No abstract

Purpose: A pharmacokinetic study in children to determine plasma flumazenil concentrations after the intranasal administration of 40 µg·kg -1 .Methods: Following institutional approval and informed written consent, 11 ASA physical status I-II patients, aged two to six years, undergoing general anesthesia for dental surgery were recruited. After induction, 40 µg·kg -1 flumazenil Anexate®, Roche, 0.1 mg·mL -1 (0.4 mL·kg -1 )) were administered via a syringe as drops, prior to nasal intubation. Venous plasma samples were drawn prior to administration of flumazenil (t=0), and then at 2, 4,6,8,10,15, 20, 30, 40, 60, and 120 min thereafter. The plasma samples were immediately processed by the onsite laboratory and then stored at -70°C, before batch analysis via high performance liquid chromatography assay. Pharmacokinetic data calculations were performed using WinNonLin software (Scientific Consulting Inc.).Results: Eleven patients were studied, but data for one patient were discarded due to insufficient sampling. The median age was 4.3 yr (range 3 to 6), with a median weight of 18.9 kg (range 14.9 to 22.2). There were seven boys and three girls. Mean C max was 67.8 ng·mL -1 (SD 41.9), with T max at two minutes. The calculated half-life was 122 min (SD 99). Conclusion:The mean plasma concentrations of flumazenil attained were similar to those reported after intravenous administration, and may be sufficient to antagonize the side-effects of benzodiazepines. This route of administration may be useful when the intravenous route is not readily available.

Purp~ 9 To compare the cost and effectiveness of intravenous regional anaesthesia (IVRA) with general anaesthesia (GA) for outpatient hand surgery. Method: A retrospe~ve record analysis of 121 patients who received IVRA were compared with 64 patients who received GA in our Daycare centre. The costs of anaesthesia and recovery were calculated from an institutional per~0ective using 1995 Canadian Dollar values. Effectiveness was measured in terms of time for anaesthesia, recovery and discharge, 96 with unsatisfactory anaesthesia and complications. Results: Both groups were well matched in terms of weight, sex and ASA class. Patients in the IVRA group were older (45 • 16 vs 38 -+ 13 yr) and had a lower frequency of two types of operation. The median total cost for the IVRA group of $24.60 (I 5.76--55.29)was less than that for the GA group of $48.66 (35.59-73. I I), (P < 0.00001). Anaesthesia was unsatisfactory in I 1% of the IVRA group, but in none having C_~, (P < 0.0 I). Recovery was faster in the IVRA group with a median time to discharge of 70 (35-I 80) min compared wilJa I 18 (45-320) min in the GA group, (P < 0.00001). Vomiting requiring treatment occurred in 5% ofthe GA group, but in none having IVRA, (P < 0.05). Dizziness which delayed discharge also occurred in 5% of the GA group, but in none having IVRA, (P < 0.05). Conclusion: The cost of anaesthesia and recovery using IVRA for outpatient hand surgery was half that of G/k Intravenous regional anaesthesia was less effective than GA in achieving satisfactory anaesthesia, equally effective in time to administer anaesthesia, and more effective in speeding recovery and minimising postoperative complications. . I:anesth~sie a ~t~ insatisfaisante pour I 1% du groupe ARIV, mais pour aucun du groupe AG, (P < 0,01). Le groupe ARIV a r&ul:~rE plus rapidement avec un s~jour median en salle de r~veil de 70 (35-180) min comparativement ~ 118 (45-320) min pour le groupe AG (P < 0,00001). Des vomissements nEcessitant traitement sont survenus chez 596 du groupe AG, mais chez aucun du groupe ARIV (P < 0,05). Cinq pour cent des patients du groupe AG ont prEsent~ des ~tourdissements suSsamment graves pour diff&er le cong~ comparativement ~ aucun du groupe ARIV (P < 0.05). Conclusion : Pour la chirurgie ambulatoire de la main, ranesth~sie et la rEcul~ration co6tent deux fog moins chef avec I'ARIV qu'avec I'AG. Uanesth&ie rEgionale intraveineuse est moins efficace sur te plan de la satisfaction, ~galement efficace sur le plan de la dur~e requise pour I'administration de I'anesthEsie et plus efficace sur le plan de la rapidit~ de la r~cul:~ration et de rincidence des complications.