Background:The administration of rocuronium is associated with severe burning pain on injection that lasts for approximately 10-20 seconds. Injection pain is probably caused by the acidic pH of rocuronium. Mixing rocuronium with 8.4% sodium bicarbonate might neutralize the acidic pH thereby decrease the level of injection pain. This study investigated the appropriate sodium bicarbonate dose for preventing injection pain.Methods: The study examined 250 patients (aged 20 to 60 years) from ASA I and II groups who scheduled for elective surgery. The patients were divided randomly into five groups. The control group (SB0) received rocuronium 50 mg (5 ml) only and the experimental groups received rocuronium 50 mg mixed with 8.4% sodium bicarbonate 1 (SB1), 2.5 (SB2.5), 5 (SB5), 7 (SB7) ml, respectively. The level of pain was evaluated as the withdrawal response as follows: no movement, 0; hand and wrist movement, 1 point; ipsilateral arm movement, 2 points; and general movement 3 points.Results: The incidence of a withdrawal response was 68% in the control group (SB0). On the other hand, the incidence of a withdrawal response was 38%, 28%, 14% and 12% in the SB1, SB2.5, SB5 and SB7 groups, respectively. The withdrawal response was significantly lower in the experimental groups than in the control group (P < 0.01). In the experimental groups, a significant difference was observed between the SB1 and SB5, SB7 groups. However, there was no significant difference observed between the SB2.5, SB5 and SB7 groups.Conclusions: Mixing 5 ml of 8.4% sodium bicarbonate with rocuronium 50 mg (5 ml) is the most effective in preventing the injection pain associated with rocuronium during the induction of anesthesia.
An 84-year-old man was admitted to our hospital with fever, jaundice, and itching. He had been diagnosed previously with chronic renal failure and diabetes, and had been taking allopurinol medication for 2 months. A physical examination revealed that he had a fever (38.8℃), jaundice, and a generalized maculopapular rash. Azotemia, eosinophilia, atypical lymphocytosis, elevation of liver enzymes, and hyperbilirubinemia were detected by blood analysis. Magnetic resonance cholangiography revealed multiple cysts similar to choledochal cysts in the liver along the biliary tree. Obstructive jaundice was suspected clinically, and so an endoscopic ultrasound examination was performed, which ruled out a diagnosis of obstructive jaundice. The patient was diagnosed with DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) syndrome due to allopurinol. Allopurinol treatment was stopped and steroid treatment was started. The patient died from cardiac arrest on day 15 following admission.
In this paper, a novel family of fourth-order accurate explicit time integration schemes is developed by combining the new time approximations and the explicit fourth-order Runge–Kutta (RK4) method. Inaccurate predictions due to the presence of excessive numerical dissipation are often observed in practical analyses of structural dynamics when the RK4 is employed for both displacement and velocity approximations. To remedy this, novel time approximations with adjustable algorithmic parameters are employed for the displacement vectors while the velocity vectors are approximated by using the RK4. For the complete elimination of numerical dissipation, algorithmic parameters are unconventionally determined by taking the determinant of the amplification matrix as unity. A set of algorithmic parameters obtained from this process makes the new schemes completely non-dissipative while keeping the computational cost the same as the RK4. Due to this improvement, the new schemes have enhanced total energy-conserving capabilities for nonlinear systems and give noticeably more accurate predictions in practical analyses. Until now, controllable numerical dissipation and fourth-order accuracy are not attained simultaneously in a unified set of time schemes. In the new schemes, however, a systematic way to adjust the level of numerical dissipation is also presented while attaining fourth-order accuracy. The numerical results of various test problems show that the new time schemes can provide more accurate predictions for nonlinear conservative dynamic problems than the existing time schemes.
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