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Biomedical subjects

B K Philip

Publications and source records attributed to B K Philip.

At least 37 records · Page 2Linked to original sources
PubMed1990

The prospective use of population pharmacokinetics in a computer-driven infusion system for alfentanil.

Maitre et al. recently evaluated the accuracy of a set of previously determined population pharmacokinetic parameters for the opioid alfentanil using data from an earlier study in which the drug had been administered using a computer-controlled infusion pump (CCIP). The present study evaluated the accuracy of these same parameters in a CCIP prospectively in two groups of clinically dissimilar patients: 29 healthy female day surgery patients and 11 relatively older and less healthy male inpatients. In addition, another set of pharmacokinetic parameters, previously determined by Scott et al. in the CCIP in 11 male inpatients was also evaluated. The bias and inaccuracy were assessed by the median performance error (MDPE) and the median absolute performance error (MDAPE) in which the performance error was determined as the difference between measured and target serum concentration as a fraction of the target serum concentration. Unlike Maitre et al., the current study found a consistent bias in both populations. The MDPE was +53% and the MDAPE was 53%, with no difference between patient groups. In the 11 patients studied using the Scott et al. pharmacokinetic parameters, the MDPE was +1% and the MDAPE was 17%. The parameters of Scott et al. were further tested by simulating the serum concentrations that would have been achieved had they been used in the CCIP in the first 40 patients; results indicated MDPE of +2% and an MDAPE of 18%. Therefore, reasonably reliable and accurate target serum concentrations of alfentanil can be achieved using the pharmacokinetic parameters of Scott et al. in a CCIP.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Flumazenil reverses sedation after midazolam-induced general anesthesia in ambulatory surgery patients.

Flumazenil, a specific competitive benzodiazepine antagonist, was evaluated for reversal of residual sedation after midazolam-induced ambulatory general anesthesia. Endotracheal anesthesia was begun with midazolam (mean +/- SD dose 12.4 +/- 2.4 mg), followed by nitrous oxide in oxygen, fentanyl, and succinylcholine, for gynecologic surgery lasting 38.6 +/- 12.5 min. After surgery, 29 women were given repeated injections of small amounts of either flumazenil or placebo until awake and calm. The mean flumazenil dose was 0.83 +/- 0.04 mg. Assessment of recovery was based on psychodiagnostic tests (visual analog sedation scale, Trieger dot, digit symbol substitution), pulse oxygen saturation, and end-expired carbon dioxide tension. Patients given flumazenil scored significantly better than did those given placebo on the psychodiagnostic tests for 5-60 min, but the groups were no longer different 120 and 180 min after the conclusion of surgery. All scores did not return to preoperative values by 180 min. Pulse oxygen saturation and end-expired carbon dioxide tension showed improvement from postoperative levels at 15 min after flumazenil injection. A controllable degree of midazolam reversal was achieved with flumazenil, but the duration of reversal was limited. Caution is needed to avoid premature discharge of ambulatory patients after midazolam-induced general anesthesia during the time that flumazenil is effective.

Adult↗
PubMed1987

Hypoxemia during ambulatory gynecologic surgery as evaluated by the pulse oximeter.

Pulse oximetry was used to determine the incidence of intraoperative hypoxemia in 108 patients undergoing ambulatory gynecologic operation. Eleven (10%) experienced moderate desaturation (arterial oxygen saturation less than 90%), and 5 (5%) suffered severe hypoxemic episodes (arterial oxygen saturation less than 85%). Among patient risk factors--including operation, body habitus, smoking habits, history of asthma, age, and airway characteristics--an association with moderate hypoxemia was found only with nonlaparoscopic gynecologic operation, obesity, and age over 35 years, and an association with severe hypoxemia was found only with obesity and age over 35. Among operative events--including inspired oxygen concentration, position, mode of ventilation, and anesthesia phase--an association with moderate hypoxemia was found only with the lithotomy position, manual ventilation, and arousal. The cost per patient of monitoring with a pulse oximeter is about +1.35. A cost-benefit analysis reveals that a mortality rate of 1 in 40,000 among patients who actually become moderately hypoxemic would justify the cost of monitoring arterial oxygen saturation. We conclude that pulse oximetry should be part of routine anesthetic monitoring.

Adult↗
PubMed1987

A comparison of clinical and psychological effects of fentanyl and nalbuphine in ambulatory gynecologic patients.

Drug dosages, length of stay (LOS), and incidence of psychological side effects of fentanyl and nalbuphine were compared in a randomized, double-blind study using unpremedicated female day-surgery patients undergoing diagnostic laparoscopy. Patients received either fentanyl 1.5 micrograms/kg (F group; n = 142), low-dose nalbuphine 300 micrograms/kg (LN group; N = 103), or high-dose nalbuphine 500 micrograms/kg (HN group; n = 41), intravenously (IV) before anesthesia consisting of thiopental, N2O, O2, and a succinylcholine infusion. Additional IV intraoperative and IM postoperative opioids were given if required for signs of inadequate anesthesia or postoperative pain. The patients' clinical and psychological status was evaluated at 20-min intervals postoperatively by a team of trained interviewers. The low- and high-dose nalbuphine groups clinically resembled the fentanyl group in terms of dosing frequency and patients' self-ratings of postoperative analgesia. Length of stay and postoperative sedation were significantly greater with nalbuphine. The incidence of psychological side effects, including dreaming and postoperative anxiety, was also greater with nalbuphine. However, patient acceptance of nalbuphine was high and was similar to that observed in patients given fentanyl.

Ambulatory Care↗
PubMedDate not supplied

Patients' assessment of ambulatory anesthesia and surgery.

STUDY OBJECTIVE: To obtain patients' assessments of ambulatory anesthesia and surgery using a return-mail questionnaire postcard. DESIGN: Return-mail questionnaire given to consecutive ambulatory surgery patients. SETTING: Adult ambulatory surgery unit of a university hospital. PATIENTS: The questionnaire was given to 3,722 patients. Responses were returned by 1,511 patients (41%). Among the respondents, 95% had gynecologic procedures and 5% had general surgical procedures. MEASUREMENTS AND MAIN RESULTS: Eighty-six percent of respondents reported at least one minor sequela persisting after discharge. Laparoscopy patients experienced significantly more aches, drowsiness, dizziness, sore throat, nausea, and vomiting. For all patients, sequelae lasted 1 day for 59% of all patients, 2 days for 28%, and 3 or more days for 14%. Different sequelae had different durations. Thirty-eight percent of respondents were able to return to their usual activities the day after surgery; the remainder required 3.2 +/- 2.0 additional days. The main reasons for delayed recovery included general malaise (57%) and surgical discomfort (38%). Assessing their overall satisfaction, 97% would choose day surgery again. CONCLUSIONS: Return-mail questionnaires can be used for patient follow-up after ambulatory surgery, with limitations characteristic of unselected-patient methods. Patients' assessments of their anesthesia and surgery can identify common sequelae that ambulatory patients should realistically expect to experience.

Adult↗
PubMedDate not supplied

Friendliness of OR staff is top determinant of patient satisfaction with outpatient surgery.

Two hundred patients (151 women) undergoing outpatient surgery at a university hospital were asked to complete a questionnaire at the time of discharge. Listing 12 factors related to preoperative intraoperative, and postoperative care, the questionnaire asked each respondent to rank the five most important factors from 1 to 5. The most important factor, ranked among the top five by 67% of the patients, was friendliness of the operating room staff. The other four (and, parenthetically, the percentage of patients ranking the factor among the top five) were as follows: surgeons's postoperative visit (63%); management of postoperative pain (62%); starting i.v. smoothly (53%); and avoidance of delays (45%).

Adult↗