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Biomedical subjects

A Ohlsson

Publications and source records attributed to A Ohlsson.

191 records · Page 11Linked to original sources
PubMedDate not supplied

Effect of epidural vs parenteral opioid analgesia on the progress of labor: a meta-analysis.

CONTEXT: Epidural labor analgesia, if selected by the patient, is associated with high cesarean delivery rates. Results of randomized trials comparing rates of cesarean delivery using epidural anesthesia vs parenteral opioids are inconsistent. OBJECTIVE: To review the effects of epidural vs parenteral opioid analgesia on cesarean delivery rates. DATA SOURCES: Studies were identified by searching MEDLINE from January 1966 through January 1998, the Cochrane Database of Perinatal Trials, and relevant nonindexed journals and abstracts. STUDY SELECTION: We included all studies that randomized patients to epidural vs parenteral opioid labor analgesia. DATA EXTRACTION: Two authors independently extracted data from 10 trials enrolling 2369 patients. Odds ratios (ORs) for categorical data, weighted mean differences (WMDs) for continuous data, and 95% confidence intervals (CIs) were calculated using a random-effects model. DATA SYNTHESIS: The risk of cesarean delivery did not differ between patients receiving epidural (8.2%) vs parenteral opioid (5.6%) analgesia (OR, 1.5; 95% CI, 0.81-2.76). Epidural patients had longer first (WMD, 42 minutes; 95% CI, 17-68 minutes) and second (WMD, 14 minutes; 95% CI, 5-23 minutes) labor stages. While epidural patients were more likely to have instrumented delivery (OR, 2.19; 95% CI, 1.32-7.78), they were no more likely to have instrumented delivery for dystocia (OR, 0.68; 95% CI, 0.31-1.49). After epidural analgesia, neonates were less likely to have low 5-minute Apgar scores (OR, 0.38; 95% CI, 0.18-0.81) or to need naloxone (OR, 0.24; 95% CI, 0.07-0.77). Women receiving epidural analgesia had lower pain scores during the first (WMD, -40 mm on a 100-mm scale; 95% CI, -42 to -38 mm) and second (WMD, -29 mm; 95% CI, -38 to -21 mm) stages of labor. The odds of dissatisfaction were lower with epidural analgesia (OR, 0.25; 95% CI, 0.20-0.32). CONCLUSIONS: Epidural labor analgesia is not associated with increased rates of instrumented vaginal delivery for dystocia or cesarean delivery. Patients receiving epidural analgesia have longer labors. Patient satisfaction and neonatal outcome are better after epidural than parenteral opioid analgesia.

Analgesics, Opioid↗
PubMedDate not supplied

Do plasma concentrations of delta 9-tetrahydrocannabinol reflect the degree of intoxication?

Plasma concentrations of THC were measured by gas-liquid chromatography and mass spectrometry following three routes of administration and correlated with clinical effects. Plasma concentrations peaked at 3 minutes after intravenous injection and then sharply declined. The peak "high" occurred at 30 minutes while plasma concentrations were declining. This lag between plasma concentration and "high" continued during most of the span of the drug's effects. The situation was quite similar following smoking, except that peak plasma concentrations were lower. After oral administration of THC, absorption was slow, with peak concentration occurring at 1 to 2 hours. Plasma concentrations were much lower. Correlations between plasma concentrations of drug and "high" were significant but not impressive. The degree of "high" was quite variable in relation to the prevailing plasma concentration. Conjunctival injection was found so long as plasma concentration of THC could be measured. Pulse rate increases occurred at lower concentration after oral administration than after the other two routes. It is unlikely that a range of plasma concentrations can be reliably equated with impaired performance. The mode of administration will become important should THC or some homolog become a therapeutic agent.

Administration, Oral↗
PubMedDate not supplied

Prenatal ultrasonic prediction of autopsy-proven pulmonary hypoplasia.

The sensitivity, specificity, and positive and negative predictive values for ultrasound estimation of fetal chest circumference in relation to autopsy-proven pulmonary hypoplasia are described in 58 singleton pregnancies at risk (39 with associated preterm premature rupture of the membranes at 30 weeks' gestation or less and of 12 or more days' duration, and 19 with associated anomalies). The ultrasonographic diagnosis of pulmonary hypoplasia was based on values at or below the lower limit of the 95% confidence intervals (for predicting a future observation) for normal pregnancies for each of the following tests; chest circumference in relation to gestational age and to femur length, for the chest circumference to abdominal circumference ratio and for a combination of the three measurements. At necropsy, the diagnosis of pulmonary hypoplasia was based on lung weight to birthweight ratio or radial alveolar counts. Pulmonary hypoplasia was diagnosed in 16 cases at autopsy. The clinicians and the pathologist were blinded to the ultrasonographic measurements. All tests performed well with a sensitivity of 0.55 to 0.80, specificity of 0.90 to 1.00, positive predictive value of 0.80 to 1.00, negative predictive value of 0.87 to 0.91, and an overall accuracy of 0.87 to 0.91. We conclude that ultrasound measurement of fetal chest circumference is of value with regard to the management of pregnancies at risk for lethal pulmonary hypoplasia.

Abnormalities, Multiple↗
PubMedDate not supplied

Neonatal follow-up of very low birthweight/extremely low birthweight infants to school age: a critical overview.

Neonatal follow-up studies of school age children, published in the last decade, were critically reviewed. Nine studies examined extremely low birthweight infants (less than or equal to 1000 g) and 16 involved very low birthweight infants (less than or equal to 1500 g). The majority of children had age appropriate I.Q. scores, however, there was a greater variability of test scores. There was an increased need for special education or remedial therapy. Visual-motor integration deficits were frequently reported. Behavioural difficulties were described. Fine and gross motor incoordination was identified. There was no conclusive correlation between perinatal course and school outcome. Gender did appear to influence outcome, in the small percent of studies which examined this variable, with females generally faring better. Low socioeconomic status was the most frequently reported predictor of poor outcome. Identified methodological limitations included heterogeneous samples, lack of control groups, high attrition, variable diagnostic criteria and lack of consensus regarding correction for prematurity.

Child↗
PubMedDate not supplied

Chemical synthesis and biological occurrence of carboxylic acid metabolites of delta1(6)-tetrahydrocannabinol.

Potential metabolites of (-)-3,4-trans-tetrahydrocannabinol (THC) with a carboxylic acid function in the side chain were synthesized as their methyl esters in the delta1(6)-series. The chromatographic and mass-spectrometric properties of the five side-chain homologues were examined and utilized to facilitate the isolation and the identification of the corresponding monocarboxylic acid metabolites of delta1(6)-THC in the mouse, guinea pig, and rabbit formed after ip administration. The metabolites were identified by gas chromatography and mass fragmentography. In mouse liver delta1(6)-THC-7-oic acid and 3'',4'',5''-trisnor delta1(6)-THC-2''-oic acid were identified as metabolites. In guinea pig liver these acids occurred together with 4'',5''-bisnor-delta1(6)-THC-3''-oic acid and 5''-nor-delta1(6)-THC-4''-oic acid. Rabbit liver contained delta1(6)-THC-7-oic acid, 2'',3'',4'',5''-tetranor-delta1(6)-THC-1''-oic acid and 4'',5''-bisnor-delta1(6)-THC-3''-oic acid. Further, the structure of three dicarboxylic acid metabolites of delta1(6)-THC in rabbit kidney were determined by mass spectrometry and proton magnetic resonance spectroscopy.

Animals↗