• 제목/요약/키워드: intravenous

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Is aggressive intravenous fluid prescription the answer to reduce mortality in severe pancreatitis? The FLIP study: Fluid resuscitation in pancreatitis

  • Julia McGovern;Samuel J Tingle;Northern Surgical Trainees Research Association (NOSTRA);Stuart Robinson;John Moir
    • 한국간담췌외과학회지
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    • 제27권4호
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    • pp.394-402
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    • 2023
  • Backgrounds/Aims: Acute pancreatitis is an emergency presentation, which can range from mild to life threatening. Intravenous fluids are the cornerstone of management. Although the WATERFALL trial described the optimal fluid rate in mild/moderate pancreatitis, this trial excluded patients with moderate-severe/severe pancreatitis. The aim of this study was to establish clinical practice regarding intravenous fluid administration in acute pancreatitis and assess its effect on mortality. Methods: Prospective multi-centre audit of patients with acute pancreatitis was conducted. Data were collected regarding intravenous fluid administration within 72 hours of admission. The primary outcome was 30-day mortality. Multivariable logistic regression was used to identify predictors of 30-day mortality. Results: Those with severe pancreatitis received more fluid; median 5.7 L versus 4 L in 72 hours (p = 0.003). Participants with severe pancreatitis who died within 30 days received a median of 2,750 mL in the first 24 hours, compared to 4,000 mL in those who survived. The following factors were significant predictors of 30-day mortality: age, Glasgow score, C-reactive protein, ischaemic heart disease, and pancreatitis aetiology. Overall, volume of intravenous fluid was not associated with mortality. However, the effect of intravenous fluid volume on mortality differed significantly depending on pancreatitis severity. In severe pancreatitis, increased volume of intravenous fluid was associated with significant reductions in mortality (odds ratio = 0.655; 0.459-0.936; p = 0.020). Conclusions: In severe pancreatitis, more aggressive fluid prescription was associated with decreased mortality; however, this was not the case in milder disease. Further prospective trials guiding fluid resuscitation in severe pancreatitis are needed, as the impact of fluid on this population appears to differ from that in those with milder disease.

Clinical Observation on Recombinant Human Endostatin Combined with Chemotherapy for Advanced Gastrointestinal Cancer

  • Gao, Shao-Rong;Li, Lu-Ming;Xia, Hai-Ping;Wang, Guang-Ming;Xu, Hong-Yan;Wang, Ai-Rong
    • Asian Pacific Journal of Cancer Prevention
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    • 제16권9호
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    • pp.4037-4040
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    • 2015
  • Objective: To explore the clinical efficacy and toxic and side effects of recombinant human endostatin (rhendostatin/endostar) combined with chemotherapy in the treatment of advanced gastric cancer. Materials and Methods: A total of 70 patients with advanced gastrointestinal adenocarcioma confirmed by histopathology and/or cytological examination were divided into group A (37 patients) and group B (33 patients). Patients in group A were given intravenous drip of 15 mg endostar added into 500 mL normal saline, once every other day until the cessation of chemotherapy or patients' maximal tolerance to chemotherapy. Patients in group B received chemotherapy alone. Two groups selected the same chemotherapy regimens. FOLFIRI scheme: 90-min intravenous drip of $180mg/m^2$ irinotecan, intravenous drip of $200mg/m^2$ calcium folinate (CF) and $400mg/m^2$ 5-fluorouracil (5-Fu) on d1, and continuous intravenous pumping of 2 $400mg/m^2$ 5-Fu for 46 h. FOLFOX4 scheme: intravenous injection of $85mg/m^2$ oxaliplatin (L-OHP), $200mg/m^2$ calcium folinate (CF) and $400mg/m^2$ 5-FU on d1 for 2 h, and then continuous intravenous pumping of 2 $400mg/m^2$ 5-Fu for 46 h. XELOX scheme: oral administration of 1 $500mg/m^2$ xeloda (or tegafur 50~60 mg) in twice during d1~14 and intravenous drip of $135mg/m^2$ L-OHP on d1 for 2 h. The modified FOLFOX scheme: intravenous injection of $135mg/m^2$ L-OHP on d1 for 2 h, $200mg/m^2$ CF and 1.0 g tegafur during d1~5. Whereas, control Group B received chemotherapy regimens which were same as Group A, but no addition of endostar. Before chemotherapy, patients were given intravenous injection of 8 mg ondansetron, intramuscular injection of 10 mg metoclopramide and 20 mg diphenhydramine for prevention of vomiting, protection of liver and stomach as well as symptomatic supportive treatment. One cycle was 21 d, 4~6 cycles in total. The efficacy was evaluated every 2 cycles. Results: 32 patients in Group A could be evaluated, and the response rate (RR) and disease control rate (DCR) were 59.38% and 78.13%, respectively. 31 patients in Groups could be evaluated, and the RR and DCR were 32.26% and 54.84%, respectively. The differences between 2 groups were significant. The toxic effects include myelosuppression, gastrointestinal reaction, fatigue, cardiotoxicity and peripheral neurotoxicity. Conclusions: Preliminary observations show that endostar (once every other day) combined with chemotherapy is effective in the treatment of advanced gastrointestinal cancer, with low toxic effects, good tolerance, deserving further study.

가토(家兎)에서 Norepinephrine, Phenylephrine 및 Clonidine의 승압반응(昇壓反應)에 대한 Diltiazem의 영향(影響) (Effects of Diltiazem on Norepinephrine-, Phenylephrine- and Clonidine-induced Pressor Response in Rabbits)

  • 신동호;최수형
    • 대한수의학회지
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    • 제28권1호
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    • pp.23-28
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    • 1988
  • To examine the selectivity of diltiazem, used in the cardiovascular diseases, on alpha-1 and alpha-2 adrenoceptor-induced pressor responses, effect of diltiazem on alpha-adrenocepter agonist-induced pressor responses were investigated in urethane-anesthetized rabbits and spinal rabbits. The results are summarized as follows: 1. Intravenous diltiazem(10, 30, 100, 300, $1000{\mu}g/kg$) produced dose-dependent depressor response in rabbits. 2. Pressor responses to intravenous norepinephrine($10{\mu}g/kg$) and phenylephrine ($30{\mu}g/kg$) were inhibited by pretreatment with intravenous diltiazem in rabbits and no difference was noted between the degree of both inhibitions of the pressor response by diltiazem. 3. Presser responses to intravenous norepinephrine ($3{\mu}g/kg$), phenylephrine ($20{\mu}g/kg$) and clonidine ($300{\mu}g/kg$) were inhibited by pretreatment with intravenous diltiazem in spinal rabbits. No difference was noted between the inhibition of norepinephrine-induced pressor response and that of phenylephrine-induced pressor response by diltiazem. The inhibition of clonidine-induced pressor response by diltiazem was slightly prominent than that of norepinephrine- or phenylephrine-induced pressor response. These results suggest that diltiazem significantly inhibits both pressor responses mediated by alpha-1 and alpha-2 adrenoceptors.

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Midazolam을 이용한 정주진정요법 (INTRAVENOUS SEDATION WITH MIDAZOLAM)

  • 이준석;김종수;김승오
    • 대한장애인치과학회지
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    • 제2권2호
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    • pp.142-146
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    • 2006
  • 환아의 연령, 과다체중, 환아의 약물 거부 등으로 인하여 chloral hydrate를 이용한 수면치료가 불가능한 경우, Midazolam을 이용한 정주진정요법이 전신마취를 대신하는 대안으로 사용될 수 있다. 본 환아의 경우, 0.3mg/kg의 midazolam을 근주하고, 70% 아산화질소 가스를 이용하여 초기 수면상태를 유도하고 정맥천자를 실시한 후, 0.2mg/kg midazolam을 정주하여 50분간 별다른 부작용 없이 성공적으로 치료할 수 있었다.

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원광대학교 대전치과병원 소아치과 환자에서의 정주 진정법 (Intravenous Sedation for Patients of Pediatric Dentistry in Wonkwang University Daejeon Dental Hospital)

  • 김윤희;김민수;오세리
    • 대한치과마취과학회지
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    • 제12권1호
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    • pp.11-16
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    • 2012
  • Background: The purpose of this study was to evaluate the safety and effectiveness of intravenous ketamine-midazolam sedation in uncooperative children and disabled people undergoing dental procedures. Methods: From September 2009 to January 2012, total 114 intravenous deep sedation were carried out using midazolam and ketamine at pediatric dentistry in Wonkwang University Daejeon Dental Hospital. Patients' dental charts and sedation records were retrospectively reviewed. Results: 103 cases were enrolled, divided into four groups. There were 22 children under five in group 1, 14 children over six years with severe anxiety in group 2, 34 disabled person in group 3 and 33 children over six years with surgical procedure in group 4. Carries treatment (56 cases) was the most common dental treatment. The highest ketamine usage was 4.15 mg/kg, the longest duration of dental treatment was 41.6 minutes in children under five group. Nausea and vomiting (16 cases) was the most common side effect. Conclusions: Intravenous ketamine-midazolam sedation appears safe and effective for uncooperative children and disabled person undergoing dental procedures. But, emesis is a common side effect of ketamine occurring with increasing age.

제왕절개술후 통증치료로 지속적 정주방법과 고식적 근주방법의 비교 (A Comparison of Continuous Intravenous Infusion and Traditional Intramuscular Injection for Postoperative Pain following Cesarean Section)

  • 조영례
    • The Korean Journal of Pain
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    • 제9권2호
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    • pp.374-379
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    • 1996
  • Background: Recently, improvements in drug administration technology have intensified interest in the treatment of postoperative pain. this has resulted in increased use of continuous intravenous infusion of opioid and epidural opioid as alternative to traditional intramuscular administration of opioid. The goal of this study, therefore, was to document the effects of pain control and side effects following continuous intravenous infusion of morphine or meperidine and intramuscular meperidine following cesarean section. Methods: The vital signs, pain score, oxygen saturation and side effects were compared in 150 patients receiving continuous intravenous infusion of morphine, 30 ${\mu}g/kg/hr$ (n=50, group 1); continuous intravenous infusion of meperidine, 150 ${\mu}g/kg/hr$ (n=50, group 2); or intramuscular meperidine, 50mg/every 6hrs (n=50, group 3). Results: VAS (Visual Analogue Scale) was significantly decreased after 30 minutes of administration in all three groups and was significantly lower at 1 hour, but higher at 6 hours in group 3 than two other groups. Severe desaturation episode, defined as $SpO_2$<90%, occurred in the group 3(0.2%). Moderate desaturation episodes, defined as $SpO_2$ 91~95%, occurred more in group 3 than in group 1 and 2 (17.4% vs. 10.4%, 8.2%). The incidence of side effects were similar among three groups. Conclusion: The continuous infusion of opioid was more effective and safe method of postoperative pain control than traditional intramuscular injection.

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소아 서혜부 탈장 환자에서 절개부위 국소침윤과 Ketorolac의 진통효과 (Effects of Intravenous Ketorolac and Wound Infiltration for Postoperative Pain after Inguinal Herniorrhaphy in Pediatric Surgery)

  • 채호승;신옥영;이두익
    • The Korean Journal of Pain
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    • 제13권2호
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    • pp.213-217
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    • 2000
  • Background: This study was conducted to evaluate and compare the effectiveness of intravenous ketorolac and wound infiltration in producing postherniorrhaphy analgesia in pediatric surgery. Methods: Forty consenting healthy children, aged 3~7 yr, were randomly assigned to receive intravenous ketorolac (1 mg/kg) or wound infiltration (0.25% bupivacaine 0.3 ml/kg) before closure of the surgical wound after inguinal herniorrhaphy. Pain was evaluated by using an observer pain score at 30 min, 60 min and 4 hrs intervals, postoperatively. Results: It is statistically significant that the wound infiltration group had lesser pain than the ketorolac group at 30 min and 60 min. But there is no difference between the groups at 4 hrs, postoperatively. Conclusions: We concluded that wound infiltration may provide better analgesia compared to intravenous ketorolac for up to 4 hours postoperative for treatment of pain after inguinal herniorrhaphy in pediatric surgery.

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黃芩芍藥湯 煎湯液이 血漿Cortisol 및 鎭痛에 미치는 影響 (Effects of Hwang Keum Jag Yag Tang Water Extract on the Plasma Cortisol Concentration and in the Rabbit and on the Analgesic Effect in the Mouse)

  • 오춘근;황충연;이기남
    • 한방안이비인후피부과학회지
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    • 제3권1호
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    • pp.41-57
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    • 1990
  • In order to investigate the effects of Hwang Keum Jag Yag Tang (HJT) water extract on the plasma cortisol concentration in the rabbit and on the analgesic effect in the mouse were administered. The results were summarized as follow: 1. Intravenous administration of HJT water extract at the dose of 0.2ml/kg remarkably increased plasma cortisol concentration after two hour. 2. Intravenous administration of HJT water extract at the dose of 0.4ml/kg significantly increased plasma cortisol concentration after one hour. 3. Intravenous administration of HJT water extract at the dose of 0.2ml/kg, all the experimental period, significantly increased plasma sodium concentration. 4. Intravenous administration of HJT water extract at the dose of 0.4m1/kg significantly decreased plasma potassium concentration. 5. Intravenous administration of HJT water extract at the dose of 0.2ml/kg and 0.4ml/kg, all the experimental period, significantly decreased plasma calcium concentration. 6. The analgesic effect of HJT water extract showed inhibitory effect more than at 0.1ml/20g. According to the results, Hwang Keum Jag Yag Tang water extract remarkably increased plasma cortisol concentration and showed analgesic effect.

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A Case of Successful Recovery from High Dose Intravenous Nicorandil Infusion in Refractory Coronary Vasospasm with Hemodynamic Collapse

  • Koh, Won-Jun;Cho, Jeong-Hyeon;Lee, Ji-Hyun;Kang, Won-Sik;Lee, Min-Kyung;Kim, Jun-Hyoung;Cho, Deok-Kyu
    • Journal of Yeungnam Medical Science
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    • 제29권2호
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    • pp.129-131
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    • 2012
  • A 70-year-old male came to the emergency room of the authors' hospital because of sudden cardiac arrest due to inferior wall ST elevation myocardial infarction. His coronary angiography revealed multiple severe coronary spasms in his very long left anterior descending artery. After an injection of intracoronary nitroglycerine, his stenosis improved. The cardiac arrest relapsed, however, accompanied by ST elevation of the inferior leads, while the patient was on diltiazem and nitrate medication to prevent coronary spasm. Recovery was not achieved even with cardiac massage, intravenous injection of epinephrine and atropine, and intravenous infusion of nitroglycerine. The patient eventually recovered through high-dose nicorandil intravenous infusion without ST elevation of his inferior leads. Therefore, intravenous infusion of a high dose of nicorandil must be considered a treatment option for cardiac arrest caused by refractory coronary vasospasm.

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영아 비후성 유문 협착증의 atropine sulfate 정맥요법 (Intravenous Atropine Sulfate Therapy for Infantile Hypertrophic Pyloric Stenosis)

  • 방승호;강윤중;조병선;이태석
    • Advances in pediatric surgery
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    • 제8권1호
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    • pp.33-38
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    • 2002
  • The purpose of this study is to evaluate the applicability of intravenous atropine sulfate therapy in infantile hypertrophic pyloric stenosis (IHPS). From 1998 to 2000 among 35 cases of IHPS, pyloromytomy was performed in 13 (Group A), and intravenous atropine was given as a primary therapy in 22 cases (Group B). In group A, all cases were cured completely. In group B, 13 (59 %) out of 22 cases were successfully treated with atropine, but 9 were failed therapy, and required operation. The recovery period to normal feeding and the hospital stay of the successful atropine group were longer than those of pyloromyotomy, 8.6 days vs. 2.9 days and 13.2 days vs. 4.1 days, respectively. In conclusion, intravenous atropine therapy did not replace pyloromyotomy, but it might be an alternative for the selected patients with contraindications for operation.

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