			Home About us Contact

Induction Agent (induction + agent)

Distribution by Scientific Domains

Medical Sciences	93%

Distribution within Medical Sciences

Anesthesia & Pain Management	39%
Transplantation	12%

Selected Abstracts

Underdosing of Midazolam in Emergency Endotracheal Intubation

ACADEMIC EMERGENCY MEDICINE, Issue 4 2003
Mark J. Sagarin MD
Objectives: To determine whether midazolam, when used as an induction agent for emergency department (ED) rapid-sequence intubation (RSI), is used in adequate and recommended induction doses (0.1 to 0.3 mg/kg), and to compare the accuracy of the dosing of midazolam for ED RSI with the accuracy of dosing of other agents. Methods: The authors conducted a systematic query of a prospectively collected database of ED intubations using the National Emergency Airway Registry data, gathered in 11 participating EDs over a 16-month period. A data form completed at the time of emergency department intubation (EDI) enabled analysis of patients' ages, weights, and indications for EDI, as well as the techniques and drugs used to facilitate EDI. Data were analyzed to determine whether midazolam is used in recommended doses during RSI. Patients intubated with midazolam alone were compared with patients who received other induction agents for RSI. Results: Of 1,288 patients entered in the study, 1,023 (79%) underwent RSI. Of the 888 RSI patients with an age recorded, midazolam was used as the sole induction agent in 140 (16%). The mean (±SD) dosages of midazolam used in RSI were 2.6 (±1.7) mg in children (age , 18) and 3.7 (±2.5) mg in adults (age ,19); the mean (±SD) dosages by weight were 0.08 (±0.04) mg/kg in children and 0.05 (±0.03) mg/kg in adults. More than half (56%) of the children, and nearly all (92%) of the adults, received dosages lower than the minimum recommended dosage (0.1 mg/kg). Of patients who received barbiturates, only 21% of children and 21% of adults received a dose lower than the minimum recommended. When combined with another induction agent, midazolam was dosed similarly to when it was used alone: mean adult doses were 3.1 (±1.2) mg and 0.04 (±0.02) mg/kg. Conclusions: Underdosing of midazolam during ED RSI is frequent, and appears to be related to incorrect dosage selection, rather than to a deliberate intention to reduce the dose used. [source]

Too much of a good thing: retinoic acid as an endogenous regulator of neural differentiation and exogenous teratogen

EUROPEAN JOURNAL OF NEUROSCIENCE, Issue 3 2003
P. J. McCaffery
Abstract Retinoic acid (RA) is essential for both embryonic and adult growth, activating gene transcription via specific nuclear receptors. It is generated, via a retinaldehyde intermediate, from retinol (vitamin A). RA levels require precise regulation by controlled synthesis and catabolism, and when RA concentrations deviate from normal, in either direction, abnormal growth and development occurs. This review describes: (i) how the pattern of RA metabolic enzymes controls the actions of RA; and (ii) the type of abnormalities that result when this pattern breaks down. Examples are given of RA control of the anterior/posterior axis of the hindbrain, the dorsal/ventral axis of the spinal cord, as well as certain sex-specific segments of the spinal cord, using varied animal models including mouse, quail and mosquitofish. These functions are highly sensitive to abnormal changes in RA concentration. In rodents, the control of neural patterning and differentiation are disrupted when RA concentrations are lowered, whereas inappropriately high concentrations of RA result in abnormal development of cerebellum and hindbrain nuclei. The latter parallels the malformations seen in the human embryo exposed to RA due to treatment of the mother with the acne drug Accutane (13- cis RA) and, in cases where the child survives beyond birth, a particular set of behavioural anomalies can be described. Even the adult brain may be susceptible to an imbalance of RA, particularly the hippocampus. This report shows how the properties of RA as a neural induction agent and organizer of segmentation can explain the consequences of RA depletion and overexpression. [source]

ProSealTM laryngeal mask airway in 120 pediatric surgical patients: a prospective evaluation of characteristics and performance

PEDIATRIC ANESTHESIA, Issue 3 2006
MELISSA WHEELER MD
Summary Background:, The ProSealTM LMA (PLMATM) has recently been introduced in pediatric sizes (1.5, 2, 2.5, 3). Limited pediatric data have been published. Methods:, After Institutional Review Board (IRB) approval, the PLMATM was placed in 120 children aged 4 months to 13 years (5,50 kg). The following data were collected prospectively: induction agent, number of placement attempts (limited to three), placement success or failure, PLMATM size, leak pressure, ventilatory pattern [spontaneous (SV) or controlled positive pressure ventilation (PPV)], success or failure of gastric suction tube placement, hypoxemia, dislodgement, laryngospasm, bronchospasm, aspiration, and traumatic placement. Results:, The PLMATM was easily placed in children with a higher first attempt success rate (94%) than reported for adults. Overall PLMATM and gastric tube placement were both 100% successful. Leak pressures were similar to those reported for the PLMATM in adults and higher than reported for the ClassicTM LMATM in children. No bronchospasm, laryngospasm, hypoxemia, dislodgement, or aspiration occurred. Conclusions:, Although the PLMATM can be used with SV or PPV, the higher leak pressure achieved with the PLMATM, and the ability to evacuate fluid and air from the stomach suggest that it may be a useful alternative to tracheal intubation for procedures in which PPV is desired in children aged 4 months to 13 years. [source]

A comparison of the effect on QT interval between thiamylal and propofol during anaesthetic induction,

ANAESTHESIA, Issue 7 2010
U. Higashijima
Summary The aim of this study was to determine the effect of thiamylal and propofol on heart rate-corrected QT (QTc) interval during anaesthetic induction. We studied 50 patients undergoing lumbar spine surgery. Patients were administered 3 ,g.kg,1 fentanyl and were randomly allocated to receive 5 mg.kg,1 thiamylal or 1.5 mg.kg,1 propofol as an induction agent. Tracheal intubation was performed after vecuronium administration. Heart rate, mean arterial pressure, bispectral index score, and 12-lead electrocardiogram were recorded at the following time points: just before (T1) and 2 min after (T2) fentanyl administration; 2 min after anaesthetic administration (T3); 2.5 min after vecuronium injection (T4); and 2 min after intubation (T5). Thiamylal prolonged (p < 0.0001), but propofol shortened (p < 0.0001), the QTc interval. [source]

Anaesthesia in haemodynamically compromised emergency patients: does ketamine represent the best choice of induction agent?

ANAESTHESIA, Issue 5 2009
C. Morris
Summary In rapid sequence induction of anaesthesia in the emergency setting in shocked or hypotensive patients (e.g. ruptured abdominal aortic aneurysm, polytrauma or septic shock), prior resuscitation is often suboptimal and comorbidities (particularly cardiovascular) may be extensive. The induction agents with the most favourable pharmacological properties conferring haemodynamic stability appear to be ketamine and etomidate. However, etomidate has been withdrawn from use in some countries and impairs steroidogenesis. Ketamine has been traditionally contra-indicated in the presence of brain injury, but we argue in this review that any adverse effects of the drug on intracranial pressure or cerebral blood flow are in fact attenuated or reversed by controlled ventilation, subsequent anaesthesia and the greater general haemodynamic stability conferred by the drug. Ketamine represents a very rational choice for rapid sequence induction in haemodynamically compromised patients. [source]

Trends in induction of labour, 1998,2007: A population-based study

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 6 2009
N. M. MEALING
Background:, Increasing rates of induction have been reported in the UK, the USA, Canada and Australia since the early 1990s; however, there is a lack of population-based studies on trends and pharmacological management of induction of labour. Aims:, To determine population trends in induction of labour and predictors of failed induction (in caesarean section, specifically for failure to progress with cervix dilation ,3 cm). Methods:, Trends in induction were determined for women in NSW who laboured at , 32 weeks from 1998 to 2007 (N = 739 904). To determine the predictors of failed induction, 92 359 deliveries of live singletons for whom linked birth and hospital data were available (2001,2005) were examined using logistic regression analysis. Results:, The rate of induction increased over the decade from 25.3 to 29.1%; however, among those induced with prostaglandin alone, it decreased from 33.5 to 23.8%. Oxytocin alone was the most commonly used labour induction agent overall (51%) and in most population subgroups. The predictors of failed induction in both nullipara and multipara included increasing maternal age, pre-term and post-term birth and the use of prostaglandin or mechanical methods of induction (neither oxytocin nor prostaglandin). Conclusions:, The pharmacological agents used for induction of labour have changed over the past decade. An important area for future research is to investigate how the dosage of oxytocin and prostaglandin affects pregnancy outcomes. [source]

A Prospective Observational Study of the Effect of Etomidate on Septic Patient Mortality and Length of Stay

ACADEMIC EMERGENCY MEDICINE, Issue 1 2009
Karis L. Tekwani MD
Abstract Objectives:, Etomidate is known to cause adrenal suppression after single-bolus administration. Some studies suggest that when etomidate is used as an induction agent for intubation of septic patients in the emergency department (ED), this adrenal suppression leads to increased mortality, vasopressor requirements, and length of hospital stay. The authors sought to determine differences in the in-hospital mortality and hospital length of stay (LOS) between septic patients given etomidate and patients given alternative or no induction agents for rapid-sequence intubation in our ED. Methods:, This was a nonrandomized, prospective observational study of all patients meeting sepsis criteria who were intubated in an ED over a 9-month period. Times of patient presentation, intubation, admission, discharge, and/or death were recorded, as well as the intubation agent used, if any, and corticosteroid use. The authors also recorded relevant laboratory and demographic variables to determine severity of illness using the Mortality in Emergency Department Sepsis (MEDS) score. Mortality and survivor LOS between the patients given etomidate and those given alternative or no induction agents were compared. Results:, A total of 106 patients with sepsis were intubated over the study period. Of these, 74 patients received etomidate, while 32 patients received ketamine, benzodiazepines, propofol, or no induction agents. Age in years (median = 78; interquartile range [IQR] = 67 to 83), gender (45% male), MEDS score (median = 13; IQR = 10 to 15), and receipt of supplemental corticosteroids (56%) were statistically similar between the two groups. In-hospital mortality of patients given etomidate (38%; 95% confidence interval [CI] = 28% to 49%) was similar to those receiving alternatives (44%; 95% CI = 28% to 61%). Surviving patients had a median hospital LOS after receiving etomidate of 10 days compared to those receiving alternatives (7.5 days; p = 0.08). Conclusions:, No statistically significant increase in hospital LOS or mortality in patients given etomidate for rapid-sequence intubation was found. Suggestions that the use of etomidate for intubation in the ED be abandoned are not supported by these data. [source]

Remifentanil for INSURE in preterm infants: a pilot study for evaluation of efficacy and safety aspects

ACTA PAEDIATRICA, Issue 9 2009
L Welzing
Abstract Aim:, To evaluate intubating conditions, extubation times and outcome in preterm infants receiving remifentanil as induction agent for the INSURE procedure. Methods:, In twenty-one preterm infants of 29 to 32 weeks gestation and signs of respiratory distress, we utilized remifentanil as induction agent for the INSURE procedure. Following intubation and surfactant application, the infants were mechanically ventilated until respiratory drive was judged to be satisfactory for continuing CPAP therapy. Intubating conditions were classified by our own scoring system by rating limb movements, coughing and breathing. Heart rate, blood pressure and oxygen saturation were recorded during the entire INSURE procedure. Results:, Remifentanil provided excellent or good intubating conditions in all patients. We observed no serious side effects after remifentanil infusion, in particular, no thorax rigidity, clinically significant bradycardia or arterial hypotension. Average extubation time after surfactant administration was 16.9 min (1,45 min); none of the infants had to be reintubated. Following extubation, the infants required only 3.3 days (1,8 days) of CPAP therapy. None exhibited serious complications of prematurity like periventricular leucomalacia, intraventricular haemorrhage >I°, necrotizing enterocolitis or retinopathy. Conclusion:, In this pilot study, INSURE with remifentanil was associated with good intubating conditions and early extubation resulting in an excellent neonatal outcome. [source]

The effect of Daclizumab in a high-risk renal transplant population

CLINICAL TRANSPLANTATION, Issue 5 2000
Herwig-Ulf Meier-Kriesche
Introduction: African,American (AA) renal transplant recipients have a higher incidence of acute rejection when compared to Caucasian renal transplant recipients. This higher rejection rate holds true even with the addition of several of the newer immunosuppressive agents (e.g. mycophenolate mofetil (MMF) and Rapamycin). Acute rejection rates among Hispanic (H) renal transplant recipients are higher in some settings, while lower or the same as in Caucasians in other settings. IL-2 receptor antibodies have been shown to decrease rejection rates when added to a regimen of cyclosporine (CsA), azathioprine and prednisone. Limited data are available on these agents in conjunction with triple CsA, MMF and prednisone therapy, particularly in higher risk group patients. We studied the effect of the addition of the IL-2 receptor antibody Daclizumab to a CsA, MMF, prednisone regimen in a group of African,American and high-risk Hispanic renal transplant recipients. Methods: This was a non-randomized, prospective study. A total of 49 renal transplant recipients (29 African,American and 20 Hispanic) were studied and followed. A simultaneous cohort of 56 (31 African,American and 25 Hispanic) renal transplant recipients receiving CsA, MMF and prednisone with no standard induction agent served as the control group. The study cohort received the same regimen with the addition of Daclizumab at 1 mg/kg for five doses over 10 wk. Multivariate analysis was performed to isolate independent factors influencing the study's results. Results: A total of 56 patients in the control group and 49 patients in the Daclizumab group received an average follow-up of 17.1±6.9 and 12.7±5.1 months, respectively. Acute rejection rates were lower in the Daclizumab group as compared to the control group 26.4% versus 49.3% per patient years, respectively. A total of eight recurrent rejections in 6 patients occurred in the control group and none in the Daclizumab arm. Graft loss at this follow-up was no different between the groups. Conclusion: The addition of Daclizumab to a regimen of CsA, MMF and prednisone decreases acute rejection episodes in a high-risk group of African,American and Hispanic renal transplant recipients. [source]

Underdosing of Midazolam in Emergency Endotracheal Intubation

The electrocardiographic and hemodynamic effect of metohexital and propofol with and without esmolol

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2006
R. Korpinen
Background:, Metohexital and propofol are short-acting induction agents, which have a tendency to prolong the QTc interval of the ECG. We studied whether this increase could be prevented by combining a beta-blocking agent, esmolol, with these drugs. Simultaneously, we studied the hemodynamic effects of these combinations. Methods:, In a randomized, double-blind study, 80 ASA I,II young adults were premedicated with oxycodone and atropin and allocated to one of four groups: propofol (P), propofol + esmolol (P + E), metohexital (E) or metohexital + esmolol (M + E). The doses were 2 mg/kg propofol/metohexital and 1 mg/kg esmolol. Alfentanil 15 µg/kg was used in all groups. The hemodynamic parameters were measured non-invasively and the electrocardiographic parameters using the signal processing method. Result:, The highest QTc values, which often exceeded the normal upper limit of 440 ms, were recorded at the baseline or immediately after the administration of the induction drugs. The intervals were significantly shorter if esmolol was co-administered with either propofol or metohexital. The heart rate increased in the group M and decreased in the group P + E but remained unchanged in the groups P and M + E. Systolic and diastolic arterial pressures decreased during the study in all groups, most prominently in group P + E. Conclusions:, During the anesthesia induction, the QTc interval was significantly shorter when esmolol was co-administered with either propofol or metohexital. The hemodynamic responses were properly controlled with the combination of metohexital and esmolol as well as with propofol alone, but the combination of propofol and esmolol tended to cause hemodynamic depression. [source]

Etomidate and thiopental inhibit platelet function in patients undergoing infrainguinal vascular surgery

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2001
A. Gries
Background: Postoperative platelet hyperaggregability following general anesthesia has been reported in patients undergoing major vascular surgery. In contrast, since anesthetic agents inhibited platelet function both in vitro and in vivo, an increased risk for postoperative bleedings due to prolonged platelet dysfunction has been discussed. Nevertheless, data describing platelet-affecting properties of induction agents such as etomidate and thiopental in patients undergoing major vascular surgery are lacking. Methods: Platelet function was determined at 0, 2, 20, and 200 ,g/ml thiopental and at 0, 0.2, 2, 20 ,g/ml etomidate in vitro in blood samples drawn from 16 patients suffering from severe occlusive arterial disease. In addition, 30 patients undergoing vascular surgery were investigated before (PRE) and after anesthesia induction (T0) either with etomidate (ETO group, n=16) or thiopental (THIO group, n=14), and 2 h after the beginning of surgery (T2). Platelet function was determined according to platelet aggregation, in vitro bleeding time, and flow cytometric measurements. Results:In vitro, P-selectin expression was inhibited by etomidate at 2 and 20 ,g/ml (,28% and ,38%, respectively) and also by thiopental at 200 ,g/ml (,27%). In patients undergoing vascular surgery, anesthesia induction in the ETO group resulted in a 31% prolongation of the in vitro bleeding time and an inhibition of ADP- and collagen-induced platelet aggregation (,30% and ,17%, respectively) and of P-selectin expression (,25%) at T0. In the THIO group, only ADP-induced platelet aggregation was affected (,16%). At T2, all parameters had reached PRE level again in both groups. Furthermore, in comparison with the THIO group, operation time was significantly prolonged and transfusion volume was significantly increased in the ETO group. In addition, platelet count and hematocrit significantly decreased at T2, whereas levels of tPA, PAI-1, fibrinogen and antithrombin III and partial thromboplastin time remained unchanged in both groups during the study period. Conclusions: In the present study, etomidate and, to a minor extent, thiopental offered significant platelet inhibitory properties. Anesthetic-induced platelet inhibition may lead to higher transfusion rates and prolonged operation times. Therefore, anesthetic-related platelet inhibitory properties should be considered when searching for the anesthetic agent of choice, especially in patients with compromised hemostasis and co-existing bleeding disorders. [source]

Postoperative shivering in children and causative factors

PEDIATRIC ANESTHESIA, Issue 12 2005
AYNUR AKIN MD
Summary Background:, The aim of this study is to investigate the incidence of shivering in children and to reveal the causative factors as well as any possible clinical implications. Methods:, This study was conducted on 1507 children who underwent surgery under general anesthesia. The patients were admitted to the postanesthesia care unit after the operation and their body temperatures measured from the tympanic membrane. The type of operation, operative time, method of anesthesia induction, age, and number of cases in which caudal block had been used were recorded. Results:, Of the 1507 children, 53 (3.5%) experienced shivering. The use of intravenous induction agents, age older than 6 years, and prolonged duration of surgery were associated with shivering. The type of the operation and gender had no effect. The frequency of shivering was lower in children who underwent caudal block with a statistical significance (P < 0.05). Conclusions:, The overall incidence of shivering in children is low (3.5%). Use of intravenous induction agents, age older than 6 years, and prolonged duration of surgery were associated with shivering; prophylaxis is not necessary in children, treatment is given only when shivering occurs. [source]

Kidney and Pancreas Transplantation in the United States, 1999,2008: The Changing Face of Living Donation

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 4p2 2010
D. A. Axelrod
The waiting list for kidney transplantation continued to grow between 1999 and 2008, from 41 177 to 76 089 candidates. However, active candidates represented the minority of this increase (36 951,50 624, a 37% change), while inactive candidates increased over 500% (4226,25 465). There were 5966 living donor (LD) and 10 551 deceased donor (DD) kidney transplants performed in 2008. The total number of pancreas transplants peaked at 1484 in 2004 and has declined to 1273. Although the number of LD transplants increased by 26% from 1999 to 2008, the total number peaked in 2004 at 6647 before declining 10% by 2008. The rate of LD transplantation continues to vary significantly as a function of demographic and geographic factors, including waiting time for DD transplant. Posttransplant survival remains excellent, and there appears to be greater use of induction agents and reduced use of corticosteroids in LD recipients. Significant changes occurred in the pediatric population, with a dramatic reduction in the use of LD organs after passage of the Share 35 rule. Many strategies have been adopted to reverse the decline in LD transplant rates for all age groups, including expansion of kidney paired donation, adoption of laparoscopic donor nephrectomy and use of incompatible LD. [source]