p < 0.001). Plasma sufentanil concentrations at extubation were similar in both groups (0.5 ng/mL). Plasma midazolam concentrations at extubation in the bolus group (17 +/- 6.7 ng/mL) were similar to those in the continuous-infusion group (23 +/- 5 ng/mL).
CONCLUSION
The simplicity of the continuous infusion is a major advantage. This technique provides hemodynamically safe and stable conditions similar to those of bolus administration.
Topics: Adjuvants, Anesthesia; Anesthetics, Combined; Anesthetics, Intravenous; Female; Hemodynamics; Humans; Infusions, Intravenous; Injections, Intravenous; Male; Midazolam; Middle Aged; Mitral Valve; Prospective Studies; Sufentanil
PubMed: 10069275
DOI: 10.1016/s1053-0770(99)90164-7 -
Emergency Medicine Australasia : EMA Jun 2013The study aims to determine if slow intravenous infusion of metoclopramide reduces the incidence of acute drug-induced akathisia (DIA) compared with intravenous bolus. (Comparative Study)
Comparative Study Randomized Controlled Trial
OBJECTIVE
The study aims to determine if slow intravenous infusion of metoclopramide reduces the incidence of acute drug-induced akathisia (DIA) compared with intravenous bolus.
METHODS
A prospective, double-blind, double dummy trial of adult patients requiring intravenous metoclopramide in the ED. Participants were randomised to receive either: metoclopramide 20 mg as a bolus and normal saline infusion over 15 min, or normal saline bolus and metoclopramide 20 mg infused over 15 min. Patients were assessed for DIA using the Prince Henry Akathisia Rating Scale before treatment was commenced and at 20, 40 and 60 min post. Nausea was assessed with a visual analog scale.
RESULTS
Of 210 participants assessed for eligibility, 206 were randomised and 205 were included in the final analysis. Participant characteristics and indication for metoclopramide were well matched between the treatment groups. Overall, incidence of DIA was 26 out of 205 participants (12.68%, 95% confidence interval [CI] 8.09-17.3). DIA occurred in 11 out of 103 (10.68%, 95% CI 4.61-16.74%) in the bolus group, and in 15 out of 102 (14.71%, 95% CI 7.71-21.70%) in the infusion group (P = 0.67). Severe DIA occurred in six patients in each group. The mean age of patients experiencing DIA was 34 years (interquartile range 29-40) and 42 years (interquartile range 40-45) in those without akathisia (P = 0.04). Nausea reduction was equivalent in both groups.
CONCLUSION
The incidence of DIA and reduction in nausea is unaffected by the rate of administration of intravenous metoclopramide 20 mg.
Topics: Adult; Akathisia, Drug-Induced; Antiemetics; Double-Blind Method; Female; Humans; Infusions, Intravenous; Injections, Intravenous; Male; Metoclopramide; Middle Aged; Prospective Studies
PubMed: 23759039
DOI: 10.1111/1742-6723.12062