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Biomedical subjects

D R Jobes

Publications and source records attributed to D R Jobes.

At least 37 records · Page 2Linked to original sources
PubMed1989

Evaluation of a user-operated patient-side blood gas and chemistry monitor in children undergoing cardiac surgery.

A study was performed to evaluate a user-operated patient-side blood gas and chemistry monitor (GEM-STAT, Mallinckrodt Sensor Systems, Ann Arbor, MI) for the first time in a group of infants and children with congenital heart disease undergoing cardiac surgery. Paired blood samples from 18 patients were analyzed by the test instrument and by standard clinical laboratory instruments. One failure of the test instrument, malfunction of a cartridge, occurred during the evaluation. The integrated and external quality control functions gave readings within the manufacturer's tolerance. The differences between the measurements obtained using the GEM-STAT and the standard laboratory instruments for five of the six variables are summarized as follows (mean +/- SD, units of measure, number of samples): pH (-0.017 +/- 0.02, 132), PaCO2 (-1.90 +/- 3.3 mm Hg, 130), hematocrit (-1.3 +/- 2.3%, 129), potassium (-0.17 +/- 0.20 mmol, 112) and sodium (-2.0 +/- 3.3 mmol, 112). The mean difference in the measurements of PaO2 in the clinically important range defined by the upper quality control limit for oxygen tension of 172 mm Hg for the GEM-STAT is: (-0.20 +/- 7.26 mm Hg, 51). The mean difference between the measurements for PaO2s below the lowest quality control point (60 mm Hg) was (-2.3 +/- 5.5 mm Hg, 30). The values for all variables obtained from the GEM-STAT during the trial period, with the exception of the PaO2 less than 60 mm Hg, showed good correlation with the laboratory over the clinically useful range.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Chemical Analysis↗
PubMed1989

Comparison of oral and intramuscular preanesthetic medication for pediatric inpatient surgery.

The child's fear of injections coupled with the concern that the psychologic advantage of intramuscular premedication may be all or in part negated by the trauma of injections prompted the authors to seek an oral preanesthetic medication to safely and reliably replace injections. The authors describe the results of a prospective, randomized, double-blind study comparing the pharmacologic effects of oral versus injectable preanesthetic medication in 67 healthy pediatric inpatients older than 1 yr. Children given the oral medication (meperidine 3.0 mg/kg, pentobarbital 4.0 mg/kg) were significantly more drowsy in the holding area (P less than 0.001) and more cooperative at the time of induction of anesthesia (P less than 0.01) than the children given intramuscular medication (morphine 0.1 mg/kg, pentobarbital 4.0 mg/kg). There were no other differences between the two groups. These data demonstrate that oral preanesthetic medication can be as or more effective compared with intramuscular medication in producing the desired effects without adverse side effects. As a result of this study, the benefits of preanesthetic medication can now be achieved in nearly all surgical patients without injections.

Administration, Oral↗
PubMed1988

An enclosed system for continuous postoperative mediastinal aspiration.

Blockage of mediastinal drainage tubes in the postoperative cardiac surgical patient can result in tamponade, and the small child, with a necessarily small drainage tube, is particularly susceptible to instability arising from accumulating blood in the mediastinum. A system for continuous evacuation of blood in drainage tubes is described that decreases the likelihood of blocked tubes and resultant tamponade.

Cardiac Tamponade↗
PubMed1985

Comparison of internal and external jugular cannulation of the central circulation in the pediatric patient.

Percutaneous catheterization of the central circulation via the internal jugular vein was compared to cannulation via the external jugular vein, in a retrospective review of 200 pediatric patients. The internal approach resulted in an 86% rate of successful cannulations with 99.9% of the catheters positioned in the thorax; this technique was accompanied by an 8% incidence of carotid artery puncture. The external jugular route eliminated the risk of carotid artery puncture; however, it was successful in only 65% of the attempts, and 14% of the successful cannulations had catheter tips incorrectly positioned outside the thorax.

Age Factors↗
PubMed1983

Hemodynamic predictors of myocardial ischemia during halothane anesthesia for coronary-artery revascularization.

The authors undertook a prospective study of 30 patients undergoing halothane anesthesia for coronary-artery revascularization to ascertain which clinically monitored hemodynamic variables--or combination of variables--associated with myocardial oxygen supply and demand best predict myocardial ischemia. Simultaneous recordings of electrocardiogram (lead II and V5), systemic, central venous, pulmonary artery, and pulmonary artery occluded pressures were analyzed for correlation with ischemic episodes. Ischemia occurred with significant increases (P less than 0.0001) in heart rate, central venous pressure, and pulmonary artery occlusion pressure and with significant decreases (P less than 0.0001) in systolic and mean arterial blood pressure and in coronary perfusion pressure (mean arterial minus pulmonary artery occluded pressure). There was no correlation between ischemia and either hypertension (systolic blood pressures up to 200 mmHg) or the rate-pressure product. Systemic systolic blood pressure, systemic mean arterial blood pressure, and coronary perfusion pressure as single determinants were the most useful to monitor in avoiding myocardial ischemia. A combination of systemic arterial blood pressure (systolic or mean) and filling pressure (central venous or pulmonary artery occluded) was generally as useful but not more so than the preceding single variables in avoiding ischemia. Rate-pressure product was not of value in this regard. Patients were divided into three groups according to preoperative left ventricular (LV) function to determine whether pulmonary artery occluded pressure (PAOP) was more useful than central venous pressure (CVP) as either a predictor of ischemia or an index of cardiac filling: normal LV function (Group I), moderately abnormal LV function (Group II), and markedly abnormal LV function (Group III). PAOP offered no advantage over CVP for either purpose, except in some Group III patients.

Blood Pressure↗