Pharm World Sci
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Various local anesthetics as in lidocaine ointment, amethocaine cream and EMLA cream are used topically for minor invasive interventions, such as venipuncture, both in children and adults. Since neonates have a nervous system that, albeit immature, enables them to feel pain, analgesia for these procedures is also indicated. Several studies in neonates have been carried out to establish effectiveness and safety of topically applied local anesthetics. These studies are reviewed in order to assess effectiveness and safety. ⋯ The articles reviewed are non conclusive in their results of effective analgesia. Due to a lipophilic base form and a hydrophilic matrix EMLA cream is most effective. An application time of 30 minutes is recommended. In spite of the present precautions due to fear of methemoglobinemia, use of EMLA cream proved to be safe when used once a day. Since the clinical situation often requires more than one application a day, more research is needed to establish a safe and effective local anesthetic which can be applied topically several times a day in the neonate.
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In this article arguments are given to stop the current practise of infusing albumin in patients in shock and low levels of serum albumin. Correcting the albumin levels is not correlated with better survival or change in morbidity. Fluid therapy including the use of synthetic plasma expanders is the accepted therapy for patients in sceptic shock.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the effects and disposition kinetics of articaine and lidocaine in 20 patients undergoing intravenous regional anaesthesia during day case surgery.
The aim of this investigation was to assess the effects and disposition kinetics of the local anaesthetic drugs (+/-) articaine and lidocaine during intravenous regional anaesthesia (IVRA). The mean onset time of surgical analgesia of articaine was 2.5 +/- 1.1 min and that of lidocaine 11.2 +/- 5.1 min (p = 0.0006). None of the patients exhibited objective symptoms of toxicity, either local or systemic, during injection of articaine or lidocaine, nor were there any subjective complaints. ⋯ After releasing the tourniquet, articaine is eliminated with a t1/2 beta of 60 min and lidocaine with a t1/2 beta of 80 min. Quicker onset and shorter elimination time favours (+/-) articaine over lidocaine for IVRA in day case settings so that patients treated with articaine will be 'drug free' more quickly than those who receive lidocaine. Faster elimination and more rapid onset are important advantages for articaine in IVRA for day-case procedures.
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The pharmacodynamic and pharmacokinetic characteristics of the non-depolarizing muscle relaxants are dependent on age. Thus differences are found between paediatric patients, adults, and elderly patients. ⋯ Prolonged effects and problems in wearing patients from the ventilator are observed when muscle relaxants are used in such patients. Critical illness neuropathy is a syndrome different from relaxant induced neuromyopathy, but may be enhanced by relaxant administration.
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Continuous infusion is an attractive method of administration when muscle relaxation is needed for a longer period. The pharmacokinetic behaviour of a drug is an important determining factor for the suitability of relaxants for continuous infusion. At present mainly intermediately long acting relaxants are used for this purpose. ⋯ The evoked response can be quantitated with mechanomyography, electromyography, or accelerography. The response of the various muscles to nerve stimulation varies due to the different characteristics of the muscles. Clinically, the use of the adductor pollicis muscle is advised.