• Title/Summary/Keyword: Bolus

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Continuous Intravenous Infusion of Morphine and Ketorolac for Postoperative Pain (Morphine과 Ketorolac의 지속적 정주에 의한 술후 통증 완화 효과)

  • Lee, Yong-Tae;Kim, Dong-Chan;Han, Young-Jin;Choe, Huhn
    • The Korean Journal of Pain
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    • v.6 no.1
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    • pp.32-39
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    • 1993
  • Despite their sometimes fatal complications such as respiratory depression when used for postoperative pain control, intravenous and epidural narcotics remain the mainstay of treatment regimens. Because of the problems, anesthesiologists are seeking alternatives. We compared the analgesic effect and complications of continuous intravenous morphine with ketorolac. Ketorolac is a non-steroidal agent with potent analgesics and moderate anti-inflammatory activity. Forty ASA physical status I or II patients were given morphine(20 patients) or ketorolac(20 patients):In the morphine group, an initial bolus dose of 2 mg i.v. was given followed by continuous infusion at a rate of 1 mg/hr for 48 hours. The ketorolac group was given initial bolus of 30 mg i.v. This was followed by continuous infusion at a rate of 3.75 mg/hr for 48 hours using a Baxter Daymate Infuser. We checked systolic, diastolic and mean arterial pressure, heart rate, visual analogue scale(VAS) and the Prince Henry Score(PHS). This was done before the initial bolus, at 5, 15, 30 and 60 min, at 2, 6, 12, 24 and 48 hours after administration. We observed the side effects nausea and vomiting, pruritus, hypotension, somnolence, urinary retention and respiratory depression. From our study we believe ketorolac in selected patients, is as effective as morphine in alleviating postoperative pain without side effects of morphine.

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A Comparison of Patient-Controlled Analgesia and Conventional Intramuscular Opioid Regimen in Relation to their Post-Operative Pain Control and Side Effects (수술후 통증 관리의 Patient-Controlled Analgesia와 마약류의 전통적인 근육내 주사와의 비교)

  • Lee, Sang-Hun;Lee, Jin-Kyung;Lee, Kyn-Chang;Woo, Nam-Sik;Lee, Ye-Chul
    • The Korean Journal of Pain
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    • v.6 no.1
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    • pp.55-59
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    • 1993
  • Using a visual analogue scale, we compare the effect of patient-controlled analgesia and conventional intramuscular opioid regimen in 68 patients undergoing lower abdominal or gynecological surgery. We also recorded the incidence of side effects. We checked visual analogue scale 4 hours interval for 30 cases managed by patient-controlled analgesia and 38 cases of conventional intramuscular opioid group managed by obstetrician. We maintained fentanyl $0.33{\mu}g/kg/hr$ and set self administrable bolus dose $5.0{\mu}g$(lockout interval: 15 min) in patient-controlled analgesia group. Conventional intramuscular bolus injection group were administered meperidine 50 mg for 4 hour interval. Mean visual analogue scale scores obtained by patient-controlled analgesia group and intramuscular bolus injection group were $2.49{\pm}0.67$ and $4.53{\pm}1.28$(p<0.05). Side effects such as; no significant incidence of respiratory depression, urinary retention, postural hypotension, nausea, vomiting and pruritus were developed by either group. These results suggest that patient-controlled analgesia was more effective method compared with conventional intraumuscular opioid injection regimen for post-operative pain management.

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Evaluation of Thrombolytic Effect of Streptokinase-Dextran Conjugate in a Rat Model of Arterial Thrombosis (흰쥐의 대퇴동맥 혈전 모델에서의 스트렙토키나제-덱스트란 포합체의 혈전용해효과의 평가)

  • Kim, Yang-Woo;Kim, Dong-Chool
    • Journal of Pharmaceutical Investigation
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    • v.29 no.3
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    • pp.211-216
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    • 1999
  • To evaluate the thrombolytic activity of streptokinase-dextran conjugate, a rat model of arterial thrombosis was used. Briefly, the femoral artery was exposed and a filter paper saturated with 70% $FeCl_3$ solution was placed around the femoral artery in order to stop the blood flow. Six minutes after the stop of the blood flow in the femoral artery, streptokinase $(10000{\sim}30000\;units\;per\;rat)$ or streptokinase-dextran conjugate $(5000{\sim}17000\;units\;per\;rat)$ was administered by i.v. bolus injection through the femoral vein. Then the blood flow in the femoral artery was monitored using a Doppler laser flow meter. The i.v. bolus administration of streptokinase could not restore the blood flow in the femoral artery in the dose range of $10000{\sim}30000$ units per rat. The i.v. bolus administration of streptokinase-dextran conjugate could restore the blood flow in the femoral artery in the dose range of $5000{\sim}17000$ units per rat. A good correlation between the dose of streptokinase-dextran conjugate and the total thrombolytic effect was observed. In addition, the lag time between the injection of streptokinase-dextran conjugate and the restoring of the blood flow was decreased as the i.v. dose of streptokinase dextran conjugate increased. These results show the superior beneficial effect of streptokinase-dextran conjugate compared with the unconjugated streptokinase with respect to the elongation of thrombolytic activity, the administration method (single injection versus continuous infusion), and the reduced dose necessary for a equivalent thrombolytic effect.

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Development and Validation of Generalized Linear Regression Models to Predict Vessel Enhancement on Coronary CT Angiography

  • Masuda, Takanori;Nakaura, Takeshi;Funama, Yoshinori;Sato, Tomoyasu;Higaki, Toru;Kiguchi, Masao;Matsumoto, Yoriaki;Yamashita, Yukari;Imada, Naoyuki;Awai, Kazuo
    • Korean Journal of Radiology
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    • v.19 no.6
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    • pp.1021-1030
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    • 2018
  • Objective: We evaluated the effect of various patient characteristics and time-density curve (TDC)-factors on the test bolus-affected vessel enhancement on coronary computed tomography angiography (CCTA). We also assessed the value of generalized linear regression models (GLMs) for predicting enhancement on CCTA. Materials and Methods: We performed univariate and multivariate regression analysis to evaluate the effect of patient characteristics and to compare contrast enhancement per gram of iodine on test bolus (${\Delta}HUTEST$) and CCTA (${\Delta}HUCCTA$). We developed GLMs to predict ${\Delta}HUCCTA$. GLMs including independent variables were validated with 6-fold cross-validation using the correlation coefficient and Bland-Altman analysis. Results: In multivariate analysis, only total body weight (TBW) and ${\Delta}HUTEST$ maintained their independent predictive value (p < 0.001). In validation analysis, the highest correlation coefficient between ${\Delta}HUCCTA$ and the prediction values was seen in the GLM (r = 0.75), followed by TDC (r = 0.69) and TBW (r = 0.62). The lowest Bland-Altman limit of agreement was observed with GLM-3 (mean difference, $-0.0{\pm}5.1$ Hounsfield units/grams of iodine [HU/gI]; 95% confidence interval [CI], -10.1, 10.1), followed by ${\Delta}HUCCTA$ ($-0.0{\pm}5.9HU/gI$; 95% CI, -11.9, 11.9) and TBW ($1.1{\pm}6.2HU/gI$; 95% CI, -11.2, 13.4). Conclusion: We demonstrated that the patient's TBW and ${\Delta}HUTEST$ significantly affected contrast enhancement on CCTA images and that the combined use of clinical information and test bolus results is useful for predicting aortic enhancement.

Performance evaluation study of a commercially available smart patient-controlled analgesia pump with the microbalance method and an infusion analyzer

  • Park, Jinsoo;Jung, Bongsu
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.22 no.2
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    • pp.129-143
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    • 2022
  • Background: Patient-controlled analgesia (PCA) has been widely used as an effective medical treatment for pain and for postoperative analgesia. However, improper dose errors in intravenous (IV) administration of narcotic analgesics from a PCA infusion pump can cause patient harm. Furthermore, opioid overdose is considered one of the highest risk factors for patients receiving pain medications. Therefore, accurate delivery of opioid analgesics is a critical function of PCA infusion pumps. Methods: We designed a microbalance method that consisted of a closed acrylic chamber containing a layer and an oil layer with an electronic balance. A commercially available infusion analyzer (IDA-5, Fluke Co., Everett, WA, USA) was used to measure the accuracy of the infusion flow rate from a commercially available smart PCA infusion pump (PS-1000, UNIMEDICS, Co., Ltd., Seoul, Korea) and compared with the results of the microbalance method. We evaluated the uncertainty of the flow rate measurement using the ISO guide (GUM:1995 part3). The battery life, delay time of the occlusion alarm, and bolus function of the PCA pump were also tested. Results: The microbalance method was good in the short-term 2 h measurement, and IDA-5 was good in the long-term 24 h measurement. The two measurement systems can complement each other in the case of the measurement time. Regarding battery performance, PS-1000 lasted approximately 5 days in a 1 ml/hr flow rate condition without recharging the battery. The occlusion pressure alarm delays of PS-1000 satisfied the conventional alarm threshold of occlusion pressure (300-800 mmHg). Average accuracy bolus volume was measured as 63%, 95%, and 98.5% with 0.1 ml, 1 ml, and 2 ml bolus volume presets, respectively. A 1 ml/hr flow rate measurement was evaluated as 2.08% of expanded uncertainty, with a 95% confidence level. Conclusion: PS-1000 showed a flow accuracy to be within the infusion pump standard, which is ± 5% of flow accuracy. Occlusion alarm of PS-1000 was quickly transmitted, resulting in better safety for patients receiving IV infusion of opioids. PS-1000 is sufficient for a portable smart PCA infusion pump.

Bolus Effect to Reduce Skin Dose of the Contralateral Breast During Breast Cancer Radiation Therapy (유방암 방사선치료 시 반대편 유방의 피부선량 감소를 위한 볼루스 효과)

  • Won, Young Jin;Kim, Jong Won;Kim, Jung Hoon
    • Journal of radiological science and technology
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    • v.40 no.2
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    • pp.289-295
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    • 2017
  • The aim of this study was to evaluate the dose comparison using Radon phantom with 5 mm and 10 mm tissue equivalent materials, FIF, Wedge(15, 30 angle) and IMRT, to reduce the skin dose of the contralateral breast during breast cancer radiation therapy(Total dose: 50.4Gy). The dose was measured for each treatment plan by attaching to the 8 point of the contralateral breast of the treated region using a optical-stimulated luminance dosimeter(OSLD) as a comparative dose evaluation method. Of the OSLD used in the study, 10 were used with reproducibility within 3%. As a result, the average reduction rates of 5 mm and 10 mm in the FIF treatment plan were 37.23 cGy and 41.77 cGy, respectively, and the average reduction rates in the treatment plan using Wedge $15^{\circ}$ were 70.69 cGy and 87.57 cGy, respectively. The IMRT showed a reduction of 67.37 cGy and 83.17 cGy, respectively. The results of using bolus showed that as the thickness of the bolus increased in all treatments, the dose reduction increased. We concluded that mastectomy as well as general radiotherapy for breast cancer would be very effective for patients who are more likely to be exposed to scattered radiation due to a more demanding or complex treatment plan.

Impact of Respiratory Motion on Breast Cancer Intensity-modulated Radiation Therapy (유방암 세기조절방사선치료에서의 호흡운동 영향)

  • Chung, Weon Kuu;Chung, Mijoo;Shin, Dong Oh;Kim, Dong Wook
    • Progress in Medical Physics
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    • v.27 no.2
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    • pp.93-97
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    • 2016
  • In this study, we evaluate the effect of respiration on the dose distribution in patient target volume (PTV) during intensity-modulated radiation therapy (IMRT) and research methods to reduce this impact. The dose distributions, homogeneity index (HI), coverage index (CVI), and conformity index of the PTV, which is calculated from the dose-volume histogram (DVH), are compared between the maximum intensity projection (MIP) image-based plan and other images at respiration phases of 30%, 60% and 90%. In addition, the reducing effect of complication caused by patient respiration is estimated in the case of a bolus and the expended PTV on the skin. The HI is increased by approximately twice, and the CVI is relatively decreased without the bolus at other respiration phases. With the bolus and expended PTV, the change in the dose distribution of the PTV is relatively small with patient respiration. Therefore, the usage of the bolus and expended PTV can be considered as one of the methods to improve the accuracy of IMRT in the treatment of breast cancer patients with respiratory motion.

Analysis of Changes in Skin Dose During Weight Loss when Tomotherapyof Nasopharynx Cancer (비인두암 토모테라피 시 체중 감소에 따른 피부선량 변화 분석)

  • Jang, Joon-Young;Kim, Dae Hyun;Choi, Cheon Woong;Kim, Bo-Hui;Park, Cheol-Soo
    • Journal of the Korean Magnetics Society
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    • v.26 no.3
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    • pp.99-104
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    • 2016
  • For patients receiving chemotherapy and radiation therapy treatment progresses as vomiting, nausea, weight of the patient because of a loss of appetite it is reduced. The patient's weight and the distance from the skin and the treatment site is expected to be closer, thereby reducing the change in the skin because of this dose. This study tests using a loose see the difference between the volume change appears as the weight of the patient using the same phantom and the phantom body of the patient. To using the same as the position EBT film is attached to the skin of the treatment site and was adjusted to the thickness of the Bolus. And using a computerized treatment planning only tomotherapy equipment was passed under the conditions according to the thickness of the radiation dose. To baseline for accurate reproduction position using the MVCT was applied to treated with verification. By passing a total of three dose reduced the error, it was a measure of the film by using a dedicated scanner, EBT VIDAR scanner. Got an increase in the skin dose is displayed each time the thickness of the bolus reduced, in a bolus was completely removed with the highest value. If the changes appeared dose was greater weight loss patients to chemotherapy and therefore bolus thickness variation considering the weight loss of the patient when applying the tomotherapy of nasopharynx cancer was found that the increase in skin dose be increased. This large patient before treatment due to weight loss over the image verification is considered to be established should consider how to re-create your mask and treatment plan for fixing it.

HPLC Analysis and Pharmacokinetics of KAL-1120, a Novel Anti-inflammation Agent, in Rats (흰쥐에서 항염증제 후보물질 KAL-1120의 HPLC 분석 및 약물동태)

  • Shin, Dae-Hwan;Lee, Jung-Yeol;Park, Seong-Hyeok;Lee, Gyeong-Bok;Han, Kun;Chung, Youn-Bok
    • Journal of Pharmaceutical Investigation
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    • v.40 no.2
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    • pp.101-107
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    • 2010
  • A rapid and sensitive reversed-phase high performance liquid chromatography (HPLC) method was developed for the determination of N-(-4-Chlorophenyl)-6-hydroxy-7-methoxy-2-chromanecarboxamide (KAL-1120), a novel anti-inflammation agent, in the rat plasma. The method was applied to analyze the compound in the biological fluids such as bile, urine and tissue homogenates. After liquid-liquid extraction, the compound was analyzed on an HPLC system with ultraviolet detection at 275 nm. HPLC was carried out using reversed-phase isocratic elution with a $C_{18}$ column, a mobile phase of a mixture of acetonitril (40 v/v%) at a flow rate of 1.0 mL/min. The chromatograms showed good resolution and sensitivity and no interference of plasma. The calibration curve for the drug in plasma was linear over the concentration range of 0.05-50 ${\mu}g$/mL. The intra- and inter-day assay accuracies of this method ranged from 0.06% to 9.33% of normal values and the precision did not exceed 6.28% of relative standard deviation. The plasma concentration of KAL-1120 decreased to below the quantifiable limit at 1.5 hr after the i.v. bolus administration of 2-10 mg/kg to rats ($t_{1/2,({\alpha})}$ and $t_{1/2,({\beta})$ of 2.15 and 26.7 min at a dose of 2 mg/kg, 3.91 and 33.0 min at a dose of 10 mg/kg, respectively). The steady-state volume of distribution ($V_{dss}$) and the total body clearance ($CL_t$) were not significantly altered in rats given doses from 2 to 10 mg/kg. Of the various tissues tested, KAL-1120 was mainly distributed in the lung and heart after i.v. bolus administration. KAL-1120 was detected in the bile by 30 min after its i.v. bolus administration. However, the concentration in the urine after i.v. bolus administration became too low to measure, suggesting that KAL-1120 is mostly excreted in the bile. In conclusion, this analytical method was suitable for the preclinical pharmacokinetic studies of KAL-1120 in rats.

Study on the Rumination Behaviour in Spotted Deer (Cervus nippon) Equipped with EMG Telemetry System (EMG Telemetry System을 이용한 꽃사슴의 반추행동에 관한 연구)

  • Jeon, B.T.;Moon, S.H.
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.22 no.3
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    • pp.161-168
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    • 2002
  • A behavioral investigation in deer equipped with EMG telemetry system was carried out to examine the chewing behavior pattern for efficient feeding management of Korean spotted deer(Cervus nippon). There was more frequent and irregular eating and rumination behavior pattern in deer than those in other ruminants. Time spent on eating and ruminating was 261 and 291 min., respectively. Total number of boli regurgitated was 647 times per a day and deer regurgitated an average boil of 21.6 times per a rumination period. Total rumination time was 291 min. and deer have an average rumination time of 26.9 sec. per a boli. Deer had 245.3 min. for total chewing time, 20,405 times fur number of chews, 31.5 times for number of chews per bolus, and 53.4 times for number of chews per minute during rumination period. An average regurgitation bolus an hour was lower with 15.3 numbers in the 09∼15 hours subperiod and higher with 26 numbers in the 15∼21 hours subperiod and it had been gradually trended to become to low after 15∼21 hours subperiod. An average numbers of chews a bolus at every 6 hours subperiod increased gradually according to time. A deer spent 23.3 min. on eating and 26.2 min. on ruminating per 100g ingested dry matter. Consequently, since deer have a different chewing behavioral pattern to other ruminants such as more frequent and irregular eating and ruminating patterns, small bolus and low number of chew, it is likely to needed to establishment and development efficient feeding system for deer.