PubMed · 11609112
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J Wiegert. 1995. [Not Available].. https://pubmed.ncbi.nlm.nih.gov/11609112/
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Free drug assay in physiological fluids is getting more and more attention nowadays. The principal reason is the fact that the unbound drug form is responsible for the therapeutic or toxic effects of its application. Unbound drug concentration significantly depends on the extent of its binding by plasma. This article describes the influence of different factors on unbound propofol concentration. These factors are presence of infusion fluids in blood, type of anticoagulant, sample storage time and plasma freezing. The following conclusions result from the experiments carried out: 1. The lowest free drug fractions are observed in samples containing carbohydrate infusion fluids. The free drug percentage is virtually independent of its total concentration in the range of clinically relevant concentrations. 2. There is no evident anticoagulant influence (heparin, citrate, EDTA and oxalate) on free propofol level in plasma samples. 3. Longer storage of plasma at 4 degrees C causes a slight rise of free propofol concentration in heparinised plasma and no evident changes in plasma containing citrate. 4. Plasma freezing induces the increase of free drug concentration both for citrate and heparin. These findings are valuable both for clinicists and pharmacologists, and important for chemical analysts.
OBJECTIVES: To assess the effectiveness of the response of NHS hospital trusts to an alert issued by the National Patient Safety Agency designed to limit the availability of concentrated potassium chloride in hospitals in England and Wales, and to determine the nature of any unintended consequences. DESIGN: Multi-method study involving interviews and a physical inspection of clinical areas. SETTING: 207 clinical areas in 20 randomly selected acute NHS trusts in England and Wales between 31 October 2002 and 31 January 2003. PARTICIPANTS: Senior managers and ward based medical and nursing staff. MAIN OUTCOME MEASURES: Degree of staff awareness of and compliance with the requirements of the national alert, withdrawal of concentrated potassium chloride solutions from non-critical areas, provision of pre-diluted alternatives, storage and recording in accordance with controlled drug legislation. RESULTS: All trusts required that potassium chloride concentrate be stored in a separate locked cup-board from common injectable diluents (100% compliance). Unauthorized stocks of potassium chloride were found in five clinical areas not authorized by the trust (98% compliance). All trusts required documentation control of potassium chloride concentrate in clinical areas, but errors were recorded in 20 of the 207 clinical areas visited (90% compliance). Of those interviewed, 78% of nurses and 30% of junior doctors were aware of the alert. CONCLUSIONS: The NPSA alert was effective and resulted in rapid development and implementation of local policies to reduce the availability of concentrated potassium chloride solutions. The success is likely to be partly due to the nature of the proposed changes and it cannot be assumed that future alerts will be equally effective. Continued vigilance will be necessary to help sustain the changes.