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Biomedical subjects

D R Cook

Publications and source records attributed to D R Cook.

121 records · Page 7Linked to original sources
PubMedDate not supplied

Continuous alfentanil infusion in pediatric patients undergoing general anesthesia for complete oral restoration.

STUDY OBJECTIVE: To study the safety and efficacy of continuous alfentanil infusions in children. DESIGN: Randomized open study. SETTING: Outpatient pediatric anesthesia at a university medical center. PATIENTS: Forty pediatric patients aged 2 to 12 years about to undergo anesthesia for complete oral restoration. INTERVENTIONS: Twenty patients were anesthetized with halothane and nitrous oxide (N2O), and 20 patients were anesthetized with N2O and a 100 micrograms/kg bolus of alfentanil followed by a continuous alfentanil infusion. MEASUREMENTS AND MAIN RESULTS: Hemodynamic measurements, emergence times, and postoperative side effects were measured. Hemodynamic stability was maintained in both groups. Although children emerged faster and were extubated earlier when anesthetized with alfentanil, they required longer times until they could be discharged from the outpatient anesthesia area. Children anesthetized with alfentanil had a higher occurrence of postoperative emesis compared with children anesthetized with halothane. These differences, however, were not statistically significant. CONCLUSIONS: Alfentanil appears to be a safe anesthetic. The reason for prolonged discharge time in the alfentanil-anesthetized patient is unclear, but it may be related to postoperative vomiting.

Alfentanil↗
PubMedDate not supplied

Mivacurium infusion during nitrous oxide-isoflurane anesthesia: a comparison with nitrous oxide-opioid anesthesia.

STUDY OBJECTIVE: To determine the potentiation of the neuromuscular blockade induced by a titrated infusion of mivacurium in the presence of isoflurane versus a nitrous oxide (N2O)-opioid anesthesia. DESIGN: An open-label, controlled study. SETTING: The inpatient anesthesia service of two university medical centers. PATIENTS: Thirty adults divided into two groups. INTERVENTION: An intravenous infusion of mivacurium during anesthesia with N2O-opioid or N2O-isoflurane. MEASUREMENTS AND MAIN RESULTS: A neuromuscular blockade was monitored by recording the electromyographic activity of the adductor pollicis muscle resulting from supramaximal stimulation at the ulnar nerve at 2 Hz for 2 seconds at 10-second intervals. The mivacurium infusion rate was significantly less in the presence of isoflurane [4.0 +/- 0.8 micrograms/kg/min (mean +/- SEM)] than during N2O-opioid anesthesia (6.4 +/- 0.6 micrograms/kg/min). The recovery rates did not differ between anesthetic groups. After the termination of the infusion, spontaneous recovery to T4/T1 of at least 0.75 occurred in an average of 17.9 +/- 1.5 minutes, with a mean recovery index (T25-75) of 6.0 +/- 0.7 minutes. CONCLUSION: Isoflurane anesthesia reduces the infusion rate of mivacurium required to produce about 95% depression of neuromuscular function.

Adult↗
PubMedDate not supplied

Advantages of infant ventilators over adapted adult ventilators in pediatrics.

A lung simulator with variable compliance and resistance components was used to evaluate the dynamic compliance of the Bournes, Babybird, and Pediatric Emerson postoperative ventilators. With increase in airway pressure from combined changes in compliance and resistance, the internal compliance of the Bournes was lowest and the internal compliance of the Emerson was highest. With low constant airway resistance (50 cm/L/sec), the Babybird exhibited tidal volume losses similar to those of the Bournes in the face of decreased lung compliance. With constant lung compliance (10 ml/cm H2O) and increasing airway resistance, the Babybird had marked volume losses at higher volumes. Under all simulated conditions, internal compliance of the Emerson, although large, was relatively constant and the Bournes had the smallest internal compliance.

Adult↗
PubMedDate not supplied

Clinical pharmacokinetics of the newer intravenous anaesthetic agents.

In the last 15 years the role of opioids in anaesthesia management has undergone dramatic change. Initially used as premedicants, or adjuvants to inhalation anaesthetic agents or as analgesics for postoperative pain relief, narcotics have now evolved into primary anaesthetic agents, primarily because of their ability to maintain cardiovascular stability especially in patients with compromised myocardial function. Sufentanil, alfentanil, and lofentanil are 3 new synthetic congeners of fentanyl. Sufentanil and alfentanil afford not only the haemodynamic stability but also the desirable anaesthetic properties of analgesia, and unconsciousness. Their major advantage lies in their pharmacokinetic behaviour; a rapid onset of action and short elimination half-life, allowing for greater flexibility in anaesthetic management. Sufentanil's pharmacokinetic profile is consistent with a 2-compartment model. Its elimination half-life is 149 minutes and its clearance is 11.3 ml/min/kg. Alfentanil's pharmacokinetic profile has been described by both 2- and 3-compartment models. Its distribution and redistribution are rapid, with an elimination half-life of 83 to 137 minutes and a clearance of 4.37 to 6.47 ml/min/kg in adult patients. Lofentanil, however, is an extremely long-acting narcotic analgesic. Presently, its use is justified only when prolonged mechanical ventilation is anticipated. Etomidate, a carboxylated imidazole, is rapidly distributed within a central compartment and then to peripheral compartments; its slow distribution and terminal elimination half-lives are 28 and 273 to 330 minutes, respectively, and its clearance (11.6 to 25 ml/min/kg) is equal to its hepatic plasma flow. Its ability to maintain cardiovascular stability in patients with compromised myocardial function make it a useful induction agent. However, reports of increased mortality and inhibition of steroidogenesis in patients receiving either single injections or constant infusions have created controversies regarding its use. Minaxolone is a water-soluble steroid whose pharmacokinetic profile is consistent with a 2-compartment model. Distribution is rapid with a mean half-life of 2.1 minutes and an elimination half-life of 47 minutes. There do not appear to be any cumulative effects. Plasma levels on recovery were similar in those patients receiving single bolus or continuous infusions. Midazolam and flunitrazepam are two new benzodiazepines. As a class of drugs, benzodiazepines provide the pharmacological properties of anxiolysis, sedation, hypnosis, muscle relaxation, amnesia and anticonvulsant activity.(ABSTRACT TRUNCATED AT 400 WORDS)

Adrenal Cortex↗
PubMedDate not supplied

Developing a merit compensation plan in an academic setting.

UACCMF believes it has created an effective tool to quantify departmental goals and objectives and the faculty's performance in attaining those attributes. Formulating the plan and marketing it to the faculty was time consuming. On several occasions, UACCMF contemplated scrapping the plan but persevered because staff believed it was supported by sound theory. By changing certain details, it won faculty acceptance. Any large change makes people resistant because it involves uncertainties, especially when compensation is affected. Naturally, people view the plan first from their own perspective (How will this affect my pay?) and only later from the department's perspective. Now that a blueprint of department values is established, faculty members have concrete goals on which to focus and some direct control over their salaries.

Academic Medical Centers↗