Anesthesiology
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The investigational etomidate analog ABP-700 causes involuntary muscle movements in humans at anesthetic doses and seizures in dogs at 10-fold higher toxicologic dosesThe mechanism of seizures in dogs, and their relationship to involuntary muscle movements in humans, is unknown WHAT THIS ARTICLE TELLS US THAT IS NEW: Toxicologic studies in dogs using supratherapeutic ABP-700 doses caused involuntary muscle movements and seizures, but these were temporally and electroencephalographically distinct, suggesting different underlying mechanismsEvents occurred at ABP-700 and metabolite concentrations one and two orders of magnitude higher, respectively, than those found in humansElectrophysiologic studies of the principal metabolite of ABP-700 in oocyte-expressed γ-aminobutyric acid type A receptors showed inhibition at the high supratherapeutic concentrations achieved in the dogs, and such inhibition may explain seizure activityProepileptiform effects of ABP-700 in dogs may not be relevant to humans at therapeutic doses BACKGROUND:: The etomidate analog ABP-700 produces involuntary muscle movements that could be manifestations of seizures. To define the relationship (if any) between involuntary muscle movements and seizures, electroencephalographic studies were performed in Beagle dogs receiving supra-therapeutic (~10× clinical) ABP-700 doses. γ-aminobutyric acid type A (GABAA) and glycine receptor studies were undertaken to test receptor inhibition as the potential mechanism for ABP-700 seizures. ⋯ High dose ABP-700 infusions produce involuntary muscle movements and seizures in Beagle dogs via distinct mechanisms. CPM-acid inhibits both GABAA and glycine receptors at the high (~100× clinical) plasma concentrations achieved during the dog studies, providing a plausible mechanism for the seizures.
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Health care-acquired hepatitis C virus infection continues to occurCurrent guidelines caution against using multidose vials for more than one patient unless the vials are kept in a location away from the patient treatment areaIt is possible that in some circumstances these guidelines are not always followed WHAT THIS ARTICLE TELLS US THAT IS NEW: When a medication vial diaphragm is contaminated with hepatitis C virus, the contents of the vial can become contaminated with subsequent access with a clean syringe, and the viral content is sufficient to infect cells in cultureHepatitis C virus remains infectious in contaminated medications for several daysCleaning the vial surface with 70% isopropyl alcohol does not eliminate the risk of vial contamination with hepatitis C virus BACKGROUND:: Health care-associated hepatitis C virus outbreaks from contaminated medication vials continue to be reported even though most practitioners deny reusing needles or syringes. The hypothesis was that when caring for hepatitis C virus-infected patients, healthcare providers may inadvertently contaminate the medication vial diaphragm and that subsequent access with sterile needles and syringes can transfer hepatitis C virus into the medication, where it remains stable in sufficient quantities to infect subsequent patients. ⋯ Hepatitis C virus can be transferred into commonly used medications when using sterile single-use needles and syringes where it remains viable for several days. Furthermore, cleaning the vial diaphragm with 70% isopropyl alcohol is not sufficient to eliminate the risk of hepatitis C virus infectivity. This highlights the potential risks associated with sharing medications between patients.