Biomedical subjects
Matti Reinikainen
Publications and source records attributed to Matti Reinikainen.
Isobaric ropivacaine 5 mg/ml for spinal anesthesia in children.
In this clinical trial, we evaluated the clinical effects of ropivacaine for spinal anesthesia in children. An open, prospective study was performed on 93 children, aged 1-17 yr, undergoing elective lower abdominal or lower limb surgery. A plain solution of ropivacaine 5 mg/mL at a dose of 0.5 mg/kg body weight (up to 20 mg) was administered via the L3-4 or L4-5 interspace with the patient in the lateral decubitus position. After injection, the patients were placed supine. The spread and duration of sensory analgesia and the degree of motor block were recorded. Satisfactory surgical anesthesia was achieved in 92 of the 93 children. Three children received general anesthesia; in one child spinal anesthesia failed, and in two cases surgery outlasted the duration of the sensory block. Four children received supplemental analgesia for skin incision. The mean highest level of sensory block was T6 (range, T2 to T12), and the mean time to the regression of sensory block to T10 was 96 min (range, 34-210 min). One child developed transient bradycardia and one hypotension. After discharge four children developed mild transient radiating neurologic symptoms and one epidural blood patch was performed for persistent position-dependent headache. We conclude that the block performance of intrathecal isobaric ropivacaine in children (>1 yr) is similar to that obtained in adults but the safety of the larger dose used in children warrants further studies.
[Metabolic acidosis quickly resolved].
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Levobupivacaine for pediatric spinal anesthesia.
UNLABELLED: In this clinical trial we evaluated the clinical effects of levobupivacaine in spinal anesthesia in children. An open, noncomparative study was performed on 40 children, aged 1-14 yr, undergoing elective lower abdominal or lower limb surgery. A plain solution of S(-)-bupivacaine 5 mg/mL at a mean dose of 0.3 mg/kg body weight (range, 0.2-0.5 mg/kg body weight) was administered via the L3-4 or L4-5 interspace with the patient in the lateral decubitus position. After injection, the patients were placed supine. The spread and duration of sensory analgesia and the degree of motor block were recorded. Satisfactory surgical anesthesia was achieved in 39 of the 40 children. One child received supplemental anesthesia. The mean highest level of sensory block was T4 (range, T2 to L1), and the mean time to the regression of sensory block to T10 was 90 min (range, 43-185 min). A complete motor block was achieved in 36 children. These results are similar to those obtained with racemic bupivacaine in subarachnoid anesthesia in children. IMPLICATIONS: This noncomparative, descriptive study showed that levobupivacaine, the S(-)-enantiomer of bupivacaine, has equivalent clinical efficacy in spinal anesthesia in children to that of racemic bupivacaine.
Pharmacokinetics of oxycodone after intravenous, buccal, intramuscular and gastric administration in children.
OBJECTIVE: To evaluate the pharmacokinetics of four administration routes of oxycodone parenteral liquid (10 mg/mL), single intravenous and intramuscular injections and buccal and gastric administration, in children. PATIENTS AND PARTICIPANTS: Forty generally healthy children, aged 6-93 months, undergoing inpatient surgery. METHODS: After induction of anaesthesia, children received a single dose of oxycodone 0.1 mg/kg intravenously (n = 9), intramuscularly (n = 10), buccally (n = 11) or via an orogastric tube into the stomach (n = 10). Regular blood samples were collected up to 12 hours, and plasma was analysed for oxycodone using gas chromatography-mass spectrometry (limit of quantification 1 microg/L). RESULTS: The peak drug concentration observed was 57-110 (mean 82) microg/L after intravenous administration, 23-54 (34) microg/L after intramuscular administration, 3.9-14 (9.8) microg/L after buccal administration and 1.7-15 (9.2) microg/L after gastric administration. The time to peak concentration was 2-30 (16) minutes in the intramuscular group, 30-480 (221) minutes in the buccal group and 60-360 (193) minutes in the gastric group. The terminal elimination half-lives were closely similar in the four groups: 124-208 (163) minutes in the intravenous group, 162-227 (150) minutes in the intramuscular group, 73-234 (150) minutes in the buccal group and 80-246 (147) minutes in the gastric group. Area under the concentration-time curve (AUC) was 5037-8954 (6612) microg x min/L in the intravenous group, 3084-5524 (4473) microg x min/L in the intramuscular group, 1444-5560 (3658) microg x min/L in the buccal group and 692-3843 (2436) microg x min/L in the gastric group. The estimated bioavailability (AUC/mean intravenous AUC) of intramuscular oxycodone was 0.47-0.84 (0.68), that of buccal oxycodone 0.22-0.84 (0.55) and that of gastric oxycodone 0.10-0.58 (0.37). CONCLUSION: The pharmacokinetics of intravenous oxycodone in children aged 6-93 months are fairly similar to those reported in adults. Intramuscular administration provides relatively constant drug absorption, but after buccal and gastric administration the interindividual variation in the rate and extent of absorption is large.