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PubMed2003

Noninvasive monitoring of cardiac output during exercise by inductance cardiography.

INTRODUCTION/PURPOSE: Inductance cardiography is a noninvasive technique that monitors changes in cardiac output from an inductance plethysmographic transducer encircling the chest at the level of the heart. The method has been previously validated in supine patients at rest by comparisons to thermodilution. Our purpose was to investigate whether the technique can be employed during bicycle exercise. METHODS: We simultaneously measured cardiac output by inductance cardiography and by two gas exchange methods based on the Fick principle during upright cycle ergometry in healthy volunteers. RESULTS: In 11 subjects, comparisons of changes in cardiac output by inductance cardiography agreed well with values measured by carbon dioxide rebreathing during a steady-state exercise protocol. In 12 subjects, cardiac output changes measured by inductance cardiography and an oxygen uptake method agreed closely during a progressive ramp exercise protocol to exhaustion. The bias (mean difference to reference methods) and limits of agreement (+/-2 SD of bias) for estimation of relative changes in cardiac output by inductance cardiography were 1% +/- 21% in 67 comparisons to the carbon dioxide rebreathing technique, and 0% +/- 22% in 98 comparisons to the oxygen uptake method. CONCLUSION: In healthy subjects, inductance cardiography accurately and unobtrusively estimates changes in cardiac output during bicycle exercise in comparison to gas exchange methods.

Adult↗

PubMed1985

Elective induction of labor: a prospective clinical study, II: Psychological effects.

Several authors have stated that induction of labor may have deleterious psychological effects on women's experiences of labor and early mother-infant interaction. Research on this subject is scarce and in most cases no distinction is made between elective induction and induction for medical reasons. For that reason the observed effects may also have been caused by the medical complications that led to the induction. Differences in experience of labor may also be in part explained by differences in personal characteristics between women choosing or rejecting induction of labor. Influences of induction of labor can only be reliably assessed in prospective studies. In the present study of 271 women with an uncomplicated pregnancy, data regarding their experiences of pregnancy and their expectations of labor and motherhood were collected before labor. In 72 women labor was electively induced, and 199 women had a spontaneous onset of labor. Of 33 women, 19 with spontaneous labor and 14 with elective induction, the first contact with their newborn was observed. All women who could be contacted were interviewed about their experience of labor and the first contact with their infant. Six months after delivery the mothers were questioned about the state of health of mother and infant and about nursing the infant. Mothers with induced labor were rated as being generally less emotionally involved in the first contact with their newborn than mothers with spontaneous labor, but the differences were not significant (Fig. 1). The duration of spontaneous labor was longer, but the subjective time experience did not differ between groups. Women with spontaneous labor were more tired during labor.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2003

Misoprostol versus oxytocin for labor induction in term and post-term pregnancy: randomized controlled trial.

CONTEXT: Misoprostol, a synthetic E1 methyl analog prostaglandin, is at present receiving attention as a cervical modifier and labor induction agent. However, there is still a need for better determination of its safety and effectiveness. OBJECTIVE: To compare intravaginal misoprostol versus intravenous oxytocin for cervical ripening and labor induction in pregnant women with unripe cervices. DESIGN: Randomized controlled trial. SETTING: The study was performed at the Leonor Mendes de Barros Maternity Hospital between November 1998 and December 2000. PARTICIPANTS: 210 pregnant women with intact membranes and indication for labor induction were selected. PROCEDURES: The women randomly received 25 g of vaginal misoprostol every 4 hours, not exceeding 8 doses (105 women), or oxytocin in a continuous infusion (105 women). MAIN MEASUREMENTS: The main parameters measured were: latent period, time from induction to vaginal delivery, delivery route, occurrence of vaginal delivery with time, occurrence of uterine tonus alterations, hypoxia and neonatal morbidity. To verify the statistical significance of the differences between the groups, the chi-squared, Student t and log-rank tests were used. RESULTS: There were no significant differences between the groups concerning conditions for labor induction, age, parity, race, marital status, family income, initial Bishop Index and number of prenatal visits. The cesarean section rate, latent period and period from induction to vaginal delivery were significantly lower for the misoprostol group. With regard to uterine tonus alterations, tachysystole was significantly more common in the misoprostol group. However, there was no difference in hypoxia and neonatal morbidity between the groups. CONCLUSION: 25 g of misoprostol used vaginally every 4 hours is safer and more efficient for cervical ripening and labor induction than oxytocin.

Abortifacient Agents, Nonsteroidal↗

PubMed2002

Effects of medetomidine-midazolam, midazolambutorphanol, or acepromazine-butorphanol as premedicants for mask induction of anesthesia with sevoflurane in dogs.

OBJECTIVE: To characterize the effects of medetomidine-midazolam, midazolam-butorphanol, or acepromazine-butorphanol as premedicants for mask induction of anesthesia with sevoflurane in dogs. ANIMALS: 10 healthy Beagles. PROCEDURE: The following premedicants were administered intramuscularly: medetomidine-midazolam (20 microg/kg and 0.3 mg/kg, respectively), midazolam-butorphanol (0.1 and 0.2 mg/kg, respectively), and acepromazine-butorphanol (0.05 and 0.2 mg/kg, respectively). Saline (0.9% NaCI) solution (0.1 ml/kg) was administered intramuscularly as a control. Anesthesia was induced in each dog with sevoflurane in a 100% O2 at a flow rate of 4 L/min developed by a facemask. Vaporizer settings were increased by 0.8% at 15-second intervals until the value corresponding to 4.8% sevoflurane was achieved. Time to onset and cessation of involuntary movements, loss of the palpebral reflex, negative response to tail-clamp stimulation, and endotracheal intubation were recorded, and the cardiopulmonary variables were measured. RESULTS: Mask induction with sevoflurane in dogs that received each premedicant resulted in a shorter induction time and milder changes in heart rate, mean arterial blood pressure, cardiac output, and respiratory rate, compared with mask induction without premedicants. Treatment with medetomidine-midazolam resulted in a shorter and smoother induction, compared with acepromazine-butorphanol or midazolam-butorphanol treatment, whereas the cardiovascular changes were greater. Cardiopulmonary variables of dogs during induction following treatment with acepromazine-butorphanol or midazolam-butorphanol were maintained close to the anesthetic maintenance values for sevoflurane, with the exception of mild hypotension that was observed in dogs following acepromazine-butorphanol treatment. CONCLUSION AND CLINICAL RELEVANCE: In dogs use of premedicants provides a smoother and better quality mask induction with sevoflurane.

Analgesics, Opioid↗

PubMed2002

Effects of medetomidine-midazolam, acepromazine-butorphanol, and midazolam-butorphanol on induction dose of thiopental and propofol and on cardiopulmonary changes in dogs.

OBJECTIVE: To evaluate dose-sparing effects of medetomidine-midazolam (MM), acepromazine-butorphanol (AB), and midazolam-butorphanol (MB) on the induction dose of thiopental and propofol and to examine cardiopulmonary changes in dogs. ANIMALS: 23 healthy Beagles. PROCEDURE: Dogs were administered MM, AB, MB, or physiologic saline (0.9% NaCI) solution (PS) IM, and anesthesia was induced with thiopental or propofol. Cardiopulmonary measurements were obtained before and after administration of medication and 0, 5, 10, and 15 minutes after endotracheal intubation. RESULTS: Induction doses were reduced significantly by preanesthetic administration of MM, AB, and MB (thiopental, 20, 45, and 46% after administration of PS; propofol, 42, 58, and 74% after administration of PS, respectively). Recovery time in dogs administered MM-thiopental or MM-propofol and AB-propofol were significantly prolonged, compared with recovery time in dogs administered PS-thiopental or PS-propofol. Relatively large cardiovascular changes were induced by administration of MM, which were sustained even after the induction of anesthesia. Administration of AB and MB induced cardiovascular changes during and immediately after endotracheal intubation that were significantly decreased by induction with thiopental or propofol. However, mild hypotension developed with AB-propofol. Apnea was observed in dogs administered MM during induction of anesthesia, but most respiratory variables did not change significantly. CONCLUSIONS AND CLINICAL RELEVANCE: Preanesthetic medication with MM greatly reduced the anesthesia induction dose of thiopental and propofol but caused noticeable cardiopulmonary changes. Preanesthetic medication with AB and MB moderately reduced the induction dose of thiopental and propofol and amelio rated cardiovascular changes induced by these anesthetics, although AB caused mild hypotension.

Acepromazine↗

PubMed1976

Influence of pretest waiting time and duration of induction on kinesthetic aftereffect.

The influence of pretest hand-resting time and induction time on kinesthetic aftereffect was determined for 22 males and females. Aftereffect was assessed with the apparatus of Koehler and Dinnerstein (1947). Three separate tests of aftereffect were administered. Each was preceded by either a 10-, 20-, or 30-min. hand-resting period. Significant differences in aftereffect were not found between pretest conditions. Scores were also determined for varying induction times at each pretest condition. Induction periods totaling 90-, 180-, and 300-sec. were used. Aftereffect was significantly less pronounced following 90 than 180 sec. of induction for the 10-and 20-min. pretest conditions but was the same following 90, 180, and 300 sec. of induction for the 30-min. condition. Results indicated that less than 300 sec. of induction could be used regardless of the duration of the pretest period. However, because the internal validity of the 180-sec. score was significantly better than the 90-sec. score, it was concluded that at least 180 sec. of induction were needed.

Female↗

PubMed1989

Depressive and elative mood inductions as a function of exaggerated versus contradictory facial expressions.

Two studies concerned the relation between facial expression cognitive induction of mood and perception of mood in women undergraduates. In Exp. 1, 20 subjects were randomly assigned to a group who were instructed in exaggerated facial expressions (Demand Group) and 20 subjects were randomly assigned to a group who were not instructed (Nondemand Group). All subjects completed a modified Velten (1968) elation- and depression-induction sequence. Ratings of depression on the Multiple Affect Adjective Checklist increased during the depression condition and decreased during the elation condition. Subjects made more facial expressions in the Demand Group than the Nondemand Group from electromyogram measures of the zygomatic and corrugator muscles and from corresponding action unit measures from visual scoring using the Facial Action Scoring System. Subjects who were instructed in the Demand Group rated their depression as more severe during the depression slides than the other group. No such effect was noted during the elation condition. In Exp. 2, 16 women were randomly assigned to a group who were instructed in facial expressions contradictory to those expected on the depression and elation tasks (Contradictory Expression Group). Another 16 women were randomly assigned to a group who were given no instructions about facial expressions (Nondemand Group). All subjects completed the depression- and elation-induction sequence mentioned in Exp. 1. No differences were reported between groups on the ratings of depression (MAACL) for the depression-induction or for the elation-induction but both groups rated depression higher after the depression condition and lower after the elation condition. Electromyographic and facial action scores verified that subjects in the Contradictory Expression Group were making the requested contradictory facial expressions during the mood-induction sequences. It was concluded that the primary influence on emotion came from the cognitive mood-induction sequences. Facial expressions only seem to modify the emotion in the case of depression being exacerbated by frowning. A contradictory facial expression did not affect the rating of an emotion.

Cognition↗

PubMed1987

Labor induction for planned vaginal delivery in patients with previous cesarean section.

The role of labor induction in patients scheduled for vaginal delivery following a previous lower segment cesarean section has been controversial. In Hong Kong, we have managed these patients by induction when there were obstetric or medical indications. A review of 137 patients who had labor induced for a trial of scar showed that induction of labor was a safe procedure and the rate of repeat caesarean section in these patients (18.2%) was similar to that in other patients with a trial of scar who had spontaneous onset of labor (12.9%). There were no serious maternal or fetal complications. Although the use of oxytocin in addition to amniotomy produced no difference in the outcome, we felt that it was useful in preventing a long induction delivery interval as well as avoiding a high failure rate of induction. We conclude that in patients selected for a trial of scar, planned induction of labor should be attempted when an indication for delivery arises, as a high proportion (more than 80%) of these patients gave birth vaginally. If induction were ruled out, most of these patients would have to be delivered by repeat cesarean section, with its associated morbidity and expense.

Cesarean Section↗

PubMedDate not supplied

The induction of hyperthermia in rabbit liver by means of duplex stainless steel thermoseeds.

OBJECTIVE: To determine the heating characteristics of needle-shaped duplex stainless steel thermoseeds, and to evaluate their effectiveness in the induction of hyperthermia in rabbit liver. MATERIALS AND METHODS: Thermoseeds of the two different shapes, L-shaped for single doses of hyperthermia and I-shaped for in-vitro study and repeated hyperthermic induction, were prepared. For the in-vitro study, an I-shaped thermoseed 0.23 mm in diameter and 25 mm long was placed inside a plastic tube filled with water. Heat was applied for 30 minutes within an induction magnetic field, and during this time changes in temperature were recorded using three thermocouples. For the in-vivo study, fifteen New Zealand white rabbits were divided into five equal groups. An I-shaped or L-shaped thermoseed was inserted in each rabbit's liver, and then placed within the center of the magnetic induction coil during a 30-minute period of hyperthermia. The rabbits in the first group were sacrificed immediately after hyperthermia was induced once, while those in the other groups were sacrificed at 1, 3, and 7 days, respectively, also after one induction. The remaining three rabbits were sacrificed 4 days after three consecutive daily treatment sessions. The resected segments of liver were subsequently evaluated histopathologically for the extent of coagulation necrosis caused by heating of the thermoseed. RESULTS: The in-vitro study demonstrated that the temperature in the thermoseed, which was 25.9 degrees C before heating and 54.8 degrees C after heating, rose rapidly at first but progressively less rapidly as time elapsed. Light microscopic examination of the rabbits' livers revealed coagulation necrosis and infiltration by inflammatory cells around the insertion site of the thermoseed. The maximum diameter of coagulation necrosis was 2.81+/-1.68 mm, and this occurred in the rabbits that were sacrificed 7 days after heat induction. CONCLUSION: Needle-shaped duplex stainless steel thermoseeds show temperature-dependent-type heating characteristics, and in rabbit liver, induced coagulation necrosis of surrounding tissues after heat is applied for 30 minutes. These thermoseeds may thus be useful for the induction of interstitial hyperthermia.

Animals↗

PubMed2001

Apoptosis and thymidylate synthase inductions by 5-fluorouracil in gastric cancer cells with or without p53 mutation.

We studied apoptosis and thymidylate synthase (TS) inductions by 5-fluorouracil (5-FU) in gastric cancer cells with wild-type p53 (MKN-45 and MKN-74) and with mutated p53 (MKN-28 and KATO-III). Apoptotic inductions in MKN-45 and MKN-74 were stronger than those in MKN-28 and KATO-III, suggesting that wild-type p53 may contribute to the induction of apoptosis. After continuous exposure to 0.1 microg/ml of 5-FU for 96 h, no TS induction was obtained in KATO-III, while approximately twice the amount of TS was observed compared to non-treatment cells in MKN-45, MKN-74, and MKN-28. The results of immunohistochemical staining for TS and p53 showed no relation between these two protein expressions in endoscopic biopsy specimens of 25 patients with advanced gastric cancer. These results indicated that p53 status may not play a pivotal role in regulating TS expression. We found no significantly different effects of 5-FU between intermittent (repeat of 24-h continuous infusion and 24-h drug-free) and continuous treatments in either MKN-28 or stem cells (CD34+ hematopoietic progenitor cells) when the same area under the time-concentration curve of 5-FU was administered. The TS induction in MKN-28 cells by intermittent treatment was significantly higher than that by continuous treatment; however, most TSs in both types of 5-FU treatment cells were of the inactive form, i.e., TS bound to FdUMP, a 5-FU metabolite. Therefore, neither intermittent nor continuous treatment appears to induce 5-FU resistance related to the level of increment free TS. In conclusion, our observations suggested that p53 mutation may be associated with apoptotic induction by 5-FU; however, p53 status may not strongly affect TS induction by 5-FU. Intermittent treatment can be replaced with continuous treatment without causing 5-FU resistance.

Antimetabolites, Antineoplastic↗

PubMed1999

The neural induction process; its morphogenetic aspects.

This posthumous review of early embryonic inductions concludes: 1) the amphibian egg has only two distinct components, animal and vegetal. Interactions at their mutual boundary forms meso-endoderm. This is "meso-endoderm induction", not just "mesoderm induction". 2) The dorso-ventral polarity of the yolk mass implies a dorsally situated inducing centre. 3) Accumulation of cells into one, two, three or many cell masses [problastopores] along the circumference of the meso-endoderm results in as many axes, implying a self-organizing capacity of meso-endoderm. 4) Induction of the meso-endoderm is slow, spreading cell to cell through the animal moiety from the boundary of the vegetal yolk mass towards the animal pole. 5) Interaction between mesoderm and ectoderm is a separate step leading to cranio-caudal differentiation of the archenteron roof. 6) The initial invaginating endoderm and mesoderm, representing the future pharynx endoderm and prechordal plate mesoderm, first contacts the most posterior presumptive neurectoderm after having passed the still uninvaginated trunk mesoderm. At that moment an antero-posterior level neural induction actually starts. 7) The ectoderm contraction wave coincides spatially and temporally with the induced neural plate. 8) Two successive homoiogenetic waves of inductive activity pass through the presumptive neurectoderm in the anterior direction, the first one, "activation", giving rise to neural differentiation and ultimately forebrain, the second one, "transformation", to more caudal CNS structures. These are separate, successive steps in CNS regional induction. 9) The midbrain represents a secondary formation in the neural plate. 10) The observed changes in morphogenesis may depend upon separate, successive binary decisions via [cell and] nuclear state splitters [involving differentiation waves].

Ambystoma↗

PubMed1999

Induction and maintenance treatment regimens for HIV-1 infection in vitro.

Can aggressive anti-human immunodeficiency virus (HIV) induction regimens be simplified after sufficient virus suppression is achieved? In vitro studies were conducted to evaluate the hypothesis that aggressive induction regimens could be followed by less aggressive maintenance regimens. A clinical HIV-1 isolate and lymphoblastoid cell line (H9) were employed. Virus multiplicities were varied, as were drug inhibitory concentrations (IC90, IC99) and induction periods (1, 2 and 3 weeks) of a three-drug regimen (zidovudine plus lamivudine and indinavir), following which maintenance regimens (no drug, zidovudine alone, indinavir alone, zidovudine plus lamivudine) were employed. After 1 week inductions at IC99 concentrations, viral rebound occurred on none or one-drug maintenance regimens but not on a two-drug regimen. After 2 week inductions, viral rebound occurred with no-drug maintenance, but not with one- and two-drug regimens. After 3 week inductions, viral rebound did not occur in zero-, one-, or two-drug maintenance regimens, although HIV-1 DNA persisted in cultured cells. These studies suggest that although some induction-maintenance regimens will fail, after a sufficient period of HIV-1 suppression with a three-drug antiretroviral regimen, maintenance on fewer drugs may be feasible.

Anti-HIV Agents↗

PubMed2000

[The role of daunorubicin in induction therapy for adult acute myeloid leukemia].

The relationship between the total dose of daunorubicin (DNR) in induction therapy and the treatment outcome were evaluated based upon individualized doses of DNR during induction therapy for patients with acute myeloid leukemia(AML). Ninety-two previously untreated adult AML patients admitted to our hospital were analyzed for the dose of DNR required for complete remission (CR), the CR rate, disease-free survival (DFS) and overall survival (OS). The induction therapy consisted of DNR (40 mg/m2/d, i.v., from D 1 until the marrow was hypoplastic), Ara-C, prednisolone, and/or 6-thioguanine. Eighty-three out of 92 patients were assessable. Sixty-three patients entered CR (76%), of whom 52 attained CR with the first course of induction therapy. The 10-year DFS and OS rates were 31.2% and 42.3%, respectively. The median total dose of DNR in the induction therapy was 280 mg/m2 (120-480 mg/m2), which was not influenced by initial WBC count, or FAB type. These results indicate that when the dose is linked to the observed tumor response, the optimal dose of DNR in the induction therapy is around 280 mg/m2 (40 mg/m2 x 7 times), which is higher than the conventional dose of 40-60 mg/m2 for 3 days. The higher dose of DNR in the induction therapy for adult AML should be selected when the feasibility of a new drug is evaluated in a randomized trial.

Adolescent↗

PubMed2000

Induction of UDP-glucuronosyltransferase UGT1A1 by the flavonoid chrysin in the human hepatoma cell line hep G2.

The UDP-glucuronosyltransferases (UGTs) have long been known to be inducible by various chemicals, including drugs, although the extent of induction in general has been modest. In the present study, we determined the ability of the dietary flavonoid chrysin to induce UGT activity, protein and mRNA. When pretreating human hepatoma Hep G2 cells with 25 microM chrysin, the glucuronidation of chrysin itself increased 4.2-fold when measured in the intact cell and 14-fold in the cell homogenate, i.e., autoinduction. Microsomes from chrysin-treated cells probed with specific antibodies in Western analyses showed marked induction of the UGT1A family of proteins. Isoform-specific induction of the important hepatic UGT1A1 protein was observed but not of UGT1A6 or UGT2B7. The strong induction of UGT1A1 was confirmed by Northern analyses of total RNA as well as mRNA, using a specific probe. UGT1A1 message as well as protein was detectable also in untreated Hep G2 cells. In catalytic activity assays with recombinant UGT1A1, 1A4, 1A6 and 1A9, chrysin was found to be a high affinity substrate for UGT1A1 (K(m) 0.35 microM). Catalytic activity was also found for UGT1A9 and 1A6 but not for 1A4. Further studies demonstrated a 20-fold induction of the glucuronidation of bilirubin by the chrysin-treated cells and a 7. 9-fold induction of the glucuronidation of the oral contraceptive drug ethinylestradiol, two of the best known and specific UGT1A1 substrates, demonstrating the potential importance of this induction. In view of these findings, it will be important to extend these studies to other dietary flavonoids.

Bilirubin↗

PubMed2000

Do practice guidelines guide practice? A prospective audit of induction of labor three years experience.

BACKGROUND: To examine the effect of implementation of guidelines for induction of labor on the process of care and outcome measures. METHOD: Guidelines for induction of labor were implemented in January 1996 following an audit report identifying inconsistency in clinical practice. A prospective audit was carried out following the implementation of a new strategy directed towards pre-induction cervical ripening in nulliparae with unfavorable cervices and the use of low dosages of vaginal prostaglandin E2 for induction of labor. Level of compliance and outcome measures were compared before and after implementation of guidelines. RESULTS: In the period of January 1995 to November 1997, 1,230 women were induced with a singleton viable pregnancy in a cephalic presentation with a gestational age > or = 37 weeks with no history of rupture of membranes or cesarean section. Completed forms were available for 1,147 women (370, 421 and 356 in 1995, 1996 and 1997, respectively). Among nulliparous women, there was a reduction in the number of women who were admitted with cervical score of < or = 4 (24%, 40%, and 54% in 1997, 1996, and 1995, respectively; p=0.0001), an increase in the number of women who had amniotomy on admission (32%, 25% and 12% in 1997, 1996, and 1995, respectively; p=0.0001) and a shorter induction-delivery interval. No change in outcome measures was noted among multiparous women despite reduced dose of prostaglandin E2 used for induction of labor. A marginal reduction of both Cesarean section and failed induction rates were noted in both nulliparae and multiparae. Level of compliance improved with successive rounds of audit. CONCLUSION: Explicit guidelines do improve clinical practice, when introduced and monitored in the context of rigorous evaluations. However, the size of improvement could vary.

Adolescent↗

PubMedDate not supplied

Transvaginal ultrasonography of uterine cervix in prediction of the outcome of labour induction.

The aim of this prospective, blind, observational study was to estimate the role of transvaginal ultrasound examination of the uterine cervix in prediction of labour induction outcome in order to adequately chose patients that will have high chance for labour induction. One hundred patients scheduled for induction of labour had a transvaginal ultrasound scan during which cervical length and anterior cervical angle were assessed and the presence/absence of cervical tunneling was noted. Induction was successful if a vaginal delivery within 24 hours took place. The difference between the mean values of the cervical lengths assessed by transvaginal ultrasonography in the group of successful (25.89 mm--SD 8.27, 95% CI 23.65-28.13) and unsuccessful inductions (32.03 mm--SD 6.25, 95% CI 29.01-34.96) is statistically significant (p < 0.05). The anterior cervical angle is not a useful predictor of induction success (sensitivity 22%, positive predictive value 40%). Cervical length assessed by transvaginal ultrasonography is a reliable predictor of labour induction outcome and the best statistical performance of this parameter this test has at the cut-off value of 30 mm (positive predictive value 87.2%, sensitivity 74%, specificity 70%).

Adult↗

PubMed2001

Effectiveness and safety of rocuronium-hypnotic sequence for rapid-sequence induction.

BACKGROUND: Either succinylcholine or rocuronium administered after a hypnotic is the current technique for rapid-sequence induction. It is assumed that rocuronium administered before a hypnotic (Rocuronium-hypnotic sequence) may equally provide an acceptable intubation condition as well as a shorter period of apnea in rapid-sequence induction. We designed a prospective, randomized study to evaluate the effectiveness and safety of the technique in a similar rapid-sequence induction. METHODS: Ninety adult patients receiving elective surgeries were enrolled in this study. In all patients the procedure in the study began with i.v. injection of fentanyl 2 micrograms/kg, followed by preoxygenation with 100% O2 for 2 min. Afterward, the patients were randomly allocated to 3 groups with each group consisting of 30 patients. In Rocuronium-thiopental (Ro-Th) group the patients received rocuronium 0.6 mg/kg and then thiopental 5 mg/kg; in Th-Ro group the patients received thiopental 5 mg/kg and then rocuronium 0.6 mg/kg; and in Thiopental-Succinylcholine (Th-Sx) group, the control group, the patients received thiopental 5 mg/kg and then succinylcholine 1 mg/kg. Laryngoscopy and endotracheal intubation were performed 60 s after the injection of the muscle relaxant. The intubation condition, the apneal time before laryngoscopy, the intubation time, and total apneal time were investigated and compared. Presence of injection pain, sense of paralysis, SpO2 less than 95% during induction, and any unexpected adverse event were also recorded. RESULTS: Six patients (1 in Ro-Th group, 2 in Th-Ro group, and 3 in Th-Sx group, respectively) were excluded from the study. The intubation conditions were acceptable in all patients of three groups who completed the study, and as to excellent intubation condition there was no difference between the three groups. In Ro-Th group both the apneal time before laryngoscopy (32.4 +/- 5.4 s) and total apneal time (48.5 +/- 11.0 s) were the shortest. Th-Ro group (53.2 +/- 5.8 and 67.5 +/- 8.3 s, respectively) and Th-Sx group (54.4 +/- 5.8 and 68.4 +/- 7.7 s, respectively) were similar in both aspects. With respect to intubation time there was no significant difference among the three groups. Five patients in Ro-Th group and one patient in Th-Sx group felt mild injection pain. Three patients in Ro-Th group were noted to have diminished breathing during induction, which was not recalled during enquiry in the postoperative visit. One patient in Ro-Th group saw a fall of SpO2 down below 95% (94% the minimal) during the apnea period. CONCLUSIONS: Compared with traditional hypnotic-rocuronium or hypnotic-succinylcholine sequence, rocuronium (0.6 mg)-thiopental sequence can provide a similar intubation condition but cause a much shorter apneal period in rapid-sequence induction. In carrying out recuronium-thiopental sequence induction, maintaining a patent infusion line is essential to avoid drug precipitation and awareness of muscular weakness as a result of ill-timed action of thiopental.

Adult↗

PubMed2001

Myocardial protection of warm blood cardioplegic induction during cardiopulmonary bypass.

In his prospective randomized clinical study, we evaluated the myocardial protection of warm blood cardioplegic induction and cold blood cardioplegic induction, respectively, during cardiopulmonary bypass. Twenty-eight adult patients who underwent valve replacement were randomly divided into two groups: group T (14 cases) received cold (6-8 degrees C) blood cardioplegic induction after ECG showed straight line induced by warm (35-37 degrees C) blood cardioplegia; whereas, group C (14 cases) received cold blood cardioplegic induction only. The effects of myocardial protection of both cardioplegic inductions were evaluated by clinical outcomes, myocardial biochemistry index (cardiac troponin T, cTnT), and myocardial automorphology. The ratio of myocardial auto resuscitation was significantly higher in group T (93%) than that in group C (50%). Only one case in group T (7%) and three cases in group C (21%) needed temporary pacemakers. No case in group T (0%) and five cases (36%) in group C received dopamine. The postoperative mechanical ventilation time and ICU stay time of group T were shorter than those of group C. Myocardial biochemistry indexplasma level of cTnT in group T was lower than that of group C immediately and 6 h after cardiopulmonary bypass. Myocardial morphology-group T had comparably better outcomes than group C. We concluded that warm blood cardioplegic induction during cardiopulmonary bypass, compared with cold blood cardioplegic induction, provides better myocardial protection.

Adult↗