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Paediatric clinical pharmacology
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
While, during continuous infusion, no fluctuations are expected in plasma concentration at steady state, during intermittent dosage the concentration of the drug rises and falls in each inter-dose interval. Drug measurements in samples obtained too soon after dosing during an intermittent regime are of no value and even misleading, as they reflect mainly the rates of absorption and of distribution, and the size of the volume of distribution, but not drug clearance. Due to slow distribution, plasma concentrations of digoxin, for instance, peak well before maximal effect and a value of >2 ng/mL (potentially toxic when taken 6 to 8 hours after the dose) must be expected when sampling too soon after dosing. In the usual clinical situation, the sample is taken just before the next planned dose, although the obtained value will represent the minimal concentration, and not the average concentration at steady state.
Principles of systemic treatment
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
Where venous access is difficult an indwelling central venous catheter has many advantages. For example: For schedules requiring lengthy infusionsWhen continuous infusion pumps are to be usedIn procedures likely to require the administration of many intravenous drugsIn transfusions such as bone marrow transplantation or high-dose chemotherapy
Preparation of the Patient for Surgery
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Michael Murray, Urmila Ratnasabapathy
As part of multi-modal analgesic delivery, surgeons can infiltrate wound sites with chirocaine (Levo-Bupivacaine) 0.5% (maximum dose 2 mg/kg) at the end of surgery. Elastomeric pumps that can deliver local anaesthetic infusions into wounds are also used particularly in free tissue transfer surgery. By providing a continuous infusion, the pumps have the potential to provide continuous analgesia, eliminating the peaks and troughs in analgesic effect that occur with intermittent local or systemic analgesics. Unlike simple incisional infiltration with local anaesthetics, evidence for the efficacy of local anaesthetic wound catheters is abundant.19 In a recent systematic review20 it was concluded that continuous local anaesthetic wound infiltration resulted in a consistently reduced requirement for post-operative opioids, a subsequent reduction in postoperative nausea and vomiting, quicker return to normal bodily function and ambulation and a reduced length of hospital stay, especially in cardiothoracic and orthopaedic populations. Despite the cost of the equipment, the reduction in complications may lead to overall cost savings.
Lipid emulsion facilitates reversal from volatile anesthetics in a rodent model
Published in Clinical Toxicology, 2022
Kotaro Hori, Tadashi Matsuura, Shogo Tsujikawa, Hideki Hino, Miyuki Kuno, Yutaka Oda, Kiyonobu Nishikawa, Takashi Mori
Soybean-based intravenous lipid emulsion (ILE, Intralipid® 20%; Fresenius Kabi, Uppsala, Sweden) or the same volume of normal saline (NS) (Otsuka normal saline; Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan) was administered in a randomized manner in in vivo experiments, using a syringe pump (CFV 3200; Nihon Kohden Corporation, Tokyo, Japan). 45 min after completing infusion of the first test drug (lipid emulsion or NS), the same experiment was repeated using the other test drug, the interval of which was determined by the half-life of triglyceride blood concentration following lipid emulsion infusion [20]. In some of the rats that were excited after waking up, another 1–2 min was required for pacification. The dose of lipid emulsion was determined by the current clinical guideline for lipid resuscitation (1.5 ml/kg bolus, followed by continuous infusion at 0.25 ml/kg/min) [2,3], which was converted to the dose for rats based on the body surface area using the guideline of U.S. Food and Drug Administration; 9 ml/kg bolus, followed by continuous infusion at 1.5 ml/kg/min [20,21]. Each drug was administered for 5 min (1 min bolus and 4 min continuous infusion; 15 ml/kg in total). This was a single (subject)-blinded randomized study (the intravenous line was filled with normal saline before administration of both drugs), and randomization was performed using computer-generated random numbers.
An evaluation of subcutaneous apomorphine for the treatment of Parkinson’s disease
Published in Expert Opinion on Pharmacotherapy, 2020
Patients with a good motor response to apomorphine, but with unsatisfactory over all control of motor impairment with repeat bolus injections, may be put on a continuous subcutaneous infusion regimen. It is mostly started at a rate of 1 mg apomorphine hydrochloride (0.1 ml) per hour with a pump device. The apomorphine dosage is gradually increased depending on motor response and tolerability. Rise of the infusion rate shall not be more than 0.5 mg per hour at intervals of not less than 4 hours. Dosing may range between 1 mg and 4 mg (0.1 ml and 0.4 ml) per hour, which is equivalent to 0.015–0.06 mg/kg/hour. Infusions shall run during waking hours only. The infusion site shall be changed every 12 hours. Patients may supplement their continuous infusion with intermittent bolus boosts via the pump system if necessary. A dosage reduction of other dopamine substituting compounds may be considered in relation to the patient’s response to apomorphine [25,26].
Pharmacological management of malignant hypertension
Published in Expert Opinion on Pharmacotherapy, 2020
Joanna Lewek, Agata Bielecka-Dąbrowa, Marek Maciejewski, Maciej Banach
Urapidil is an antiadrenergic drug that acts through the dilatation of arterioles and thus reduces the total peripheral resistance [15]. It is dedicated to hypertensive emergencies. The initial dosage is 10 to 50 m and it should be slowly injected. Blood lowering is expected within 5 min. Next doses can be repeated if necessary. Continuous infusion is used to maintain an achieved level of blood pressure. The infusion rate depends on the individual patient with the initial infusion rate being 2 mg/min. The maintenance dose is on average 9 mg/hour. The duration of the treatment should not exceed 7 days because, from toxicological point of view, it seems to be safe. Similarly to nicardipine, urapidil should not be used in patients with aortic valve stenosis and additionally with an atriovenous shunt [15].