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Biomedical subjects

A M Lynn

Publications and source records attributed to A M Lynn.

52 records · Page 3Linked to original sources
PubMed1987

AIDS and the dentist.

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Acquired Immunodeficiency Syndrome↗
PubMed1987

Morphine pharmacokinetics in early infancy.

The pharmacokinetics of morphine in ten infants less than or equal to 10 weeks of age who were receiving morphine infusions were determined. Infants 1-4 days of age (newborns) showed longer elimination half-lives than the older infants (6.8 vs. 3.9 h). Clearance in the newborns is less than one-half that found in older infants (6.3 vs. 23.8 ml X min-1 X kg-1). The combination of lower clearance and longer elimination half-life in newborns (0-7 days) may well explain a prolonged duration of action for morphine in very young infants, but other etiologies are needed to explain the respiratory sensitivity believed to persist in older infants.

Female↗
PubMed1987

Brain death?

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Brain Death↗
PubMed1987

Caudal morphine for postoperative analgesia in children: a comparison with caudal bupivacaine and intravenous morphine.

We compared the efficacy, duration, and side effects of preservative-free morphine injected into the caudal space in children, with caudal bupivacaine and with intravenous morphine administration for relief of postoperative pain. Forty-six children, ages 1-16 yr, were randomly assigned to receive intravenous morphine (control group), caudal bupivacaine (0.25%, 1 ml/kg), or caudal morphine (0.5 mg/ml, 0.1 mg/kg). In half the patients given caudal morphine, the morphine was mixed with a dose of lidocaine adequate to produce sacral analgesia, to confirm correct caudal injection of the morphine. Caudal injections were performed at the end of surgery. Time until the first required postoperative intravenous morphine dose was recorded for each patient. The duration of analgesia was significantly greater with caudal morphine (median 12 hr, P less than 0.02) than with caudal bupivacaine (median 5 hr), and both were greater than with intravenous morphine in control patients (median 45 min). Urinary retention, pruritus, and nausea appeared with slightly greater frequency in the caudal morphine group, but no delayed respiratory depression occurred. Caudal morphine (0.5 mg/ml, 0.1 mg/kg) provided 8-24 hr of analgesia in children without a significantly greater incidence of side effects than caudal bupivacaine or intravenous morphine.

Adolescent↗
PubMed1986

Pulse oximetry during cardiac catheterization in children with congenital heart disease.

One hundred and five children with congenital heart disease were monitored by pulse oximetry during cardiac catheterization. Excellent correlation (r = 0.95) was found between oxygen saturation values obtained with pulse oximetry and those obtained from arterial blood in 133 data pairs. This correlation was described by the regression equation y = 0.91x + 8.1. The correlation was also excellent in 47 data pairs with saturation values of less than 90% (r = 0.94, y = 0.93x + 6.0) from 36 cyanotic children. The clinical usefulness of pulse oximetry in the early recognition of decreased pulmonary blood flow or partial airway obstruction was demonstrated. Early diagnosis of changes in oxygenation was especially helpful in children with cyanotic congenital heart disease, in whom small changes in arterial oxygen tension may cause large changes in oxygen saturation.

Adolescent↗
PubMed1986

Systemic responses to tourniquet release in children.

The hemodynamic and metabolic effects of deflation of pneumatic tourniquets were assessed in 15 children, seven of whom had bilateral tourniquets applied. Systemic acidosis from release of lactate and PaCO2 after tourniquet deflation did not cause adverse effects in these healthy children. Larger increases in lactate were seen with longer tourniquet inflation times (greater than 75 min) or with bilateral tourniquets. The greatest decrease in pH was seen with simultaneous deflation of bilateral tourniquets. Heart rate did not change with tourniquet deflation, whereas systolic blood pressure decreased 8-10 mm Hg with deflation. Blood pressure returned to control values within 5-10 min; no arrhythmias were seen. Recommendations to minimize the systemic metabolic effects after release of tourniquets in children under general anesthesia include the following: 1) attempt to limit tourniquet inflation times to less than 75 min; 2) use controlled ventilation prior to and after tourniquet deflation to remove the respiratory component of acidosis; 3) check blood gas tensions within 5 min of tourniquet deflation in children with long tourniquet inflation times (greater than 75 min), and where bilateral tourniquets are deflated simultaneously or within 30 min of each other.

Adolescent↗
PubMed1985

Isolated deafness following recovery from neurologic injury and adult respiratory distress syndrome. A sequela of intercurrent aminoglycoside and diuretic use.

We report two children who survived neurologic injury (near-drowning and Reye's syndrome) and adult respiratory distress syndrome and who required prolonged ventilatory support. Follow-up examination in both children showed steady neurologic recovery, but five months following discharge from their acute illness, profound hearing loss was diagnosed in both children. A review of the literature is reported and the hypothesis that combined aminoglycoside antibiotic and loop diuretic therapy caused the hearing loss is presented. Recommendation is made for audiologic assessment within six months of recovery from critical illness of pediatric patients in whom therapy has included loop diuretic and aminoglycoside antibiotic therapy.

Aminoglycosides↗
PubMed1984

Morphine infusion after pediatric cardiac surgery.

After cardiac surgery, 44 children received a continuous iv infusion of morphine sulfate at 10 to 30 micrograms/kg X h. During weaning from assisted ventilation and during spontaneous ventilation serum morphine levels less than 30 ng/ml were not associated with elevated PaCO2. Five extubated patients breathed spontaneously, and 35 patients were weaned from assisted to spontaneous ventilation with normal PaCO2 while receiving morphine by infusion, indicating that morphine did not interfere with spontaneous ventilation. In 12 older children who gave verbal pain scores, pain was relieved at serum morphine levels above 12 ng/ml.

Adolescent↗
PubMed1984

Hemodynamic effects of ketamine in children with congenital heart disease.

Pulmonary and systemic vascular responses to ketamine (2 mg X kg-1, intravenously) were studied during cardiac catheterization in 20 children with congenital heart lesions. Pulmonary and systemic resistances (Rp, Rs), ratios between pulmonary and systemic flows (Qp/Qs), and left to right (L----R) and right to left shunts (R----L) were calculated before and after ketamine administration. Statistically significant (P less than 0.05) but clinically minor increases in heart rate (106.8 to 109.9 beats/min), mean pulmonary artery pressure (20.6 to 22.8 mm Hg), and Rp/Rs (0.12 to 0.14) were seen after ketamine. There were no significant changes in systemic arterial pressure, Rs, Qp/Qs, L----R, R----L, or arterial oxygen or carbon dioxide tensions. No patient had any major untoward effects from ketamine administration. It is concluded that the hemodynamic alterations after ketamine administration in children undergoing cardiac catheterization are small and do not alter the clinical status of the patients or the information obtained by cardiac catheterization.

Blood Gas Analysis↗
PubMed1983

Diaphragmatic paralysis after pediatric cardiac surgery: a retrospective analysis of 34 cases.

Thirty-four cases of diaphragmatic paralysis after pediatric cardiac surgery are reviewed. Differences between pediatric and adult pulmonary physiology account for the increased severity of respiratory distress seen in children with this condition. The efficacy of treatment with endotracheal intubation and continuous positive airway pressure (CPAP) is confirmed. No patient over 3 yr of age required intubation for longer than 2 wk. This finding is consistent with the development of sufficient chest wall stability to compensate for paralysis of the hemidiaphragm. Patients under 3 yr of age, without complicating heart failure, who still required intubation and CPAP 3-4 wk after injury to the phrenic nerve should consider operative plication.

Adolescent↗
PubMed1982

Acute hepatic failure following cardiac operation in children.

A retrospective analysis has been performed of children who have undergone cardiac operations during the past 6 years to determine the clinical presentation and management of acute hepatic failure (AHF) in the postoperative period. Eleven patients had a clinical picture of AHF with jaundice, elevation of the levels of serum glutamic oxaloacetic transaminase (SGOT) and serum ammonia, and marked prolongation of the prothrombin time associated with failure of hemostasis. Hypoglycemia developed in seven. All patients had evidence of low cardiac output and acute renal failure. Patients with AHF had evidence of reduced hepatic perfusion during the previous 24 hours with reduced mean arterial pressure and elevated central venous pressure. Six children died of myocardial failure. A modified Fontan procedure was performed in six children, of whom four died. All had a right atrial pressure of 21 torr or greater. Five children survived the acute episode of hepatic failure. The importance of early diagnosis and effective management of complications such as hypoglycemia and the bleeding tendency are emphasized.

Acute Disease↗