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Biomedical subjects

A R Boutros

Publications and source records attributed to A R Boutros.

At least 19 recordsLinked to original sources
PubMed1994

Acute airway obstruction following placement of a subclavian Hickman catheter.

The purpose of this case report is to describe the events, intervention, and aetiology which led to acute airway obstruction in an adult patient after the placement of a Hickman catheter. Airway obstruction secondary to superior vena cava obstruction occurred after placement of a subclavian vein Hickman catheter. This was felt to occur, in part, to a narrowed superior vena cava as evident by subclavian venography. It resulted in emergency oral tracheal intubation to relieve airway obstruction. Shortly after removal of the Hickman catheter, the signs of superior vena cava obstruction syndrome resolved and the patient was extubated without incidence. It is concluded that, although rare, the serious complication of acute airway obstruction can occur after placement of a Hickman catheter.

Acute Disease↗
PubMed1990

Perioperative management of 63 patients with pheochromocytoma.

During a 10-year period, 60 patients with confirmed diagnoses of pheochromocytoma underwent a total of 63 surgical procedure. To control extreme blood pressure elevations, 6 patients received phenoxybenzamine preoperatively and 28 patients received prazosin. The remaining 29 patients received neither drug. Intravenous sodium nitroprusside and nitroglycerin, alone or in combination, were used in all but 10 patients to control intraoperative hypertensive episodes. One patient died after surgery due to pre-existing intracranial malignant tumor. All other patients were discharged from the hospital with no clinical evidence of stroke or myocardial infarction. We conclude that pheochromocytoma patients can undergo successful surgery without preoperative profound and long-lasting alpha adrenergic blockade.

Adolescent↗
PubMed1989

The role of prostacyclin in the mesenteric traction syndrome during anesthesia for abdominal aortic reconstructive surgery.

Mesenteric traction syndrome consists of sudden tachycardia, hypotension, and cutaneous hyperemia, and frequently occurs during mesenteric traction in patients undergoing abdominal aortic aneurysm (AAA) reconstructive surgery. The etiology and clinical impact of this phenomenon are unknown, but the symptoms suggest a release of vasoactive materials from the mesenteric vascular bed. Thirty-one patients who underwent AAA surgery were studied. Mesenteric traction was accompanied by a decrease in systolic (p = 0.005) and diastolic (p less than 0.05) blood pressures, and in systemic vascular resistance (p less than 0.005), and was accompanied by an increase in heart rate (HR) (p less than 0.005), and cardiac output (p = 0.01). These hemodynamic changes coincided with an increase (p less than 0.001) in plasma concentrations of 6-keto-prostaglandin F1 (6-K-PGF1). No apparent change was found in prostaglandin E2, thromboxane B2, and histamine concentrations. The concentration of 6-K-PGF1 was correlated with diastolic blood pressure (r = -0.52, p less than 0.005) and HR (r = 0.65, p less than 0.001). Cutaneous hyperemia was observed in 58% of the patients. In an additional six patients, who had taken aspirin daily before AAA surgery, no significant changes were observed in the hemodynamic measurements or 6-K-PGF1 concentrations. These data suggest that mesenteric traction syndrome may be mediated at least in part by a selective release of prostacyclin.

6-Ketoprostaglandin F1 alpha↗
PubMed1986

Value of continuous monitoring of mixed venous blood oxygen saturation in the management of critically ill patients.

Continuous SVO2 measurement using a triple-lumen flow-directed pulmonary artery catheter with fiberoptic filaments has been described. The purpose of this study was to identify whether the availability of SVO2 as a continuously monitored signal could have altered patient management decisions made by the medical staff on the basis of clinical and laboratory data and signals currently used in ICUs. Subjects for this study were 15 critically ill patients requiring arterial cannulation and insertion of a pulmonary artery catheter. The central processor of the device was placed in a specially constructed wooden box in such a way as to conceal the digital display of the signal. The folded paper used for a continuous 72-h recording of the signal was also not available to the personnel managing the patient. In detailed and repeated assessments of the patient's status, the medical team managing the patient entered on a special form all clinical and laboratory data as well as medical decisions made. At the end of each study the SVO2 value recorded at each assessment was entered on the form. The investigators then determined whether knowledge of SVO2 would have changed the clinical decision actually made. The SVO2 signal was continuously recorded for a total of 1065 h and 173 individual assessments. The SVO2 signal as measured by the Oximetrix device was compatible with decisions made on the basis of standard measurements used in the ICU in a majority of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Intraoperative anesthetic consultation.

This article deals with consultation between anesthesiologists and urologic surgeons. Some of the subjects discussed represent problems that occur commonly, such as cardiac arrhythmias and intraoperative hypertension. Other subjects, though representing less common problems, have much more serious consequences and thus should be brought to the attention of surgeons. This latter group includes malignant hyperthermia, hyponatremia during transurethral prostatic resection, and cardiac arrest.

Anesthesiology↗
PubMed1980

Pediatric intensive care in general hospitals.

With the upward spiraling costs of health care delivery in the United States, the subject of cost effectiveness can no longer be considered as an abstract notion of secondary importance to what is perceived as the life-saving function of such units. The expense of building and equipping ICUs is not necessarily related to the quality of patient care provided. The number of staff members required is of critical importance.

Adolescent↗
PubMed1980

Reye syndrome: a predictably curable disease.

Seventeen years after the initial description of this syndrome of hepatic failure and encephalopathy, the etiology and pathophysiology are still not well defined. Clinical staging of the disease proposed by Lovejoy and colleagues is helpful and is recommended as a standard to be followed by referring physicians and hospital-based pediatricians and intensivists. A new classification based on the status of intracranial pressure and unrelated to clinical, laboratory, or EEG staging is presented.

Adolescent↗
PubMed1979

Comparison of hemodynamic, pulmonary, and renal effects of use of three types of fluids after major surgical procedures on the abdominal aorta.

Hemodynamic, pulmonary, and renal variables were measured in 24 patients scheduled for major abdominal aortic operations. Control values were obtained before preoperative medications were given. All patients received 5% dextrose in Lactated Ringer's solution intraoperatively. Postoperatively, group 1 patients received 5% dextrose in water plus albumin, group 2 received 5% dextrose in 0.45 sodium chloride solution, and group 3 received 5% dextrose in lactated Ringer's solution. There were significant increases in Qs/Qt and AaDO2, 48 hours after operation in group 3. Oxygen consumption and cardiac output increased in all groups 24 hours after operation. Twenty-four hours later, these two variables returned to control values in group 1 but continued to rise in the other two groups. Significant diuresis occurred in group 1, 48 hours postoperatively, whereas the other two groups continued to retain water. Use of albumin and 5% dextrose in water in the postoperative period seemed to produce less deviations from control values of most measured variables, than the other two groups.

Albumins↗
PubMed1976

Cardiovascular and respiratory changes in response to change of posture in the very obese.

Circulatory and respiratory effects of change of posture from sitting to supine were studied in 11 obese patients scheduled for gastric bypass operations. Patients were studied on the morning of operation before any medication was given. Average weight was 138.8 kg, 108.6 per cent above ideal weight. Change of posture from sitting to supine was associated with 11 per cent increase in oxygen consumption (VO2), 35.5 per cent increase in cardiac output (CO), 35.8 per cent increase in cardiac index, 17.85 per cent decrease in arteriovenous oxygen difference, 31 per cent increase in mean pulmonary arterial pressure, 44 per cent increase in pulmonary-artery wedge pressure, 21.5 per cent decrease in peripheral resistance (PR), 6 per cent decrease in heart rate, and 17.7 per cent increase in venous admixture (QS/Qt). All these changes were significant. There was no change in mean arterial pressure, alveolo-arterial O2 difference and respiratory rate. The increase in CO was attributed to reduction in PR and to increased V02 probably due to increased work of breathing.

Adult↗