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1.
Target-controlled infusion of alfentanil for postoperative analgesia: a feasibility study and pharmacodynamic evaluation in the early postoperative period 总被引:10,自引:0,他引:10
Van Den Nieuwenhuyzen MCO.; Engbers FHM.; Burm AGL.; Vletter A. A.; Van Kleef J. W.; Bovill J. G. 《British journal of anaesthesia》1997,78(1):17-23
We have examined the feasibility of target-controlled infusion of
alfentanil (TCIA) and the pharmacodynamics of alfentanil in the early
postoperative period. Patients were allocated randomly to one of the three
groups to receive balanced anaesthesia with bolus injections of fentanyl
(group F), sufentanil (group S) or alfentanil (group A). In the recovery
room all patients received the same analgesic regimen, comprising TCIA. To
evaluate the efficacy of postoperative analgesia, pain scores were measured
on a visual analogue scale (VAS) and patients indicated a need for
additional analgesia. EC50, the concentration at which, with a 50%
probability, patients reported adequate analgesia, was estimated using
logistic regression. Six patients did not complain of pain. The time from
the last intraoperative bolus injection of opioid until patients complained
of postoperative pain was shorter (P < 0.05) in group A (mean 68 min)
than in group F (101 min) and group S (136 min). The time to onset of
satisfactory analgesia was comparable in the three groups (median 18 min in
group F, 15 min in group S and 14 min in group A). EC50 of alfentanil was
determined in 28 patients; mean values were 26 ng ml-1 (group F), 39 ng
ml-1 (group S) and 52 ng ml-1 (group A). We conclude that TCIA, under the
conditions studied, resulted in a fast onset of adequate analgesia,
irrespective of the opioid administered during operation. Also, there was
no effect of opioids administered during operation on postoperative
pharmacodynamics of alfentanil.
相似文献
2.
Factor VIII assays. Assessment of variables 总被引:1,自引:0,他引:1
J T Brandt D A Triplett K Musgrave C Arkin E G Bovill F V Lucas W A Rock 《Archives of pathology & laboratory medicine》1988,112(1):7-12
Factor VIII assays are the most common specific coagulation factor assay performed in the United States. Interlaboratory proficiency studies have documented persistent problems with variation in results between laboratories. The Coagulation Resource Committee of the College of American Pathologists conducted a workshop to analyze variables that may affect performance of the one-stage factor assay. The results indicate that accuracy of the assay can be improved by uniform standardization of reference plasma samples and that reproducibility can be enhanced through appropriate choice of reagents and instruments. Optimizing performance of this assay should lead to more reproducible interlaboratory results. 相似文献
3.
4.
This paper describes the tragic case of a young woman who died of cancer of
the colon after successfully donating eggs to her younger sister. Although
there is no direct link between her operation and the subsequent
development of bowel carcinoma, this case imparts a feeling of unease when
seen in conjunction with other cases reported during the last few years. It
is a reminder that little is known of the long-term consequences of some
aspects of assisted conception. Women undergoing ovarian stimulation for
themselves or a matched recipient have the right to be advised, in an
agreed format, that there is some concern about unproven potential risks
from the stimulatory drugs. The safety of egg donors must assume priority
over all other considerations, including lack of donors or any moral
position. The recent decision by the Human Fertilisation and Embryology
Authority (HFEA) to withdraw any form of payment or recompense to egg
donors does not seem to us to be based on a balance of scientific advances,
patient needs and the ethics of gamete supply. They state that the
intention to withdraw payments was implicit in the 1990 Human Fertilisation
and Embryology (HFE) Act. However the Act was based on the Warnock report
made 6 years earlier. Even in 1990 ovum donation was uncommon and fertility
drugs had not yet caused any unease. The Act provided the HFEA with
discretionary powers to issue directions so that the future policies would
be consistent with any emerging new medical evidence. It is imperative that
the HFEA provide convincing evidence on how the current policy of payment
to donors harms society, donors or recipients, and how in the UK the new
policy will improve medical practice in assisted conception. Successful
pilot studies must precede the implementation of any new policy. Failure to
do this could cause irreversible harm to the practice of assisted
conception using donor gametes, which will ultimately be against the basic
aims of the 1990 HFE Act.
相似文献
5.
Kuipers JA Boer F Olofsen E Olieman W Vletter AA Burm AG Bovill JG 《Anesthesiology》1999,90(4):1146-1157
BACKGROUND: Cardiac output (CO) is likely to influence the pharmacokinetics of anesthetic drugs and should be accounted for in pharmacokinetic models. The influence of CO on the pharmacokinetic parameters of alfentanil in pigs was evaluated using compartmental and recirculatory models. METHODS: Twenty-four premedicated pigs were evaluated during halothane (0.6-2%) anesthesia. They were assigned randomly to one of three groups. One group served as control. In the other groups, the baseline CO was decreased or increased by 40% by pharmacologic intervention (propranolol or dobutamine). Boluses of alfentanil (2 mg) and indocyanine green (25 mg) were injected into the right atrium. Blood samples were taken for 150 min from the right atrium and aortic root. Arterial concentration-time curves of indocyanine green and alfentanil were analyzed using compartmental models (two-stage and mixed-effects approach) and a recirculatory model, which can describe lung uptake and early distribution. RESULTS: The CO of individual pigs varied from 1.33 to 6.44 l/min. Three-compartmental modeling showed that CO is a determinant of the central compartment volume (V1, r2 = 0.54), fast peripheral compartment volume (V2, r2 = 0.29), steady state distribution volume (Vss, r2 = 0.29), fast distribution clearance (Cl12, r2 = 0.39), and elimination clearance (Cl10, r2 = 0.51). Recirculatory modeling showed that CO is a determinant of total distribution volume (r2 = 0.48), elimination clearance (r2 = 0.54), and some distribution clearances. The pulmonary distribution volume was independent of CO. CONCLUSIONS: Cardiac output markedly influences the pharmacokinetics of alfentanil in pigs. Therefore, accounting for CO enhances the predictive value of pharmacokinetic models of alfentanil. 相似文献
6.
First-pass lung uptake and pulmonary clearance of propofol: assessment with a recirculatory indocyanine green pharmacokinetic model 总被引:12,自引:0,他引:12
BACKGROUND: The principal site for elimination of propofol is the liver. The clearance of propofol exceeds hepatic blood flow; therefore, extrahepatic clearance is thought to contribute to its elimination. This study examined the pulmonary kinetics of propofol using part of an indocyanine green (ICG) recirculatory model. METHODS: Ten sheep, immobilized in a hammock, received injections of propofol (4 mg/kg) and ICG (25 mg) via two semipermanent catheters in the right internal jugular vein. Arterial blood samples were obtained from the carotid artery. The ICG injection was given for measurement of intravascular recirculatory parameters and determination of differences in propofol and ICG concentration-time profiles. No other medication was given during the experiment, and the sheep were not intubated. The arterial concentration-time curves of ICG were analyzed with a recirculatory model. The pulmonary uptake and elimination of propofol was analyzed with the central part of that model extended with a pulmonary tissue compartment allowing elimination from that compartment. RESULTS: During the experiment, cardiac output was 3.90+/-0.72 l/min (mean +/- SD). The blood volume in heart and lungs, measured with ICG, was 0.66+/-0.07 l. A pulmonary tissue compartment of 0.47+/-0.16 l was found for propofol. The pulmonary first-pass elimination of propofol was 1.14+/-0.23 l/min. Thirty percent of the dose was eliminated during the first pass through the lungs. CONCLUSIONS: Recirculatory modeling of ICG allows modeling of the first-pass pulmonary kinetics of propofol concurrently. Propofol undergoes extensive uptake and first-pass elimination in the lungs. 相似文献
7.
Hereditary thrombophilia as a model for multigenic disease 总被引:4,自引:0,他引:4
8.
Anne EG Lenferink Joanne Magoon Christiane Cantin Maureen D O'Connor-McCourt 《Breast cancer research : BCR》2004,6(5):R514
Introduction
This report describes the isolation and characterization of three new murine mammary epithelial cell lines derived from mammary tumors from MMTV (mouse mammary tumor virus)/activated Neu + TβRII-AS (transforming growth factor [TGF]-β type II receptor antisense RNA) bigenic mice (BRI-JM01 and BRI-JM05 cell lines) and MMTV/activated Neu transgenic mice (BRI-JM04 cell line). 相似文献9.
OBJECTIVE: To assess the antibody response to influenza vaccine of children vertically infected with HIV. DESIGN: Prospective study in HIV infected children vaccinated during the winter of 1994-5. SETTING: Family HIV clinic at St Mary's Hospital, Paddington. SUBJECTS: 25 children, aged 1-11 years, vertically infected with HIV. MAIN OUTCOME MEASURES: Responses to influenza antigens (H1N1-A/Taiwan/1/86, H3N2-A/Shandong/9/93, B/Panama/45/ 90) were tested by haemagglutination inhibition. Antibody responses were assessed according to clinical symptoms and immune function, stratified according to the 1994 revised classification for HIV infection in children. RESULTS: 23 children (92%) had either very low or no detectable antibody before vaccination. New protective antibody responses were made by 10 children (40%): in seven to a single antigen, in two to two antigens, and in one to all three antigens. For each antigen there was an overall small increase in the mean geometric titre of antibody produced, but this only reached a protective level for antigen H1N1 and for children with minimal symptoms. Less symptomatic children were significantly more likely to produce a protective antibody response to influenza vaccination. No association was found between immune function, as measured by CD4 count, and vaccine response. CONCLUSIONS: Only vaccination of the least symptomatic HIV infected children against influenza is likely to be effective. This will not only protect them against influenza, but will also protect other more immunosuppressed and vulnerable members of their families. 相似文献
10.
R. A. McKerlie D. A. Cameron A. Sherriff C. Bovill 《European journal of dental education》2012,16(1):e122-e127
This paper describes the implementation of syndicate learning (tutor‐less group working) to teach the basic principles and skills of removable partial denture design within an undergraduate dental curriculum at the University of Glasgow. Student perceptions of syndicate group learning were collected through using questionnaires with Likert scales and through focus group interviews. The majority of students expressed positive views of syndicate learning that focused on the following themes: the added value of the group in terms of learning and in terms of social cohesion; the sense of responsibility to peers that led them to work harder; the autonomy of tutor‐less groups that led them to improve their ability to justify their work; and the effectiveness of the syndicate groups in comparison with other learning methods. On the basis of these findings along with reports from students that learning about group roles enhanced their preparation for future work, we argue that syndicate learning can offer some valuable benefits to the undergraduate dental curriculum. 相似文献