An ideal dexmedetomidine protocol has yet to be determined for standing sedation in horses. It was hypothesized that an intravenous (IV) bolus followed by continuous rate infusion (CRI) dexmedetomidine would have a quicker increase in plasma concentrations compared to repeated intramuscular (IM) injections. In a cross-over design, eight adult, female horses were randomly placed in two groups: the CRI group (IV bolus dexmedetomidine at 0.005 mg/kg followed by a CRI at 0.01 mg/kg/hr for 15 minutes then 0.005 mg/kg/hr for 60 minutes) and the IM group (dexmedetomidine at 0.01 mg/kg, followed by 0.005 mg/kg in 30-minute intervals for 60 minutes). Analgesia was evaluated using a mechanical pressure threshold device. Intravenous dexmedetomidine produced faster onset of sedation and increased pressure threshold compared to IM administration. Individual horses had a large variability in dexmedetomidine plasma concentrations between CRI and IM administration.

No description available.

published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Nursing Studies / Master / Master of Nursing

Intravenous cannulation of pediatric patients is a common procedure in emergency departments. It is a useful tool to facilitate medical investigations and drug administration. However, the pain induced by the procedure can lead to patient distress and bother the nursing and medical procedures afterwards. There are many kinds of topical anesthesia but no relevant evidence-based guideline for their use is available for the emergency departments. This dissertation synthesizes the available evidence in the literature to establish an evidence-based guideline for the use of topical anesthesia to reduce pain caused by pediatric intravenous cannulation in an emergency department. The communication, implementation and evaluation plan are also developed. A systematic literature review was conducted from 30th August to 2nd September, 2011. A number of electronic databases, including PubMed, CINAHL Plus and Embase were searched. Thirteen eligible randomized controlled trials were identified. They were integrated into a table of evidence and were critically appraised by the SIGN Methodology Checklist. After synthesis of evidence, it is suggested that needleless anesthesia with apparatus assistance significantly reduced pain as early as in five minutes. Patients should however be observed for two hours after the administration of anesthesia for signs of adverse effects. The implementation potential, in terms of the transferability, feasibility and cost-benefit ratio, was examined. Among the anesthesia devices, the Jet lidocaine device has satisfactory transferability, feasibility and cost-benefit ratio. The evidence is then translated into a practice guideline with the recommendations scored based on the “SIGN 50: A guideline developer’s handbook”. A fourteen-month implementation plan,including a communication plan, a pilot study and an evaluation plan is developed. The communication phase lasts for three months and the stakeholders including the Chief of Service, Department Operation Manager, Advanced Practice Nurses, frontline healthcare professionals and the pharmacy department are identified. The pilot plan lasts for ten weeks, which includes a two-week training period, a three-week observational period for baseline measurement, a three-week intervention period and an eight-week amendment period. The pilot study collects data regarding the pain level at baseline and identifies unanticipated problems in the guideline. Amendments would be made accordingly and the revised guideline would be sent for ethical approval before the implementation phase. In the evaluation plan, the primary outcome for the innovation is the level of pain. The secondary outcomes are the admission rate and length of hospital stay. Other outcomes are the satisfaction of healthcare professionals, utilization rate and cost. It is expected that the cannulation pain, admission rate and length of hospital stay would be lower with the application of topical anesthesia. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Not available / text

The experimental work described in this thesis was conducted in the surgical research laboratories of Dr Francis D. Moore in the Peter Bent Brigham Hospital (now the Brigham & Women's Hospital) Boston, Massachusetts, USA, between 1978-1979. It formed part of an ongoing programme of research into protein metabolism in man; specifically to measure total body nitrogen turnover and hence protein synthesis and breakdown, initially in normal volunteers receiving various intravenous feeding regimens, and subsequently in patients. The previous year, 1977, had seen the publication of 'Substrate Interaction in Intravenous Feeding' by Bruce Wolfe et al., from the same laboratories. This was an extensive piece of work incorporating many studies and compared nitrogen balance data together with biochemical, hormonal and plasma amino acid data in normal men fed intravenously with a variety of regimens. Shortly afterwards a series of protein turnover studies was embarked upon, using the uN glycine method, and in collaboration with Dr Vernon Young of the Massachusetts Institute of Technology. The first experiments were essentially a repeat of the studies described by Wolfe et al. (vide supra) but in addition nitrogen turnover, protein synthesis and breakdown were estimated using a continuous 60 hour infusion of uN glycine and measuring enrichment of urinary urea with uN when a plateau was reached. Normal volunteers were studied firstly on normal oral diet and then on a iv succession of intravenous regimens:- amino acids alone (AA), amino acids plus 'high dose' glucose (AA + HOG), amino acids plus fat emulsion (AA + FE), amino acids plus 'low dose' glucose (AA + LOG), amino acids, fat emulsion and low dose glucose (AA + LDG+ FE), and finally 'low dose' glucose alone (LOG). The studies on normal diet, AA and AA+HOG were conducted by Andrew Sim (a Glasgow/Harvard exchange fellow) and Bruce Wolfe. The author took no practical role in these experiments, but was responsible for analysis of the data and the protein metabolism calculations, and was a co-author when the work was published in 1979 (Sim et al., Glucose Promotes Whole-Body Protein Synthesis from Infused Aminoacids in Fasting Man, Lancet i, 68-71). Subsequently, the author did the experiments using AA + LOG + FE, AA + FE, and AA + LOG and LOG. The results on these four regimens were incorporated in a paper presented in 1979 at the Tripartite Meeting of the Surgical Research Society at Oxford under the title 'Isotope Studies of substrate interaction in parenteral nutrition', and also at the 2nd European Congress on Parenteral and Enteral Nutrition at Newcastle upon Tyne in 1980, and later published as 'The Effect of Fat Infusion on Protein Metabolism' (Acta. Chir. Scand., Suppl. 507, 475-484, 1981). When the studies on the various intravenous feeding regimens were completed, attention was turned to the possible distorting effects of variables such as exercise and diet v on the behaviour of the isotope equilibrium curve and plateau. Such effects, if present, might have significance when studies were carried out on patients at a later stage in the research programme. Because each study lasted 48-60 hours, changes might occur either unintentionally or as a result of the needs of clinical management, and if they affected the plateau would alter the resultant calculations of turnover, synthesis and breakdown. Such a potential source of error clearly needed investigation. A pilot study was done in two subjects, later repeated on each, to observe any effects on the curve and plateau of both doubling protein intake and bicycle exercise. Subsequently, more extensive studies were done varying the protein and energy intakes, both orally and intravenously, allowing a detailed analysis of curve perturbation, and introducing the concept of basal catabolic rate. Finally, protein turnover, synthesis and breakdown were estimated seven times in four seriously ill patients. All of the studies mentioned above form the basis of the thesis. Unfortunately, the gestation period of this thesis has been long. There are two main reasons for this. Firstly, the work done was part of a five-year programme of research, with the intention of publishing a paper in a scientific journal at the completion of each stage. This was done vi with the first three regimens (normal diet, AA and AA + HDG) but not with the last four (AA + FE, AA + LOO+ FE, AA + LOG, LDG), although the results were presented at two scientific meetings. Shortly after returning to the United Kingdom the author was appointed a consultant surgeon and this career move assumed priority. Secondly, although it was intended to publish the perturbation studies, it proved impossible to reduce the size of the text to a manageable level suitable for publication in the form of a scientific paper. However, despite the long interval since the experiments were done, no similar work has been published. In particular, virtually no attention has been paid to intentional perturbation. Also, whereas there was a spate of interest in protein turnover studies in the late 1970s and early 1980s, virtually no publications have appeared since 1985. It seems that the potential applications of the method are considered exhausted, and interest has been lost, rather as it was in the 1950s following a short flurry of activity exploring the first cumbersome technique. Hence, it seemed all the more pertinent, even at this late stage, to publish the work in the form of a thesis which could describe in chronological order the continuum of studies as briefly mentioned above. In order to preserve such a progression, the following Introduction contains, with few exceptions, only references up to the time that the experimental studies were commenced, 1978, but the subsequent Discussion(s) in the various sections will attempt to include the relevant literature up to the present time.

Antidiuretic hormone (ADH) is a fundamental regulator of fluid and electrolyte homeostasis. Osmotically unregulated ADH secretion during intravenous fluid therapy has been implicated in the development of iatrogenic hyponatraemia. The case report and 3 prospective studies of this thesis provide evidence for this and examine the relative contributions of salinity versus infusion rate of intravenous fluids to the development of hyponatraemia. Two studies of plasma and urinary electrolytes and osmolality during intravenous rehydration of children with gastroenteritis were performed. The first, an observational study of 52 children receiving 0.45% (N/2) saline documented persistently raised plasma ADH concentrations independent of plasma sodium. In both studies, plasma and urinary biochemistry suggested osmotically unregulated ADH action. When N/2 and NS were compared in a randomised study of 102 children, NS emerged as superior in the prevention and correction of hyponatraemia, independent of infusion rate. In the third study, 124 pre-operative children were randomised to receive N/2 or NS intravenously at 100% or 50% of maintenance rates post-operatively. Plasma ADH concentrations increased in all groups, and the plasma and urinary biochemistry indicated persistent non-osmotic ADH activity in some children for up to 24 hours. Baseline urinary tonicity approximated NS. Comparison of urinary tonicity with the infused fluid largely explained changes observed in plasma sodium. The risk of hyponatraemia was decreased by isotonic saline but not fluid restriction; however plasma sodium concentration decreased in the NS 100% group between 8 and 24 hours, suggesting that a decreased rate should be considered during prolonged intravenous fluid administration. Fourteen (23%; 7NS) of those on 50% maintenance were assessed as dehydrated, with hypernatraemia in 3 receiving NS50%. The chloride load associated with NS in the second and third studies was not associated with the development of acidosis. The studies also showed that 2.5% dextrose resolved and prevented hypoglycaemia in children with gastroenteritis but was inadequate to prevent hypoglycaemia and/or ketosis in 38% of children under 6 years when infused at maintenance rates. Non-osmotically regulated ADH activity in hospitalised children is common, in the face of which, isotonic is superior to hypotonic saline in decreasing the risk of hyponatraemia.

Thesis (M.A.)--Northern Kentucky University, 2008. / Made available through ProQuest. Publication number: AAT 1459945. ProQuest document ID: 1622198801. Includes bibliographical references (p. 41-43)