In Europe, use of potatoes (Solani tuberosi tuberecens) is a traditional remedy for stomach complaints. We performed a pilot study on the effectiveness and tolerability of freshly squeezed potato ...juice in patients suffering from dyspeptic symptoms.
After informed written consent, 44
1
1
Forty-five subjects were originally enrolled. One patient withdrew consent after completing the study and was treated as if she had not been enrolled.
patients with various dyspeptic symptoms were enrolled, to drink for 1 week twice daily 100
ml or more of potato juice (Biotta
®), if complaints persisted, a further 100
ml was recommended. Validated outcome measures included the gastrointestinal symptom (GIS) profile, a disease-specific health assessment questionnaire (QOLRAD) and self-rated treatment success (efficacy, a 5-point Likert Scale).
The study was completed by 42 patients. The GIS and QOLRAD scores improved significantly by 41.9±40.8% (
p
=
0.0
0
1
) and 50.7±36.1% (
p
<
0.0
0
1
), respectively (ITT); the absolute values changed from 11.5±5.1 to 6.3±5.3 (GIS) and 62.0±25.7 to 32.0±28.8 (QORAD).
Sixteen, 18 and 26 patients, respectively, rated the effectiveness of the treatment as very good or good on the GIS, QOLRAD (improvements >60%) and on efficacy, respectively. Poor treatment success was achieved in 13 (GIS), 11 (QOLRAD) and 10 (Efficacy), not necessarily by the same patients.
Since about two-thirds of the patients benefited to some extent from the treatment, potato juice in its present formulation may be useful for self-treatment. However, placebo-controlled studies with a longer treatment period are needed to confirm this.
Persistent neuromuscular blockade is not uncommon in the recovery room and contributes to postoperative morbidity and possibly mortality. The use of neuromuscular monitoring and intermediate rather ...than long-acting neuromuscular blocking drugs have been shown to reduce its incidence. Clinically available methods of detecting and quantitating neuromuscular blockade are reviewed. The writer concludes that such monitoring should be routine when neuromuscular blocking drugs are used.
The Education and Experience in Engineering (E3) Program was developed at Illinois Institute of Technology (IIT) in 1970. The Programs goals were: 1) to motivate students for continuous independent ...learning, 2) to educate engineers capable of bringing interdisciplinary knowledge to bear on problem solving, 3) to cause students to become honest and realistic evaluators of their own work as well as that of their associates, 4) to provide students the opportunity to learn how to work in teams of engineering and non‐engineering professionals, and 5) to foster the development of diverse communication skills. The students acquired knowledge of the “core” curriculum by means of learning modules; beyond the core materials, students were encouraged to learn advanced materials on their own. Conventional classes were eliminated and seminars supported broadening of knowledge. Solving open‐ended problems re‐defined the role of faculty from lecturers to mentors and guides. Requirement of mastery in every aspect of the Program substituted for grades and students prepared comprehensive portfolios of their accomplishments. Since educational goals of the Program were clearly defined, prospective students were able to assess whether E3 would be suitable for them.
The purpose of this study was to compare the use of 0.5% ropivacaine with 0.5% bupivacaine for axillary brachial plexus anaesthesia. Sixty-six patients undergoing upper limb surgery were enrolled in ...a double-blind, randomized, multicentre trial. Five patients were subsequently excluded for various reasons. Of the remaining patients, 30 received 40 ml of 0.5% ropivacaine and 31 received 40 ml of 0.5% bupivacaine. Brachial plexus block was performed by the axillary approach using a standardized technique with a peripheral nerve stimulator. Parameters investigated included the frequency, onset and duration of sensory and motor block, the quality of anaesthesia and the occurrence of any adverse events. The six principal nerves of the brachial plexus were studied individually. The frequency for achieving anaesthesia per nerve ranged from 70 to 90% in the ropivacaine group and 81 to 87% in the bupivacaine group. The median onset time for anaesthesia was 10 to 20 minutes with ropivacaine and 10 to 30 minutes with bupivacaine, and the median duration was 5.3 to 8.7h with ropivacaine and 6.9 to 20.3h with bupivacaine. Motor block was evaluated at the elbow, wrist and hand, and was completely achieved at a rate of 60 to 73% in the ropivacaine group and 55 to 71% in the bupivacaine group. The median duration of motor block was 6.5 to 7.5h with ropivacaine and 6.0 to 9.0h with bupivacaine. These parameters were not statistically different. The duration of partial motor block at the wrist (6.8 v 16.4h) and hand (6.7 v 12.3h) was significantly longer with bupivacaine. Ropivacaine 0.5% and bupivacaine 0.5% appeared equally efficacious as long-acting local anaesthetics for axillary brachial plexus block.
Fentanyl 50 μg, bupivacaine 50 mg and two mixtures containing fentanyl 50 ng and bupivacaine 25 mg or 12.5 mg (0.25 and 0.125%), respectively, in a volume of 10 ml were administered via thoracic ...extradural catheters to 24 patients after major abdominal surgery. All patients received all four treatments, in a randomized order, so that each patient received one of the 24 possible combinations of the four treatments. Pain relief was assessed by a linear analogue pain scale and the Prince Henry Hospital pain score. The duration of pain relief, effects on ventilatory frequency, heart rate, arterial pressure and central venous pressure were also recorded. Mean reductions in the analogue pain scale for fentanyl, bupivacaine, and fentanyl in 0.25% and 0.125% bupivacaine were 80 (sem 5)%, 87 (4)%, 86 (5)% and 77 (5)%, respectively (ns). Pain scores decreased by 62(6)%, 83(5)%, 77 (6)% and 72 (6)%, respectively (ns). Mean arterial pressure decreased to 90 (2)%, 70 (2)%, 81 (2)% and 82 (3)%, respectively, of pretreatment values. In this respect, bupivacaine alone was significantly different from the three other treatments (P < 0.001). Hypotension (reduction in arterial pressure greater than 25% of pretreatment mean arterial pressure) was also more frequent after bupivacaine alone (P < 0.01). Effects on ventilation, heart rate and central venous pressure did not differ between the four treatments. We conclude that in patients who had undergone major abdominal surgery, analgesia after thoracic extradural injection of fentanyl 50 μg did not differ significantly from analgesia after 0.5% bupivacaine 10 ml, or the fentanyl-bupivacaine mixtures. Bupivacaine alone caused a greater decrease in arterial pressure and a higher incidence of hypotension than fentanyl or the fentanyl-bupivacaine mixtures.
An association between the administration of paracetamol and relative hypotension in critically ill intensive care patients has been reported anecdotally by nursing staff working in the Intensive ...Care Unit (ICU) of Prince Henry Hospital. An observational study was therefore undertaken, to determine whether there is a temporal association between the administration of paracetamol and changes in blood pressure.
A dose of 1 gram of paracetamol was administered orally or by feeding tube. Blood pressure was recorded 30 minutes prior to paracetamol administration, at the time of administration and then at 15-minute intervals for the first hour and at half-hour intervals for the second hour after administration.
Analysis of data from 37 individuals using a repeated measures ANOVA showed that systolic arterial pressure (SAP) and mean arterial pressure (MAP) were reduced significantly over the observation period (p < 0.0001 for both). SAP and MAP fell by an average of approximately 10 and 7 per cent respectively, with maximum falls of 36 and 34 per cent respectively.
Paracetamol administration may be indicated for the control of fever in critically ill patients, thereby reducing oxygen demand. However, this must be balanced against the possibility of causing a significant fall in blood pressure.
Methods of the kinetic analysis of vecuronium based on effect only were developed but have been limited by the short time period of the studies. Using a multicompartment model and sequential dosing, ...the authors studied the ability of tests to determine most pharmacokinetic and pharmacodynamic parameters of vecuronium without measuring plasma concentrations.
The time course of neuromuscular blockade by successive bolus doses of vecuronium was recorded using electromyography. Inhibition of neuromuscular transmission by vecuronium was modeled by a biexponential decline in the concentrations in the central compartment and first-order transfer between the central and the effect compartments responsible for the inhibition of the first (T1) and fourth (T4) responses to train-of-four stimulation.
The time course of the effect of vecuronium was described well by the model. The mean half-lives of equilibration between plasma and the effect compartments to inhibit T1 and T4 were 2.5 and 3.2 min, respectively. The mean half-lives of distribution and elimination from the central compartment were 7.7 and 7.8 min, respectively. From the kinetic and dynamic parameters calculated after two and three doses, the time taken to recover to 50% of the maximal block of T1 was predicted for the succeeding dose. The mean prediction errors (100 x absolute difference between actual and predicted times/actual) were 13.6% (range, 0-40%) and 15% (range, 0-25%) after three and four doses, respectively.
After sequential doses, measurement of the time course of the effect of vecuronium yields pharmacokinetic and pharmacodynamic parameters with clinically acceptable accuracy in individual patients.
The purpose of this study was to compare the epidural use of 0.5% ropivacaine and 0.5% bupivacaine in patients undergoing lower limb orthopaedic surgery. In a double-blind, randomized, multi-centre ...study involving 67 patients, thirty-two patients received 20 ml of 0.5% ropivacaine and 35 patients received 20 ml of 0.5% bupivacaine at the L2,3 or L3,4 interspace. Parameters measured were the onset time, duration and spread of sensory block, the onset time, duration and degree of motor block, the quality of anaesthesia and the heart rate and blood pressure profile during block onset. Four patients (3 ropivacaine, 1 bupivacaine) were excluded from the study due to technical failure of the block. The onset and duration of analgesia at the T10 dermatome (median, interquartile range) was 10 (5-15) minutes and 3.5 (2.7-4.3) hours respectively for ropivacaine, and was 10 (6-15) minutes and 3.4 (2.5-3.8) hours respectively for bupivacaine. Maximum block height (median, range) was T6 (T2-T12) for ropivacaine and T6 (C7-T10) for bupivacaine. Nine patients receiving ropivacaine and eight patients receiving bupivacaine developed no apparent motor block. The incidence of complete motor block (Bromage grade 3) was low in both groups, being 4/27 for ropivacaine and 6/34 for bupivacaine. In the ropivacaine group, motor and sensory block were judged to be satisfactory in 78% of patients. In the bupivacaine group, motor and sensory block were judged to be satisfactory in 71% and 62% of patients respectively. Cardiovascular changes were similar in both groups. No statistical differences were found between the two groups regarding any of the study parameters.
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