by Wong Kwok Kong. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1995. / Includes bibliographical references (leaves 163-184). / Abstract --- p.2 / Preface / Acknowledgements --- p.6 / List of abbreviations --- p.7 / List of Tables --- p.8 / List of Figures --- p.13 / CONTENTS --- p.16 / Chapter Chapter One： --- Introduction --- p.23 / Chapter Chapter Two： --- Review of pharmacology of propofol --- p.26 / Chapter 1： --- Chemistry structure-Activity relationship --- p.27 / Chapter 2: --- Pharmacokinetics --- p.28 / Chapter 2.1： --- Distribution --- p.29 / Chapter 2.2： --- Elimination --- p.30 / Chapter 2.3: --- "Effects of age, sex, and hepatic and renal disease on the pharmacokinetics of propofol" --- p.35 / Chapter 2.3.1： --- Effects of age / Chapter 2.3.2： --- Effects of sex / Chapter 2.3.3: --- Effects of renal and hepatic disease / Chapter 3: --- Pharmacodynamic --- p.38 / Chapter 3.1： --- Anaesthetic concentrations --- p.38 / Chapter 3.2: --- Recovery characteristics --- p.39 / Chapter 3.3： --- Effects on the cardiovascular system --- p.40 / Chapter 3.4： --- Effects on the respiratory system --- p.43 / Chapter 3.5： --- Effects on cerebral blood flow and intracranial pressure --- p.44 / Chapter 3.6： --- Other effects --- p.45 / Chapter 3.6.1： --- Effects on liver function / Chapter 3.6.2： --- Effects on renal function / Chapter 3.6.3: --- Effects on coagulation / Chapter 3.6.4： --- Effects on adrenal steroidgenesis / Chapter 3.7： --- Side effects --- p.47 / Chapter 3.7.1： --- Pain on injection / Chapter 3.7.2: --- Excitatory & respiratory / Chapter 3.7.3: --- Nausea and vomiting / Chapter 3.7.4： --- Bradycardia / Chapter 3.7.5: --- Anaphylaxes / Chapter 4: --- Clinical use --- p.51 / Chapter 4.1： --- Anaesthesia induction --- p.52 / Chapter 4.2: --- Anaesthesia maintenance --- p.53 / Chapter 4.3: --- Use in sedation --- p.57 / Chapter Chapter Three ： --- Analytical Technique:Propofol content analysis --- p.58 / Chapter 1: --- Introduction high-pressure liquid chromatography --- p.58 / Chapter 2: --- Methods of propofol content analysis --- p.61 / Chapter 2.1: --- Reagents and solutions --- p.61 / Chapter 2.1.1: --- Sodium dihydrogen phosphate / Chapter 2.1.2： --- Cyclohexane / Chapter 2.1.3: --- Tetramethylammonium Hydroxide Solution / Chapter 2.1.4： --- Acetonitrile / Chapter 2.1.5: --- Acetic acid / Chapter 2.2: --- Standard solution --- p.62 / Chapter 2.2.1: --- Propofol standards / Chapter 2.2.2： --- Internal standard / Chapter 2.2.3： --- Control standard / Chapter 2.3： --- Mobile phase --- p.63 / Chapter 2.4： --- High-pressure liquid chromatography --- p.63 / Chapter 2.5: --- Quantification --- p.64 / Chapter 2.6： --- Procedure --- p.67 / Chapter 2.7： --- Throughput --- p.69 / Chapter 2.7.1： --- Fist working day / Chapter 2.7.2: --- Second working day / Chapter 2.7.3： --- Third working day / Chapter 2.7.4: --- Fourth working day / Chapter 2.7.5： --- Fifth working day / Chapter 3: --- Results of propofol content analysis --- p.71 / Chapter 3.1: --- Calibration standard of propofol (Linearity) --- p.71 / Chapter 3.2： --- Control standard of propofol --- p.74 / Chapter 3.2.1： --- Reproducibility / Chapter 3.2.2: --- Recovery / Chapter 3.2.3： --- Stability / Chapter 4: --- Discussion of propofol content analysis --- p.80 / Chapter 4.1： --- Calibration standard of propofol --- p.80 / Chapter 4.2: --- Precision and accuracy of analytical method --- p.86 / Chapter 4.3： --- Extraction efficiency of analytical method --- p.87 / Chapter 4.4： --- Stability of analytical met --- p.89 / Chapter Chapter Four： --- Analytical technique： Protein binding of propofol --- p.91 / Chapter 1: --- Introduction protein binding of propofol --- p.91 / Chapter 1.1: --- Ultrafiltration --- p.92 / Chapter 1.2： --- Equilibrium dialysis --- p.92 / Chapter 2: --- Methods of protein binding of propofol --- p.94 / Chapter 2.1： --- Material & Solution --- p.94 / Chapter 2.1.1: --- Dialysis buffer / Chapter 2.1.2: --- Molecularporous Dialysis Membrane / Chapter 2.2: --- Equilibrium dialysis --- p.96 / Chapter 2.3： --- Determine the optimum dialysis time to reach equilibrium --- p.97 / Chapter 2.3.1： --- Material / Chapter 2.3.2： --- Procedure / Chapter 3: --- Results of protein binding of propofol --- p.99 / Chapter 3.1： --- Results for optimum dialysis time to reach equilibrium --- p.99 / Chapter 3.2： --- Results for reproducibility --- p.101 / Chapter 3.2.1: --- Intraassay coefficient of variation (One analysis day) of propofol in plasma and in protein binding / Chapter 3.2.2: --- Interassay coefficient of variation (Seven analysis days) of propofol in plasma and in protein binding / Chapter 3.3: --- Results for recovery of propofol in plasma and in protein binding --- p.106 / Chapter 3.3.1: --- Recovery of propofol (unheated samples) / Chapter 3.3.2: --- Recovery of propofol (samples heated at 37°C) / Chapter 3.3.3: --- Recovery of propofol (after dialysis at 37°C) / Chapter 3.4： --- Results for stability of propofol in plasma --- p.112 / Chapter 4: --- Discussions of protein binding of propofol --- p.114 / Chapter 4.1: --- Optimum dialysis time to reach equilibrium --- p.114 / Chapter 4.2: --- Discussion for Intraassay & Interassay coefficient of variation of propofolin plasma and in protein binding --- p.114 / Chapter 4.3： --- Recovery of propofol in plasma and in protein binding --- p.116 / Chapter 4.4： --- Discussion for stability of propofolin plasma --- p.118 / Chapter Chapter Five： --- Clinical application of pharmacokinetic studies --- p.119 / Chapter 1: --- Introduction pharmacokinetic model controlled infusion / Chapter 1.1： --- Theoretical basis --- p.119 / Chapter 1.2: --- Use of computer & appropriate pump --- p.123 / Chapter 2: --- Results of propofol pharmacokinetic studies --- p.124 / Chapter 2.1: --- Sample prepare --- p.124 / Chapter 2.2: --- Computer control infusion of propofol according to pharmacokinetic model --- p.126 / Chapter 2.3: --- Comparison of measured and predicted blood concentrations of propofol --- p.129 / Chapter 2.4: --- Test the new paediatric pharmacokinetic model (the revised paediatric rate constants) --- p.136 / Chapter 3: --- Discussion of propofol pharmacokinetics studies： Infusion for Chinese children --- p.141 / Chapter Chapter Six： --- Clinical application on protein binding studies --- p.143 / Chapter 1: --- Plasma proteins and drug binding --- p.143 / Chapter 2: --- Methods of propofol protein binding studies --- p.145 / Chapter 2.1： --- Blood sample acquisition --- p.145 / Chapter 2.2: --- Population characteristics --- p.145 / Chapter 2.3： --- Methods of protein binding assay --- p.145 / Chapter 3: --- Results of propofol protein binding --- p.146 / Chapter 4: --- Discussion of propofol protein binding --- p.153 / Chapter 4.1: --- Protein binding of propofol in Chinese children --- p.154 / Chapter 4.2： --- Protein binding of propofol in pregnant women & neonate --- p.155 / Chapter Chapter Seven： --- Conclusions --- p.158 / References --- p.163 / Appendix --- p.180

Lim Thiam Aun. / Thesis (M.D.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (p. 142-154). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.

Made available in DSpace on 2014-06-11T19:22:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2001Bitstream added on 2014-06-13T18:47:25Z : No. of bitstreams: 1 ishiy_hm_me_botfm.pdf: 2335235 bytes, checksum: a5502e4b5a245d692a73e68b697160de (MD5) / A anestesia epidural empregando-se anestésicos locais normalmente produz anestesia apenas da região retro umbilical. O trabalho investiga e compara o uso da lidocaína isolada ou associada ao butorfanol ou à quetamina, em anestesia epidural lombo-sacra de cães, no seu aspecto cardiorrespiratório e analgésico. Todos os animais foram tranquilizados com 0,1 mg/kg de acepromazina IV. Na primeira fase, seis cães adultos, foram anestesiados, em três ocasiões distintas, em ordem aleatória, com: 5 mg/kg lidocaína 2% com vasoconstritor (GAL); 1 mg/kg de quetamina (GAQ) e 0,1 mg/kg de butorfanol (GAB), nestes dois últimos complementando-se o volume de 1 ml/4 kg com lidocaína 2% com vasoconstritor. Foram avaliados: freqüência cardíaca, pressão arterial sistólica, freqüência respiratória, concentração expirada de CO2, volume minuto e corrente e temperatura retal. Ainda observou-se período de latência, duração do bloqueio, região bloqueada, duração da cirurgia e grau de miorrelaxamento. Na segunda fase, dezoito cadelas foram divididas em três grupos de mesmo número, anestesiadas com os mesmos protocolos anestésicos da primeira fase (GCL, GCQ, GCB) e submetidas à ovariosalpingohisterectomia. Para análise estatística dos dados paramétricos foram utilizadas a análise de variância, seguida do teste de Student-Newman-Keuls, para comparação entre momentos. Para comparação entre grupos, foi utilizado o teste T. Para as variáveis não paramétricas... / The aim of this study was to compare the cardiorespiratory effects and duration of lumbosacral epidural anaesthesia produced by lidocaine alone or combined with ketamine or butorphanol in dogs submitted or not to ovariohysterectomy. In the first stage, six mixed breed adult dogs (mean weight 14,0 ± 3,1 kg) were used in three different occasions: lidocaine 2% with adrenaline – 5 mg/kg (GAL), ketamine – 1 mg/kg (GAQ) or butorphanol – 0,1 mg/kg (GAB). In groups GAQ and GAB, the total volume of 1 ml/4 kg was completed with lidocaine. Heart heat, sistolic arterial blood pressure, respiratory rate, expired CO2, tidal and minute volume and rectal temperature were measured 15 minutes after pre-medication and every 30 minutes after epidural anesthesia until 120 minutes. The time to loss the interdigital reflex, duration and region of block were observed. In the second stage, eighteen mixed breed female dogs (mean weight 13,4 ± 3,5 kg) were divided in three groups(GCQ, GCB and GCL), anaesthetised as before and submitted to ovariohysterectomy. All animals were sedated with acepromazine 0,1 mg/kg IV. Data were analysed using ANOVA, followed by Student-Newman-Keuls test or Kruskal-Wallis and Friedman tests as appropriate. The rectal temperature reduced in all groups. Muscle relaxation was better in the GCQ and GCB groups than the in GCL group. Anaesthesia was not sufficient for ovariohysterectomy in animals treated with lidocaine and general anaesthesia... (Complete abstract click electronic access below)

Thesis (M.D.S.)--University of Hong Kong, 2000. / Includes bibliographical references (leaves 169-197).

Många patienter blir hypoterma under den perioperativa vården. Det finns en mängd åtgärder som kan vidtas för att minska oönskad hypotermi. Pre- och intraoperativ uppvärmning med värmetäcke, varmt på operationssalen, cirkelsystem och användning av varma infusioner kan vara en bra kombination. Oavsett vilken terapi som används är normotermi alltid högt prioriterat.  Det handlar om patientsäkerhet. Genom att effektivt motverka hypotermi skulle möjligheten öka till snabbare återhämtning, färre postoperativa infektioner, mindre kostnader för sjukhuset och minskat lidande för patienter. Syftet med studien var att undersöka anestesisjuksköterskans upplevelser av att förebygga perioperativ hypotermi hos vuxna elektiva patienter. En kvalitativ intervjustudie med induktiv ansats gjordes inom problemområdet. Insamlingen av data gjordes genom intervjuer som spelades in. Intervjuerna transkriberades och analyserades med kvalitativ innehållsanalys. I resultatet framkommer att, även om normotermi är målet och ambitionen finns, är det många faktorer som spelar in hur vida de hypotermiförebyggande åtgärderna når framgång. Det krävs en god planering samt erfarenhet av förebyggande arbete. Att mätmetoderna är ifrågasatta kan bidra till att mätning inte alltid utförs. Avsaknad av riktlinjer kring hypotermiförebyggande åtgärder bidrar till oklarheter för vårdpersonalen. Alla de olika personalkategorierna kring en operation tenderar att fokusera på sina egna uppgifter. En stor ansvarskänsla samt till viss del ensamhetskänsla i besluten, om vilka åtgärder som skall vidtas samt när finns hos anestesisjuksköterskan. När patienten blir kall trots att anestesisjuksköterskan har gjort allt kan det upplevas som ett misslyckande att inte räcka till. När patienten anländer kall till uppvaket kan anestesisjuksköterskan känna skuld till patientens tillstånd samt lidandet det medför. Strävan är att patienten ska må bra även postoperativt. Genom att informera patienten om varför det är nödvändigt att det tillförs extra värme gör att patienten blir delaktig i omvårdnaden. Anestesisjuksköterskan upplever att värmda täcken, strumpor samt mössa gör patienten mindre spänd samt stressad. På så vis ökar man patientens upplevs av välbefinnandet.

According to the World Health Organization, life-threatening infectious diseases, even in remote and vulnerable locations, can be minimised through immunisation. Vaccines interact with the immune system to produce an immune response similar to that produced by natural infection. However, about 10% of the population avoid vaccination and other needle procedures because of “needle fear”. Because of the prevalence of injection pain and more concern about the adequacy of pain management, and with the steadily increasing number of recommended childhood immunisation, we identified a need for evidence-based guidelines on pain management to be developed in our local setting through translational nursing practice. After a critical appraisal of randomised controlled trials and systematic reviews, it is highly recommended that “topical anaesthetics are effective in reducing vaccination pain” (Grade A recommendation, based on level I evidence by SIGN). In order to facilitate practice from evidence, the implementation potential, transferability, feasibility and cost-benefit ratio - has been examined, and an evidence-based guideline has been developed simultaneously for the new practice. With the identification of stakeholders and the development of a communication plan, potential users of the guideline and pilot testing are discussed. Innovation outcomes and their effectiveness are examined and explored. It is expected that, through this translational nursing practice, vaccination induced pain and distress among healthy children can be managed well, according to the best evidence and up-to-date recommendations. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Introduction Simulation training is widely adopted in clinical medicine. Simulated environment provides a safe condition for participants to practice without any harm inflicted on patients. Within the spectrum of clinical anaesthesia, simulation mannequin was first developed in 1960. The first journal article with description about the use of simulator to teach intubation to anaesthesia residents occurred in 1969. The first report about simulated anaesthesia training was in 1988. Since then, there has been a flourishing trend of adopting this simulation training in clinical anaesthesia, across various subspecialties including obstetric anaesthesia, cardiac anaesthesia. For individual perspective, simulation training expanded beyond skill development into non technical skill training. This article is to review the impact of simulation training for individual development for anaesthesia residents or trainees. The aim is to evaluate the evidence of simulation training on individual anaesthesia resident performance and improvement on patient outcome. As a result, more vigorous use of simulation is adopted in modular subspecialty anaesthesia and also non-technical skill training for residents. Methods A search of literatures through search engines of Pubmed, Google Scholars, EMBASE, Cochrane library for ‘Simulation for training of clinical anaesthesia’ was done. After limit the search for English language and past 10 years, there are 223 articles. With appropriate exclusion criteria, 25 articles are selected for detail evaluation. Results Simulation has good effects in various aspects. For various anaesthesia subspecialties, simulation-based training can improve trainees’ confidence and capability in handling rare but life-threatening peri-operative crises. For assessments, simulation is an essential part of Israeli Board Examination in Anesthesia with good discriminating power. For technical skill development, simulation-based training can reduce residents’ time requirement to perform cricothyroidotomy and improve successful rate of central line insertion. The specific skill developed can retain for long period of time such as 12 months. For non-technical skills, there are conflicting results in behavioural scores. For patient safety and outcome perspective, there lacks the result from individual simulation-based training study. Conclusions Simulation in anaesthesia residents training is a worldwide practice. These simulation training allow residents to have exposure in various anesthesia subspecialty including cardiac, obstetrics, liver transplant. There are specific technical and non-technical skill development. Individual performance particularly time to complete cricothyroidotomy and confidence, understanding of procedures and anatomy by residents are also enhanced. Thus, simulation should be allocated more proportion of anaesthesia resident training in Hong Kong. Although there remains no study showing better patient outcome after simulation-based individual training, future studies should be done to confirm such presence and degree of association with simulation training. / published_or_final_version / Community Medicine / Master / Master of Public Health

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This thesis contains two studies. The first study consisted of a prospective, randomized, clinical trial involving twenty-five client-owned dogs with intracranial disease. Each dog was randomly assigned to receive propofol or isoflurane for maintenance of anesthesia, without premedication. All dogs received propofol IV to effect, were intubated and mechanically ventilated (end-tidal carbon dioxide [ETCO2] 30-35 mmHg). Temperature and cardiac output were measured pre- and post-magnetic resonance imaging (MRI). Scores for mentation, neurological status, maintenance, and recovery were obtained. Pulse oximetry, end tidal gases, arterial blood pressure (AP), heart rate (HR) and requirements for dopamine administration to maintain mean AP > 60 mmHg were recorded throughout anesthesia. Cardiac index was higher, while HR was lower, with propofol in dogs younger than 5 years. Dogs receiving isoflurane were 14.7 times more likely to require dopamine. Sedation and maintenance scores and temperature were not different. Mean and diastolic AP were higher in the propofol group. Recovery scores were better with propofol. Change in neurological score from pre- to post-anesthesia was not different between treatments. In the second study, blood and CSF were collected from 11 dogs with intracranial disease after MRI (Group ID-MRI), in 10 healthy dogs post-MRI (Group H-MRI), and in 39 healthy dogs after induction of anesthesia (Group H-Anesth). Groups ID-MRI and H-MRI were induced to anesthesia with propofol, IV to effect, and maintained on isoflurane or propofol. Dogs in H-Anesth were premedicated with acepromazine and hydromorphone, induced with propofol or thiopental, IV to effect, and maintained on isoflurane. Neurologic scores (NS) and sedation scores (SS) were assessed pre-anesthesia in ID-MRI dogs. There was a tendency for higher cerebrospinal fluid lactate (CSFL) in ID-MRI than H-MRI or H-Anesth (p = 0.12). There was agreement between CSFL and plasma lactate (PL) in ID-MRI dogs (p = 0.007), but not in H-MRI (p = 0.45) or H-Anesth (p = 0.15). Of the ID-MRI dogs, those with worse NS had higher CSFL (r2 = 0.44). Propofol showed some advantages to isoflurane in this patient population for maintenance of blood pressure and recovery. The results of the second study warrant further investigation. / OVC Pet Trust