Diagnostic activation of epileptogenic foci by enflurane.
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Adult↗
Biomedical subjects
B H Hoff
Publications and source records attributed to B H Hoff.
Use of positive airway pressure without endotracheal intubation.
Continuous positive airway pressure (CPAP) and expiratory positive airway pressure (E-PAP) may be used safely without endotracheal intubation in patients with acute respiratory failure when strict selection criteria are adhered to. The therapy should be titrated to reduce intrapulmonary shunting, improve PaO2, and reduce FIO2. Other considerations include balancing oxygen consumption against cardiac output and oxygen transport. Absolute or relative indications for abandoning the technique and using endotracheal intubation with mechanical ventilatory support include unrelenting hypoxia, patient exhaustion, rising PaCO2, development of metabolic acidosis, presence of ventricular arrhythmias, and inability to protect the airway.
Acute Disease↗
Drug-induced lupus erythematosus.
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Complement System Proteins↗
Multisystem failure: a review with special reference to drowning.
Near-drowning represents an insult that can affect all organ systems. A common pathway for injury is hypoxemia, acidosis, and hypoperfusion. Pulmonary insufficiency and CNS dysfunction are major causes of morbidity and mortality. Variations in vascular volume, heart failure, renal failure, coagulation disorders, and electrolyte disturbances may also be present. Patients should be observed for multisystem failure and therapy tailored to the particular needs of each victim.
Acidosis↗
Patuxent and discretion in the criminal justice system.
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Commitment of Persons with Psychiatric Disorders↗
The spectrum of thromboembolization in the central circulation.
The right heart and great veins can be the harbinger of septic and aseptic thromboemboli, which can result in a spectrum of clinical syndromes. This report presents five distinct clinical scenarios of thromboembolization, the occurrence of which in the central circulation resulted in life-threatening sepsis and hemodynamic and pulmonary insufficiency. Recommendations for therapeutic intervention and a review of the literature also are presented.
Adult↗
Spinal anesthesia using a 1:1 mixture of bupivacaine and tetracaine for peripheral vascular surgery.
STUDY OBJECTIVE: To present our preliminary experience using three doses of an equimilligram mixture of 1% tetracaine and 0.75% bupivacaine in 8.25% dextrose for spinal anesthesia in patients undergoing peripheral vascular surgery. SETTING: Operating and recovery rooms at a university medical center. PATIENTS: 60 patients who received femoral popliteal or femoral distal bypass with spinal anesthesia. INTERVENTIONS: All patients had intravenous cannulae inserted and received lactated Ringer's solution. There were no bolus infusions of fluid preanesthesia. Fluid administration occurred at a rate of 8 to 15 ml/kg/hr, with additional fluid and inotropic drugs administered to treat hypotension. Oxygen (O2) was delivered by nasal cannula, and peripheral O2 saturation was monitored. Blood pressure (BP) was monitored every 1 to 5 minutes using an automatic BP device, and ECG was displayed continually. MEASUREMENTS AND MAIN RESULTS: Initially, 8 patients received a dose of 15 mg of each drug combined with 0.2 mg of epinephrine injected in a 20-degree head-up tilt. Because the duration of anesthesia was prolonged, subsequent patients received 12 mg of each drug mixed with 0.2 mg of epinephrine for cases in which an extended duration was predicted and 10 mg of each drug plus epinephrine for proximal first-time bypasses. With mixtures of 15 mg, 12 mg, and 10 mg of each drug plus epinephrine, a mean duration of approximately 300 minutes of surgically acceptable anesthesia was obtained. As the dose was decreased, the SD increased. There was a 0% failure rate for the spinal anesthetics at doses of 15 mg and 12 mg of each drug and a 19.5% failure rate at a dose of 10 mg of each drug. In each case, the rapid onset of a sensory blockade regressed in a standard and predictable fashion. The decline in BP and the use of inotropic and vasoconstrictive drugs were comparable to those in previously published reports of spinal anesthetics using single drug techniques with smaller doses. In none of the patients were there any untoward cerebrovascular or neurologic events, nor were there any clinically evident episodes of coronary insufficiency. CONCLUSION: Spinal anesthesia using bupivacaine and tetracaine mixed in a single-injection technique can last 5 hours at the T12 level without added untoward effects when compared with lower-dose spinal anesthetics.
Aged↗
Multiple organ failure after near-hanging. A case report.
Near-hanging and strangulation injuries can result in multiorgan failure. A 13-year-old male sustained an ischemic anoxic cerebral injury that was followed by an encephalopathy lasting approximately 30 hours and pulmonary edema lasting more than 48 hours. The patient was treated with continuous positive pressure ventilation followed by spontaneous breathing with continuous positive airway pressure by a mask; shock was reversed. The loss of cardiovascular competency and pulmonary insufficiency are problems frequently encountered in the patient who has sustained an hypoxic insult. Cerebral injury can result from hypoxemia related to tracheal compression, aspiration, and pulmonary edema; cerebral vascular engorgement secondary to venous compression; and ischemic anoxia related to arterial compression. Cerebral changes continue after circulatory and pulmonary competence has been restored. Multiorgan monitoring and control including intracranial pressure monitoring may be required to guide therapy. Respiratory distress syndrome may develop secondary to multiple factors including autonomic reflexes triggered by cerebral hypoxia and edema.
Adolescent↗