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Biomedical subjects

B D Wright

Publications and source records attributed to B D Wright.

At least 55 records · Page 3Linked to original sources
PubMed1983

Video stethoscope--a simple method for assuring continuous bilateral lung ventilation during anesthesia.

Complications of endotracheal intubation and mechanical ventilation are infrequent but important causes of intraoperative morbidity and mortality. We have developed a simple method of monitoring the ventilation of both lungs during general anesthesia and have evaluated this technique in 25 patients undergoing surgery under general anesthesia. A small plastic electrocardiographic electrode casing fitted with a microphone was affixed to the skin overlying each hemithorax in a location where preliminary auscultation showed that breath sounds could be heard. The sounds from each microphone were amplified and displayed on an oscilloscope screen in an X-Y format. The patterns seen on the screen allowed easy identification of right mainstem intubation, esophageal intubation, or proper endotracheal tube placement. This preliminary study suggests that our technique is feasible and provides more information about the position of the endotracheal tube than presently used methods.

Anesthesiology↗
PubMed1982

Patient-controlled analgesia: a new concept of postoperative pain relief.

This report concerns evaluation of patient-controlled analgesia (PCA) in the form of two preliminary investigations. In the first study, the patient-controlled analgesia device, which consists of a pump linked to a timer so that patients can activate intravenous administration of morphine sulfate to themselves during the postoperative period, was used in seven morbidly obese patients. The amount of morphine used during the first 36 hours was found to vary between 32 and 185 mg, with a significant difference in drug usage when related to weight as well as to body surface area. In the second study, morbidly obese patients undergoing gastric bypass operations were prospectively randomized into 12 patients who used the PCA device in the postoperative period and 12 patients who were given standard intramuscular dosages of morphine sulfate. An analgesia and sedation scale was then used to compare the two groups. The patients in the PCA group were able to maintain a state of adequate analgesia without sleep with a significantly greater frequency than were those in the intramuscular injection group. On the basis of answers to a questionnaire given to the patient after 60 hours of morphine analgesia, it was apparent that the PCA group was much more satisfied with that form of postoperative analgesia. It would appear that PCA is an efficacious and safe method of providing for postoperative pain relief.

Analgesia↗
PubMed1982

Evaluating the rehabilitation process: an example with the blind.

The research methods presented here were developed for the evaluation of the CBRC (Central Blind Rehabilitation Center) at Hines. These methods are applicable to the evaluation of other blind rehabilitation programs. In addition, most of the strategies are applicable to other kinds of rehabilitation programs. The process of defining goals and of determining outcome variables is a necessary step in effective evaluation regardless of the population and program in question. It is essential to measure the influence of patient variables on treatment outcomes for all populations undergoing rehabilitation. The measures to evaluate these out-come and patient variables must be demonstrably reliable and valid. The methods used to identify and define variables, the research design and methods to produce reliable measures all can be used to evaluate a variety of programs as well as individual treatments and devices.

Blindness↗
PubMed1980

Tracheobronchial disruption: delayed diagnosis.

Traumatic rupture of the tracheobronchial tree is an increasingly occurring complication of blunt chest trauma. Early detection and surgical repair are important for definitive and successful reconstruction. Bronchoscopy is the most reliable diagnostic procedure. Use of a rigid bronchoscope is difficult and traumatic to the patient, and the flexible fiberoptic bronchoscope, with its greater technical simplicity, is more easily applied. We report the case of a patient who suffered bronchial stenosis and total atelectasis before discovery of a fracture was made.

Accidents, Traffic↗
PubMed1980

Subconjunctival emphysema as a complication of PEEP.

This report describes the unusual case of a four-year-old girl who developed subconjunctival emphysema as a complication of mechanical ventilatory support with high positive expiratory pressure (PEEP)--which was applied after she sustained multiple injuries in a motor vehicle accident. The patient's left lower palpebral conjunctiva ballooned outward with air collection subconjunctivally, but it was crepitant and deflatable with light pressure. Saline, garamycin ointment, and Lacrilube were used to prevent drying. The condition persisted during the period when the patient required high PEEP (more than 18 cm H2O) but resolved after PEEP was decreased to below 5 cm H2O. The patient eventually died on the 66th ventilatory day due to complications of intractable tracheobronchial fistula and Pseudomonas pneumonia.

Child, Preschool↗
PubMed1979

Pharmacokinetic properties of thiopental in two patients treated for uncontrollable seizures.

Thiopental was administered for seizure control in 2 patients with uncontrollable seizures. Serum samples were collected from each patient and assayed for thiopental, and the resulting serum concentration--time data were analyzed pharmacokinetically. The biologic half-life in both patients was significantly longer than previously reported values. Based on the limited number of patients studied, it would appear that half-life and volume of distribution increase with the degree of obesity, while clearance remains unchanged. These pharmacokinetic characteristics would be worthy of consideration in cases where there may be prolonged use of thiopental, eg., for the control of uncontrollable seizures.

Adolescent↗
PubMedDate not supplied

Variation in postoperative analgesic requirements in the morbidly obese following gastric bypass surgery.

Patient-controlled analgesia is a relatively new method of administering intravenous narcotics for postoperative pain relief. The technique involves the self-administration of a given analgesic in a bolus dose with the aid of a timed infusion and sequencing device. Ten morbidity obese patients undergoing elective gastric bypass surgery were treated in a prospective, unblinded, pilot project to evaluate the efficacy of patient-controlled analgesia. Analgesic therapy was satisfactory in all patients. The mean total dose of morphine sulfate administered during the first 36 hours postoperatively was 66 mg, an average of 1.7 mg/hr. There was a tenfold variation (17.5-175 mg) in the 36 hr total dose. The total dose was not related to body surface area, age, sex, dose per injection, or anesthetic agent. The large variation in individual narcotic analgesic requirements could be a major factor in the suboptimal management of postoperative pain with conventional dosing. Patient-controlled analgesia may circumvent these problems.

Adult↗
PubMedDate not supplied

Functional status and therapeutic intensity during inpatient rehabilitation.

The objective of this study was to describe the relationships between functional status at discharge and intensity of therapies received during inpatient medical rehabilitation. The sample was comprised of 140 patients with traumatic brain injury and 106 patients with spinal cord injury at eight hospitals that subscribe to the Uniform Data System for Medical Rehabilitation. Data included linear measures of motor and cognitive ability derived from the Functional Independence Measure at admission to and discharge from rehabilitation. Multiple regression was used to predict intensity of therapies, discharge motor and cognitive function, the extent to which potential functional gains were achieved, and the efficiency of gains. Intensities of occupational, physical, and speech therapies were not significant predictors of outcomes for either group, controlling linearly for admission function, psychology intensity, length of stay, onset to admission interval, age, and interrupted stays. Only intensity of psychology services seemed to have any relation to functional gain (in cognition for patients with traumatic brain injury). The apparent lack of benefit related to intensity of therapies may be due to factors such as spontaneous recovery, goals not measured by the Functional Independence Measure, limited modulation of therapy intensity according to likely patient responsiveness, or therapies focused on impairment or other goals rather than disability. We suggest that efficiently staged rehabilitation should vary the intensity and nature of services according to patients' functional status, impairments, comorbid conditions, and other clinical factors.

Adult↗
PubMedDate not supplied

Automatic intracranial pressure regulation.

This paper emphasizes our approach to control increased ventricular fluid volume and pressure; it utilizes an improved device based upon hydrostatic pressure principles. Intracranial pressure may be maintained at any preselected value, usually 25 cm H2O. Pressure increases beyond this value will result in a venting of fluid into a calibrated reservoir. The hydrostatic column will act to cushion the surrounding ventricular mass, helping to prevent ventricular collapse. The method overcomes the hazards of techniques, using intermittent withdrawal of fluid which requires human judgment. Ventricular pressure response curves performed on a number of patients showed a marked stability with a response less than 2 mm Hg/ml. This indicates a favorable influence on the intracranial compliance. The system is completely closed and its use in 52 neurosurgical patients in over 400 patient days has not been associated with any infection problem.

Humans↗