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Biomedical subjects

R P Rapp

Publications and source records attributed to R P Rapp.

At least 55 records · Page 3Linked to original sources
PubMed1988

Prophylactic parenteral antibiotics in clean neurosurgical procedures: a review.

Clean surgical procedures carry a risk of postoperative wound infection that is less than 5% in most hospitals. The use of prophylactic antibiotic agents in clean neurosurgical cases is controversial, and the neurosurgical literature through 1980 contains no controlled clinical trials to study its effectiveness in such cases. A report of 1732 consecutive procedures without a single postoperative wound infection in patients receiving systemic gentamicin, vancomycin, and streptomycin irrigation fluids is often quoted by neurosurgeons; however, these results have not yet been duplicated by others. Since 1980, there have been several controlled trials that support the use in clean neurosurgical cases of prophylactic antibiotics, including the vancomycin/gentamicin/streptomycin regimen and the first-generation cephalosporins. A report in 1986 of 1602 cases without a primary wound infection supports the use of a single perioperative dose of cefazolin. A review of causative organisms in postoperative wound infections demonstrates the preponderance of Gram-positive pathogens. Therefore, when antibiotic prophylaxis is indicated, adequate Gram-positive bacterial coverage, including protection against Staphylococcus infection, is required. With consideration of the present data, the cost of antibiotic therapy, and the danger of drug toxicity, a short perioperative regimen of cefazolin as prophylaxis is preferred in clean neurosurgical cases.

Anti-Bacterial Agents↗
PubMed1987

Clinical outcome of nosocomial pneumonia following imipenem/cilastatin therapy.

Eighteen patients in a neurosurgery intensive care unit who had nosocomial pneumonia and/or bacteremia were treated with imipenem/cilastatin. The 16 patients who were evaluable had pneumonia; 4 of these had concurrent bacteremia. Eleven patients had a satisfactory clinical response (69 percent) and all patients with positive blood cultures had the organism eradicated. There were 44 organisms isolated from the initial culture of bronchial secretion and 32 of these organisms were gram-negative bacilli (72.5 percent). One patient with pneumonia who initially had Pseudomonas aeruginosa sensitive to imipenem developed resistance during therapy. Adverse effects were minimal; one case of nausea occurred, which was thought to be related to a short infusion time. The most prominent laboratory abnormality was an increase in platelet count, seen in 50 percent of treated patients.

Adult↗
PubMed1987

Pentobarbital pharmacokinetics in patients with severe head injury.

Intravenous administration of high-dose pentobarbital has been proposed as a treatment for elevated intracranial pressure refractory to other measures in brain-injured patients. The purpose of this clinical study was to examine the pharmacokinetics of high-dose continuous intravenous infusion of pentobarbital in this critical care setting. Six patients received a 25-34 mg/kg intravenous loading dose followed by a 1-3 mg/kg/h continuous infusion for 61-190 hours. Dosing rates were adjusted based on the patient's clinical status. The mean clearance was 0.72 ml/min/kg, with a volume of distribution (Vd) of 1.03 L/kg and a terminal half-life of 19.1 h. Considerable variation in individual patient parameters was observed. In addition, a change in clearance was suggested in patients requiring a longer infusion duration.

Adolescent↗
PubMed1987

Evaluation of a disposable, nonelectronic, patient-controlled-analgesia device for postoperative pain.

The safety and efficacy of a disposable, nonelectronic, patient-controlled-analgesia (PCA) device for alleviating postoperative pain were evaluated. Patients who were to undergo abdominal surgical procedures under general anesthesia were instructed in the use of the Travenol Infusor with Patient Control Module. Patients used the PCA device upon emerging from anesthesia in the recovery room. The PCA device delivered a 1-mg i.v. injection of morphine sulfate upon patient demand, with a relative delay of six minutes between allowable administrations. Nursing staff evaluated pain and sedation every four hours using a five-point scale. In the 50 patients evaluated, the highest analgesic use occurred during the first four to eight postoperative hours. After the immediate postoperative period, patients experienced either mild or no pain during approximately 90% of the evaluation periods. No patient suffered respiratory depression during self-dosing. Results of a poststudy self-assessment questionnaire showed that 90% of the patients reported experiencing mild to moderate pain overall, and 78% reported only mild discomfort throughout the postoperative period. Ninety-two percent of the patients strongly preferred PCA therapy over intramuscular injections. The Travenol Infusor with Patient Control Module represents a safe and effective device for PCA therapy of postoperative pain.

Abdomen↗
PubMed1986

Serum and urine zinc response in head-injured patients.

A prospective longitudinal evaluation of serum zinc concentrations was performed in 26 head-trauma patients, and 24-hour urine zinc excretion was determined in 15 of these subjects. Patients had markedly depressed admission serum zinc concentrations (mean +/- standard error of the mean: 40.2 +/- 3.2 micrograms/dl; normal values: 70 to 120 micrograms/dl), which gradually increased during the 16-day study period. All subjects demonstrated increased urinary zinc losses throughout the study period. Urinary zinc excretion was greater in patients with more severe head injuries. Indeed, patients with more severe head trauma had mean peak urinary zinc losses of greater than 7000 micrograms/day (normal less than 500 (micrograms/day). The implications of this altered zinc metabolism for protein metabolism, wound healing, and immune function, and the specific role of zinc in brain function and recovery from injury are discussed.

Adolescent↗
PubMed1986

Comparison of single-dose moxalactam and a three-dose regimen of cefoxitin for prophylaxis in vaginal hysterectomy.

In patients undergoing vaginal hysterectomy, prophylactic use of a single dose of moxalactam was compared with use of a standard three-dose regimen of cefoxitin for efficacy and for rate of postoperative colonization of the vaginal cuff with resistant bacteria. In a prospective, randomized study, patients hospitalized for vaginal hysterectomy received either cefoxitin sodium 2 g intramuscularly on call to the operating room followed by 2 g intravenously every six hours for two additional doses or a single dose of moxalactam disodium 2 g intramuscularly on call. Cultures of the meatal area and of urine were obtained preoperatively; postoperatively, cultures of urine, of the vaginal cuff, and of any site or fluid presumed to be infected were obtained. Data were evaluated for 38 patients in the moxalactam group and 40 patients in the cefoxitin group. There was no significant difference in the incidence of infectious morbidity (7.5% of cefoxitin-treated patients and 10.5% of moxalactam-treated patients). Infectious morbidity was not related to age, length of surgery, or estimated blood loss. The incidence of febrile morbidity was not significantly different (7.5% of the cefoxitin group and 13.2% of the moxalactam group). Colonization of the vaginal cuff with resistant organisms occurred in 70% of cefoxitin patients and 71% of moxalactam patients and was a poor predictor of infectious morbidity. In these 78 women undergoing vaginal hysterectomy, single-dose moxalactam and a three-dose regimen of cefoxitin were equally effective for surgical prophylaxis.

Adult↗
PubMed1986

Pharmacy initiatives to reduce clindamycin use.

The effectiveness of clinical pharmacists and attending physicians in altering the prescribing of metronidazole and clindamycin by resident physicians was evaluated, and the effect of these changes on antibiotic costs was determined. In July 1983, clinical pharmacists and attending physicians educated resident physicians about the efficacy and cost-effectiveness of substituting metronidazole for clindamycin in the treatment of intraabdominal and pelvic infections. A three-month educational program was implemented, which included distribution of a newsletter and involvement of clinical pharmacists in patient rounds. The use patterns of these drugs were then monitored for a 12-month period. A total of 425 treatment periods for 414 patients were reviewed, representing 91% of all therapy with metronidazole and clindamycin. Metronidazole use increased from 18.2% one month after implementation of the educational program to a plateau of 50% by November. Clindamycin expenditures decreased by more than 50% from the previous fiscal year, resulting in a savings of $33,469 to the pharmacy. The prescribing patterns of resident physicians were altered and cost savings were realized as a result of a comprehensive educational program that focused on substituting metronidazole for clindamycin. The program's success was enhanced because an equally efficacious agent was available and because of the participation of clinical pharmacists in patient rounds.

Anti-Bacterial Agents↗
PubMed1986

Postinfusion phlebitis associated with a syringe system versus minibags.

The incidence of postinfusion phlebitis was compared in patients receiving i.v. drugs in 50- and 100-mL minibags of 5% dextrose injection or 0.9% sodium chloride injection versus 20- and 50-mL quantities of sterile water for injection or 0.45% sodium chloride injection in plastic syringes used with a venting administration set. Patients 16-75 years of age receiving one or more i.v. drugs and a concurrent maintenance i.v. fluid through a Teflon catheter in a peripheral vein were included. Patients receiving antineoplastic drugs, drugs that require a minimum diluent volume greater than 50 mL, or i.v. heparin sodium in doses of greater than or equal to 500 units/hr were excluded. For the syringe system, the type and amount of diluent were selected to achieve a solution osmolarity of approximately 300 mOsm/L. Patients' i.v. sites were examined every eight hours for 72 hours, and phlebitis was assessed according to predetermined criteria. There were 47 patients in the minibag group and 46 in the syringe group. There were no significant differences between the groups in demographic characteristics, catheter size, duration of infusion, number of doses, number or type of i.v. drugs, or incidence or severity of phlebitis. Administration of i.v. drugs with controlled solution osmolarity via this syringe infusion system was not associated with an incidence of postinfusion phlebitis different from that for i.v. drugs diluted in minibags.

Adolescent↗
PubMed1986

Computer program for comparing total costs of intravenous antibiotic regimens.

A computer program for estimating and comparing the costs of intravenous antibiotic therapy is described, and a cost comparison of two antibiotic regimens using the program is demonstrated. Data unique to each antibiotic (e.g., dosage regimen, duration of therapy, need for pharmacokinetic monitoring, and acquisition cost per dose) are entered into the first part of the program (ABDATA) and combined with preprogrammed hospital-specific data, such as personnel and material costs, to produce an itemized list of the total cost of therapy. With the second part of the computer program (ABCOMP), antibiotic regimen costs that have been entered into ABDATA can be compared. Cost comparisons are made with the assumption that the antibiotic regimens have similar efficacy and toxicity. A sample cost comparison was performed using data from a recent study comparing the use of ceftazidime or tobramycin-ticarcillin therapy in the treatment of nosocomial pneumonia and bacteremia. The computer-generated cost comparison showed that although the unit cost of ceftazidime was more than the combined unit cost of tobramycin and ticarcillin, the total cost of a 10-day course of therapy with ceftazidime (which included personnel and material costs) was less than the cost of therapy with a combination of tobramycin and ticarcillin. A computer program that incorporates hospital-specific personnel and material costs with unit drug costs can be used to facilitate comparisons of the overall cost of intravenous antibiotic regimens.

Anti-Bacterial Agents↗
PubMed1985

Comparison of epsilon aminocaproic acid and normal saline for postoperative bladder irrigation following transurethral resection of prostate.

A prospective, randomized, double-blind trial of bladder irrigation with a 0.5% solution of epsilon aminocaproic acid (EACA) versus normal saline plus placebo was undertaken in 75 patients undergoing transurethral resection of the prostate for benign or malignant disease. Systemic absorption after irrigation with EACA was not detectable. No significant advantage, however, was demonstrated for the EACA solution over normal saline irrigation in measured postoperative blood loss, irrigant volume, hours of catheterization, or length of hospital stay.

Aminocaproates↗
PubMed1985

Influence of high-dose pentobarbital on theophylline pharmacokinetics: a case report.

The effect of high dose pentobarbital coma therapy on the total body clearance of theophylline (CLT) was evaluated in a neurosurgical patient. Preinduction and induction CLT were 4.22 and 8.02 L/h, respectively, which represented a 95% increase in the CLT as a consequence of pentobarbital therapy. Although barbiturates have been shown to induce hepatic microsomal enzymes, previous reports minimize their effect on CLT in humans. This case report demonstrates remarkable alterations in the CLT as a result of high doses of pentobarbital, necessitating the need for substantial dosage adjustments of theophylline.

Aminophylline↗