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Biomedical subjects

D L Bourke

Publications and source records attributed to D L Bourke.

At least 73 records · Page 4Linked to original sources
PubMed1984

General anesthesia for whole-body hyperthermia.

General anesthesia was used to facilitate 259 whole-body hyperthermia treatments in 90 patients. These patients fell into American Society of Anesthesiologists Classifications 3 (moderate to severe systemic disease) and 4 (severe systemic disease with life-threatening potential). Whole-body hyperthermia imposes severe stress on cardiopulmonary and renal function. In this series, elevation of temperature from 38 degrees to 41.5 degrees raised cardiac output to approximately 200% of control, while oxygen consumption rose 35%. General anesthesia provides conditions which allow for more precise control and support of vital signs, fluid requirements, and blood gases.

Anesthesia, General↗
PubMed1983

Dextroamphetamine with morphine: respiratory effects.

The combination of dextroamphetamine and morphine has been shown to be synergistic for analgesia and antagonistic for most other effects. However, the claim that dextroamphetamine antagonizes the respiratory depression caused by morphine has not been well substantiated. In this double-blind study, we investigated respiratory effects, including resting respiration, isohypercapnic ventilation, CO2 response, dose response, and duration of these effects with dextroamphetamine alone and in combination with morphine. Dextroamphetamine alone (0.215 mg/kg) caused increases in minute ventilation and a leftward shift of the CO2 response curve that lasted for less than 2 hours. Dextroamphetamine combined with low-dose morphine (0.15 mg/kg) antagonized respiratory depression throughout the 5-hour observation period. Dextroamphetamine combined with high-dose morphine (0.30 mg/kg) was unable to completely antagonize depressed ventilation, and some residual effects of morphine persisted at 23 hours.

Carbon Dioxide↗
PubMed1978

Cardiac arrest.

Explore the source record for details and available documents.

Atropine↗
PubMedDate not supplied

Epidural opioids during laminectomy surgery for postoperative pain.

STUDY OBJECTIVE: To determine whether morphine applied directly to the dura during laminectomy surgery provides superior postoperative analgesia during the first 24 hours. DESIGN: Randomized, double-blind study. SETTING: A university-affiliated hospital. PATIENTS: Twenty ASA physical status I and II patients ages 18 to 60 years. INTERVENTIONS: Simultaneous topical dural application and intramuscular (IM) injection of unknown solutions of saline and morphine 3 mg. MEASUREMENTS AND MAIN RESULTS: Postoperative analgesia was assessed using the visual analog scale (VAS), a modified McGill-Melzack pain questionnaire, subjective nursing evaluations, and the amount of supplemental analgesic medication used. Patients were observed for complications and side effects. Compared with the patients who received epidural saline and IM morphine, the patients who received epidural morphine and IM saline had less postoperative pain as determined by VAS scores, nursing evaluations, and amount of supplemental opioid analgesic doses (1.6 +/- 1.2 vs. 4.1 +/- 1.2 analgesic doses per patient; p less than 0.05) required in the first 24 hours. Minor side effects were similar for the two groups. No patient developed respiratory depression. CONCLUSIONS: Morphine 3 mg applied topically to the dura at the end of laminectomy surgery is a simple, safe, and effective way of providing improved postoperative analgesia.

Adolescent↗
PubMedDate not supplied

Improved postoperative analgesia with morphine added to axillary block solution.

STUDY OBJECTIVE: To determine whether the addition of morphine to the axillary block local anesthetic solution provides improved or prolonged postoperative analgesia. DESIGN: Prospective, randomized, double-blind clinical trial with 24-hour follow-up. SETTING: Ambulatory unit of a large academic referral center. PATIENTS: Consecutive healthy volunteers scheduled for elective upper extremity surgery. INTERVENTIONS: Patients in the treatment group (AX) were given intravenous (IV) saline and had morphine 0.1 mg/kg added to their axillary block solution. Control subjects (CT) received morphine 0.1 mg/kg IV and had saline added to their axillary block solution. All axillary blocks were performed using 0.55 ml/kg of 1.5% lidocaine with epinephrine 1:200,000. MEASUREMENTS AND MAIN RESULTS: During the first 24 hours after surgery, visual analog scale (VAS) scores, supplementary analgesic (oxycodone 5 mg with acetaminophen 500 mg) use, and complications were recorded. Both groups had similar VAS scores throughout the study. In the 24-hour postoperative study period, AX patients required approximately half as many doses (median, 2 doses; range, 0 to 7 doses of supplemental analgesic as CT patients (median, 4 doses; range, 0 to 12 doses). There were no major complications in either group. CONCLUSIONS: The addition of morphine 0.1 mg/kg to the local anesthetic axillary block solution provided improved postoperative analgesia without an increased frequency of side effects or major complications.

Acetaminophen↗
PubMedDate not supplied

Randomized double-blind clinical trial of celiac plexus block for percutaneous biliary drainage.

PURPOSE: This study was undertaken to determine the efficacy of celiac plexus block (CPB) as a method of providing analgesia for percutaneous biliary drainage (PBD). PATIENTS AND METHODS: Thirty-two patients scheduled to undergo PBD were prospectively assigned randomly into placebo (30 mL of normal saline) and treatment (30 mL of 0.25% bupivacaine) CPB groups. Each patient received .03 mg/kg of midazolam for premedication before PBD and had access to a patient-controlled analgesia pump during the procedure. The pump was set to deliver 0.2 mg of midazolam and 25 micrograms of fentanyl per dose with a 3-minute lockout time. Vital signs, including heart rate and blood pressure, were continuously monitored during the procedure and recorded for comparison with baseline values. Patients completed a 10-point visual analogue pain scale following completion of their procedure. RESULTS: Patients in the placebo and treatment groups self-administered a mean of 2.0 and 1.85 mg of midazolam, respectively (P = .40), and a mean of 247 and 231 micrograms of fentanyl, respectively (P = .40). On a 10-point pain scale, the mean postprocedure versus preprocedure elevation in pain was 2.1 points in the placebo group versus 1.6 points in the treatment group (P = .60). Overall, the degree of satisfaction with the analgesia was equal in both groups. CONCLUSION: This study indicates that CPB is not an effective means of providing additional visceral pain relief over and above that which can be accomplished with self-administered intravenous medication for patients who undergo PBD.

Adult↗
PubMedDate not supplied

A randomized trial of perioperative hemodilution versus transfusion of preoperatively deposited autologous blood in elective surgery.

Hemodilution, one of several methods proposed to decrease homologous blood transfusion in elective surgery, has not been studied in a prospective controlled trial to determine if it is successful. A prospective, randomized controlled study was conducted to determine if hemodilution can serve as an alternative to preoperative autologous blood donation. Fifty patients were randomized to preoperatively deposit 3 units of autologous blood or to undergo hemodilution immediately before elective radical retropubic prostatectomy. All patients were treated under a standard protocol, including surgery performed by a single surgeon. The preoperative deposit groups received a mean of 2.44 +/- 1.0 units of blood; 2 of 25 patients required homologous blood transfusion for blood loss of 2600 mL and 1700 mL. The hemodilution group received a mean of 2.88 +/- 0.4 units of autologous blood: no hemodilution patient received homologous blood. At discharge, the mean hematocrit for the preoperative deposit group was 35.5 +/- 4.9 (0.35 +/- 0.05), and that for the hemodilution group was 31.8 +/- 4.7 (0.32 +/- 0.05) (p less than 0.001). There were no differences in perioperative morbidity in the treatment groups. The best predictor of discharge hematocrit was the initial hematocrit of the patient. It can be concluded that hemodilution can safely replace or at least augment preoperative autologous donations as a means of decreasing homologous blood transfusion in study patients. These results can be applied to any elective surgery procedure in which a 1000-mL blood loss is anticipated. Other advantages of hemodilution, including convenience, lower cost, and better preservation of all components of autologous blood, suggest that this practice deserves wider application.

Blood Transfusion, Autologous↗