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Biomedical subjects

D J Kopacz

Publications and source records attributed to D J Kopacz.

31 records · Page 2Linked to original sources
PubMed1991

Continuous spinal anaesthesia for abdominal surgery in a patient receiving amiodarone.

The perioperative management of a 57-yr-old patient receiving chronic amiodarone therapy with a continuous spinal anaesthetic for a low anterior resection of the colon is discussed. The most appropriate anaesthetic technique for patients receiving chronic amiodarone therapy remains controversial, but the avoidance of general anaesthesia may be beneficial because of the risk of postoperative pulmonary failure. In this patient continuous spinal anaesthesia was slowly titrated to the desired level, coincident haemodynamic alterations were easily treated as they developed, and high serum local anaesthetic concentrations which occur with other regional anaesthetic techniques were avoided.

Adenocarcinoma↗
PubMed1989

Effect of ropivacaine on cutaneous capillary blood flow in pigs.

The effect of subcutaneous infiltration of ropivacaine and bupivacaine on local cutaneous blood flow was assessed by the laser Doppler method. One milliliter of each of ten test solutions (ropivacaine 0.25% and 0.75%, bupivacaine 0.25% and 0.75%, and saline, each with and without added epinephrine 5 micrograms/ml) was injected subcutaneously at separate sites on the side of each pig (n = 6). Skin blood flow was measured by laser Doppler at all sites before and 5, 10, 15, and 30 min after injection. Subcutaneous injection of ropivacaine 0.25% or 0.75% decreased cutaneous blood flow by a maximum of 52% +/- 11% and 54% +/- 14% (mean +/- SE), respectively. In contrast, bupivacaine 0.25% or 0.75% increased flow by 90% +/- 32% and 82% +/- 48%, and injection of saline increased blood flow by 32% +/- 17%. Cutaneous blood flow after the injection of ropivacaine was significantly lower than after injection of bupivacaine or saline, and was also lower than at the uninjected control site (P = 0.0009). All of the solutions with epinephrine decreased blood flow to a similar extent (48-73%, P = 0.3). The ability of ropivacaine to produce cutaneous vasoconstriction offers several advantages over the other local anesthetics presently available for infiltration anesthesia.

Amides↗
PubMed1989

Accuracy of laser Doppler capillary flow measurements for predicting blood loss from skin incisions in pigs.

This study assesses the clinical applicability of laser Doppler capillary flow measurements for predicting blood loss from a surgical incision. To produce a wide range of blood flows, we injected lidocaine 1%, lidocaine 1% plus octapressin (0.03 IU.ml-1), and lidocaine 1% plus epinephrine (5 micrograms.ml-1) subcutaneously into three separate sites on the flank of each animal (N = 6). Laser Doppler flow measurements were made before and 10 minutes after injection Subcutaneous injection of lidocaine tended to increase cutaneous blood flow (96 +/- 13 to 153 +/- 30 mV, mean +/- SE, P = 0.09). Blood flow tended to decrease after injection of lidocaine with epinephrine (101 +/- 13 to 57 +/- 10 mV, P = 0.03) or octapressin (108 +/- 20 to 58 +/- 11 mV, P = 0.08). Laser Doppler measurements were higher after the injection of plain lidocaine than after that of lidocaine with either epinephrine or octapressin (P = 0.004). A standard incision was performed at each site and blood loss measured over the subsequent 10 minutes. Laser Doppler measurements correlated with the amount of bleeding from the surgical incision (R = 0.69, P less than 0.001). We conclude that the laser Doppler is a useful tool for evaluating the ability of subcutaneously injected local anesthetics (vasodilators) or vasoconstrictors to alter bleeding from skin incisions.

Animals↗
PubMedDate not supplied

Hospital discharge after ambulatory knee arthroscopy: A comparison of epidural 2-chloroprocaine versus lidocaine.

BACKGROUND AND OBJECTIVES: This prospective, randomized, double-blind study compares the efficacy of epidural 2-chloroprocaine and lidocaine for attaining hospital discharge criteria after ambulatory knee arthroscopy. We hypothesized that 2-chloroprocaine would facilitate earlier discharge than lidocaine. METHODS: American Society of Anesthesiologists (ASA) I and II patients were randomized to receive equipotent doses of epidural 3% 2-chloroprocaine or 1.5% lidocaine, both without epinephrine. Time to block resolution and discharge were compared between groups, along with the need for epidural reinjection, surgical times, and postoperative back pain. RESULTS: Twenty-seven patients completed the study, 13 in the 2-chloroprocaine group and 14 in the lidocaine group. The 2-chloroprocaine group was ready for discharge significantly earlier than the lidocaine group (130 +/- 17 min [range, 105 to 160] v 191 +/- 32 min [range 144 to 251]; P <.0001, 90% power). The lidocaine group required more epidural reinjections. Anesthesia-related side effects were similar in both groups. CONCLUSIONS: Epidural 3% 2-chloroprocaine without epinephrine is an advantageous choice for ambulatory knee arthroscopy. It enables readiness for discharge an hour sooner than 1.5% lidocaine, requires fewer reinjection interventions, and may reduce delayed discharge secondary to prolonged time to void. This clinical study shows the superiority of epidural 3% 2-chloroprocaine over 1.5% lidocaine for expediting hospital discharge after ambulatory surgery.

Adolescent↗
PubMedDate not supplied

Training anesthesia personnel to perform bleeding times.

Template bleeding time results generated by residents in anesthesiology correlate well with those obtained by trained laboratory personnel (p less than 0.002). Anesthesia personnel can accurately perform bleeding time tests when laboratory support is not available. The results of these tests can be used to guide clinical decisions.

Anesthesiology↗
PubMedDate not supplied

The reliability of epidural anesthesia for repeat ESWL: a study of changes in epidural compliance.

Changes in epidural compliance were investigated before and after extracorporeal shock wave lithotripsy (ESWL) in 11 outpatients. Epidural pressures were unchanged acutely by ESWL (p greater than 0.15). In contrast to previous reports of failures of epidural anesthesia in patients having repeat ESWL treatments, a review of our population of patients having repeat ESWL indicates that epidural anesthesia is reliable and not associated with any greater failure rate than for initial ESWL treatments. The difference between our results and previous reports of high failure rates is likely due to differences in anesthetic and surgical techniques such as: (1) use of air for loss-of-resistance when locating the epidural space, (2) differences in the time interval between ESWL treatments, and (3) frequency of use of epidural catheters.

Anesthesia, Epidural↗
PubMedDate not supplied

Chloroprocaine and lidocaine decrease hospital stay and admission rate after outpatient epidural anesthesia.

Lumbar epidural anesthesia with 20 ml of either 3% 2-chloroprocaine (C), 1.5% lidocaine (L), or 1.5% mepivacaine (M) with epinephrine was studied in 84 outpatients undergoing surgery (extracorporeal shock wave lithotripsy (ESWL]. The average duration of the procedure was 31.9 minutes. The total duration of sensory anesthesia was 133 +/- 28 minutes (C), 182 +/- 38 (L), and 247 +/- 42 (M) (p less than 0.05). Times to discharge were 269 +/- 62 minutes (C), 284 +/- 62 (L), and 357 +/- 71 (M). The time to discharge with M, almost six hours, was significantly longer than with C or L. There was a trend to an increasing rate of unplanned overnight hospital admission with increasing duration of the local anesthetic drug employed. Continuous epidural anesthesia with C, L or M appears safe and effective for outpatient surgical procedures such as ESWL. In contrast to previous understanding, mepivacaine produces significantly longer anesthesia and recovery times and may not be optimal for outpatient epidural use.

Adult↗
PubMedDate not supplied

Are anesthesia residency programs failing regional anesthesia? The past, present, and future.

BACKGROUND: A survey of anesthesia training programs in 1980 reported the use of a regional anesthetic technique in 21.3% of cases. Since that time, numerous changes have occurred in anesthesia residency programs. This survey was conducted to assess the impact these changes have had on the use and teaching of regional anesthetic techniques in residency training programs. METHODS: All anesthesia residency program directors were requested to send blinded copies of their residents' 1989-1990 American Board of Anesthesiology Annual Training Report Forms. Data from responding programs were compared to similar data from 1980, and analyzed for factors expected to influence the use of regional anesthesia during training. RESULTS: The use of regional anesthesia in residency training programs has increased from 21.3% in 1980 to 29.8% in 1990, primarily because of a two-fold rise in the use of epidural anesthesia. The use of regional anesthesia is strongly correlated with a resident's exposure to obstetric anesthesia and pain consultations. Wide variability between residency programs remains. CONCLUSION: Some training programs continue to fail to provide adequate regional anesthesia exposure to train residents fully in these techniques, despite the overall increased use of regional anesthesia.

Anesthesia, Conduction↗
PubMedDate not supplied

The regional anesthesia "learning curve". What is the minimum number of epidural and spinal blocks to reach consistency?

BACKGROUND AND OBJECTIVES: Wide variability exists in the amount of regional anesthesia practice to which residents are exposed during training. The number of attempts at various blocks before a trainee becomes proficient at performing these regional anesthetic techniques is not known. This study addresses the question: What is the minimum number of blocks a resident must perform to reach consistency during training in these techniques? METHODS: Every regional anesthetic technique attempted by all beginning CA-1 anesthesiology residents (n = 7) during their first 6 months of training (July 1993 to December 1993) were recorded on a daily basis. Nonregional anesthetic techniques attempted were recorded for comparison. The objective measures used to define the degree of success were obtaining cerebrospinal fluid during attempted spinal anesthesia, subsequent anesthetic block during epidural placement, and detection of end-tidal carbon dioxide for endotracheal intubation. RESULTS: An average of 77 +/- 9 epidural anesthetics, 44 +/- 6 spinal anesthetics, and 86 +/- 13 endotracheal intubations were attempted during the 6 months of training. The learning curves for each technique are of similar shape. Residents show significant (P < .05) improvement over baseline after 20 spinal and 25 epidural anesthetics, but a 90% success rate is not reached and maintained until 45 spinal and 60 epidural anesthetics are performed. CONCLUSIONS: Approximately 20-25 procedures each are necessary before improvement in the techniques of spinal and epidural anesthesia is demonstrated by residents in training. If a 90% success rate is desired, 45 and 60 attempts at spinal and epidural anesthesia, respectively, may be necessary.

Anesthesia, Conduction↗