Rapid injection of rocuronium reduces withdrawal movement on injection

Study ObjectiveTo test whether rapid injection of rocuronium reduces withdrawal movement on injection.DesignRandomized, prospective trial.SettingOperating room in a university hospital.Patients150 ASA physical status I and II patients aged 18 to 60 years, undergoing general anesthesia.InterventionsPatients were randomized to three groups. After undergoing anesthesia induction with thiopental sodium, then 5 seconds later receiving a rubber tourniquet applied to the mid-forearm to stop intravenous (IV) flow by gravity, the pretreatment drug was injected. The tourniquet was held for 15 seconds then released, and 1.0 mg/kg of 1% rocuronium was injected IV. Group C patients (n = 50) were pretreated with 0.1 mL/kg of 0.9% NaCl and then injected with rocuronium slowly within 10 seconds. Group L patients (n = 50) were pretreated with 0.1 mL/kg of preservative-free 1% lidocaine and then injected with rocuronium slowly within 10 seconds. Group R patients (n = 50) were pretreated with 0.1 mL/kg of 0.9% NaCl and then rapidly injected with rocuronium within approximately one second (as quickly as possible).MeasurementsAfter injection of the patient with the study drug, a single anesthesiologist with no knowledge of the study protocol graded each patient's response as follows: 0 = no response; 1 = mild movement limited to the wrist only; 2 = moderate movement involving the elbow and shoulder; and 3 = severe movement involving more than one extremity.Main ResultsGroup C had the most intense and frequent withdrawal response. The frequency and intensity of withdrawal movement was significantly less in Groups L and R than Group C. No significant difference in withdrawal response between Groups L and R was noted.ConclusionsWithdrawal response can be significantly reduced for rocuronium injection without lidocaine pretreatment, simply through rapid injection.     

Fat injection

The results of grafts of fat obtained through liposuction are presented. They are the outcome of the current revitalization of the old technique of fat extraction and transplant. Both doctor and patient should be aware that a successful treatment is achieved through continuity. Fat grafts evolve with respect to time and permanence with reabsorption a part of the normal evolutionary process. Fat reinjection is a consequence of tissue reabsorption or a complement of the preceding injection. There is no complication associated with repeated reinjection. All cases reported here include patients with two or more reinjections, depending on their pathology and evolution.     

Accurate stereotactic injection by radially curved injection needles

A method has been developed for planning, constructing, and inserting radially curved injection needles for stereotactic surgery in primates. The stereotactic coordinates of the top of a guide tube and the targeted site, together with sagittal and coronal projections of the slant of the guide tube, are provided for the computer, which calculates the length, curvature, and rotational angle at which a curved injector should be inserted through the guide tube to reach the site. Development of the method included a test surgery in which curved injectors were lowered through one set of guide tubes and straight injectors through another set, targeted on the same points in the brain. Formulas used by the programs are presented, and the source code for the software is available on request.     

Fat injection

The results of grafts of fat obtained through liposuction are presented. They are the outcome of the current revitalization of the old technique of fat extraction and transplant. Both doctor and patient should be aware that a successful treatment is achieved through continuity. Fat grafts evolve with respect to time and permanence with reabsorption a part of the normal evolutionary process. Fat reinjection is a consequence of tissue reabsorption or a complement of the preceding injection. There is no complication associated with repeated reinjection. All cases reported here include patients with two or more reinjections, depending on their pathology and evolution.     

The influence of injection speed on pain during injection of local anaesthetic

Study objective: To determine the influence of injection speed on pain during injection of local anaesthetics. Methods: In a blinded randomised study with 36 healthy volunteers, each volunteer received three injections of 4.5 ml lidocaine subcutaneously on the abdomen. The injections were given during 15 seconds (0.3 ml/s), 30 seconds (0.15 ml/s), and 45 seconds (0.1 ml/s). The needle tip remained beneath the skin for 45 seconds during all three injections. Participants rated the pain experienced on a 100 mm visual analogue scale (VAS) immediately after each injection. After the last injection, they were asked which injections were the least and most painful. Results: The mean VAS pain score for the 15 seconds injections was 26 (SD = 19), for the 30 seconds injections 24 (SD = 19), and for the 45 seconds injections also 24 (SD = 18) (ns). Eight subjects preferred the 15 seconds injection, 15 preferred the 30 seconds injection, and 10 preferred the 45 seconds injection (ns). Conclusion: It is concluded that varying the injection speed between 0.3 ml/s and 0.1 ml/s has no influence on the pain experienced during subcutaneous injection of 4.5 ml lidocaine.     

不同静脉注射速度对小儿罗库溴铵注射痛反应的影响

目的 观察静脉注射速度对小儿罗库溴铵静脉注射痛反应的影响.方法 全麻下择期手术患儿60例均分为两组,给予咪唑安定、氯胺酮,入睡后给予罗库溴铵0.6 mg/kg(浓度10mg/ml).A组注速≤3 s,B组注速60 s.采用加速度肌松监测仪监测肌松指标,观察罗库溴铵静脉注射痛反应、气管插管条件和肌松起效时间.结果 B组静脉注射痛反应的发生率明显低于A组(P<0.01);两组插管条件和肌松起效时间的差异无统计学意义.结论 缓慢静脉注射罗库溴铵能明显减轻罗库溴铵静脉注射痛,对气管插管条件和肌松起效时间无明显影响.     

Intravitreal injection of piperacillin

Piperacillin was injected into the vitreous body of rabbit eyes to evaluate its suitability for intraocular injection and its toxicity on intraocular tissues. Doses ranged from 50 micrograms to 3,000 micrograms. Toxicity was determined through histology and electroretinograms by comparing the piperacillin-injected eyes with eyes injected with balanced saline solution. Retinal toxicity was noted in the outer layer of the retina when 3,000 micrograms was injected intravitreally. No toxicity was noted by histology with 1,500 micrograms of piperacillin. The minimal inhibitory concentration of piperacillin is 800 micrograms/cc for both gram negative and gram positive organisms. The large dose of intravitreal piperacillin tolerated by rabbit eyes makes piperacillin a potentially safe and effective broad spectrum antibiotic for the treatment of bacterial endophthalmitis in human eyes.     

Botulinum toxin injection: a review of injection principles and protocols

Despite the favorable outcomes seen using botulinum toxin (BTX) for voiding dysfunction using BTX, a standardized technique and protocol for toxin injection is not defined. We reviewed the current literature on intravesical BTX injection for DO (detrusor overactivity). Specific attention was placed on defining optimal injection protocol, including dose, volume, and injection sites. In addition, we sought to describe a standard technique to BTX injection.     

Compressed air injection technique to standardize block injection pressures

PURPOSE: Presently, no standardized technique exists to monitor injection pressures during peripheral nerve blocks. Our objective was to determine if a compressed air injection technique, using an in vitro model based on Boyle's law and typical regional anesthesia equipment, could consistently maintain injection pressures below a 1293 mmHg level associated with clinically significant nerve injury. METHODS: Injection pressures for 20 and 30 mL syringes with various needle sizes (18G, 20G, 21G, 22G, and 24G) were measured in a closed system. A set volume of air was aspirated into a saline-filled syringe and then compressed and maintained at various percentages while pressure was measured. The needle was inserted into the injection port of a pressure sensor, which had attached extension tubing with an injection plug clamped "off". Using linear regression with all data points, the pressure value and 99% confidence interval (CI) at 50% air compression was estimated. RESULTS: The linearity of Boyle's law was demonstrated with a high correlation, r = 0.99, and a slope of 0.984 (99% CI: 0.967-1.001). The net pressure generated at 50% compression was estimated as 744.8 mmHg, with the 99% CI between 729.6 and 760.0 mmHg. The various syringe/needle combinations had similar results. CONCLUSION: By creating and maintaining syringe air compression at 50% or less, injection pressures will be substantially below the 1293 mmHg threshold considered to be an associated risk factor for clinically significant nerve injury. This technique may allow simple, real-time and objective monitoring during local anesthetic injections while inherently reducing injection speed.     

Infraclavicular plexus block: multiple injection versus single injection

BACKGROUND AND OBJECTIVES: This prospective, randomized, and multicentered study was undertaken to evaluate the success rate of coracoid infraclavicular nerve block performed with a nerve stimulator when either 1 or 3 motor responses were sought. METHODS: Eighty patients who presented for elbow, forearm, or wrist surgery were randomly allocated to one of the following groups: in group 1 (single stimulation), 30 mL local anesthetic (LA) was injected after locating only 1 of the median, ulnar, or radial motor responses. In group 2 (multistimulation), 3 responses were located: musculocutaneous, median or ulnar, and radial response, corresponding, respectively, to the lateral, medial, and posterior cords. A total of 10 mL LA was injected on each response. Bupivacaine 0.5% and lidocaine 2% with epinephrine 1:200000 (1:1 vol) were used as the LA mixture. Sensory and motor blocks were tested by a blinded observer. RESULTS: Block duration was slightly increased in the multistimulation group (P =.004). The onset time of sensory and motor block was faster in each nerve distribution, particularly in the radial, musculocutaneous, and antebrachial nerves. The success of anesthesia increased in the multistimulation group. The success rate of the block, without any additional block, sedation, or general anesthesia, increased from 40% in the single stimulation group to 72.5% in the multistimulation group (P <.0001). If the brachial and antebrachial cutaneous nerves were not included in the evaluation, success rate reached 87.5%. CONCLUSIONS: We conclude that by performing an infraclavicular block with stimulation of all 3 cords of the brachial plexus, the success rate is higher than when only a single stimulation is used.     

比较金黄地鼠和人卵浆内单精子注射技术受精率

卵浆内单精子注射技术（ｉｎｔｒａｃｙｔｏｐｌａｓｍｉｃｓｐｅｒｍｉｎｊｅｃｔｉｏｎ，ＩＣＳＩ）１９９２年后已广泛应用于治疗严重的男性不孕患者，平均受精率可达６５％～７０％。但仍有大约１／３的卵在ＩＣＳＩ后未能受精。金黄地鼠ＩＣＳＩ试验（ｈａｍｓｔｅｒ ＩＣＳＩａｓａｙ）可能有助于在临床ＩＣＳＩ治疗前了解精子受精的潜力。为了证明金黄地鼠ＩＣＳＩ和人类ＩＣＳＩ受精率之间的相关性，探索金黄地鼠ＩＣＳＩ能否用为临床ＩＣＳＩ的预试验，本研究采用同一男性不孕患者的精子经显微注射技术在同一天分别注入人和金黄地鼠卵。１６～１８小时后在光镜下观察有无双原核形成（２ ｐｒｏｎｕｃｌｅｕｓ，２ＰＮ）。人卵１１０个其受精率为５８２％（６４／１１０）。金黄地鼠卵１１４个其受精率为１６５％（１４／８０）。经统计学处理，二者无相关性。金黄地鼠ＩＣＳＩ分为两组，Ａ组：无选择地注射了已激活与未激活的卵６３个；Ｂ组：注意选择未激活的卵共５１个。虽经统计学处理无明显差异，但仍可看出Ｂ组的损伤率（１９７±１６６％）低于Ａ组（３５９±５．７％）（Ｐ＝００８）；而Ｂ组的受精率（１８３±１０．９％）略高于Ａ组（１４２±８．７％）（Ｐ＝０?