Intravenous Infusion Pump Research Articles

Treatment of cancer-related pain-From pharmacotherapy to invasive procedures

Depending on the stage of the tumor up to 80% of the patients suffer from cancer-related pain but treatment is often inadequate. Multiple causes can trigger pain and these can be due to the tumor itself, its secondary consequences but also treatment related. Adifferentiated assessment and individually tailored treatment of cancer-related pain not only improve the quality of life but also reduce the risk of pain chronification. A differentiation between nociceptive pain and pain caused by hypersensitivity is amandatory requirement for adequate pharmacotherapy. There is arisk of inadequate pain control, particularly with a lack of consideration and treatment of hypersensitivity, e.g., with anticonvulsants or analgesic antidepressants. Opioids are an integral part of drug treatment for cancer-related pain and especially for the treatment of breakthrough cancer pain. The risk of abuse should be considered. Other substance groups are suitable for special pain situations or in cases refractory to treatment. Nonpharmacological treatment options should also be considered, in particular by offering low-threshold access to psychotherapeutic or psycho-oncological options. Invasive procedures can be a useful supplement. These range from patient-controlled subcutaneous or intravenous infusion pump systems and intrathecal drug administration up to neurolytic and ablative procedures. Due to the invasiveness of these procedures, an interdisciplinary approach is recommended to confirm the indications.

Optimizing the Use of Dose Error Reduction Software on Intravenous Infusion Pumps.

Intravenous infusions have the potential to cause significant harm in patients and are associated with a high rate of adverse drug events and medication errors. Infusion pumps with dose error reduction software (DERS) can be used to reduce errors by establishing safe infusion parameters. In 2019, a quality improvement project was initiated with the aim to increase DERS compliance from 46% to 75% at our specialty institution by October 1, 2022. An interdisciplinary group was tasked with improving compliance with DERS by identifying key drivers, including informed staff, engaged staff, and an accurate smart pump library. We used the Model for Improvement framework to guide this improvement project, and Plan-Do-Study-Act (PDSA) cycles were used to plan for interventions. PDSA cycles included drug library updates, education, and unit-level compliance reporting. Weekly average DERS compliance was monitored as the outcome measure, and weekly pump alerts per 100 infusions were monitored as a balancing measure; statistical process control charts were used to monitor measures from 2018 to 2022. Over the course of 25 months, 8 PDSA cycles resulted in 5 centerline improvements from a baseline mean of 46% to a final mean of 78%. Pump alerts per 100 infusions decreased from 15.9 to 6.4 with the first PDSA cycle and then continued to decrease to 3.9 with subsequent interventions. Although features like DERS can help ensure safe medication administration, continuous improvement efforts to increase DERS compliance without increasing alert burden are needed to ensure that benefits of this technology are optimized.

Pharmacokinetic and pharmacodynamic evaluation study of etomidate: a randomized, open-label, 2-period crossover study in healthy Chinese subjects

Etomidate is a sedative and hypnotic drug through intravenous administration that act on the central nervous system through GABA (Gamma-Amino Butyric Acid) receptors, which is widely used in anesthesia induction and maintenance and long-term sedation in severe patients. The study aimed to evaluate the pharmacokinetic and pharmacodynamic properties of two etomidate fat emulsions after administration through the intravenous infusion pump in healthy Chinese subjects. A randomized, open-label, 2-period crossover study was performed in 52 healthy subjects. The wash-out period was 7 days. Blood samples and pharmacodynamic index values were collected at the specified time points. Etomidate concentrations were measured using validated liquid chromatography-tandem mass spectrometry. Pharmacokinetic parameters were analyzed using a non-compartment model method. Pharmacodynamic parameters were calculated using pharmacodynamic index values. The study also evaluated the safety of the etomidate. Both the pharmacokinetic parameters and pharmacodynamic parameters result of the test and reference formulation were very similar. The 90% confidence intervals (CI) of the geometric least-squares mean (GLSM) ratios of the test to reference formulation were 91.33–104.96% for the maximum plasma concentration (Cmax), 97.21–102.03% for the area under the plasma concentration time curve from time 0 to the time of the last measurable concentration (AUC0–t), and 97.22–102.33% for the area under the plasma concentration time curve from time 0 to infinity (AUC0–∞). Meanwhile, the 90% CI of the GLSM ratios of the test to reference formulation were 102.28–110.69% for the minimal BIS value (BISmin), 99.23–101.17% for the area under the BIS time curve from time 0–60 min after administration (BISAUC0–60 min), respectively. The 90% CI of these pharmacokinetic and pharmacodynamic parameters all fall in the accepted bioequivalence range of 80.00–125.00%. No serious adverse events occurred during the study. This study has shown that the etomidate fat emulsion test and reference formulation had similar pharmacokinetic and pharmacodynamic characteristics in vivo. The two formulations exhibited good safety and well-tolerance.Clinical trials registration number:http://www.chinadrugtrials.org.cn/index.html. # CTR20191836.

A retrospective study on the efficacy and safety of Endostar with chemotherapy in EGFR-TKI-resistant NSCLC

BackgroundEndostar is a strong angiogenesis inhibitor that is effective in treating non-small cell lung cancer (NSCLC), but the effect of Endostar in the treatment of patients with EGFR-TKI-resistant NSCLC remains unclear. We evaluated the clinical efficacy and safety of Endostar in EGFR-mutant NSCLC patients resistant to EGFR inhibition treatment.MethodsFrom January 1, 2016 to June 30, 2018, 68 patients were selected from the 4 institutions for the study. Patients with NSCLC received Endostar plus chemotherapy every 21-day cycle. Chemotherapy types included platinum-containing dual drugs and platinum-free single drugs. Endostar was administered by intermittent intravenous infusion or continuous microinfusion pump infusion. The overall response rate (ORR), disease control rate (DCR) and adverse events were analyzed. Survival of patients was also evaluated.ResultsFor all patients, the median progression-free survival (PFS) was 2.8 months, and the median overall survival (OS) was 14.2 months. PFS and OS in the Endostar pump continuous group were better than those in the Endostar intravenous infusion group. The disease control rate (DCR) was 79.4%. A total of 28 (41.2%) patients experienced varying grades of adverse events during treatment. No treatment-associated deaths were observed. The grade 3 treatment-emergent adverse events (TEAEs) were myelosuppression, weakness, and nausea/vomiting.ConclusionsEndostar was effective and well tolerated in advanced NSCLC patients. Endostar treatment showed promising survival results in EGFR-mutant NSCLC patients.

Protocolization of Analgesia and Sedation Through Smart Technology in Intensive Care: Improving Patient Safety.

The risk of medication errors in intensive care units is high, primarily in the drug administration phase. Management of high-alert medications within intensive care units in the study institution varied widely. The aim of this quality improvement project was to protocolize and centralize the management of high-alert medications in acute care settings and to implement smart intravenous infusion pump technology in intensive care units. The project was conducted in 4 phases: (1) protocolization and standardization of intravenous mixtures, (2) centralization of intravenous mixture preparation in the Pharmacy Department, (3) programming of the smart pumps, and (4) dissemination and staged implementation of intravenous mixture protocols. Smart pumps (Alaris, CareFusion) were used to deliver the medicines, and the manufacturer's software (Alaris Guardrails, CareFusion) was used to analyze data regarding adherence to the drug library and the number of programming errors detected. Morphine, remifentanil, fentanyl, midazolam, dexmedetomidine, and propofol were included. After implementation of the smart pumps, 3283 infusions were started; of these, 2198 were programmed through the drug library, indicating 67% compliance with the safety software. The pumps intercepted 398 infusion-related programming errors that led to cancellation or reprogramming of drug infusions. Protocolization and centralization of the preparation of high-alert sedative and analgesic medications for critically ill patients and the administration of these drugs using smart pump technology decrease variability of clinical practice and intercept potentially serious medication errors.

Successful Emerging Technologies in Nursing Care

Now that technology is becoming available in nursing care, the quality of care can be improved. Our study will answer this question: What is the effect of electronic health record, infusion pump, and near-infrared vein finder on nursing practice and patient outcomes? The purpose of this article is to determine the pros and cons of electronic health records on work and patients' outcome, to evaluate the extent to which intravenous infusion pumps contribute to reducing medication errors and facilitating the nurse's work, and to assess Near- Infrared Vein Finder effectiveness. The research design is qualitative and quantitative. The study population is nursing staff in Saudi Arabia. A near-infrared vein finder device has been found to increase nurses' confidence, result in more successful IV cannulations, and reduce pain, tension, and physical disturbances in adults. Electronic health records improve the quality of health care and expedite task completion. As a result of the use of an infusion pump, patients' fears of medication have been reduced. Patients' confidence in nursing care has increased.

Diffuse refractory coronary artery spasm after off-pump coronary artery bypass grafting: a case series

BackgroundDiffuse coronary artery spasm after coronary artery bypass grafting may cause disastrous circulatory collapse and death if not detected and managed promptly.Case presentationFour out of 387 patients who underwent uneventful off-pump coronary artery bypass grafting between January 2019 and December 2021 at our centre developed unexplained arrhythmias and hypotension within 2 to 6 h of the postoperative period. Coronary angiogram showed diffuse coronary vasospasm involving both grafted and ungrafted native coronary arteries. Vasospasm was refractory to intracoronary vasodilators in all these cases. All of the patients recovered completely with the use of intravenous verapamil infusion and intraaortic balloon pump support.ConclusionsCoronary artery spasm should remain in the differential diagnosis in patients developing unexplained arrhythmias and haemodynamic instability following coronary artery bypass grafting. Prompt diagnosis with coronary angiogram and proper management strategy using calcium channel blockers and intraaortic balloon pump can revert this deadly complication. Surgical intervention may delay precious time needed for therapeutic intervention.

Effects of Dexmedetomidine on Hemodynamics and Anesthesia Effect of Different Doses of General Anesthesia in Patients Undergoing Hepatobiliary Surgery.

In order to provide corresponding anesthesia methods of hepatobiliary diseases and obtain better clinical effect, the hemodynamics and clinical efficacy are evaluated by using different doses of dexamethasone (DEX) during the operation. 97 patients undergoing general anesthesia for hepatobiliary surgery in our hospital from April 2020 to August 2021 are analyzed retrospectively. All patients are divided into G1 (n = 24), G2 (n = 24), G3 (n = 24), and control group (n = 25) according to the random number table method. The G1, G2, and G3 groups are injected with DEX 1.0 ug/kg, DEX 0.8 ug/kg, and DEX 0.5 ug/kg by intravenous infusion pump before induction of general anesthesia, and the control group is injected with 0.9%Nacl solution 10 mL. Intraoperative anesthesia time, postoperative eye opening time, and extubation time of all groups are observed, and the incidences of postoperative adverse reactions are compared. The experimental results show that during general anesthesia in the liver and gallbladder surgery, the patients with high dose of DEX can better maintain the intraoperative hemodynamic parameters, and effectively restrain the postoperative stress reaction.

Where is my infusion pump? Harnessing network dynamics for improved hospital equipment fleet management.

Timely availability of intravenous infusion pumps is critical for high-quality care delivery. Pumps are shared among hospital units, often without central management of their distribution. This study seeks to characterize unit-to-unit pump sharing and its impact on shortages, and to evaluate a system-control tool that balances inventory across all care areas, enabling increased availability of pumps. A retrospective study of 3832 pumps moving in a network of 5292 radiofrequency and infrared sensors from January to November 2017 at The Johns Hopkins Hospital in Baltimore, Maryland. We used network analysis to determine whether pump inventory in one unit was associated with inventory fluctuations in others. We used a quasi-experimental design and segmented regressions to evaluate the effect of the system-control tool on enabling safe inventory levels in all care areas. We found 93 care areas connected through 67,111 pump transactions and 4 discernible clusters of pump sharing. Up to 17% (95% confidence interval, 7%-27%) of a unit's pump inventory was explained by the inventory of other units within its cluster. The network analysis supported design and deployment of a hospital-wide inventory balancing system, which resulted in a 44% (95% confidence interval, 36%-53%) increase in the number of care areas above safe inventory levels. Network phenomena are essential inputs to hospital equipment fleet management. Consequently, benefits of improved inventory management in strategic unit(s) are capable of spreading safer inventory levels throughout the hospital.

Surge capacity of intensive care units in case of acute increase in demand caused by COVID-19 in Australia.

ObjectivesTo assess the capacity of intensive care units (ICUs) in Australia to respond to the expected increase in demand associated with COVID‐19.DesignAnalysis of Australian and New Zealand Intensive Care Society (ANZICS) registry data, supplemented by an ICU surge capability survey and veterinary facilities survey (both March 2020).SettingsAll Australian ICUs and veterinary facilities.Main outcome measuresBaseline numbers of ICU beds, ventilators, dialysis machines, extracorporeal membrane oxygenation machines, intravenous infusion pumps, and staff (senior medical staff, registered nurses); incremental capability to increase capacity (surge) by increasing ICU bed numbers; ventilator‐to‐bed ratios; number of ventilators in veterinary facilities.ResultsThe 191 ICUs in Australia provide 2378 intensive care beds during baseline activity (9.3 ICU beds per 100 000 population). Of the 175 ICUs that responded to the surge survey (with 2228 intensive care beds), a maximal surge would add an additional 4258 intensive care beds (191% increase) and 2631 invasive ventilators (120% increase). This surge would require additional staffing of as many as 4092 senior doctors (245% increase over baseline) and 42 720 registered ICU nurses (269% increase over baseline). An additional 188 ventilators are available in veterinary facilities, including 179 human model ventilators.ConclusionsThe directors of Australian ICUs report that intensive care bed capacity could be near tripled in response to the expected increase in demand caused by COVID‐19. But maximal surge in bed numbers could be hampered by a shortfall in invasive ventilators and would also require a large increase in clinician and nursing staff numbers.

Infusion of Hematopoietic Stem Cell Products Using Pump Mechanism: An Approach Worth Consideration?

Hematopoietic stem cell transplantation using progenitor cells is a potentially curative treatment option for patients with high-risk malignancies and nonmalignant hematologic, immunologic, and genetic conditions. There is a need for evidence regarding safe practices and controlled infusion processes. Syringe and intravenous infusion pumps are not commonly used to deliver hematopoietic stem cell products (HPCs) due to a paradigm of thought that suggests that the pressure from the pump might damage the HPCs. Here, we describe a retrospective analysis of 114 patients who received HPC infusions using either a syringe or intravenous pump, providing support for this method along with successful engraftment data. This method may be a viable option to obtain reliable and consistent infusion rates, especially in pediatrics. To the best of our knowledge, this is the only study to date demonstrating safely using syringe and intravenous pump mechanisms in the setting of autologous and allogeneic pediatric stem cell transplantation.

Abstract 57: Deployment of Portable, Bedside, Low-Field Magnetic Resonance Imaging for Evaluation of Stroke Patients

Background: Magnetic resonance imaging (MRI) is a powerful modality for diagnosing stroke. Conventionally, patients must travel to the location of a high-field MRI device. Advances in low-field MRI have enabled acquisition of clinically useful images using a portable device at the bedside. The feasibility of using point of care (POC) MRI in a clinical stroke setting is unknown. Objective: To determine the safety and feasibility of portable, bedside, low-field MRI in a clinical setting. Design/Methods: POC MRI exams were performed in Yale’s Neuroscience Intensive Care Unit (NICU) from July 2018 to August 2019. Images were acquired at the bedside using a standard 110V, 15A power outlet. The environment included the bedside vitals monitor, ventilators and intravenous infusion pumps. Exams were performed by research staff trained to operate the POC scanner in the absence of a trained MRI technician. No special precautions were necessary to remove ferrous metals from the room. Scan parameters were controlled using a tablet computer interface, and images were available immediately after acquisition. Results: POC MRI was obtained in 85 stroke cases (46% female, ages 18-96 years, 46% ischemic stroke, 34% intracerebral hemorrhage, 20% subarachnoid hemorrhage). Scans were obtained within 7 days of symptom onset. NIHSS scores ranged from 1 to 29 (median of 7). Of the 85 patients analyzed, 68 underwent T2-weighted imaging, 72 underwent FLAIR imaging, and 39 underwent diffusion weighted imaging (DWI). DWI was only tested in ischemic stroke cases. Patients’ BMI ranged from 20.0 to 46.5 with a median of 26.7. The majority 74 (87%) of patients completed the entire exam. Five patients (6%) were unable to fit in the scanner’s 30 cm opening, while 6 patients (7%) experienced claustrophobia resulting in early termination of the exam. Mean exam time was 28.9 ± 8.4 minutes. The 64 mT static magnetic field, gradient and RF pulses of the POC MRI scanner did not interfere with NICU equipment, and no significant adverse events occurred. Conclusions: We report the first use of a portable, low-field MRI system to image stroke patients at the bedside. This early work suggests our approach is safe and viable in a complex clinical care environment.

Effect of dexmedetomidine or epidural blockade combined with general anesthesia on perioperative inflammatory cytokines in lung cancer patients undergoing video-assisted thoracoscopic surgery

Objective To investigate the effect of dexmedetomidine (Dex) or epidural blockade combined with general anesthesia on perioperative inflammatory cytokines in lung cancer patients undergoing video-assisted thoracoscopic surgery. Methods Ninety lung cancer patients [American Society of Anesthesiologists (ASA) Ⅰ-Ⅲ , age<70 years] undergoing video-assisted thoracoscopic surgery were divided into three groups according to a random number table: a general anesthesia group (group G), an epidural blockade combined with general anesthesia group (group GE) and a Dex combined with general anesthesia group (group GD), with 30 patients in each group. Patients in group GE underwent epidural catheterization at T7-T8 before anesthesia induction, while groups G and GD was given normal saline or 1 μg/kg Dex via an intravenous infusion pump over 10 min after anesthesia induction. Before induction (T0), at the end of surgery (T1), and 24 h after surgery postoperatively (T3), blood samples from the right internal jugular vein were taken to measure the levels of interleukins (IL-1β, IL-6, and IL-10) and tumor necrosis factor-α (TNF-α) by a double antibody sandwich ABC-ELISA method. The scores of Prince-Henry Pain Scale were evaluated 2 h after surgery (T2) and T3. The incidences of intraoperative hypotension, bradycardia and postoperative nausea and vomiting were recorded. Results Compared with those at T0, there were significant increases in the levels of IL-1 β , IL-6, and TNF-α and sharp decreases in the levels of IL-10 at T1 and T3 in all groups (P 0.05). The scores of Prince-Henry Pain Scale in group GE were lower than those in other two groups (P< 0.05). The incidence of nausea in groups GD and GE was significant lower than that in group G (P<0.05). Conclusions For lung cancer patients undergoing video-assisted thoracoscopic surgery under general anesthesia, a combined use of 1 μg/kg Dex can significantly relieve inflammatory response, to an extent comparable to epidural blockade combined with general anesthesia. Key words: Dexmedetomidine; Anesthesia, epidural; Anesthesia, general; Inflammation; Thoracoscopes; Lung cancer

Effects of ulinastatin combined with furosemide on myocardial enzymes, renal function and adverse reactions in patients with acute renal failure after cardiopulmonary resuscitation

Objective To explore the effects of ulinastatin combined with intravenous pump injection of furosemide on myocardial enzymes, renal function and adverse reactions in patients with acute renal failure(ARF) after cardiopulmonary resuscitation(CPR). Methods From January 2016 to May 2018, 117 patients with ARF after successful CPR in the Second People's Hospital of Hefei were divided into observation group(n=59) and control group(n=58) using simple random method.The control group received routine treatment, while the observation group added ulinastatin combined with intravenous pump infusion of furosemide.Myocardial enzymology, renal function, metabolism, inflammatory index, adverse reaction and survival rate were compared. Results Three and 7 days after treatment, the hydroxybutyrate dehydrogenase(HDBH), isoenzymes of creatine kinase isoenzyme(CK-MB) and mitochondrial aspartate aminotransferase isoenzyme(m-AST) were decreased in the two groups, and compared with the control group, which of the observation group were lower [HDBH: (231.42±31.15)U/L vs.(268.59±34.87)U/L; F=12.01, P=0.00; CK-MB: (32.38±4.15)ng/mL vs.(37.57±3.96)ng/mL; F=15.12, P=0.00; m-AST: (25.18±4.24)U/L vs.(33.92±5.60)U/L; F=12.36, P=0.00]. After treatment, the blood urea nitrogen(BUN), 24h urine protein quantity and creatinine(Cr) in the two groups increased firstly and then decreased, and compared with the control group, those of the observation group were lower[BUN: (7.02±1.66)mmol/L vs.(8.47±1.38)mmol/L; F=11.24, P=0.00; Cr: (82.69±9.87)μmol/L vs.(90.18±10.37)μmol/L; F=10.39, P=0.00; 24h urine protein quantity: (15.43±2.17)mg vs.(18.62±3.14)mg; F=11.06, P=0.00]. Three and 7 days after treatment, the levels of blood lactic acid(Lac), hypersensitive C-reactive protein(hs-CRP) and tumor necrosis factor-α(TNF-α) were decreased in the two groups, and compared with the control group, those of the observation group were lower [Lac: (1.18±0.27)mmol/L vs.(2.17±0.34)mmol/L, F=16.29, P=0.00; hs-CRP: (4.89±0.81)mg/L vs.(6.17±1.10)mg/L, F=13.41, P=0.00; TNF-α: (72.18±7.62)ng/L vs.(83.16±7.79)ng/L, F=11.39, P=0.00]. The incidence rates of adverse reactions in the observation group and the control group were 5.09% and 1.72%, respectively, the difference was statistically significant(χ2=0.24, P=0.62). The survival rates in the observation group and the control group were 50 cases (84.75%) and 39 cases (67.24%) respectively, the difference was statistically significant(χ2=4.92, P=0.02). Conclusion Intravenous pump injection of furosemide combined with ulinastatin can protect the heart and kidney, and improve the survival rate of patients with ARF after CPR and it is worthy of popularizing. Key words: Cardiopulmonary resuscitation; Renal insufficiency; Blood urea nitrogen; Creatinine; Blood lactic acid; Ulinastatin; Furosemide

Unintended Patient Safety Risks Due to Wireless Smart Infusion Pump Library Update Delays.

Our previous study showed that the issue of drug library update delays on wireless intravenous (IV) infusion pumps of one major vendor was widespread and significant. However, the impact of such a delay was unclear. The objective of this study was to quantify the impact of pump library update delays on patient safety in terms of missed and false infusion programming alerts. The study data sets included infusion logs and drug libraries from three hospitals of one health system from January 2015 to December 2016. We identified limit setting changes of any two consecutive drug library versions. We quantified the impact of using outdated drug limit settings by missed and false infusion programming alerts. Twenty-five updates of the drug library were released within the health system during the 2-year period with an average interval of 28.8 days. After a new library version was issued, it took at least 6 days for 50% of all pumps to become up-to-date and 15 days or more to reach 80%. All three hospitals had at least 16% of all IV infusions programmed with outdated libraries. This resulted in 18%, 24.4%, and 27% of false alerts in the three hospitals, respectively. We identified two cases of missed alert infusions of high-risk medications, propofol, and potassium chloride, which could have negatively impacted patient safety. These findings support our assumption that potential serious harm can happen when IV infusions are administered with outdated drug limit settings due to delays in drug library updates on the pump.

Effect of dexmedetomidine anesthesia on respiratory function in pediatric patients undergoing retinoblastoma resection.

The aim of this study was to investigate the effect of dexmedetomidine (Dex) on the respiratory function during anesthesia induction in pediatric patients undergoing retinoblastoma (RB) resection. A total of 87 pediatric patients who underwent RB resection in Yidu Central Hospital of Weifang were recruited into this study. General anesthesia was first induced for all patients, of which 45 were randomly assigned to the experimental group and received Dex through an intravenous infusion pump to maintain general anesthesia. The remaining 42 patients were assigned to the control group and received saline through an intravenous infusion pump. Respiratory function and hemodynamic indexes at five time-points, i.e., before anesthesia induction (T0), 5 min after injection of anesthetic agents (T1), before intubation (T2), 15 min after intubation (T3), and 30 min after extubation (T4), were recorded and compared. Incidence of perioperative cardiac and respiratory adverse events was counted in both groups, and post-anesthesia resuscitation was evaluated and compared. Compared with T0, the respiratory rate (R) of the experimental group was lower at T1-T4, but there was no statistical difference (P<0.05). Compared with T0, the control group had a higher R at T2, lower R at T3 and T4 (P<0.05), and there was no significant difference in R between T0 and T1 (P>0.05). At the same time-point, compared with the experimental group, the R was higher at T2, and lower at T3 and T4 in the control group (P<0.05), and no significant difference was found at T1. Blood oxygen saturation (SpO2) of the experimental group was slightly lower than that of T0 at T1-T4 (P>0.05). In the control group, the levels of SpO2 were significantly lower at T1-T4 than those at T0 (P<0.05). Compared with the experimental group at the same time-point, SpO2 of the control group at T1-T4 decreased significantly (P<0.05). The heart rate (HR) of the experimental and control groups was lower at T1-T4 than that at T0 (P<0.05). The HR of the experimental group was higher than that of the control group at T1-T4 (P<0.05). Mean arterial pressure (MAP) of the experimental and control groups was lower at T1-T4 than that at T0 (P<0.05). MAP of the control group was higher than that of the experimental group at T2 but lower than that at T0 of the control group. MAP of the control group was lower than that of the experimental group at T1-T4. There was no significant difference in incidence of tachycardia, bradycardia, vomiting, hypoxia and laryngism between the two groups (P>0.05). There was no difference in resuscitation and extubation time between the two groups (P>0.05). Finally, agitation of the control group was more severe than that of the experimental group (P<0.05). Therefore, Dex can improve the respiratory function and hemodynamic stability during anesthesia induction in children with RB resection.

Evaluation of Intravenous Parecoxib Infusion Pump of Patient-Controlled Analgesia Compared to Fentanyl for Postoperative Pain Management in Laparoscopic Liver Resection.

BackgroundAs laparoscopic liver resection is becoming a commonly used method for hepatic surgery, postoperative pain management is emerging as one of the trickiest problems after surgery. The ideal method of pain management is controversial and the optimal strategy for postoperative pain management after surgery remains unclear. The present study evaluated the postoperative analgesic efficacy of parecoxib and fentanyl, and the benefit of a new intravenous parecoxib infusion pump with patient-controlled analgesia after laparoscopic liver resection.Material/MethodsThis controlled, prospective, randomized, double-blind trial compared VAS scores among 3 groups of patients: a fentanyl group (FEN group) using a fentanyl citrate pump, an intravenous parecoxib group (IVPA group) receiving intravenous parecoxib, and a parecoxib pump group (PUPA group) receiving parecoxib sodium by analgesia pump. We enrolled 124 patients planned for laparoscopic liver resection. The primary outcome was VAS score at rest and with movement. Secondary outcomes were adverse effects (including nausea), sedation, pruritus, and quality of life.ResultFor all time intervals, the VAS scores were significantly lower in the PUPA group. VAS scores at rest and with movement in the PUPA group were the lowest among the 3 groups, while the scores in the FEN group were the highest. More adverse effects were detected in the FEN group, and no significant differences in adverse effects were found between the intravenous group and the parecoxib pump group.ConclusionsUse of the intravenous infusion parecoxib pump for patient-controlled analgesia provides superior analgesic efficacy and fewer adverse effects for patients after laparoscopic liver resection.

Application of pre-injection of dexmedetomidine of different doses in pediatric intravenous general anesthesia without tracheal intubation.

This study observed the clinical efficacy of pre-injection of dexmedetomidine of different doses before surgery and the adverse reactions during the recovery period in pediatric intravenous general anesthesia without tracheal intubation. Pediatric patients who received general anesthesia without tracheal intubation before surgery from January 2016 to March 2017 were randomly divided into four groups (n=30), and were respectively treated with intravenous pump infusion of loaded dexmedetomidine of high-dose (2.5 µg/kg), middle-dose (1.5 µg/kg) and low-dose (0.5 µg/kg), while the children in the control group received injection of normal saline in same dose. Then, the mean arterial pressure (MAP) at different time points (5 and 10 min after administration, after anesthesia and after surgery), heart rate, Ramsay sedation score changes and adverse reactions during recovery period of anesthesia of pediatric patients were compared among four groups. At 5 and 10 min after administration, Ramsay scores of high-dose group and middle-dose group were higher than that of the control group, and the differences had statistical significance (P<0.05). There was no significant difference in comparison of Ramsay scores between low-dose group and the control group. The MAP and heart rate after anesthesia and after surgery of pediatric patients with pump infusion of dexmedetomidine in the three groups were decreased significantly compared to those of the control group, and the differences had statistical significance (P<0.05). The incidence rate of adverse reaction of pediatric patients during the recovery period after pump infusion in the three groups and the control group was, respectively, 13/30, 8/30, 7/30 and 8/30, and the differences were statistically significant (P<0.05). The sedative effect and safety of pre-injection of dexmedetomidine in pediatric intravenous general anesthesia without tracheal intubation are promising, and the medium dosage can maximize the anesthetic effect with less side effects.

Design and production of a demountable modular infusion pump

The study aimed to produce a new pump with different and improved features and included three phases. In phase one, we collected the views of 40 nurses on pumps available in the market. In phase two, a pump was designed and a prototype was produced. In phase three, 10 nurses used and evaluated the prototype. The prototype combined three intravenous infusion pumps and one enteral pump in a single machine. Nurses assessed the prototype in a practice laboratory. All nurses found prototype very adequate with respect to carrying and installing. 90% of nurses found the prototype very adequate and practical in general. Moreover, the majority (80%) stated that the prototype produced less noise than the available pumps in the market. Keywords: Nurse; design; infusion pump; enteral nutrition; patient safety.

Improved usability of a multi-infusion setup using a centralized control interface: A task-based usability test.

The objective of this study was to assess the usability benefits of adding a bedside central control interface that controls all intravenous (IV) infusion pumps compared to the conventional individual control of multiple infusion pumps. Eighteen dedicated ICU nurses volunteered in a between-subjects task-based usability test. A newly developed central control interface was compared to conventional control of multiple infusion pumps in a simulated ICU setting. Task execution time, clicks, errors and questionnaire responses were evaluated. Overall the central control interface outperformed the conventional control in terms of fewer user actions (40±3 vs. 73±20 clicks, p<0.001) and fewer user errors (1±1 vs. 3±2 errors, p<0.05), with no difference in task execution times (421±108 vs. 406±119 seconds, not significant). Questionnaires indicated a significant preference for the central control interface. Despite being novice users of the central control interface, ICU nurses displayed improved performance with the central control interface compared to the conventional interface they were familiar with. We conclude that the new user interface has an overall better usability than the conventional interface.