Pulmonary artery catheterization: past, present, and future.
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Cardiac Catheterization↗
Biomedical subjects
D M Thys
Publications and source records attributed to D M Thys.
Inseparable disposables.
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Anesthesia, Inhalation↗
Catheter-induced pulmonary artery hemorrhage. Diagnosis and management in cardiac operations.
Three case reports describing catheter-induced pulmonary artery hemorrhage in patients having cardiac operations are presented--a 0.2% incidence of this complication. One patient exsanguinated and died, another survived after undergoing an emergency lobectomy, and the third escaped without surgical intervention. As a result of this experience and the recommendations in the literature, we have developed and describe herein a rational therapy for this highly lethal complication.
Aged↗
A study of the human aortic valve orifice by transesophageal echocardiography.
The transverse short-axis plane of the aortic valve was imaged by transesophageal echocardiography at a relatively high frame rate in 25 anesthetized patients undergoing heart surgery. The effective, time-averaged aortic valve area (a-AVA) was compared with areas obtained with triangular and circular valve orifice models (t-AVA and c-AVA, respectively). The aortic valve orifice was circular during 33.6% +/- 17.5% of systole. The relations between the triangular or circular aortic valve areas and a-AVA were as follows: t-AVA = 1.04 x a-AVA - 0.14 (r = 0.90; standard error of the estimate = 0.24 cm2) and c-AVA = 1.37 x a-AVA + 0.00 (r = 0.90; SEE = 0.30 cm2). Bias analysis showed no significant difference between a-AVA and t-AVA (bias = -0.04 +/- 0.23 cm2; difference not significant) but a significant overestimation of the average valve area by c-AVA (bias = +0.88 +/- 0.30 cm2; p < 0.001). Thus the aortic valve orifice was not circular for the entire duration of systole and valve area calculations based on a triangular model approximated a-AVA more closely than did those based on a circular model. These findings suggest that, for echocardiographic measurements that incorporate the aortic valve orifice area (e.g., stroke volume determinations), the use of a triangular valve area model, rather than a circular model, may produce more accurate results in anesthetized patients with heart disease.
Aortic Valve↗
Does metoclopramide supplement postoperative analgesia using patient-controlled analgesia with morphine in patients undergoing elective cesarean delivery?
BACKGROUND AND OBJECTIVES: Recent studies have shown that metoclopramide may decrease postoperative narcotic requirements in patients undergoing second-trimester induced abortions or prosthetic hip surgery. It is often used to decrease the incidence of nausea and vomiting in the patient undergoing cesarean delivery under regional anesthesia. If metoclopramide were found to be an analgesic adjunct in these patients, it would offer an additional impetus for its routine use. METHODS: After elective cesarean delivery under spinal anesthesia, 32 patients were monitored for initial and 24-hour postoperative morphine requirements via intravenous patient-controlled analgesia. These patients were divided into two groups. Prior to spinal block, group 1 (n = 17) received 10 mg intravenous metoclopramide, and group 2 (n = 15) received an intravenous saline placebo. RESULTS: No differences were found between groups in the time from spinal placement to the time of pain onset, the amount of morphine necessary to initially achieve comfort, or 24-hour postoperative morphine requirements. (P > .05). CONCLUSIONS: This study demonstrates that metoclopramide decreases intraoperative nausea but does not supplement analgesia in patients undergoing elective cesarean delivery.
Adult↗
Mobile resuscitation. A review of 200 calls attended by anaesthetists.
Evaluation of practice in a mobile resuscitation unit, staffed routinely by anaesthetists, over a 3 month period is described. Of 200 calls attended, the doctor was considered to have played a necessary role in sixty-seven, and in seven patients the doctor's attendance was considered to have contributed significantly to the patient's survival.
Anesthesiology↗
Anatomic considerations for sciatic nerve block in the popliteal fossa through the lateral approach.
BACKGROUND AND OBJECTIVES: The disadvantage of the classic posterior approach to block of the sciatic nerve at the knee level (popliteal nerve block [PNB]) is the need to position a patient in the prone position for performance of the block. In this study on cadavers, a lateral approach to the popliteal nerve in the supine position was investigated, and some anatomic considerations of relevance to popliteal nerve block were addressed. METHODS: In 19 cadaver right legs, the lateral approach to PNB was simulated with a needle, introduced in the groove between the biceps femoris and vastus lateralis muscles 7 cm above the knee, at either 30 degrees or 60 degrees relative to the horizontal plane, and 1 mL of dye solution was injected through the needle. After dissection of the popliteal fossa, the position of the solidified bolus of dye in relation to the popliteal nerve was determined. Additionally, the dye was injected into the popliteal nerve sheath, and the spread of the dye and continuity of the sheaths were determined. RESULTS: In 10 legs, the lateral approach was attempted at a 30 degrees angle and in 9 legs at a 60 degrees angle. The solidified injectates at 30 degrees were closely distributed anterolaterally to the nerve, while injectates at 60 degrees tended to be further from the nerve and scattered along its posterolateral aspect (P = .02). The dye injected into the nerve sheaths traveled 5 to 10 cm within the sheath, surrounding both main divisions of the popliteal nerve, the tibial and the common peroneal nerve. CONCLUSION: A lateral approach to the popliteal nerve with insertion of the needle at a 30 degrees angle relative to the horizontal plane results in predictable approximation of the needle tip to the popliteal nerve. The results also suggest the existence of a continuous neural sheath encompassing the popliteal nerve and its main branches. This may have clinical implications similar to those in perivascular neuronal block.
Dissection↗
The "three-in-one block" for treatment of pain in a patient with acute herpes zoster infection.
BACKGROUND AND OBJECTIVES: Herpes zoster infection in elderly patients frequently results in disabling pain, carries a high risk of postherpetic neuralgia (PHN), and can pose a significant therapeutic challenge. METHODS: We describe a successful use of the perivascular technique of lumbar plexus blockade ("three-in-one block") for treatment of pain during acute herpes zoster infection in an 82-year-old severely ill patient in whom other modalities were contraindicated. RESULTS: Three-in-one block using 40 mL of 0.25% bupivacaine with 1:300,000 epinephrine resulted in excellent pain relief that lasted for 2 weeks. CONCLUSIONS: The perivascular technique of lumbar plexus blockade may be a useful alternative to epidural and paravertebral techniques of lumbar blockade in the occasional patient for whom these other approaches are contraindicated.
Acute Disease↗