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Biomedical subjects

A Baraka

Publications and source records attributed to A Baraka.

At least 19 recordsLinked to original sources

Onset of vecuronium neuromuscular block is more rapid in patients undergoing caesarean section.

This investigation was carried out in ten patients undergoing elective Caesarean section and the results were compared with those of a control group of ten nonpregnant females of the same age group. The study investigated the onset of vecuronium neuromuscular block and the conditions of tracheal intubation when ketamine (1.5 mg.kg-1)-vecuronium 100 micrograms.kg-1) sequence was used for rapid-sequence induction of anaesthesia. The ulnar nerve was stimulated supra-maximally at the wrist with train-of-four stimuli every 20 sec, and the electromyographic response of the adductor pollicis muscle was displayed. The onset of 50% neuromuscular block as monitored by electromyography was shorter in the Caesarean group (80 +/- 30 sec) than in the control group (144 +/- 43 sec). The conditions of intubation at 50% block were adequate in both groups. Also, the onset of 90% block was shorter in the Caesarean group. The time of recovery to T1/control ratio of 25% was longer in the Caesarean group (46 +/- 10 min) than in the control patients (28 +/- 10 min). The results show that administration of vecuronium according to body weight results in a more rapid onset and delayed recovery of neuromuscular block in pregnant women undergoing Caesarean section than in the nonpregnant control patients.

Adult

Management of an unusual presentation of foreign body aspiration.

Foreign body aspiration is a very common problem in children and toddlers and still a serious and sometimes fatal condition. We are reporting on a 2-year-old white asthmatic male who choked on a chick pea and presented with subcutaneous emphysema, and on chest X-ray with an isolated pneumomediastinum but not pneumothorax. On review of the literature an isolated pneumomediastinum without pneumothorax was rarely reported. This presented a challenge in management mainly because of the technique that we had to use in order to undergo bronchoscopy and removal of the foreign body. Apnoeic diffusion oxygenation was used initially while the foreign body was removed piecemeal, and afterwards intermittent positive pressure ventilation was used. The child did very well, and his subcutaneous emphysema and pneumomediastinum remarkably improved immediately post surgery.

Bronchi

Suxamethonium block in the myasthenic patient. Correlation with plasma cholinesterase.

The neuromuscular block of suxamethonium 1.5 mg.kg-1 was investigated in three myasthenic patients (Class IIA), undergoing thymectomy. Two of the patients were receiving pre-operative pyridostigmine therapy. In the three patients, plasma cholinesterase activity was determined on the morning of surgery and was correlated with the neuromuscular response to suxamethonium as monitored by electromyography. The results suggest that the response to suxamethonium in the myasthenic patients can show wide variations according to the level of their plasma cholinesterase activity. The degree and duration of suxamethonium block is inversely related to the plasma cholinesterase activity.

Adolescent

Cimetidine-dobutamine interaction?

The report describes a patient during induction of anaesthesia for coronary artery by-pass grafting, in whom the infusion of dobutamine at a rate of 5 micrograms.kg-1.min-1 resulted in unanticipated severe hypertension. The exaggerated response may be attributed to cimetidine--dobutamine interaction.

Anesthesia, Intravenous

"Crash induction" in patients with full stomach.

The rationale of "crash induction" in patients with full stomach is reviewed. The technique does not precipitate regurgitation in normal patients having competent cardia, provided respiratory obstruction and IPPV are avoided during induction. On the other hand, in patients with incompetent cardia such as intestinal obstruction or hiatus hernia, excessive material may accumulate in the lower oesophagus. The accumulation will be suddenly released with the cricopharyngeal relaxation subsequent to "crash induction". The stomach and oesophagus should be adequately decompressed pre-operatively, and precautionary measures such as backward cricoid pressure must be taken during induction.

Anesthesia

Antagonism of neuromuscular block by physostigmine in man.

In 20 adult patients undergoing inguinal herniorrhaphy neuromuscular block was induced with tubocurarine 10 mg. In 10 patients, neostigmine 1--2 mg antagonized the block and restored the twitch response to its baseline value. Physostigmine, up to 4 mg, did not produce significant antagonism of the neuromuscular block.

Adult

Suxamethonium-induced muscle contracture following traumatic denervation in man.

The effects of the systemic and of the i.v. regional administration of suxamethonium were investigated in 23 patients with traumatic nerve injury. Following the systemic administration of suxamethonium 100 mg, normally innervated muscles showed muscle fasciculations initially, followed by muscular relaxation. On the other hand, denervated muscles did not fasciculate and, in 21 patients, manifested suxamethonium-induced contractures. In the other two patients no response was observed. In 10 of the patients, the i.v. regional administration of suxamethonium 5 mg was followed by a contracture of the denervated muscle which was maintained until the tourniquet was deflated. No systemic reaction to suxamethonium, other than mild ptosis, followed the release of the tourniquet.

Humans