Abstract:
BACKGROUND:IV infusion systems can be configured with manifolds connecting multiple drug infusion lines to transcutaneous catheters. Prior in vitro studies suggest that there may be significant lag times for drug delivery to reflect changes in infusion rates set at the pump, especially with low drug and carrier flows and larger infusion system dead-volumes. Drug manifolds allow multiple infusions to connect to a single catheter port but add dead-volume. We hypothesized that the time course of physiological responses to drug infusion in vivo reflects the impact of dead-volume on drug delivery. METHODS:The kinetic response to starting and stopping epinephrine infusion ([3 mL/h] with constant carrier flow [10 mL/h]) was compared for high- and low-dead-volume manifolds in vitro and in vivo. A manifold consisting of 4 sequential stopcocks with drug entering at the most upstream port was contrasted with a novel design comprising a tube with separate coaxial channels meeting at the downstream connector to the catheter, which virtually eliminates the manifold contribution to the dead-volume. The time to 50% (T50) and 90% (T90) increase or decrease in drug delivery in vitro or contractile response in a swine model in vivo were calculated for initiation and cessation of drug infusion. RESULTS:The time to steady state after initiation and cessation of drug infusion both in vitro and in vivo was much less with the coaxial low-dead-volume manifold than with the high-volume design. Drug delivery after initiation in vitro reached 50% and 90% of steady state in 1.4 ± 0.12 and 2.2 ± 0.42 minutes with the low-dead-volume manifold and in 7.1 ± 0.58 and 9.8 ± 1.6 minutes with the high-dead-volume manifold, respectively. The contractility in vivo reached 50% and 90% of the full response after drug initiation in 4.3 ± 1.3 and 9.9 ± 3.9 minutes with the low-dead-volume manifold and 11 ± 1.2 and 17 ± 2.6 minutes with the high-dead-volume manifold, respectively. Drug delivery in vitro decreased by 50% and 90% after drug cessation in 1.9 ± 0.17 and 3.5 ± 0.61 minutes with the low-dead-volume manifold and 10.0 ± 1.0 and 17.0 ± 2.8 minutes with the high-dead-volume manifold, respectively. The contractility in vivo decreased by 50% and 90% with drug cessation in 4.1 ± 1.1 and 14 ± 5.2 with the low-dead-volume manifold and 12 ± 2.7 and 23 ± 5.6 minutes with the high-dead-volume manifold, respectively. CONCLUSIONS:The architecture of the manifold impacts the in vivo biologic response, and the drug delivery rate, to changes in drug infusion rate set at the pump.
journal_name
Anesth Analgjournal_title
Anesthesia and analgesiaauthors
Lovich MA,Wakim MG,Wei A,Parker MJ,Maslov MY,Pezone MJ,Tsukada H,Peterfreund RAdoi
10.1213/ANE.0b013e3182a76f3bsubject
Has Abstractpub_date
2013-12-01 00:00:00pages
1313-8issue
6eissn
0003-2999issn
1526-7598pii
00000539-201312000-00009journal_volume
117pub_type
杂志文章abstract:UNLABELLED:This study was performed to evaluate both the effects of pentobarbital on disruption of the blood-brain barrier (BBB) by hyperosmolar mannitol and the relationship between its effect on blood pressure and the integrity of the BBB. Under isoflurane anesthesia, rats in the control group were infused with 25% m...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199806000-00018
更新日期:1998-06-01 00:00:00
abstract::Sufentanil is a potent opioid that occasionally has been associated with hypotension. The mechanism behind this hypotension is unclear. We hypothesized that sufentanil had a direct effect on vascular smooth muscle to cause vasodilation. Sufentanil was infused into the brachial artery of 10 young, healthy volunteers at...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ANE.0000184119.85400.0E
更新日期:2005-12-01 00:00:00
abstract::We investigated the usefulness of peripheral flow index (PFI) measurement using a standard pulse oximetry digit probe for early prediction of successful regional blocks. Sixty-six patients scheduled for limb surgery underwent either axillary or sciatic block using a nerve stimulator technique with mepivacaine 1.5%. PF...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000220947.02689.9f
更新日期:2006-07-01 00:00:00
abstract:BACKGROUND:Hyperkalemia poses serious hazards to patients undergoing orthotopic liver transplantation (OLT), and its predictors have not been thoroughly examined. METHODS:We retrospectively studied 1124 consecutive adult patients who underwent OLT. Hyperkalemia was defined as serum K+ > or =5.5 mmol/L. A total of 47 r...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000271914.54261.17
更新日期:2007-09-01 00:00:00
abstract:BACKGROUND:In this randomized study, we compared intrathecal (i.t.) morphine with or without clonidine and i.v. postoperative patient-controlled analgesia (PCA) morphine for analgesia after radical retropubic prostatectomy. METHODS:Fifty patients were randomly divided into three groups. They were allocated to receive ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ane.0b013e3181a30182
更新日期:2009-06-01 00:00:00
abstract:BACKGROUND:Hypothermia (HT) reduces neuronal injury after perinatal asphyxia. The anesthetic gas xenon (XE) may enhance this effect. We investigated the sedative and respiratory effects of variable XE concentrations at 37 degrees C normothermia (NT) or 32 degrees C HT after a hypoxic-ischemic (HI) insult to determine t...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e3181618669
更新日期:2008-03-01 00:00:00
abstract::One of the most important physical properties affecting the level of analgesia achieved after intrathecal administration of a local anesthetic is its density relative to the density of the cerebrospinal fluid (CSF) at 37 degrees C. In this study, density, specific gravity, and baricity of local anesthetic solutions at...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199305000-00018
更新日期:1993-05-01 00:00:00
abstract:BACKGROUND:Neuromuscular blocking drugs have been implicated in intraoperative bronchoconstrictive episodes. We examined the effects of clinically relevant doses of cisatracurium and rocuronium on the lung mechanics of pediatric subjects. We hypothesized that cisatracurium and rocuronium would have bronchoconstrictive ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0b013e3182a6d191
更新日期:2013-12-01 00:00:00
abstract::Noma (cancrum oris) is a disease of poverty and malnutrition, which predominantly affects children younger than 10 years in developing countries. Although the majority of sufferers die of sepsis at the time of the initial infection, or of subsequent starvation due to severe trismus and an inability to eat, a small min...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3182908e6f
更新日期:2013-07-01 00:00:00
abstract::Quantitative Sensory Testing (QST) is a psycho-physiological test used to identify dysfunction of individual nerve fiber types. In the present study, we investigated whether selective nerve fiber dysfunction, as assessed by QST, correlates with the effectiveness of epidural steroid injections (ESI) in patients with lu...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/01.ane.0000078583.47735.69
更新日期:2003-09-01 00:00:00
abstract:UNLABELLED:Systemically-administered morphine reduces infarct size in rat models of myocardial ischemia-reperfusion. We sought to determine whether much smaller doses of spinally-administered morphine offer a similar cardioprotective benefit. Barbiturate-anesthetized, open-chested, Wistar rats with chronic indwelling t...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000105878.96434.05
更新日期:2004-04-01 00:00:00
abstract:UNLABELLED:Genitofemoral neuritis, which occurs when the neurolytic solution spreads into the psoas muscle, is the most common complication after neurolytic lumbar sympathetic block. We developed a transdiscal approach for neurolytic lumbar sympathetic block to reduce the danger of genitofemoral neuritis by making a sy...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199712000-00024
更新日期:1997-12-01 00:00:00
abstract::Early tracheal extubation has been safely performed after large operative procedures, questioning the need for routine postoperative ventilation. Because immediate postoperative tracheal extubation of liver transplantation patients has not been previously reported, we performed preliminary studies at two institutions ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199702000-00003
更新日期:1997-02-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:As part of the Thai Anesthesia Incidents Study of anesthetic adverse outcomes, we evaluated the incidence and factors related to cardiac arrest during spinal anesthesia. METHODS:During a 12-mo period (March 1, 2003, to February 28, 2004), a prospective, multicenter registry of patients receiv...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,多中心研究
doi:10.1213/ane.0b013e31817bd143
更新日期:2008-11-01 00:00:00
abstract::Aprotinin, a potent antifibrinolytic drug, reduces the proportion of adults who receive blood transfusions during cardiac surgery, although the effect in children remains unclear. We performed a systematic review of the literature to identify all English language, randomized controlled trials of aprotinin involving ch...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,meta分析
doi:10.1213/01.ane.0000194954.64293.61
更新日期:2006-03-01 00:00:00
abstract:BACKGROUND:Patients with muscular dystrophy have been reported to experience a variety of life-threatening complications during and after general anesthesia. We performed a systematic analysis to define the spectrum of anesthetic-related complications in patients with muscular dystrophy, with an emphasis on malignant h...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ane.0b013e3181aa5cf6
更新日期:2009-10-01 00:00:00
abstract:BACKGROUND:Tardiness from scheduled start times is a common source of frustration for both operating room (OR) personnel and patients. Factors that influence tardiness were quantified in a companion paper and have been used to develop interventions that have the potential for reducing tardiness. METHODS:Data from two ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e31819f9fd2
更新日期:2009-06-01 00:00:00
abstract::Preoperative use of angiotensin-converting enzyme (ACE) inhibitors is common and has been associated with hypotension at separation from cardiopulmonary bypass (CPB). This study prospectively examined the influence of chronic preoperative ACE inhibitor use and other perioperative factors on the incidence of vasoconstr...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199503000-00007
更新日期:1995-03-01 00:00:00
abstract::The effects of ropivacaine, a new amide local anesthetic, on uterine blood flow and fetal well-being were compared with those of bupivacaine in 10 chronically instrumented pregnant ewes. In random sequence, animals received two intravenous infusions of each drug. The low infusion rate regimens were chosen to result in...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199201000-00011
更新日期:1992-01-01 00:00:00
abstract:UNLABELLED:Prepared endotracheal tubes (PETTs) are frequently used for unanticipated difficult intubation, but their storage time is highly variable and institution-dependent. We sought to determine first, if open, unused PETTs are a potential source of pathogenic microorganisms, and second, if PETTs can provide a medi...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000082241.56353.97
更新日期:2003-10-01 00:00:00
abstract:BACKGROUND:Although detailed analyses of the postmortem findings of various critically ill patient groups have been published, no such study has been performed in patients with sepsis. In this retrospective cohort study, we reviewed macroscopic postmortem examinations of surgical intensive care unit (ICU) patients who ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e318195e11d
更新日期:2009-06-01 00:00:00
abstract:IMPLICATIONS:Manipulating the density of local anesthetic solutions by using a simple formula may be clinically useful in producing optimal density solutions for spinal anesthesia under a variety of clinical conditions. ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200206000-00048
更新日期:2002-06-01 00:00:00
abstract::Complement activation and the resulting inflammatory response is an important potential mechanism for multisystem organ injury in cardiac surgery. Novel therapeutic strategies using complement inhibitors may hold promise for improving outcomes for cardiac surgical patients by attenuating complement activation or its b...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ANE.0b013e3182652b7d
更新日期:2012-10-01 00:00:00
abstract:BACKGROUND:Pulmonary aspiration of gastric contents is associated with significant perioperative morbidity and mortality. Previous studies have investigated the validity, reliability, and possible clinical impact of gastric ultrasound for the assessment of gastric content at the bedside. In the present study, we examin...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0000000000003372
更新日期:2019-01-01 00:00:00
abstract:UNLABELLED:This report describes treatment with cervical epidural blood patch of low cerebrospinal fluid (CSF) pressure headache resulting from spontaneous CSF leak via a tear in a cervical dural cuff. The leak was diagnosed by a dynamic computed tomography (CT)-myelography study followed by gadolinium enhanced magneti...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000117225.31416.36
更新日期:2004-06-01 00:00:00
abstract:UNLABELLED:With the development of new computer-assisted target-controlled infusion (TCI) systems and the availability of short-acting anesthetics, total IV anesthesia (TIVA) has become increasingly popular. The aim of this study was to compare costs of TCI-based anesthesia with two standard anesthesia regimens. Sixty ...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验,收录出版
doi:10.1097/00000539-199901000-00015
更新日期:1999-01-01 00:00:00
abstract::This study was conducted to assess the learning function of murine progeny born of mothers that had received either 1% or 2% halothane or 2% or 4% enflurane, on days 6 and 10 or days 14 and 17 or gestation. Their timed performance at the age of 6 to 7 weeks was compared in a maze with that of control mice of similar a...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1981-11-01 00:00:00
abstract::We built and tested a combined proportional/derivative and minimum variance adaptive control algorithm for the regulation of blood pressure using sodium nitroprusside (SNP). In ten dogs the pressure was reduced by 30 mm Hg for 1 hr. The blood pressure came to within 5 mm Hg of the desired pressure in 1.7 +/- 4 min and...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1985-01-01 00:00:00
abstract:UNLABELLED:Brain dysfunction after cardiopulmonary bypass (CPB) is common, and it has been hypothesized that this injury might be due partly to activation of inflammatory processes in the brain. We measured juguloarterial gradients for interleukin-1beta, interleukin-6, and interleukin-8 (IL-8) as indices of local proin...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199910000-00003
更新日期:1999-10-01 00:00:00
abstract:BACKGROUND:Cerebral cholinergic transmission plays a key role in cognitive function, and anticholinergic drugs administered during the perioperative phase are a hypothetical cause of postoperative cognitive dysfunction (POCD). We hypothesized that a perioperative increase in serum anticholinergic activity (SAA) is asso...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/ANE.0000000000000390
更新日期:2014-10-01 00:00:00