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Biomedical subjects

D C Oxorn

Publications and source records attributed to D C Oxorn.

12 recordsLinked to original sources
PubMed1997

The effects of midazolam on propofol-induced anesthesia: propofol dose requirements, mood profiles, and perioperative dreams.

UNLABELLED: This study examined the effects of midazolam on the doses of propofol required for the induction of hypnosis and the maintenance of propofol/nitrous oxide anesthesia. In addition, the effects of midazolam on the time to patient recovery, perioperative mood profiles, incidence of perioperative dreams, patient satisfaction scores, and requirement for postoperative analgesics were assessed. This investigation was a prospective, randomized, and double-blind study of female patients undergoing dilatation and curettage. Patients received midazolam (30 microg/kg, n = 30) or an equal volume of placebo (n = 30) immediately before the induction of anesthesia. Recall of dreams was assessed immediately postoperatively, in the postanesthesia care unit (PACU), and on the day after surgery using a questionnaire designed for surgical patients. Mood profiles were quantified using the Multiple Affect Adjective Check List-Revised, which was completed preoperatively and 1 h postoperatively. The Client Satisfaction Questionnaire-8, an eight-item self-administered version of the Client Satisfaction Questionnaire, was used to assess patient satisfaction on the day after surgery. Our results indicate that although the time to the loss of the lid reflex was significantly shorter in patients receiving midazolam (43.8 +/- 2.7 vs 74.7 +/- 7.6 s, P < 0.0003), there was no significant difference in the dose of propofol required to induce hypnosis or maintain anesthesia. There were no group differences in postoperative sedation and orientation scores, perioperative mood profiles, incidence of dreams, and patient satisfaction scores. More patients who received midazolam requested analgesics in the PACU (11 vs 4, P < 0.05). In conclusion, midazolam did not reduce the anesthetic dose requirement of propofol in patients undergoing anesthesia with nitrous oxide, nor did it accelerate patient recovery. Our results call into question the benefit of coinducing anesthesia with propofol and midazolam. IMPLICATIONS: Midazolam, administered immediately before anesthetic induction with propofol, did not decrease the dose of propofol necessary for hypnosis, nor the maintenance of surgical anesthesia, in female patients undergoing diagnostic dilatation and curettage. In addition, midazolam did not alter patient recovery characteristics, postoperative mood, incidence of perioperative dreams, or patient satisfaction. The use of midazolam was associated with an increased need for postoperative analgesics. Our study calls into question the benefit of administering midazolam immediately before anesthetic induction with propofol.

Affect↗
PubMed1994

An anaesthetic drug error: minimizing the risk.

A medication error caused a near fatal cardiac arrest in a previously healthy patient undergoing elective surgery. Inadvertent epinephrine injection induced ventricular dysrhythmias, hypertension, hypotension and pulmonary oedema. The case was investigated using critical-incident technique and was reviewed by the Risk Management Team of the Department of Anaesthesia. The purpose of this report is to present the recommendations resulting from the investigation. These include: improved resident training in intravenous drug management, the use of anaesthetic drug ampoules with distinct labels, and the development of a standardized colour code system for labels on anaesthetic drug ampoules. Furthermore, it is recommended that all anaesthetic drug errors be reported to the Canadian agencies responsible for drug packaging in order to identify patterns in anaesthetic drug errors, and to facilitate the implementation of effective drug identification systems.

Adult↗
PubMed1992

The importance of activity and pretreatment in the prevention of suxamethonium myalgias.

We have studied the effectiveness of pretreatment with atracurium 0.05 mg kg-1 and placebo before administration of suxamethonium, in the prevention of postoperative myalgia in inpatients having surgery in which rapid postoperative mobilization was possible (vaginal hysterectomy). On the second day after operation, the patients pretreated with atracurium had significantly fewer postoperative myalgias than those receiving placebo (P < 0.025). All patients were significantly more active on the second day compared with the first day after operation (P < 0.025). Possible causal relationships are discussed.

Adult↗
PubMed1989

Post-cholecystectomy pulmonary function following interpleural bupivacaine and intramuscular pethidine.

Twenty-four patients who were to undergo cholecystectomy were randomised into two groups, one to receive postoperative analgesia with interpleural bupivacaine, 20 ml of a 0.5% solution with adrenaline 5 micrograms/ml, and the other to receive intramuscular pethidine, 1 mg/kg. Preoperative and postoperative pulmonary function, postoperative pain scores, and days from operation to hospital discharge were recorded and statistically compared. There was no significant difference in pain scores, nor in days to discharge; however, postoperative pulmonary mechanics were significantly poorer in the interpleural group. A hypothesis to explain the differences is offered.

Adult↗
PubMed1987

Anaesthetic management for oophorectomy in pulmonary lymphangiomyomatosis.

Pulmonary lymphangiomyomatosis is an idiopathic disease, resulting in severe respiratory impairment. Bilateral oophorectomy has led to objective and subjective amelioration of the pulmonary pathology. In the anaesthetic management of such a patient, careful attention must be paid to pulmonary and systemic haemodynamics, and gas exchange. We describe the successful anaesthetic management of a 34-year-old female, using epidural anaesthesia, and pulmonary artery catheterization. Although the intraoperative and immediate postoperative courses were heralded by marked cardiorespiratory stability, refractory respiratory failure developed, and she died five months after surgery.

Adult↗
PubMed1987

Pneumothorax and pulmonary embolism complicating post-traumatic hip surgery.

A case of intraoperative pneumothorax preceded by a pulmonary embolus is presented. A high index of suspicion led to further investigation, after resolution of the pneumothorax was not accompanied by clinical improvement. The literature is reviewed, and the various methods of prophylaxis and treatment discussed.

Acetabulum↗
PubMed1984

Continuous in-vivo monitoring of arterial oxygen tension in a patient treated with bleomycin.

Patients receiving bleomycin therapy may develop pulmonary fibrosis. The risk of fibrosis is increased by the administration of general anaesthesia and fatal cases with pulmonary lesions resembling those of "oxygen toxicity" have been reported. The causes are not entirely clear but the enriched inspired oxygen given intraoperatively or postoperatively has been identified as an etiological factor. Optimal intraoperative management thus requires the administration of the lowest inspired oxygen fraction (FIO2) compatible with adequate oxygenation. To achieve this aim safely, continuous in vivo monitoring of arterial oxygen tension would be preferable to intermittent sampling of blood gases. We report the successful management of a patient undergoing thoracotomy following bleomycin therapy using an intravascular PO2 sensor to monitor arterial oxygen tension continuously. The uses and limitations of the PO2 sensor are discussed.

Adult↗