Guest guest Posted March 25, 2005 Report Share Posted March 25, 2005 If he rode a Yamaha his ICP WOULD be high. Larry > > Barry, > > I thought you rode a Yamaha. Sorry. > > GG > In a message dated 3/24/05 23:04:28, ultrahog2001@a... writes: > > > > > > Rather judgmental statement don't you think Gene? > > > > Barry Meffert > > > > In a message dated 3/24/2005 2:24:25 PM Central Standard Time, > > wegandy1938@a... writes: > > I've intubated a few swine in my day also. Most were riding Harleys as I > > recall, so I naturally assumed low ICP to begin with. > > > > Gene > > > > > > In a message dated 3/23/05 21:40:35, bbledsoe@e... writes: > > > > > > > > > > Emerg Med J. 2001 Nov;18(6):453-7. > > > > > > In patients with head injury undergoing rapid sequence intubation, does > > > pretreatment with intravenous lignocaine/lidocaine lead to an improved > > > neurological outcome? A review of the literature. > > > > > > N, Clancy M. > > > > > > Emergency Department, Southampton General Hospital, Tremona Road, > > > Southampton SO16 6YD, UK. poppabear66@h... > > > > > > It is well known that laryngeal instrumentation and endotracheal > > intubation > > > is associated with a marked, transient rise in intracranial pressure > > (ICP). > > > Patients with head injury requiring endotracheal intubation are considered > > > particularly at risk from this transient rise in ICP as it reduces > > cerebral > > > perfusion and thus may increase secondary brain injury. The favoured > > method > > > for securing a definitive airway in this patient group is by rapid > > sequence > > > intubation (RSI). In the United States the Emergency Airway Course teaches > > > emergency physicians to routinely administer intravenous lidocaine as a > > pre > > > treatment for RSI in this patient group in an attempt to attenuate this > > rise > > > in ICP. A literature search was carried out to identify studies in which > > > intravenous lidocaine was used as a pretreatment for RSI in major head > > > injury. Any link to an improved neurological outcome was also sought. > > Papers > > > identified were appraised in the manner recommended by the evidence based > > > medicine group to ensure validity. There were no studies identified that > > > answered our question directly and, furthermore, it is our belief that no > > > such study, at present, exists in the literature. Six valid papers were > > > found, which individually contained elements of the question posed and > > these > > > are presented in a narrative and graphic form. There is currently no > > > evidence to support the use of intravenous lidocaine as a pretreatment for > > > RSI in patients with head injury and its use should only occur in clinical > > > trials. > > > > > > Publication Types: > > > Review > > > Review, Tutorial > > > > > > ______________________________ > > ______________________________________________ > > > __- > > > J Trauma. 2005 Feb;58(2):278-83. > > > > > > > > > Intracranial pressure changes during rapid sequence intubation: a swine > > > model. > > > > > > Bozeman WP, Idris AH. > > > > > > Department of Emergency Medicine, Wake Forest University School of > > Medicine, > > > Winston-Salem, NC 27157, USA. wbozeman@w... > > > > > > BACKGROUND: Controversy and speculation exist regarding intracranial > > > pressure (ICP) changes produced by various combinations of rapid sequence > > > intubation (RSI) agents. In this pilot study, we sought to develop a swine > > > model to investigate these changes in classic RSI. METHODS: Eight adult > > > swine were instrumented with arterial and intracranial pressure monitors. > > > Four different versions of rapid sequence intubation were then performed > > > sequentially in each animal in a crossover trial design: regimen 1, > > > thiopental; regimen 2, thiopental and succinylcholine; regimen 3, > > lidocaine, > > > thiopental, and succinylcholine; and regimen 4, pancuronium, lidocaine, > > > thiopental, and succinylcholine. ICP and hemodynamic parameters were > > > recorded and compared. Trials were excluded from analysis if baseline ICP > > > measurements were unstable or if intubation was difficult. RESULTS: Peak > > > changes in ICP were noted at 2 to 3 minutes after administration of > > > induction agents. Mean values for peak changes in ICP were as follows: > > > regimen 1 (n = 5), 3.6 mm Hg (95% confidence interval [CI], 1.0-6.2 mm > > Hg); > > > regimen 2 (n = 9), 13.6 mm Hg (95% CI, 9.6-17.6 mm Hg); regimen 3 (n = 2), > > > 16.0 mm Hg (95% CI, -34.8-66.8 mm Hg); and regimen 4 (n = 3), 12.0 mm Hg > > > (95% CI, -8.3-32.3 mm Hg). CONCLUSION: The model is effective. It enables > > > investigators to examine the aggregate ICP effects of combinations of RSI > > > medications. RSI regimens with paralysis produced threefold increases in > > > peak ICP change compared with the sedation-only regimen. Pretreatment > > agents > > > did not affect ICP changes. Future investigations can examine other agents > > > and add experimental manipulation of ICP to simulate head injury > > physiology. > > > Additional parameters including cerebral metabolism and/or oxygenation may > > > also be explored. > > > > > > > > _____________________________________________________________________ _______ > > > _______________________________ > > > Lidocaine toxicity. > > > > > > Mehra P, Caiazzo A, Maloney P. > > > > > > Department of Oral and Maxillofacial Surgery, Boston University School of > > > Dental Medicine, Massachusetts 02118, USA. > > > > > > Local anesthetics are the most commonly used drugs in dentistry. The > > number > > > of adverse reactions reported, particularly toxic reactions, are > > > extraordinarily negligible. This article reports a case of lidocaine > > > toxicity with its typical manifestation in a 37-yr-old healthy male. The > > > toxic reaction followed transoral/transpharyngeal topical spraying of > > > lidocaine preoperatively during preparation for general anesthesia. A > > review > > > of dosages of the most commonly used local anesthetic drugs in dentistry > > and > > > the management of a toxic reaction is presented. Clinicians need to be in > > a > > > position to recognize and successfully manage this potential adverse > > > reaction. > > > > > > Publication Types: > > > Case Reports > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2005 Report Share Posted March 25, 2005 If he rode a Yamaha his ICP WOULD be high. Larry > > Barry, > > I thought you rode a Yamaha. Sorry. > > GG > In a message dated 3/24/05 23:04:28, ultrahog2001@a... writes: > > > > > > Rather judgmental statement don't you think Gene? > > > > Barry Meffert > > > > In a message dated 3/24/2005 2:24:25 PM Central Standard Time, > > wegandy1938@a... writes: > > I've intubated a few swine in my day also. Most were riding Harleys as I > > recall, so I naturally assumed low ICP to begin with. > > > > Gene > > > > > > In a message dated 3/23/05 21:40:35, bbledsoe@e... writes: > > > > > > > > > > Emerg Med J. 2001 Nov;18(6):453-7. > > > > > > In patients with head injury undergoing rapid sequence intubation, does > > > pretreatment with intravenous lignocaine/lidocaine lead to an improved > > > neurological outcome? A review of the literature. > > > > > > N, Clancy M. > > > > > > Emergency Department, Southampton General Hospital, Tremona Road, > > > Southampton SO16 6YD, UK. poppabear66@h... > > > > > > It is well known that laryngeal instrumentation and endotracheal > > intubation > > > is associated with a marked, transient rise in intracranial pressure > > (ICP). > > > Patients with head injury requiring endotracheal intubation are considered > > > particularly at risk from this transient rise in ICP as it reduces > > cerebral > > > perfusion and thus may increase secondary brain injury. The favoured > > method > > > for securing a definitive airway in this patient group is by rapid > > sequence > > > intubation (RSI). In the United States the Emergency Airway Course teaches > > > emergency physicians to routinely administer intravenous lidocaine as a > > pre > > > treatment for RSI in this patient group in an attempt to attenuate this > > rise > > > in ICP. A literature search was carried out to identify studies in which > > > intravenous lidocaine was used as a pretreatment for RSI in major head > > > injury. Any link to an improved neurological outcome was also sought. > > Papers > > > identified were appraised in the manner recommended by the evidence based > > > medicine group to ensure validity. There were no studies identified that > > > answered our question directly and, furthermore, it is our belief that no > > > such study, at present, exists in the literature. Six valid papers were > > > found, which individually contained elements of the question posed and > > these > > > are presented in a narrative and graphic form. There is currently no > > > evidence to support the use of intravenous lidocaine as a pretreatment for > > > RSI in patients with head injury and its use should only occur in clinical > > > trials. > > > > > > Publication Types: > > > Review > > > Review, Tutorial > > > > > > ______________________________ > > ______________________________________________ > > > __- > > > J Trauma. 2005 Feb;58(2):278-83. > > > > > > > > > Intracranial pressure changes during rapid sequence intubation: a swine > > > model. > > > > > > Bozeman WP, Idris AH. > > > > > > Department of Emergency Medicine, Wake Forest University School of > > Medicine, > > > Winston-Salem, NC 27157, USA. wbozeman@w... > > > > > > BACKGROUND: Controversy and speculation exist regarding intracranial > > > pressure (ICP) changes produced by various combinations of rapid sequence > > > intubation (RSI) agents. In this pilot study, we sought to develop a swine > > > model to investigate these changes in classic RSI. METHODS: Eight adult > > > swine were instrumented with arterial and intracranial pressure monitors. > > > Four different versions of rapid sequence intubation were then performed > > > sequentially in each animal in a crossover trial design: regimen 1, > > > thiopental; regimen 2, thiopental and succinylcholine; regimen 3, > > lidocaine, > > > thiopental, and succinylcholine; and regimen 4, pancuronium, lidocaine, > > > thiopental, and succinylcholine. ICP and hemodynamic parameters were > > > recorded and compared. Trials were excluded from analysis if baseline ICP > > > measurements were unstable or if intubation was difficult. RESULTS: Peak > > > changes in ICP were noted at 2 to 3 minutes after administration of > > > induction agents. Mean values for peak changes in ICP were as follows: > > > regimen 1 (n = 5), 3.6 mm Hg (95% confidence interval [CI], 1.0-6.2 mm > > Hg); > > > regimen 2 (n = 9), 13.6 mm Hg (95% CI, 9.6-17.6 mm Hg); regimen 3 (n = 2), > > > 16.0 mm Hg (95% CI, -34.8-66.8 mm Hg); and regimen 4 (n = 3), 12.0 mm Hg > > > (95% CI, -8.3-32.3 mm Hg). CONCLUSION: The model is effective. It enables > > > investigators to examine the aggregate ICP effects of combinations of RSI > > > medications. RSI regimens with paralysis produced threefold increases in > > > peak ICP change compared with the sedation-only regimen. Pretreatment > > agents > > > did not affect ICP changes. Future investigations can examine other agents > > > and add experimental manipulation of ICP to simulate head injury > > physiology. > > > Additional parameters including cerebral metabolism and/or oxygenation may > > > also be explored. > > > > > > > > _____________________________________________________________________ _______ > > > _______________________________ > > > Lidocaine toxicity. > > > > > > Mehra P, Caiazzo A, Maloney P. > > > > > > Department of Oral and Maxillofacial Surgery, Boston University School of > > > Dental Medicine, Massachusetts 02118, USA. > > > > > > Local anesthetics are the most commonly used drugs in dentistry. The > > number > > > of adverse reactions reported, particularly toxic reactions, are > > > extraordinarily negligible. This article reports a case of lidocaine > > > toxicity with its typical manifestation in a 37-yr-old healthy male. The > > > toxic reaction followed transoral/transpharyngeal topical spraying of > > > lidocaine preoperatively during preparation for general anesthesia. A > > review > > > of dosages of the most commonly used local anesthetic drugs in dentistry > > and > > > the management of a toxic reaction is presented. Clinicians need to be in > > a > > > position to recognize and successfully manage this potential adverse > > > reaction. > > > > > > Publication Types: > > > Case Reports > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2005 Report Share Posted March 25, 2005 What's the fuss? I thought Gene was referring obliquely to his pig trachea airway presentations. >I've intubated a few swine in my day also. Most were riding Harleys as I >recall, so I naturally assumed low ICP to begin with. > >Gene Conley Harmon ---------- No virus found in this outgoing message. Checked by AVG Anti-Virus. Version: 7.0.308 / Virus Database: 266.8.1 - Release Date: 3/23/2005 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2005 Report Share Posted March 25, 2005 Do you have any literature on keeping the Succinylcholine at room temp for 90 days? If so, I would love to have it. Our pharmacist make us change every 14 days. Cost for us is not a big deal, I think we pay something like 33 cents per vial, but there is a hassle factor of keeping it changed out. In a message dated 3/22/05 1:39:55 PM Central Standard Time, acilis1@... writes: > Succinylcholine is kept on the units for 90 > days at room temperature and then discarded. Zemuron > is discarded after 60 days. Being a smaller service > the cost factor for discarding the meds annually is > fairly low. > > Jimmy Hoskins, EMS Director > Lake Whitney Medical Center EMS > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2005 Report Share Posted March 25, 2005 Do you have any literature on keeping the Succinylcholine at room temp for 90 days? If so, I would love to have it. Our pharmacist make us change every 14 days. Cost for us is not a big deal, I think we pay something like 33 cents per vial, but there is a hassle factor of keeping it changed out. In a message dated 3/22/05 1:39:55 PM Central Standard Time, acilis1@... writes: > Succinylcholine is kept on the units for 90 > days at room temperature and then discarded. Zemuron > is discarded after 60 days. Being a smaller service > the cost factor for discarding the meds annually is > fairly low. > > Jimmy Hoskins, EMS Director > Lake Whitney Medical Center EMS > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2005 Report Share Posted March 25, 2005 Do you have any literature on keeping the Succinylcholine at room temp for 90 days? If so, I would love to have it. Our pharmacist make us change every 14 days. Cost for us is not a big deal, I think we pay something like 33 cents per vial, but there is a hassle factor of keeping it changed out. In a message dated 3/22/05 1:39:55 PM Central Standard Time, acilis1@... writes: > Succinylcholine is kept on the units for 90 > days at room temperature and then discarded. Zemuron > is discarded after 60 days. Being a smaller service > the cost factor for discarding the meds annually is > fairly low. > > Jimmy Hoskins, EMS Director > Lake Whitney Medical Center EMS > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2005 Report Share Posted March 25, 2005 Our morphine has to be kept above 59F. You might want to check this before storing in the fridge. However, with that in mind, if you check the " ranges " on all the meds we carry, we have a 6 degree window of allowable temperature. IMPOSSIBLE, even with on board ACs, heaters and refrigerators. It would be incredibly difficult to maintain that strict a level in the pharmacy itself. In a message dated 3/22/05 12:05:31 PM Central Standard Time, ftstems@... writes: > These meds are kept in refrig along with > narcs and treated just like narcs, just due to the way they work and > potential risk of them falling into the wrong hands. Hope this helps. > Shanna Worthington EMT-P > EMS Director > Fort Stockton EMS > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2005 Report Share Posted March 25, 2005 Our morphine has to be kept above 59F. You might want to check this before storing in the fridge. However, with that in mind, if you check the " ranges " on all the meds we carry, we have a 6 degree window of allowable temperature. IMPOSSIBLE, even with on board ACs, heaters and refrigerators. It would be incredibly difficult to maintain that strict a level in the pharmacy itself. In a message dated 3/22/05 12:05:31 PM Central Standard Time, ftstems@... writes: > These meds are kept in refrig along with > narcs and treated just like narcs, just due to the way they work and > potential risk of them falling into the wrong hands. Hope this helps. > Shanna Worthington EMT-P > EMS Director > Fort Stockton EMS > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2005 Report Share Posted March 25, 2005 , In the 2001 PDR, it states that the multi-dose vials are stable up to 14 days at room temperature without significant loss of potency. I found a product information sheet that states the same as the PDR at http://us.gsk.com/products/assets/us_anectine.pdf Here is a related article: Am J Hosp Pharm. 1984 Feb;41(2):300-2. Shelf life of unrefrigerated succinylcholine chloride injection. Boehm JJ, Dutton DM, Poust RI. The shelf life of succinylcholine chloride injection at several pH values when stored at room temperature was evaluated. Solutions containing 20 mg/ml of succinylcholine chloride were stored at 25 and 40 degrees C. The reaction was studied at pH values ranging from 3.0 to 4.5. At two-week intervals, the solutions were assayed by high- pressure liquid chromatography. The initial amount of succinylcholine chloride in all samples was 100.1 +/- 2.37% of label claim. Hydrolysis of succinylcholine chloride in unbuffered solutions followed apparent zero-order kinetics. The pH range of maximum stability was found to be from 3.75 to 4.50. Succinylcholine chloride decomposed at a considerably higher rate at 40 degrees C. Allowing for the effects of pH adjustment during manufacture and degradation during shipping, losses of 7.0% and 9.0% potency can be expected after storage at 25 degrees C for four and six weeks, respectively. Succinylcholine Chloride Injection, USP, should be stored in the refrigerator; if unbuffered succinylcholine chloride injection complying with USP pH limits must be stored at room temperature, it should not be kept for longer than four weeks D. Stone > Do you have any literature on keeping the Succinylcholine at room temp for 90 > days? If so, I would love to have it. Our pharmacist make us change every > 14 days. Cost for us is not a big deal, I think we pay something like 33 cents > per vial, but there is a hassle factor of keeping it changed out. > > > > In a message dated 3/22/05 1:39:55 PM Central Standard Time, > acilis1@y... writes: > > > > Succinylcholine is kept on the units for 90 > > days at room temperature and then discarded. Zemuron > > is discarded after 60 days. Being a smaller service > > the cost factor for discarding the meds annually is > > fairly low. > > > > Jimmy Hoskins, EMS Director > > Lake Whitney Medical Center EMS > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2005 Report Share Posted March 25, 2005 , In the 2001 PDR, it states that the multi-dose vials are stable up to 14 days at room temperature without significant loss of potency. I found a product information sheet that states the same as the PDR at http://us.gsk.com/products/assets/us_anectine.pdf Here is a related article: Am J Hosp Pharm. 1984 Feb;41(2):300-2. Shelf life of unrefrigerated succinylcholine chloride injection. Boehm JJ, Dutton DM, Poust RI. The shelf life of succinylcholine chloride injection at several pH values when stored at room temperature was evaluated. Solutions containing 20 mg/ml of succinylcholine chloride were stored at 25 and 40 degrees C. The reaction was studied at pH values ranging from 3.0 to 4.5. At two-week intervals, the solutions were assayed by high- pressure liquid chromatography. The initial amount of succinylcholine chloride in all samples was 100.1 +/- 2.37% of label claim. Hydrolysis of succinylcholine chloride in unbuffered solutions followed apparent zero-order kinetics. The pH range of maximum stability was found to be from 3.75 to 4.50. Succinylcholine chloride decomposed at a considerably higher rate at 40 degrees C. Allowing for the effects of pH adjustment during manufacture and degradation during shipping, losses of 7.0% and 9.0% potency can be expected after storage at 25 degrees C for four and six weeks, respectively. Succinylcholine Chloride Injection, USP, should be stored in the refrigerator; if unbuffered succinylcholine chloride injection complying with USP pH limits must be stored at room temperature, it should not be kept for longer than four weeks D. Stone > Do you have any literature on keeping the Succinylcholine at room temp for 90 > days? If so, I would love to have it. Our pharmacist make us change every > 14 days. Cost for us is not a big deal, I think we pay something like 33 cents > per vial, but there is a hassle factor of keeping it changed out. > > > > In a message dated 3/22/05 1:39:55 PM Central Standard Time, > acilis1@y... writes: > > > > Succinylcholine is kept on the units for 90 > > days at room temperature and then discarded. Zemuron > > is discarded after 60 days. Being a smaller service > > the cost factor for discarding the meds annually is > > fairly low. > > > > Jimmy Hoskins, EMS Director > > Lake Whitney Medical Center EMS > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 26, 2005 Report Share Posted March 26, 2005 Thats what we are doing. I want the info on keeping it 90 days. In a message dated 3/25/05 10:46:54 PM Central Standard Time, donnie7435@... writes: > , > > In the 2001 PDR, it states that the multi-dose vials are stable up to > 14 days at room temperature without significant loss of potency. I > found a product information sheet that states the same as the PDR at > http://us.gsk.com/products/assets/us_anectine.pdf Here is a related > article: > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 26, 2005 Report Share Posted March 26, 2005 Thats what we are doing. I want the info on keeping it 90 days. In a message dated 3/25/05 10:46:54 PM Central Standard Time, donnie7435@... writes: > , > > In the 2001 PDR, it states that the multi-dose vials are stable up to > 14 days at room temperature without significant loss of potency. I > found a product information sheet that states the same as the PDR at > http://us.gsk.com/products/assets/us_anectine.pdf Here is a related > article: > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 26, 2005 Report Share Posted March 26, 2005 Thats what we are doing. I want the info on keeping it 90 days. In a message dated 3/25/05 10:46:54 PM Central Standard Time, donnie7435@... writes: > , > > In the 2001 PDR, it states that the multi-dose vials are stable up to > 14 days at room temperature without significant loss of potency. I > found a product information sheet that states the same as the PDR at > http://us.gsk.com/products/assets/us_anectine.pdf Here is a related > article: > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2005 Report Share Posted March 27, 2005 Is there no such thing as permissible humor anymore? Are we left to write nothing but serious and scholarly messages? It was a joke, for cryin out loud. Perhaps not a great one. They say ny Carson and Bob Hope threw away hundreds of jokes for every one used. Lighten up, everybody. Kinky for Governor, then President Gene Gandy > > What a sad assumption you make, Gene. > > Re: RSI Drugs > > > I've intubated a few swine in my day also. Most were riding Harleys as I > recall, so I naturally assumed low ICP to begin with. > > Gene > > > > > > > > > Emerg Med J. 2001 Nov;18(6):453-7. > > > > In patients with head injury undergoing rapid sequence intubation, does > > pretreatment with intravenous lignocaine/lidocaine lead to an improved > > neurological outcome? A review of the literature. > > > > N, Clancy M. > > > > Emergency Department, Southampton General Hospital, Tremona Road, > > Southampton SO16 6YD, UK. poppabear66@... > > > > It is well known that laryngeal instrumentation and endotracheal > intubation > > is associated with a marked, transient rise in intracranial pressure > (ICP). > > Patients with head injury requiring endotracheal intubation are considered > > particularly at risk from this transient rise in ICP as it reduces > cerebral > > perfusion and thus may increase secondary brain injury. The favoured > method > > for securing a definitive airway in this patient group is by rapid > sequence > > intubation (RSI). In the United States the Emergency Airway Course teaches > > emergency physicians to routinely administer intravenous lidocaine as a > pre > > treatment for RSI in this patient group in an attempt to attenuate this > rise > > in ICP. A literature search was carried out to identify studies in which > > intravenous lidocaine was used as a pretreatment for RSI in major head > > injury. Any link to an improved neurological outcome was also sought. > Papers > > identified were appraised in the manner recommended by the evidence based > > medicine group to ensure validity. There were no studies identified that > > answered our question directly and, furthermore, it is our belief that no > > such study, at present, exists in the literature. Six valid papers were > > found, which individually contained elements of the question posed and > these > > are presented in a narrative and graphic form. There is currently no > > evidence to support the use of intravenous lidocaine as a pretreatment for > > RSI in patients with head injury and its use should only occur in clinical > > trials. > > > > Publication Types: > > Review > > Review, Tutorial > > > > > ____________________________________________________________________________ > > __- > > J Trauma. 2005 Feb;58(2):278-83. > > > > > > Intracranial pressure changes during rapid sequence intubation: a swine > > model. > > > > Bozeman WP, Idris AH. > > > > Department of Emergency Medicine, Wake Forest University School of > Medicine, > > Winston-Salem, NC 27157, USA. wbozeman@... > > > > BACKGROUND: Controversy and speculation exist regarding intracranial > > pressure (ICP) changes produced by various combinations of rapid sequence > > intubation (RSI) agents. In this pilot study, we sought to develop a swine > > model to investigate these changes in classic RSI. METHODS: Eight adult > > swine were instrumented with arterial and intracranial pressure monitors. > > Four different versions of rapid sequence intubation were then performed > > sequentially in each animal in a crossover trial design: regimen 1, > > thiopental; regimen 2, thiopental and succinylcholine; regimen 3, > lidocaine, > > thiopental, and succinylcholine; and regimen 4, pancuronium, lidocaine, > > thiopental, and succinylcholine. ICP and hemodynamic parameters were > > recorded and compared. Trials were excluded from analysis if baseline ICP > > measurements were unstable or if intubation was difficult. RESULTS: Peak > > changes in ICP were noted at 2 to 3 minutes after administration of > > induction agents. Mean values for peak changes in ICP were as follows: > > regimen 1 (n = 5), 3.6 mm Hg (95% confidence interval [CI], 1.0-6.2 mm > Hg); > > regimen 2 (n = 9), 13.6 mm Hg (95% CI, 9.6-17.6 mm Hg); regimen 3 (n = 2), > > 16.0 mm Hg (95% CI, -34.8-66.8 mm Hg); and regimen 4 (n = 3), 12.0 mm Hg > > (95% CI, -8.3-32.3 mm Hg). CONCLUSION: The model is effective. It enables > > investigators to examine the aggregate ICP effects of combinations of RSI > > medications. RSI regimens with paralysis produced threefold increases in > > peak ICP change compared with the sedation-only regimen. Pretreatment > agents > > did not affect ICP changes. Future investigations can examine other agents > > and add experimental manipulation of ICP to simulate head injury > physiology. > > Additional parameters including cerebral metabolism and/or oxygenation may > > also be explored. > > > > > ____________________________________________________________________________ > > _______________________________ > > Lidocaine toxicity. > > > > Mehra P, Caiazzo A, Maloney P. > > > > Department of Oral and Maxillofacial Surgery, Boston University School of > > Dental Medicine, Massachusetts 02118, USA. > > > > Local anesthetics are the most commonly used drugs in dentistry. The > number > > of adverse reactions reported, particularly toxic reactions, are > > extraordinarily negligible. This article reports a case of lidocaine > > toxicity with its typical manifestation in a 37-yr-old healthy male. The > > toxic reaction followed transoral/transpharyngeal topical spraying of > > lidocaine preoperatively during preparation for general anesthesia. A > review > > of dosages of the most commonly used local anesthetic drugs in dentistry > and > > the management of a toxic reaction is presented. Clinicians need to be in > a > > position to recognize and successfully manage this potential adverse > > reaction. > > > > Publication Types: > > Case Reports > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2005 Report Share Posted March 27, 2005 Is there no such thing as permissible humor anymore? Are we left to write nothing but serious and scholarly messages? It was a joke, for cryin out loud. Perhaps not a great one. They say ny Carson and Bob Hope threw away hundreds of jokes for every one used. Lighten up, everybody. Kinky for Governor, then President Gene Gandy > > What a sad assumption you make, Gene. > > Re: RSI Drugs > > > I've intubated a few swine in my day also. Most were riding Harleys as I > recall, so I naturally assumed low ICP to begin with. > > Gene > > > > > > > > > Emerg Med J. 2001 Nov;18(6):453-7. > > > > In patients with head injury undergoing rapid sequence intubation, does > > pretreatment with intravenous lignocaine/lidocaine lead to an improved > > neurological outcome? A review of the literature. > > > > N, Clancy M. > > > > Emergency Department, Southampton General Hospital, Tremona Road, > > Southampton SO16 6YD, UK. poppabear66@... > > > > It is well known that laryngeal instrumentation and endotracheal > intubation > > is associated with a marked, transient rise in intracranial pressure > (ICP). > > Patients with head injury requiring endotracheal intubation are considered > > particularly at risk from this transient rise in ICP as it reduces > cerebral > > perfusion and thus may increase secondary brain injury. The favoured > method > > for securing a definitive airway in this patient group is by rapid > sequence > > intubation (RSI). In the United States the Emergency Airway Course teaches > > emergency physicians to routinely administer intravenous lidocaine as a > pre > > treatment for RSI in this patient group in an attempt to attenuate this > rise > > in ICP. A literature search was carried out to identify studies in which > > intravenous lidocaine was used as a pretreatment for RSI in major head > > injury. Any link to an improved neurological outcome was also sought. > Papers > > identified were appraised in the manner recommended by the evidence based > > medicine group to ensure validity. There were no studies identified that > > answered our question directly and, furthermore, it is our belief that no > > such study, at present, exists in the literature. Six valid papers were > > found, which individually contained elements of the question posed and > these > > are presented in a narrative and graphic form. There is currently no > > evidence to support the use of intravenous lidocaine as a pretreatment for > > RSI in patients with head injury and its use should only occur in clinical > > trials. > > > > Publication Types: > > Review > > Review, Tutorial > > > > > ____________________________________________________________________________ > > __- > > J Trauma. 2005 Feb;58(2):278-83. > > > > > > Intracranial pressure changes during rapid sequence intubation: a swine > > model. > > > > Bozeman WP, Idris AH. > > > > Department of Emergency Medicine, Wake Forest University School of > Medicine, > > Winston-Salem, NC 27157, USA. wbozeman@... > > > > BACKGROUND: Controversy and speculation exist regarding intracranial > > pressure (ICP) changes produced by various combinations of rapid sequence > > intubation (RSI) agents. In this pilot study, we sought to develop a swine > > model to investigate these changes in classic RSI. METHODS: Eight adult > > swine were instrumented with arterial and intracranial pressure monitors. > > Four different versions of rapid sequence intubation were then performed > > sequentially in each animal in a crossover trial design: regimen 1, > > thiopental; regimen 2, thiopental and succinylcholine; regimen 3, > lidocaine, > > thiopental, and succinylcholine; and regimen 4, pancuronium, lidocaine, > > thiopental, and succinylcholine. ICP and hemodynamic parameters were > > recorded and compared. Trials were excluded from analysis if baseline ICP > > measurements were unstable or if intubation was difficult. RESULTS: Peak > > changes in ICP were noted at 2 to 3 minutes after administration of > > induction agents. Mean values for peak changes in ICP were as follows: > > regimen 1 (n = 5), 3.6 mm Hg (95% confidence interval [CI], 1.0-6.2 mm > Hg); > > regimen 2 (n = 9), 13.6 mm Hg (95% CI, 9.6-17.6 mm Hg); regimen 3 (n = 2), > > 16.0 mm Hg (95% CI, -34.8-66.8 mm Hg); and regimen 4 (n = 3), 12.0 mm Hg > > (95% CI, -8.3-32.3 mm Hg). CONCLUSION: The model is effective. It enables > > investigators to examine the aggregate ICP effects of combinations of RSI > > medications. RSI regimens with paralysis produced threefold increases in > > peak ICP change compared with the sedation-only regimen. Pretreatment > agents > > did not affect ICP changes. Future investigations can examine other agents > > and add experimental manipulation of ICP to simulate head injury > physiology. > > Additional parameters including cerebral metabolism and/or oxygenation may > > also be explored. > > > > > ____________________________________________________________________________ > > _______________________________ > > Lidocaine toxicity. > > > > Mehra P, Caiazzo A, Maloney P. > > > > Department of Oral and Maxillofacial Surgery, Boston University School of > > Dental Medicine, Massachusetts 02118, USA. > > > > Local anesthetics are the most commonly used drugs in dentistry. The > number > > of adverse reactions reported, particularly toxic reactions, are > > extraordinarily negligible. This article reports a case of lidocaine > > toxicity with its typical manifestation in a 37-yr-old healthy male. The > > toxic reaction followed transoral/transpharyngeal topical spraying of > > lidocaine preoperatively during preparation for general anesthesia. A > review > > of dosages of the most commonly used local anesthetic drugs in dentistry > and > > the management of a toxic reaction is presented. Clinicians need to be in > a > > position to recognize and successfully manage this potential adverse > > reaction. > > > > Publication Types: > > Case Reports > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2005 Report Share Posted March 27, 2005 Is there no such thing as permissible humor anymore? Are we left to write nothing but serious and scholarly messages? It was a joke, for cryin out loud. Perhaps not a great one. They say ny Carson and Bob Hope threw away hundreds of jokes for every one used. Lighten up, everybody. Kinky for Governor, then President Gene Gandy > > What a sad assumption you make, Gene. > > Re: RSI Drugs > > > I've intubated a few swine in my day also. Most were riding Harleys as I > recall, so I naturally assumed low ICP to begin with. > > Gene > > > > > > > > > Emerg Med J. 2001 Nov;18(6):453-7. > > > > In patients with head injury undergoing rapid sequence intubation, does > > pretreatment with intravenous lignocaine/lidocaine lead to an improved > > neurological outcome? A review of the literature. > > > > N, Clancy M. > > > > Emergency Department, Southampton General Hospital, Tremona Road, > > Southampton SO16 6YD, UK. poppabear66@... > > > > It is well known that laryngeal instrumentation and endotracheal > intubation > > is associated with a marked, transient rise in intracranial pressure > (ICP). > > Patients with head injury requiring endotracheal intubation are considered > > particularly at risk from this transient rise in ICP as it reduces > cerebral > > perfusion and thus may increase secondary brain injury. The favoured > method > > for securing a definitive airway in this patient group is by rapid > sequence > > intubation (RSI). In the United States the Emergency Airway Course teaches > > emergency physicians to routinely administer intravenous lidocaine as a > pre > > treatment for RSI in this patient group in an attempt to attenuate this > rise > > in ICP. A literature search was carried out to identify studies in which > > intravenous lidocaine was used as a pretreatment for RSI in major head > > injury. Any link to an improved neurological outcome was also sought. > Papers > > identified were appraised in the manner recommended by the evidence based > > medicine group to ensure validity. There were no studies identified that > > answered our question directly and, furthermore, it is our belief that no > > such study, at present, exists in the literature. Six valid papers were > > found, which individually contained elements of the question posed and > these > > are presented in a narrative and graphic form. There is currently no > > evidence to support the use of intravenous lidocaine as a pretreatment for > > RSI in patients with head injury and its use should only occur in clinical > > trials. > > > > Publication Types: > > Review > > Review, Tutorial > > > > > ____________________________________________________________________________ > > __- > > J Trauma. 2005 Feb;58(2):278-83. > > > > > > Intracranial pressure changes during rapid sequence intubation: a swine > > model. > > > > Bozeman WP, Idris AH. > > > > Department of Emergency Medicine, Wake Forest University School of > Medicine, > > Winston-Salem, NC 27157, USA. wbozeman@... > > > > BACKGROUND: Controversy and speculation exist regarding intracranial > > pressure (ICP) changes produced by various combinations of rapid sequence > > intubation (RSI) agents. In this pilot study, we sought to develop a swine > > model to investigate these changes in classic RSI. METHODS: Eight adult > > swine were instrumented with arterial and intracranial pressure monitors. > > Four different versions of rapid sequence intubation were then performed > > sequentially in each animal in a crossover trial design: regimen 1, > > thiopental; regimen 2, thiopental and succinylcholine; regimen 3, > lidocaine, > > thiopental, and succinylcholine; and regimen 4, pancuronium, lidocaine, > > thiopental, and succinylcholine. ICP and hemodynamic parameters were > > recorded and compared. Trials were excluded from analysis if baseline ICP > > measurements were unstable or if intubation was difficult. RESULTS: Peak > > changes in ICP were noted at 2 to 3 minutes after administration of > > induction agents. Mean values for peak changes in ICP were as follows: > > regimen 1 (n = 5), 3.6 mm Hg (95% confidence interval [CI], 1.0-6.2 mm > Hg); > > regimen 2 (n = 9), 13.6 mm Hg (95% CI, 9.6-17.6 mm Hg); regimen 3 (n = 2), > > 16.0 mm Hg (95% CI, -34.8-66.8 mm Hg); and regimen 4 (n = 3), 12.0 mm Hg > > (95% CI, -8.3-32.3 mm Hg). CONCLUSION: The model is effective. It enables > > investigators to examine the aggregate ICP effects of combinations of RSI > > medications. RSI regimens with paralysis produced threefold increases in > > peak ICP change compared with the sedation-only regimen. Pretreatment > agents > > did not affect ICP changes. Future investigations can examine other agents > > and add experimental manipulation of ICP to simulate head injury > physiology. > > Additional parameters including cerebral metabolism and/or oxygenation may > > also be explored. > > > > > ____________________________________________________________________________ > > _______________________________ > > Lidocaine toxicity. > > > > Mehra P, Caiazzo A, Maloney P. > > > > Department of Oral and Maxillofacial Surgery, Boston University School of > > Dental Medicine, Massachusetts 02118, USA. > > > > Local anesthetics are the most commonly used drugs in dentistry. The > number > > of adverse reactions reported, particularly toxic reactions, are > > extraordinarily negligible. This article reports a case of lidocaine > > toxicity with its typical manifestation in a 37-yr-old healthy male. The > > toxic reaction followed transoral/transpharyngeal topical spraying of > > lidocaine preoperatively during preparation for general anesthesia. A > review > > of dosages of the most commonly used local anesthetic drugs in dentistry > and > > the management of a toxic reaction is presented. Clinicians need to be in > a > > position to recognize and successfully manage this potential adverse > > reaction. > > > > Publication Types: > > Case Reports > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2005 Report Share Posted March 27, 2005 Even worse if the lawyer was also a doctor! GG > > Gene, > Hey now, I resemble that remark!!!! > > And if the swine you refer had also been a lawyer... > Their heads are so swollen with hot air and methane, likely no further > damage occurred in impact. > > (production of methane gas from organic waste, primarily manure, which is > easily accomplished) > > bkw > > > Re: RSI Drugs > > > > I've intubated a few swine in my day also. Most were riding Harleys as I > recall, so I naturally assumed low ICP to begin with. > > Gene > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2005 Report Share Posted March 27, 2005 Even worse if the lawyer was also a doctor! GG > > Gene, > Hey now, I resemble that remark!!!! > > And if the swine you refer had also been a lawyer... > Their heads are so swollen with hot air and methane, likely no further > damage occurred in impact. > > (production of methane gas from organic waste, primarily manure, which is > easily accomplished) > > bkw > > > Re: RSI Drugs > > > > I've intubated a few swine in my day also. Most were riding Harleys as I > recall, so I naturally assumed low ICP to begin with. > > Gene > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2005 Report Share Posted March 27, 2005 Even worse if the lawyer was also a doctor! GG > > Gene, > Hey now, I resemble that remark!!!! > > And if the swine you refer had also been a lawyer... > Their heads are so swollen with hot air and methane, likely no further > damage occurred in impact. > > (production of methane gas from organic waste, primarily manure, which is > easily accomplished) > > bkw > > > Re: RSI Drugs > > > > I've intubated a few swine in my day also. Most were riding Harleys as I > recall, so I naturally assumed low ICP to begin with. > > Gene > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2005 Report Share Posted March 27, 2005 Hey, I'm just jealous. I never could afford one of those kinds of toys. GG > > Ah Gene, I know you group all of us organ donors into one category. > > Barry M > > In a message dated 3/25/2005 12:11:51 AM Central Standard Time, > wegandy1938@... writes: > Barry, > > I thought you rode a Yamaha. Sorry. > > GG > > > > > > > Rather judgmental statement don't you think Gene? > > > > Barry Meffert > > > > In a message dated 3/24/2005 2:24:25 PM Central Standard Time, > > wegandy1938@... writes: > > I've intubated a few swine in my day also. Most were riding Harleys as I > > recall, so I naturally assumed low ICP to begin with. > > > > Gene > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2005 Report Share Posted March 27, 2005 I ride a hog and I thought it was funny -------------------------------------------------------------------------------- Re: RSI Drugs > > > I've intubated a few swine in my day also. Most were riding Harleys as I > recall, so I naturally assumed low ICP to begin with. > > Gene > > > > > > > > > Emerg Med J. 2001 Nov;18(6):453-7. > > > > In patients with head injury undergoing rapid sequence intubation, does > > pretreatment with intravenous lignocaine/lidocaine lead to an improved > > neurological outcome? A review of the literature. > > > > N, Clancy M. > > > > Emergency Department, Southampton General Hospital, Tremona Road, > > Southampton SO16 6YD, UK. poppabear66@... > > > > It is well known that laryngeal instrumentation and endotracheal > intubation > > is associated with a marked, transient rise in intracranial pressure > (ICP). > > Patients with head injury requiring endotracheal intubation are considered > > particularly at risk from this transient rise in ICP as it reduces > cerebral > > perfusion and thus may increase secondary brain injury. The favoured > method > > for securing a definitive airway in this patient group is by rapid > sequence > > intubation (RSI). In the United States the Emergency Airway Course teaches > > emergency physicians to routinely administer intravenous lidocaine as a > pre > > treatment for RSI in this patient group in an attempt to attenuate this > rise > > in ICP. A literature search was carried out to identify studies in which > > intravenous lidocaine was used as a pretreatment for RSI in major head > > injury. Any link to an improved neurological outcome was also sought. > Papers > > identified were appraised in the manner recommended by the evidence based > > medicine group to ensure validity. There were no studies identified that > > answered our question directly and, furthermore, it is our belief that no > > such study, at present, exists in the literature. Six valid papers were > > found, which individually contained elements of the question posed and > these > > are presented in a narrative and graphic form. There is currently no > > evidence to support the use of intravenous lidocaine as a pretreatment for > > RSI in patients with head injury and its use should only occur in clinical > > trials. > > > > Publication Types: > > Review > > Review, Tutorial > > > > > ____________________________________________________________________________ > > __- > > J Trauma. 2005 Feb;58(2):278-83. > > > > > > Intracranial pressure changes during rapid sequence intubation: a swine > > model. > > > > Bozeman WP, Idris AH. > > > > Department of Emergency Medicine, Wake Forest University School of > Medicine, > > Winston-Salem, NC 27157, USA. wbozeman@... > > > > BACKGROUND: Controversy and speculation exist regarding intracranial > > pressure (ICP) changes produced by various combinations of rapid sequence > > intubation (RSI) agents. In this pilot study, we sought to develop a swine > > model to investigate these changes in classic RSI. METHODS: Eight adult > > swine were instrumented with arterial and intracranial pressure monitors. > > Four different versions of rapid sequence intubation were then performed > > sequentially in each animal in a crossover trial design: regimen 1, > > thiopental; regimen 2, thiopental and succinylcholine; regimen 3, > lidocaine, > > thiopental, and succinylcholine; and regimen 4, pancuronium, lidocaine, > > thiopental, and succinylcholine. ICP and hemodynamic parameters were > > recorded and compared. Trials were excluded from analysis if baseline ICP > > measurements were unstable or if intubation was difficult. RESULTS: Peak > > changes in ICP were noted at 2 to 3 minutes after administration of > > induction agents. Mean values for peak changes in ICP were as follows: > > regimen 1 (n = 5), 3.6 mm Hg (95% confidence interval [CI], 1.0-6.2 mm > Hg); > > regimen 2 (n = 9), 13.6 mm Hg (95% CI, 9.6-17.6 mm Hg); regimen 3 (n = 2), > > 16.0 mm Hg (95% CI, -34.8-66.8 mm Hg); and regimen 4 (n = 3), 12.0 mm Hg > > (95% CI, -8.3-32.3 mm Hg). CONCLUSION: The model is effective. It enables > > investigators to examine the aggregate ICP effects of combinations of RSI > > medications. RSI regimens with paralysis produced threefold increases in > > peak ICP change compared with the sedation-only regimen. Pretreatment > agents > > did not affect ICP changes. Future investigations can examine other agents > > and add experimental manipulation of ICP to simulate head injury > physiology. > > Additional parameters including cerebral metabolism and/or oxygenation may > > also be explored. > > > > > ____________________________________________________________________________ > > _______________________________ > > Lidocaine toxicity. > > > > Mehra P, Caiazzo A, Maloney P. > > > > Department of Oral and Maxillofacial Surgery, Boston University School of > > Dental Medicine, Massachusetts 02118, USA. > > > > Local anesthetics are the most commonly used drugs in dentistry. The > number > > of adverse reactions reported, particularly toxic reactions, are > > extraordinarily negligible. This article reports a case of lidocaine > > toxicity with its typical manifestation in a 37-yr-old healthy male. The > > toxic reaction followed transoral/transpharyngeal topical spraying of > > lidocaine preoperatively during preparation for general anesthesia. A > review > > of dosages of the most commonly used local anesthetic drugs in dentistry > and > > the management of a toxic reaction is presented. Clinicians need to be in > a > > position to recognize and successfully manage this potential adverse > > reaction. > > > > Publication Types: > > Case Reports > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2005 Report Share Posted March 27, 2005 I ride a hog and I thought it was funny -------------------------------------------------------------------------------- Re: RSI Drugs > > > I've intubated a few swine in my day also. Most were riding Harleys as I > recall, so I naturally assumed low ICP to begin with. > > Gene > > > > > > > > > Emerg Med J. 2001 Nov;18(6):453-7. > > > > In patients with head injury undergoing rapid sequence intubation, does > > pretreatment with intravenous lignocaine/lidocaine lead to an improved > > neurological outcome? A review of the literature. > > > > N, Clancy M. > > > > Emergency Department, Southampton General Hospital, Tremona Road, > > Southampton SO16 6YD, UK. poppabear66@... > > > > It is well known that laryngeal instrumentation and endotracheal > intubation > > is associated with a marked, transient rise in intracranial pressure > (ICP). > > Patients with head injury requiring endotracheal intubation are considered > > particularly at risk from this transient rise in ICP as it reduces > cerebral > > perfusion and thus may increase secondary brain injury. The favoured > method > > for securing a definitive airway in this patient group is by rapid > sequence > > intubation (RSI). In the United States the Emergency Airway Course teaches > > emergency physicians to routinely administer intravenous lidocaine as a > pre > > treatment for RSI in this patient group in an attempt to attenuate this > rise > > in ICP. A literature search was carried out to identify studies in which > > intravenous lidocaine was used as a pretreatment for RSI in major head > > injury. Any link to an improved neurological outcome was also sought. > Papers > > identified were appraised in the manner recommended by the evidence based > > medicine group to ensure validity. There were no studies identified that > > answered our question directly and, furthermore, it is our belief that no > > such study, at present, exists in the literature. Six valid papers were > > found, which individually contained elements of the question posed and > these > > are presented in a narrative and graphic form. There is currently no > > evidence to support the use of intravenous lidocaine as a pretreatment for > > RSI in patients with head injury and its use should only occur in clinical > > trials. > > > > Publication Types: > > Review > > Review, Tutorial > > > > > ____________________________________________________________________________ > > __- > > J Trauma. 2005 Feb;58(2):278-83. > > > > > > Intracranial pressure changes during rapid sequence intubation: a swine > > model. > > > > Bozeman WP, Idris AH. > > > > Department of Emergency Medicine, Wake Forest University School of > Medicine, > > Winston-Salem, NC 27157, USA. wbozeman@... > > > > BACKGROUND: Controversy and speculation exist regarding intracranial > > pressure (ICP) changes produced by various combinations of rapid sequence > > intubation (RSI) agents. In this pilot study, we sought to develop a swine > > model to investigate these changes in classic RSI. METHODS: Eight adult > > swine were instrumented with arterial and intracranial pressure monitors. > > Four different versions of rapid sequence intubation were then performed > > sequentially in each animal in a crossover trial design: regimen 1, > > thiopental; regimen 2, thiopental and succinylcholine; regimen 3, > lidocaine, > > thiopental, and succinylcholine; and regimen 4, pancuronium, lidocaine, > > thiopental, and succinylcholine. ICP and hemodynamic parameters were > > recorded and compared. Trials were excluded from analysis if baseline ICP > > measurements were unstable or if intubation was difficult. RESULTS: Peak > > changes in ICP were noted at 2 to 3 minutes after administration of > > induction agents. Mean values for peak changes in ICP were as follows: > > regimen 1 (n = 5), 3.6 mm Hg (95% confidence interval [CI], 1.0-6.2 mm > Hg); > > regimen 2 (n = 9), 13.6 mm Hg (95% CI, 9.6-17.6 mm Hg); regimen 3 (n = 2), > > 16.0 mm Hg (95% CI, -34.8-66.8 mm Hg); and regimen 4 (n = 3), 12.0 mm Hg > > (95% CI, -8.3-32.3 mm Hg). CONCLUSION: The model is effective. It enables > > investigators to examine the aggregate ICP effects of combinations of RSI > > medications. RSI regimens with paralysis produced threefold increases in > > peak ICP change compared with the sedation-only regimen. Pretreatment > agents > > did not affect ICP changes. Future investigations can examine other agents > > and add experimental manipulation of ICP to simulate head injury > physiology. > > Additional parameters including cerebral metabolism and/or oxygenation may > > also be explored. > > > > > ____________________________________________________________________________ > > _______________________________ > > Lidocaine toxicity. > > > > Mehra P, Caiazzo A, Maloney P. > > > > Department of Oral and Maxillofacial Surgery, Boston University School of > > Dental Medicine, Massachusetts 02118, USA. > > > > Local anesthetics are the most commonly used drugs in dentistry. The > number > > of adverse reactions reported, particularly toxic reactions, are > > extraordinarily negligible. This article reports a case of lidocaine > > toxicity with its typical manifestation in a 37-yr-old healthy male. The > > toxic reaction followed transoral/transpharyngeal topical spraying of > > lidocaine preoperatively during preparation for general anesthesia. A > review > > of dosages of the most commonly used local anesthetic drugs in dentistry > and > > the management of a toxic reaction is presented. Clinicians need to be in > a > > position to recognize and successfully manage this potential adverse > > reaction. > > > > Publication Types: > > Case Reports > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2005 Report Share Posted March 27, 2005 I ride a hog and I thought it was funny -------------------------------------------------------------------------------- Re: RSI Drugs > > > I've intubated a few swine in my day also. Most were riding Harleys as I > recall, so I naturally assumed low ICP to begin with. > > Gene > > > > > > > > > Emerg Med J. 2001 Nov;18(6):453-7. > > > > In patients with head injury undergoing rapid sequence intubation, does > > pretreatment with intravenous lignocaine/lidocaine lead to an improved > > neurological outcome? A review of the literature. > > > > N, Clancy M. > > > > Emergency Department, Southampton General Hospital, Tremona Road, > > Southampton SO16 6YD, UK. poppabear66@... > > > > It is well known that laryngeal instrumentation and endotracheal > intubation > > is associated with a marked, transient rise in intracranial pressure > (ICP). > > Patients with head injury requiring endotracheal intubation are considered > > particularly at risk from this transient rise in ICP as it reduces > cerebral > > perfusion and thus may increase secondary brain injury. The favoured > method > > for securing a definitive airway in this patient group is by rapid > sequence > > intubation (RSI). In the United States the Emergency Airway Course teaches > > emergency physicians to routinely administer intravenous lidocaine as a > pre > > treatment for RSI in this patient group in an attempt to attenuate this > rise > > in ICP. A literature search was carried out to identify studies in which > > intravenous lidocaine was used as a pretreatment for RSI in major head > > injury. Any link to an improved neurological outcome was also sought. > Papers > > identified were appraised in the manner recommended by the evidence based > > medicine group to ensure validity. There were no studies identified that > > answered our question directly and, furthermore, it is our belief that no > > such study, at present, exists in the literature. Six valid papers were > > found, which individually contained elements of the question posed and > these > > are presented in a narrative and graphic form. There is currently no > > evidence to support the use of intravenous lidocaine as a pretreatment for > > RSI in patients with head injury and its use should only occur in clinical > > trials. > > > > Publication Types: > > Review > > Review, Tutorial > > > > > ____________________________________________________________________________ > > __- > > J Trauma. 2005 Feb;58(2):278-83. > > > > > > Intracranial pressure changes during rapid sequence intubation: a swine > > model. > > > > Bozeman WP, Idris AH. > > > > Department of Emergency Medicine, Wake Forest University School of > Medicine, > > Winston-Salem, NC 27157, USA. wbozeman@... > > > > BACKGROUND: Controversy and speculation exist regarding intracranial > > pressure (ICP) changes produced by various combinations of rapid sequence > > intubation (RSI) agents. In this pilot study, we sought to develop a swine > > model to investigate these changes in classic RSI. METHODS: Eight adult > > swine were instrumented with arterial and intracranial pressure monitors. > > Four different versions of rapid sequence intubation were then performed > > sequentially in each animal in a crossover trial design: regimen 1, > > thiopental; regimen 2, thiopental and succinylcholine; regimen 3, > lidocaine, > > thiopental, and succinylcholine; and regimen 4, pancuronium, lidocaine, > > thiopental, and succinylcholine. ICP and hemodynamic parameters were > > recorded and compared. Trials were excluded from analysis if baseline ICP > > measurements were unstable or if intubation was difficult. RESULTS: Peak > > changes in ICP were noted at 2 to 3 minutes after administration of > > induction agents. Mean values for peak changes in ICP were as follows: > > regimen 1 (n = 5), 3.6 mm Hg (95% confidence interval [CI], 1.0-6.2 mm > Hg); > > regimen 2 (n = 9), 13.6 mm Hg (95% CI, 9.6-17.6 mm Hg); regimen 3 (n = 2), > > 16.0 mm Hg (95% CI, -34.8-66.8 mm Hg); and regimen 4 (n = 3), 12.0 mm Hg > > (95% CI, -8.3-32.3 mm Hg). CONCLUSION: The model is effective. It enables > > investigators to examine the aggregate ICP effects of combinations of RSI > > medications. RSI regimens with paralysis produced threefold increases in > > peak ICP change compared with the sedation-only regimen. Pretreatment > agents > > did not affect ICP changes. Future investigations can examine other agents > > and add experimental manipulation of ICP to simulate head injury > physiology. > > Additional parameters including cerebral metabolism and/or oxygenation may > > also be explored. > > > > > ____________________________________________________________________________ > > _______________________________ > > Lidocaine toxicity. > > > > Mehra P, Caiazzo A, Maloney P. > > > > Department of Oral and Maxillofacial Surgery, Boston University School of > > Dental Medicine, Massachusetts 02118, USA. > > > > Local anesthetics are the most commonly used drugs in dentistry. The > number > > of adverse reactions reported, particularly toxic reactions, are > > extraordinarily negligible. This article reports a case of lidocaine > > toxicity with its typical manifestation in a 37-yr-old healthy male. The > > toxic reaction followed transoral/transpharyngeal topical spraying of > > lidocaine preoperatively during preparation for general anesthesia. A > review > > of dosages of the most commonly used local anesthetic drugs in dentistry > and > > the management of a toxic reaction is presented. Clinicians need to be in > a > > position to recognize and successfully manage this potential adverse > > reaction. > > > > Publication Types: > > Case Reports > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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