Effect of atracurium or pancuronium on the anemic fetus during and directly after intravascular intrauterine transfusion. A double blind randomized study

BACKGROUND

To determine the effect of atracurium or pancuronium on onset and duration of fetal paralysis, movements and heart rate parameters directly after transfusion, using computer analyzed fetal heart rate recording (c-FHR).

METHODS

Double blind randomized study of 23 RhD alloimmunized pregnant women requiring an intravascular intrauterine fetal blood transfusion (IUT) between 24 and 36 weeks. Atracurium was injected in 11 fetuses at 17 IUT's and pancuronium in 12 fetuses at 19 IUT's. For statistical analysis the Mann-Whitney test was used.

RESULTS

No statistical differences were found in fetal heart rate and movements between both groups before transfusion. The fetal movements returned more rapidly in the atracurium group when compared to the pancuronium-group (median 24 vs. 57 min, range 6-55 vs. 4-220; (p<0.02). Fetal movements did not hamper the procedure in any case. The atracurium group showed significantly more fetal movements (p<0.01), more accelerations (0<0.05) but no significant reduction of fetal heart rate variability directly after transfusion which was in direct contrast to the pancuronium group.

CONCLUSIONS

Neuromuscular blockade with atracurium produces sufficient paralysis for intrauterine transfusion with minimal disturbance of the parameters used to monitor fetal wellbeing after the procedure. Although the routine use of fetal paralysis during IUT may be questionable, we believe that when it is necessary the use of atracurium is the better choice.

[Ophthalmic preparations Polyspectran (combination of neomycin, polymyxin B and bacitracin/gramicidin) and Terramycin (oxytetracycline with polymyxin B) mistakenly no longer reimbursed]

The Netherlands' Ministry of Health and the health insurance companies have drawn up a list of preparations which will no longer be reimbursed. The ocular antibiotic preparations Polyspectran and Terramycin are on the list. However, there are no satisfactory alternative with respect to the broadness of the antibiotic spectrum required. In addition, some alternatives have serious side effects or may induce bacterial resistance.

Specific stimulation of brain serotonin mediated neurotransmission by dexfenfluramine does not restore growth hormone responsiveness in obese women

OBJECTIVE

Growth hormone release in response to all known stimuli of GH secretion is blunted in obese subjects. Several studies, using d,l-fenfluramine (d,l-FF) as a serotoninergic tool, suggest that brain serotonin plays a role in the pathogenesis of this phenomenon. However, the effect of d,l-FF appears to be dependent on the stimulus used to induce GH release. Furthermore, d,l-FF has catecholamingergic properties apart from its capacity to stimulate serotonin release and to block its re-uptake. In this study, we investigated whether subchronic treatment with the highly selective serotoninergic drug dexfenfluramine (d-FF) affects the GH response to galanin or GHRH in obese subjects.

DESIGN

The study had a randomized, cross-over, placebo controlled design. d-FF was administered in a dose of 15 mg twice daily during 6 days. On days 5 and 6 of treatment (with either d-FF or placebo) an i.v. bolus injection of 100 micrograms hGHRH(1-44) or a continuous infusion of p-galanin (40 pmol/kg/min over 40 minutes) were administered in randomized order. All tests were performed in the follicular phase of two consecutive menstrual cycles.

PATIENTS

Eight obese women (body mass index (BMI) 34.5 +/- 3.6 kg/m2); 7 normal weight (BMI 21.9 +/- 1.9 kg/m2) age-matched control women. All women had a regular menstrual cycle. None used oral contraceptive drugs.

MEASUREMENTS

GH response to either stimulus was measured both during treatment with d-FF and during treatment with placebo.

RESULTS

The GH response to galanin and the response to GHRH were significantly smaller in obese subjects. d-FF significantly reduced the galanin induced GH secretion in obese subjects, but not in normal weight controls. It did not significantly affect GH release in response to GHRH in either group.

CONCLUSION

This study confirms that GH secretion in response to stimuli with varying mechanisms of action is blunted in obese subjects. A decrease of central serotonin mediated neurotransmission does not appear to play a role in the pathogenesis of this phenomenon.

The bioavailability of digoxin from three oral formulations measured by a specific h.p.l.c. assay

1. We have studied the absolute bioavailability of three oral formulations of digoxin, 1.0 mg, in 12 young healthy volunteers in a four way randomised cross-over study using an intravenous control. 2. Digoxin tablets (250 micrograms), liquid filled digoxin capsules (100 micrograms) and an experimental enteric-coated capsule (100 micrograms) were evaluated. In vitro dissolution at pH 1 demonstrated extensive hydrolytic breakdown of digoxin from the tablets and capsules but not from the enteric-coated capsules. 3. Serum 'digoxin' concentrations were measured by fluorescence polarization immunoassay (FPI). The systemic availability (+/- s.d.) of the capsules was 70.5 +/- 11.3%, and that of the tablets 71.5 +/- 8.6%. Drug was less available from the enteric-coated capsules (62.1 +/- 10.3%) measured with FPI. These results were reflected in the urinary drug recoveries measured by FPI. 4. By contrast, there were no differences in urinary recovery of unchanged digoxin between any of the oral treatments, when this was measured by h.p.l.c. The cross-reactivity of immunoassays for metabolites of digoxin may produce artefactual results and the optimal pharmaceutical formulation for digoxin remains to be determined.

Stability of azacitidine in lactated Ringer's injection frozen in polypropylene syringes

The stability of azacitidine diluted in lactated Ringer's injection was studied. Azacitidine was reconstituted with ice-cold lactated Ringer's injection to concentrations of 2.0 and 0.5 mg/mL and stored in polypropylene syringes at -20 degrees C. On days 1, 3, 7, and 14, the solutions were thawed over 30-45 minutes and the azacitidine concentration was determined by high-performance liquid chromatography immediately after thawing and one, three, and six hours later. Other studies were conducted at 37, 20, and 0-4 degrees C to determine decomposition rate constants for azacitidine at both concentrations. Hydrolysis of azacitidine resulted in a biphasic decline when the log of the percentage of drug remaining was plotted against time. No substantial decomposition occurred during storage at -20 degrees C. In thawed samples, azacitidine concentrations decreased to 90% of the initial concentrations within three hours after reaching room temperature; similar decreases in concentration were seen in nonfrozen samples stored at room temperature. The results of these studies indicate that azacitidine solutions in lactated Ringer's injection can be stored in polypropylene syringes at -20 degrees C for two weeks without decomposition. The thawed solutions should be used within three hours.