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ABSTRACT Objective: To investigate infusion pumps start-up delay according to different brands of infusion pumps, flow rates and intravenous sets priming techniques. Method: The experimental study simulated clinical practice under controlled conditions, using a 50 mL syringe with NaCl 0.9% solution, two syringe infusion pumps (A and B), six rates (0.3, 0.5, 1.0, 5, 10 and 20 mL/h), two purging techniques (manually or infusion pump’s electronic bolus). Data were analyzed according to mean, standard deviation, Student’s t and ANOVA tests (p

ABSTRACT Objective: To analyze the usability of two infusion pump models in a Pediatric Intensive Care Unit. Method: This is a cross-sectional study of exploratory descriptive quantitative approach. A task was carried out in a controlled environment using infusion pump with 72 nursing staff members from August to September 2018. The Methodological Guideline for Medical Care Equipment Assessment Studies and the quality model proposed by NBR ISO/IEC 9126-1 were followed. Descriptive statistical analysis was used applying Fisher’s exact test, binomial test and Mann-Whitney test. Results: 91.7% of tasks were completed. The infusion pump-2 model was associated (p < 0.001) with operationalization, tasks accomplished with non-conformities, use of a manual calculator (measure effectiveness) and task accomplishment time (measure efficiency). Conclusion: Efficacy and efficiency measures can evidence a better context of usability of IPs and identify interaction failures with the nursing staff to be improved in care practice.

Objectives: To describe the experience of home antibiotic infusion therapy using elastomeric infusion pumps, administered to patients admitted to the Home Hospitalisation Unit of a tertiary hospital for 3 years and to analyse clinical evolution and mortality., Method: Retrospective observational study. The medical history of the patients included in the study was reviewed. Information was obtained on personal history, antimicrobial therapy received, and clinical evolution. Statistical analysis was performed using SPSS® 19 software., Results: 81 patients were included, 61.7% men, with a mean age of 73.5±17.5 years. The most frequent comorbidities were diabetes mellitus (30.9%) and chronic kidney disease (28.4%). Patients received a mean of 11.9±8.5 days of antibiotic treatment in an elastomeric infusion pump. The main focus of infection was respiratory (27.2%), followed by bacteremia (16%) and skin and soft tissue infections (12.3%). Of the infections, 65.4% were monomicrobial, with Pseudomonas aeruginosa being the main microorganism involved (39.6%). The most commonly used antimicrobial was piperacillin/tazobactam (33.3%). The clinical course was good in 85.2% of the patients, but the mortality rate in the 30 days following the end of treatment was 24.7%. In the univariate analysis, a history of neoplasia in the last 5 years (p=.01) and having received fewer days of antibiotic therapy prior to the start of outpatient antimicrobial therapy in infusion pump (p=.04) were associated with worse clinical outcome. Age over 80 years was associated with better outcome (p=.03). The diagnosis of heart failure was associated with higher mortality (p=.026) and patients from surgical services, with lower mortality (p=.047). In the multivariate analysis, the presence of neoplasia was associated with unfavourable evolution (p=.012) and heart failure with higher mortality (p=.027)., Conclusions: Outpatient antimicrobial therapy in elastomeric infusion pumps is an alternative in patients requiring prolonged intravenous treatment, and age is not a conditioning factor for inclusion in these programs. However, the presence of certain comorbidities can negatively affect the clinical course and mortality of patients., Competing Interests: Declaration of competing interest None declared., (Copyright © 2024 Sociedad Española de Farmacia Hospitalaria (S.E.F.H). Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: To describe the experience of home antibiotic infusion therapy using elastomeric infusion pumps, administered to patients admitted to the Home Hospitalization Unit of a tertiary hospital for three years and to analyse clinical evolution and mortality., Method: Retrospective observational study. The medical history of the patients included in the study was reviewed. Information was obtained on personal history, antimicrobial therapy received and clinical evolution. Statistical analysis was performed using SPSS® 19 software., Results: Eighty-one patients were included, 61.7% men, with a mean age of 73.5 ± 17.5 years. The most frequent comorbidities were diabetes mellitus (30.9%) and chronic kidney disease (28.4%). Patients received a mean of 11.9 ± 8.5 days of antibiotic treatment in an elastomeric infusion pump. The main focus of infection was respiratory (27.2%), followed by bacteremia (16%) and skin and soft tissue infections (12.3%). Of the infections, 65.4% were monomicrobial, with Pseudomonas aeruginosa being the main microorganism involved (39.6%). The most commonly used antimicrobial was piperacillin/tazobactam (33.3%). The clinical course was good in 85.2% of the patients, but the mortality rate in the 30 days following the end of treatment was 24.7%. In the univariate analysis, a history of neoplasia in the last 5 years (p = 0.01) and having received fewer days of antibiotic therapy prior to the start of outpatient antimicrobial therapy in infusion pump (p = 0.04) were associated with worse clinical outcome. Age over 80 years was associated with better outcome (p = 0.03). The diagnosis of heart failure was associated with higher mortality (p = 0.026) and patients from surgical services, with lower mortality (p = 0.047). In the multivariate analysis, the presence of neoplasia was associated with unfavorable evolution (p = 0.012) and heart failure with higher mortality (p = 0.027)., Conclusions: Outpatient antimicrobial therapy in elastomeric infusion pumps is an alternative in patients requiring prolonged intravenous treatment, and age is not a conditioning factor for inclusion in these programs. However, the presence of certain comorbidities can negatively affect the clinical course and mortality of patients., (Copyright © 2024 Sociedad Española de Farmacia Hospitalaria (S.E.F.H). Publicado por Elsevier España, S.L.U. All rights reserved.)

Abstract Objective: To identify the scientific evidence on the frequency of handling errors of conventional and smart pump infusions in intravenous insulin therapy in intensive care units. Method: A systematic review with meta-analysis conducted in the Virtual Health Library, MEDLINE via PubMed, Scopus and Web of Science databases. Articles were assessed regarding the level of evidence by applying the Oxford Center for Evidence-Based Medicine Evidence Scale. Results: Twelve (12) publications were selected which met the eligibility criteria. The programming error rate using the conventional infusion pump ranged from 10% to 40.1%, and the smart pump technology error rate ranged from 0.3 to 14%. The meta-analysis of two studies favored the smart pump in reducing the relative risk of programming errors by 51%. Conclusion: Based on selected articles, the smart pump reduces the risk of programming errors.

Justificación y objetivo: Se evaluó in vitro la precisión en el flujo de nutrición enteral en bombas peristálticas de nutrición enteral con el fin de determinar si ésta puede ser una variable que cause errores en la administración de la fórmula. Materiales y Métodos: Se evaluaron 13 bombas de infusión enteral del tipo peristáltico mediante la aplicación de un modelo de laboratorio que simulaba la administración a un paciente. Se usó para todos los casos una fórmula estándar diluida de la manera recomendada por el fabricante. Con un volumen meta de 240 mL. Se programó en cada bomba un flujo de infusión de 40 mL por hora. Para cada caso según el tiempo de infusión, se calculó el flujo de infusión real y a partir de la diferencia se calculó el porcentaje de error. Resultados: En 12 de las 13 bombas se detectó un error por exceso que fue de 7.5% hasta 52.5%. Solo una bomba, de marca distinta a todas las demás demostró un error de 0 mL/h con respecto a lo programado. Ninguna bomba mostró un déficit en el volumen de infusión. Conclusión: En la mayoría de las bombas evaluadas se detectó un porcentaje de error por exceso que supera lo estipulado por el fabricante.Justification and aim: To evaluate in vitro the accuracy of volume infusion of peristaltic enteral nutrition pumps to determine if this variable may be responsible for error’s in the administration of nutrition support. Materials and Methods: Thirteen pumps were evaluated through simulation using a model that resembles the administration of enteral nutrition to a patient. For every case, we used an standard formula diluted as recommended by the manufacturer. A volume of 240 mL was programmed to be infused at 40 ml per hour. For each case, time was measured until finishing the volume, comparing to the programmed time and calculating the delivery error. Results: In 12 of 13 pumps, we detected error by excess, which varied from 7.5% to 52.5%. Only one pump showed an error of 0%. None of the pumps demonstrated infusion less than programmed. Conclusion: Most of the pumps analysed demonstrate high percentage of error in comparison to what is accepted by the manufacturer.

This document introduces drug-induced sleep endoscopy to the specialist treating sleep breathing disorders and is intended as a guide for those willing to perform the procedure so that it can be reproducible., (Copyright © 2019 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Publicado por Elsevier España, S.L.U. All rights reserved.)

Aims: To analyze the incidence of complications related to the central peripheral insertion catheter and the viability of the infusion of haematopoietic stem cells through volumetric perfusion pumps., Method: Prospective descriptive study that includes all patients who received a haematopoietic transplant in the Haematology Service of the Hospital Clínico de Valencia between January and December 2016 (n=73). All of them received a central peripheral insertion catheter. SPSS™ v22 was used to perform the descriptive analysis of the main variables using a confidence interval of 95%. The student's t-test was used to compare the means of two independent samples assuming unequal variances., Results: The 63% (n=73) of the catheters remained without problems throughout the procedure. Fever of unknown origin (28.8%) was the main cause of catheter removal. The median number of days for haematological recovery was 12.5 for the autologous transplants and 15 for the allogeneic transplants., Conclusions: The central peripheral insertion catheter presents few complications related to insertion. The administration of haematopoietic cells through these catheters with volumetric perfusion pumps does not imply a delay in haematological recovery. Good acceptance by the patient is confirmed., (Copyright © 2020 Elsevier España, S.L.U. All rights reserved.)

Introduction: The higher injection pressure obtained with epidural boluses give greater anaesthetic spread, and therefore better sensory block. Therefore, it stands to reason that anaesthetic administered at greater injection pressure and a higher flow rate would spread to a higher sensory level., Objective: Our aim was to compare the sensory level reached with the high flow. and standard flow set at maximum rates., Material and Methods: We included 73 primiparous women who requested epidural analgesia for labour using programmed intermittent epidural boluses of 0.1% ropivacaine at a flow rate of 10ml/h and 2 ug/ml fentanyl plus patient-controlled epidural analgesia. The boluses were administered with a standard (250ml/h) or high-flow (500ml/h) infusion set, according to the usual clinical practice of each anaesthesiologist. The primary objective was to evaluate the sensory level reached. Secondary objectives were pain on a visual analogue scale, motor block measured on the modified Bromage scale, and anaesthesia consumption in terms of rescue analgesia (patient-controlled epidural analgesia) and anaesthesiologist-administered boluses., Results: The median maximum sensory level reached was T9 in the high flow group and T7 in the standard flow group; this difference was statistically significant (p=.0002). There were no significant differences in visual analogue scale, Bromage or rescue analgesia between groups., Conclusion: Our results show that the high flow set does not offer benefits. The use of such sets need to be evaluated due to their higher cost., (Copyright © 2019 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background and Objective: Analgesia in Ambulatory Surgery (AS) needs to evolve in parallel with surgical complexity. We designed a study to try to improve analgesia in painful surgery using an intravenous elastomeric pump. As a novelty, methadone was included., Patients and Methods: An observational study, physical status ASA I-II, underwent ambulatory surgeries with moderate-severe postoperative pain. Analgesia was administered for 48h by an intravenous multimodal elastomeric pump (methadone, tramadol, dexketoprofen and ondansetron at low doses). Visual Analogue Scale (VAS) at rest and movement were evaluated at 24 and 48h. Andersen Scale, Lattinen Test, rescue analgesia and side-effects were recorded at 24h after surgery., Results: We included 73 patients: 37% abdominal wall surgery, 30% hemorrhoidectomies and 33% perineal surgery. Median VAS score at rest and movement were 0 and 3 at 24h, and 0 and 2 at 48h. At 24h, Andersen's Scale score was ≤1 in 89%, and Lattinen Test ≤6 in 90% of patients. Rescue medication was administered in 30% of patients. Two patients had vomiting at 24 and 48h. Minor catheter and pump dysfunctions were observed in 8% of patients., Conclusions: Multimodal analgesia with intravenous methadone administered by elastomeric perfusion at home is effective and safe. However, monitoring is needed to diagnosis dysfunction of devices., (Copyright © 2018 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To follow up pain in the immediate postoperative period, using an elastomeric pump in anterior cruciate ligament surgery., Material and Methods: 309 patients who had undergone anterior cruciate ligament repair with bone-tendon-bone allograft. Pain control was assessed with a visual analogue scale (VAS) during the immediate postoperative period, in the postoperative care unit, in the recovery room, and after the first 24-48-72hours following home discharge. The need for rescue medication, adverse effects observed and emergency visits were also registered., Results: 309 patients were assessed (264 males, 45 females), mean age 33 (range: 18 - 55). Postoperative pain was mild in 44.7% of patients, and 38.5% were pain-free. At discharge, 41.1% of patients reported mild pain and 57% were pain-free. At home, mild to moderate levels of pain were maintained and over 97% of patients presented VAS values ≤ 3. Fewer than 3% had adverse effects, 8.7% had to use analgesic medication at some point. Pruritus occurred in less than 1% of patients receiving intravenous analgesia at home, and fewer than 2% had device-related complications., Discussion: There is no consensus regarding the postoperative management of anterior cruciate ligament lesions, although most surgeons use multimode anaesthesia and different combinations of analgesics to reduce postoperative pain., Conclusions: The use of an intravenous elastomeric pump as postoperative analgesia for anterior cruciate ligamentoplasty has yielded good results., (Copyright © 2017. Publicado por Elsevier España, S.L.U.)

Introduction: Our institution implemented the use of pre-designed labeling of intravenous drugs and fluids, administration routes and infusion pumps of to prevent medication errors., Objective: To evaluate the effectiveness of predesigned labeling in reducing medication errors in the preparation and administration stages of prescribed medication in patients hospitalized with invasive lines, and to characterize medication errors., Methods: This is a pre/post intervention study. Pre-intervention group: invasively administered dose from July 1st to December 31st, 2014, using traditional labeling (adhesive paper handwritten note). Post-intervention group: dose administered from January 1st to June 30th, 2015, using predesigned labeling (labeling with preset data-adhesive labels, color- grouped by drugs, labels with colors for invasive lines). Outcome: medication errors in hospitalized patients, as measured with notification form and record electronics. Tabulation/analysis Stata-10, with descriptive statistics, hypotheses testing, estimating risk with 95% confidence., Results: In the pre-intervention group, 5,819 doses of drugs were administered invasively in 634 patients. Error rate of 1.4 x 1,000 administrations. The post-intervention group of 1088 doses comprised 8,585 patients with similar routes of administration. The error rate was 0.3 x 1,000 (p = 0.034). Patients receiving medication through an invasive route who did not use predesigned labeling had 4.6 times more risk of medication error than those who had used predesigned labels (95% CI: 1.25 to 25.4). The adult critically ill patient unit had the highest proportion of medication errors. The most frequent error was wrong dose administration. 41.2% produced harm to the patient., Conclusions: The use of predesigned labeling in invasive lines reduces errors in medication in the last two phases: preparation and administration.

Objective: To describe the incidence and complications arising in a number of cases of patients with cerebrospinal fluid leak treated by external lumbar drainage with infusion pump (IP) volumetric continuous from 2001 to 2014. Quantify cerebrospinal fluid leak closed by lumbar drainage with IP., Methods: Retrospective descriptive case series study., Population: patients undergoing transsphenoidal pituitary surgery, Chiari surgery and laminectomy, that developed postoperative cerebrospinal fluid leak treated with continuous external lumbar drainage by IP., Variables: age, sex, type of intervention, variables related to the practice of the pump and complications. Average and medians were calculated for quantitative variables, frequencies and percentages for qualitative., Results: Sample: 11 subjects. Incidence in running IP: disconnection, occlusion and acoustic alarm activation. Most frequently complication is headache; a case of pneumocephalus., Discussion: The small number of subjects and the heterogeneity of these do not allow for comparison or establishing associations between variables. The resolution of the cerebrospinal fluid leak with continuous IP is lower in this study than others, and may be influenced by the small number of subjects. It should be noted the frequent activation of the pump alarm for no apparent cause., Implications for Practice: Protocol would be developed for preparing the IP team to reduce the acoustic alarm activation, and would make a prospective multicenter study., (Copyright © 2016 Elsevier España, S.L.U. All rights reserved.)

Objectives: To estimate the impact of smart pump implementation in a pediatric intensive care unit in terms of number and type of administration errors intercepted., Design: Observational, prospective study carried out from January 2010 to March 2015 with syringe and great volumen infusion pumps available in the hospital., Setting: A tertiary level hospital pediatric intensive care unit., Participants: Infusions delivered with infusion pumps in all pediatric intensive care unit patients., Interventions: Design of a drug library with safety limits for all intravenous drugs prescribed., Main Variables: Users' compliance with drug library as well as number and type of errors prevented were analyzed., Results: Two hundred and eighty-three errors were intercepted during 62 months of study. A high risk drug was involved in 58% of prevented errors, such as adrenergic agonists and antagonists, sedatives, analgesics, neuromuscular blockers, opioids, potassium and insulin. Users' average compliance with the safety software was 84%., Conclusions: Smart pumps implementation has proven effective in intercepting high risk drugs programming errors. These results might be exportable to other critical care units, involving pediatric or adult patients. Interdisciplinary colaboration is key to succeed in this process., (Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.)

Enteral nutrition (NE) is a technique of artificial nutrition that enables management by digestive tract of a defined mixture of nutrients and water, by means of probes implanted nasally or by enterostomies (eg: gastrostomy). Whenever the patient present limitations for voluntary oral ingestion or swallowing of the nutrients, and digestive capacity permitted to absorb nutrients, will draw the administration through a tube. Concern for the nutritional status of the patients is a more present reality among health professionals have demonstrated the direct relationship between malnutrition and morbidity and mortality of hospitalized patients. Enteral nutrition has become a useful procedure for the treatment of these patients, reducing their morbidity and mortality. The NE can be administered by infusion by gravity drip (less clinical use) pump and syringe (bolus), taking into account the speed of it, thus avoiding a large number of complications (usually due to too rapid administrations), so the method employed will be adjusted to the needs of each patient, whereas, the tolerance and its risk of aspiration. In this paper we will focus on the NE by infusion pump administration emphasizing the reduction of complications with this methodology against the administration by bolus (syringe).

We report the case of a patient who underwent surgical aortic valve replacement. During general anaesthesia maintenance, the patient received a remifentanyl infusion via a target controlled infusion (TCI) system. The infusion pump that was prepared to deliver the infusion showed malfunction at the beginning of the surgery, so it was quickly replaced with a second pump. After a few minutes into the surgery, the patient presented with hypotension refractory to treatment. The remifentanyl syringe also emptied faster than expected. On reviewing the TCI pump, it was found that it was erroneously programmed for propofol instead of remifentanyl, thus the patient had received a very high dose of remifentanyl that was probably the cause of the haemodynamic disturbances. The incident was an error in equipment use, facilitated by hurry, lack of checking of the equipment prior to its use, and the complex and unclear design of the devices' screens. After analysis of this incident, all TCI pumps were reviewed, and all the programs for infrequently used drugs were deleted. Furthermore, 2 pumps were selected for exclusive use in the cardiac surgery theatre, one with propofol-only programming, and the other with remifentanyl-only programming, both clearly marked and situated in fixed places in that theatre., (Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.)

Elastomeric infusions pumps are single use devices that permit continuous drugs infusion in a safe and simple way. They help to maintain drugs plasma level stability and analgesia in order to control acute pain and improves patients quality of life, which are an effective alternative for de treatment of pain.

Introduction: Neuraxial anesthesia in upper abdominal laparoscopic surgery decreases perioperative morbidity and mortality. However, shoulder pain is common and difficult to control. Use of a major opioid (e.g., fentanyl) for the control of this event may depress respiratory function. This is why we believe that a safe and effective therapeutic control of this disease pain is a multimodal analgesic scheme which we have called infusional therapy., Objective: To compare various schemes for controlling shoulder pain secondary to pneumoperitoneum., Methods: Nonrandomized clinical trial with 56 patients ASA I-II divided into four groups undergoing laparoscopic cholecystectomy. Group I (n= 15) managed with ketorolac 1 mg kg, group II (n = 12) ketoprofen 100 mg, group III (n = 14) ketoprofen 50 mg + 50 mg tramadol, and group IV (n = 15) ketoprofen 100 mg + 100 mg tramadol. The following ariables were analyzed: presence and intensity of pain, analgesia rescue and operative time., Results: Group I had more shoulder pain events compared to other groups (p= 0.002) in the same way the group IV required less rescue analgesia (p= 0.034)., Conclusion: preemptive analgesia to infusional therapy with ketoprofen-tramadol at doses of 100 mg each is safe for laparoscopic surgery.

Background and Objectives: The number of bilateral total hip arthroplasties (THA) has been increasing every year. Postoperative analgesia by continuous perineural infusion of local anesthetic has been shown favorable results when compared to systemic analgesia. The use of elastomeric pumps has increased patient satisfaction when compared to electronic models. The objective of this report was to describe a case of continuous bilateral posterior lumbar plexus block with an elastomeric infusion pump in a patient submitted to bilateral hip arthroplasty., Case Report: This is a 46 year-old female patient weighing 65 kg, 162 cm, with rheumatoid arthritis and hypertension, physical status ASA II, scheduled for bilateral THA in a single stage. She had been on corticosteroids for 13 years. Hemoglobin=10.1 g.dL⁻¹, hematocrit=32.7%. Routine monitoring. Spinal anesthesia with 15 mg of 0.5% isobaric bupivacaine. General anesthesia with propofol (PFS) and remifentanil, and intubation without neuromuscular blockers. Right THA and, at the end, lumbar plexus block with a stimulator and a set of 150 mm needle and injection of 20 mL of 0.2% bupivacaine and introduction of a catheter. Left THA and, at the end, the same procedure. Anesthetic dispersion and contrast were investigated. Elastomeric pump was installed with 0.1% bupivacaine (400 mL) at a rate of 14 mL.h⁻¹. The patient was transferred to the Intensive Care Unit (ICU). After 24 hour, a new pump was installed with the same solution. She did not receive any boluses for 50 hours. After removal of the catheter, pain was controlled with oral ketoprofen and dypirone., Conclusions: Continuous peripheral blockade with infusion of 0.1% bupivacaine with elastomeric pumps is a safe and effective procedure in adults., (Copyright © 2011 Elsevier Editora Ltda. All rights reserved.)

Objective: To determine whether inhalation induction is faster than target-controlled infusion (TCI)., Material and Methods: Patients in ASA physical status 1 or 2 who were scheduled for elective surgery were randomized to a propofol TCI group or a sevoflurane group. Both groups received a TCI of 5 ng L(-1) of remifentanil. Rapid induction was performed using an effect-site TCI of 2.8 microg mL(-1) of propofol in the propofol group and 8% sevoflurane in the sevoflurane group. We recorded time until loss of the palpebral reflex, hemodynamic variables, respiratory variables, hypnotic depth of anesthesia using the auditory evoked potentials index (AAI), and the moment the anesthesiologist decided to intubate. Also recorded was the time taken to reach an AAI of less than 40, which was established as the threshold of hypnotic depth sufficient for tracheal intubation., Results: Forty-four patients were enrolled in the trial. The palpebral reflex loss time was 60 (44-90) seconds in the TCI-propofol group and 72 (38-265) seconds in the sevoflurane group (P<.05). An AAI of less than 40 was reached in 105 (90-195) seconds in the TCI-propofol group and in 230 (125-355) seconds in the sevoflurane group. The variation in the calculated effect-site concentration (Ce) was consistent with the direction of change in the AAI value, which decreased as Ce increased; the variation in the expired fraction of sevoflurane did not show the same relationship. The anesthesiologist was not authorized to intubate 2 patients in the sevoflurane group as the AAI threshold was not reached. The decrease in blood pressure was significantly greater in patients in the sevoflurane group than in those in the propofol group., Conclusion: Anesthetic induction is faster with a TCI of propofol based on Ce than with sevoflurane. The propofol Ce was consistent with the direction of change in the AAI.

Objective: To compare the utility of intra-articular analgesia (IA) to that of a continuous interscalene block (CIB) by evaluating the quality of postoperative analgesia, a satisfaction index, and the incidence of complications., Patients and Method: A randomized controlled trial enrolling patients classified as ASA 1 or 2. The IA group received 25 mL of ropivacaine 0.2% plus 2 mg of morphine. The CIB group received a 7-mL/h infusion of bupivacaine 0.0625% plus 1 microg/mL of sufentanil. Postoperative pain was expressed on a visual analog scale (VAS) at 2, 4, 6, 12, 24, and 48 hours. Intravenous morphine was used as a rescue analgesic. Morphine use, incidence of adverse effects, and level of patient satisfaction after 48 hours were recorded., Results: Twenty-three patients were randomized to the IA group and 24 to the CIB group. There were no between-group differences in patient characteristics. VAS scores and morphine use were similar in the 2 groups in the first 12 hours but were lower in the CIB group at 24 and 48 hours. The level of patient satisfaction was higher in the CIB group. There was a higher incidence of nausea and/or vomiting in the IA group at 24 and 48 hours., Conclusions: Postoperative pain in the first 12 hours after shoulder surgery can be adequately managed with either IA or CIB. CIB is more effective than IA between 12 and 48 hours after surgery.

Since prevention and control of hospital-generated infections comprises one of the priorities in today's hospitals, the authors analyze how two infusion kits function; one kit is the classical version normally used in the hospital where this study took place and the other is a new kit which incorporates a security system. After carrying out a statistical and cost analysis, the authors conclude that the new perfusion system is cost effective, providing, among other factors, a savings of 62.083 Euro per hospitalized patient.

Objective: In 1995 a specialized home care service for infectious diseases was created in our institution. The aim was to improve the quality of life of patients with prolonged parenteral antimicrobial therapy requirements, reduce the length of hospital stay, and improve the care received after discharge by clinical and analytical surveillance. This study reviews the experience of this service from 1995 to 2002 using prospectively recorded data., Methods: An analysis was performed of the number of patients included in the home care program per year, number of patients with HIV infection, infectious disease diagnosed, department referring the patient, antimicrobial treatment administered, destination at discharge, and reason for hospital re-admission., Results: The number of patients included each year from 1995 to 2002 was 52, 55, 77, 232, 213, 321, 280 and 219, respectively. The percentage of HIV-infected patients decreased from 90% in 1995 to 23% in 2002. The main reason for referral to the program changed from substitution of day-care hospital treatment to early discharge from hospitalization. Whereas CMV infection was the most frequent infection treated during the 1995-1998 period, bacterial infections predominated in the following years. In 148 episodes, self-administration or a portable infusion pump was used for drug administration. Self-administration was associated with a greater risk of complications (24% vs. 12%, OR 2.3, 95% CI 1.5-3.6, P < 0.001) and catheter-related sepsis (4% vs. 0%, OR 12.9, 95% CI 10.9-15.3, P < 0.001). HIV-infected patients were re-hospitalized due to complications unrelated to the home care service more frequently than HIV-uninfected patients., Conclusions: The percentage of HIV-infected patients included in the infectious disease home care service has progressively decreased since 1996, a fact likely to be related to the introduction of highly active antiretroviral therapy and better control of opportunistic infections. Currently, bacterial infections are the most frequent infections treated in the service. Early hospital discharge is now the main reason for referral to the home program.

Objective: Postoperative pain is one of the most frequent complications of outpatient orthopedic surgery. We therefore studied the efficacy, feasibility, and safety of the continuous femoral nerve block as an analgesic technique for outpatient anterior cruciate ligament reconstruction., Material and Methods: We carried out a single-blind prospective study of ASA 1-2 patients who received a continuous femoral nerve block with 0.125% bupivacaine through an elastomeric pump to treat postoperative pain as part of a multimodal approach. Postoperative pain was assessed on a verbal numerical scale from the immediate postoperative period until 48 hours after the operation. Side effects and patient satisfaction were also assessed., Results: Sixty-three patients were enrolled. The continuous femoral nerve block was effective: in the first 24 hours following surgery 90% of patients had mild or no pain, and 92% required no rescue medication. It also proved safe, as there were no significant side effects., Conclusion: The continuous femoral nerve block with 0.125% bupivacaine is a safe, effective option for the management of postoperative pain in outpatient anterior cruciate ligament reconstruction.

Objective: To assess the effectiveness of therapy, type of infection, hospital department of origin and outcome of 515 cases of infection requiring home intravenous antibiotic therapy treated by the home care service., Methods: The clinical records of patients undergoing intravenous antibiotic therapy through the home care service over a 6-year period were retrospectively reviewed., Results: A total of 439 patients (244M/195F; mean age, 55.9 years, range 7-96) requiring 515 courses of home intravenous antibiotic therapy were reviewed. Mean duration of antibiotic therapy was 7.9 days (1-58). Urinary (42.3%) and respiratory infections (25.8%) were the most frequent indications for home treatment. Most patients were referred from the emergency room (50.5%) followed by the Internal Medicine Department (11.5%) and Oncology Department (11.1%). Ceftriaxone was the most widely prescribed antibiotic (41.8%) followed by aminoglycosides (35.3%) and glycopeptides (11.7%). In 49 cases electronic infusion pumps were used, with ceftazidime being the predominant antibiotic (32.7%) in these cases. Hospitalization was required in 7% of patients due to infectious disease-related complications. Clinical outcome was positive in 79% of the patients, with improvement in 90% of patients from the emergency room, Conclusions: The advantages of home care services to provide home intravenous antibiotic therapy are evident. More than half of the patients were referred from the emergency room and 90% of these progressed well. The presence of medical and nursing staff qualified to handle infectious diseases is necessary, as well as continuing home care.

Objective: To evaluate the predictive capability of a target-controlled infusion (TCI) system in patients with terminal chronic renal failure by comparing real drug concentrations with predicted concentrations., Methods: Forty ASA II-III patients undergoing kidney transplants were enrolled and grouped by age: group A 18-54 years old and group B 55-80 years old. Propofol was administered through the Diprifusor TCI system (Astra Zeneca) with the target concentration of propofol for induction set at 3 micrograms/mL for group A patients and 2.5 micrograms/mL for group B patients. Arterial blood samples were taken for analysis of drug concentrations at the following times: 2 and 5 minutes after starting the infusion; immediately after the incision; before and 5 minutes after increasing or decreasing the target concentration > 25%; before and 5 minutes after switching off the perfusion for surgery; upon eye opening; and 30 minutes after switching off the infusion pump. The predictive capability of the system was determined by performance error (PE). We calculated bias (%, median PE) and accuracy (%, median absolute PE)., Results: Twenty group A and 20 group B patients were studied. The median PEs in groups A and B, respectively, were -3.45 (-20.3-28.4) and -1.1 (-19.7-15.4). Median absolute PEs were 21.2 (11.9-45.1) and 16.3 (11.5-27.4), respectively., Conclusions: The results indicate that the predictive capability of the Diprifusor pharmacokinetic model is acceptable in patients with terminal kidney failure, given the minor bias of 10% to 20% and the degree of accuracy between 20% and 40%.

Background and Objective: The treatment of pulmonary hypertension associated with infection by human immunodeficiency virus has not been well defined. Treprostinil is a prostacyclin analogue that has recently been shown to be useful for the treatment of pulmonary hypertension, whether primary, secondary to congenital heart disease, or associated with collagen disease, in a 12-week, double-blind study. We report the results of a one-year follow-up of three patients with pulmonary hypertension associated with human immunodeficiency virus infection who are being treated with treprostinil at our center., Patients and Method: After secondary causes of pulmonary hypertension were excluded by a routine work-up, patients started treatment with subcutaneous prostacyclin (treprostinil) with progressive up-titration of the dose. Functional status and effort capacity were assessed every three months and an echocardiographic study was performed every six months., Results: All patients showed improvement in clinical status, as shown by the NYHA functional class and the results of the six-minute walking test (increase of at least 75 meters). All the patients remain alive after one year of follow-up. Echocardiographic systolic pulmonary pressure decreased in two patients. No serious adverse events were observed., Conclusions: Subcutaneous prostacyclin (treprostinil) seems to be an effective and safe therapeutic option for the treatment of pulmonary hypertension associated with human immunodeficiency virus infection.

Spasticity is the most common movement disorder in cerebral palsy. Cerebral spasticity has traditionally been treated with physical therapy and orthopedic surgery. Oral medications have been used with limited success. Intrathecal administration of baclofen may be a valuable alternative in selected patients. We comment the patient management and clinical practice guidelines on the use of intrathecal baclofen for the treatment of spasticity.

Objective: To evaluate at the laboratory a self-designed computer-controlled kidney perfusion system. A vacuum powered tubular pump with active valves developed by our group is used. This pump is able to produce a flow and pressure patterns very similar to the pulse wave in the human circulatory system., Basic Procedures: This is an experimental study performed with mini-pig kidneys. After transperitoneal bilateral nephrectomy, both organs are sorted either to immediate perfusion or to perfusion after a period of 24 hours of cold storage in Eurocollins solution. The system is able to record continuously perfusion pressure, flow and intrarenal resistance., Results: A progressive decrease in renal vascular resistance along with an increase in the flow value were observed during the procedures. These dynamic changes become evident both in immediate and deferred renal perfusions., Conclusions: Computer-controlled kidney perfusion system provide us the opportunity of recording in real time renal microcirculatory state modifications during a perfusion. Vascular system seems to be actively modified by the perfusion. This fact should be researched in the next future.

Unlabelled: The authors determine whether or not nurses should use perfusion pumps for concentrated hematin transfusions, measuring the degree of hemolysis which occurs in two distinct models., Study Sample: Concentrated hematin transfusions by means of an infusion pump on children in a Pediatrics Intensive Care Unit at the Maternity-Pediatrics Ward in Granada. Dependent Variable: Degree of Hemolysis, measured by means of: free hemoglobin, potassium, LDH., Independent Variables: Pump; dated/used blood; hematocrit; catheter caliber; type of procedure; pump working pressure; other perfusion rhythms; infusion rhythm. Sample size. One year study group, 95% confidence rate, 0.50 prevalence of awaited hemolysis, +/- 0.05 precision (relative precision 10%). Data Obtained: Two samples are taken per transfusion: removal of blood bag, extreme distal removal system. Investigative Method: Prospective descriptive study., Statistical Analysis: Descriptive statistics, by means of frequency distributions. Variable analysis, multiple variable analysis., Results: 55 observations were carried, of these, 50.9% corresponded to pump number one. Simple regression linear analysis showed differences in the degree of hemolysis in terms of free hemoglobin and hematocrit. Dated/used blood registered a higher hemolysis level above 75 percentile. The greater hemolysis in terms of potassium difference was associated with the type of procedure, having an average of 0.44 mEq/l, in presence of other perfusions, greater rhythm (p = 0.118), dated/used blood (p = 0.008), hematocrit (p = 0.063). The greatest difference in LDH occurred with smaller caliber catheters, other perfusions, more dated blood (p = 0.117). In multiple linear regression, results were equal to those predicted: an average difference in hemoglobin of 3.87 mg/l (p = 0.661); in potassium, 0.39 mEq/l (p = 0.138); in LDH, 53.6 (p = 0.568). This documents with verify this study have been consulted by the ROL Editorial Board and may be requested from the authors.

Continuous perfusion administration of chemotherapy can be performed by means of various devices known as pumps. There are syringe pumps, elastomeric pumps, peristaltic pumps and pumps which can be implanted. In our hospital environment, the elastomeric pump enjoys a high degree of acceptance since it permits a cancer patient to maintain a large degree of autonomy while he/she carries on his/her activities.

Objectives: We show the effectiveness of treatment with continuous intrathecal baclofen infusion in a case of hereditary generalized dystonia refractory to anticholinergics, tetrabenazine, pimozide, L-dopa, benzodiazepines and thalamotomy., Clinical Case: A 26 years old female patient, when she was 11 years old began with torsion dystonia in her left feet, that progressively worsened to involve her entire body. She had painful spasms. She had four brothers, three of them with dystonia and one healthy. Her uncle grandfather had similar symptoms. Complementary explorations to reject secondary origin was negatives. She was treated with high and progressive dosages of anticholinergics, pimozide, tetrabenazine, benzodiazepines, L-dopa and thalamotomy without improvement. Underwent intrathecal baclofen test dosing, we used 25, 50, 100 micrograms/day, the last one with improvement during 10 hours. A pump was inserted with an initial dose of 220 micrograms/day. After pump insertion, baclofen dosage was gradually increased to 450 micrograms/day. She had a great improvement in right part of her body and less in her left body. Painful spasms had disappeared., Conclusion: We propose continuous baclofen intrathecal infusion pump for patients with severe torsion dystonia that not response to ordinal treatment.

Introduction and Objective: It is well known that in aged animals cognitive deficit occurs, homologous with that occurring in Alzheimer's disease in humans, and as has been shown in others species, this may be attenuated by administration of nerve growth factor (NGF). Therefore the basic aim of this study was to make an electrophysiological evaluation of the repercussion that there might be after long-term administration of this neurotropin in the sacred baboon (Papio hamadryas) comparing aged with young animals., Material and Methods: We studied a six year old male and a 39 year old female, after sedation. Long-term intraventricular administration of NGF was carried out using a continuous infusion pump, at a dose of 2.1 micrograms/kg/day. Recordings were made before installing the pump and 1, 3 and 6 months after insertion. A Neuropack Four-mini set for evoked potentials (Nihon Kohden) was used to record auditory evoked potentials from the brain stem and visual evoked potentials due to flash., Results and Conclusion: In both animals there were modifications of their electrophysiological responses. These reached a maximum after one month, more markedly in the older animal and this could possibly be related to the neuromodulator effect of NGF.

Quality of analgesia provided by continuous infusion of tramadol through an elastomeric infuser (Baxter PC1071) was studied in a group of 40 women undergoing laparotomy to treat non tumoral disease. After a loading dose of 100 mg of tramadol in the recovery room, the elastomeric infuser was connected, loaded with 300 mg of tramadol in 48 ml of saline. The patient was then transferred to the ward. Analgesic quality was assessed on a visual analog scale (VAS) of 1 to 10 and on a semantic scale. Side effects, the need for supplemental analgesia and the opinion of the nurse were all recorded. The highest VAS score in the 24 h period was 2.69. Pain was described as slight by 52.5% of the women, moderate by 12.5% and absent by 35%. The main side effects were nausea and vomiting (12.5%). Three patients needed supplementary analgesia. The technique was described by 85% of the nurses as good (62.5%) or very good (22.5%). Elastomeric infusers are an effective way to deliver analgesics, and tramadol proved to be a valid analgesic for continuous infusion.

Objective: To apply a fuzzy logic expert control system for the treatment of postoperative pain in a clinical setting., Material and Methods: A system was designed consisting of a perfusion pump guided by a fuzzy logic computer interface to regulate the perfusion of alfentanil in accordance with the patient's pain response. The system was also equipped with a safety device that halted perfusion in case of desaturation, bradypnea or heart rate or blood pressure variations greater than 25%. The system was used in the first 90 minutes after surgery in a patient who underwent bilateral saphenectomy., Results: All system functions worked properly, maintaining the target analgesic values (visual analog scale < or = 2) 77% of the time., Conclusion: It is possible to use fuzzy logic to obtain adequate treatment of postoperative pain.