Search PubMed⌕ Search

Biomedical subjects

D W Coombs

Publications and source records attributed to D W Coombs.

At least 73 records · Page 4Linked to original sources
PubMed1983

Relief of continuous chronic pain by intraspinal narcotics infusion via an implanted reservoir.

Ten patients with intractable pain (five cancer and five nonmalignant) were treated with continuous intraspinal morphine delivered by an implanted continuous infusion system. Both patient groups were evaluated and compared using an identical battery of psychometric examinations administered before and 12 weeks after therapy. The cancer-pain group reported significant reduction in pain on serial visual pain analogue scales at 12 weeks compared with no change in the nonmalignant-pain group reports despite a much lower baseline report in the cancer group. Both groups of patients reduced their oral narcotic requirement significantly during continuous intraspinal morphine infusion. While the cancer patients took more oral narcotic at baseline, at 12 weeks no difference existed in oral intake between the two groups. Both groups required significant serial increases in infused morphine, indicating that spinal opiate receptor tolerance occurs. The results of this study confirm the sustained analgesic efficacy reported earlier in cancer-related pain syndromes, thus supporting further cautious expansion of this therapy within the cancer-related pain population. In contrast, a poor response was seen in the nonmalignant-pain group, consistent with the unsatisfactory responses to many potentially analgetic approaches to chronic nonmalignant pain. We are thus discouraged from further use of this therapy in the patient with chronic nonmalignant pain.

Administration, Oral↗
PubMed1983

Comparison of cimetidine (Tagamet) with antacid for safety and effectiveness in reducing gastric acidity before elective cesarean section.

One hundred twenty-six parturients for elective cesarean section under general anesthesia were allocated to either a cimetidine or an antacid group in a randomized, double-blind, multicenter trial. The cimetidine-treated group received 300 mg cimetidine orally the evening before the operation and 300 mg intramuscularly between 1 and 3 h preoperatively. The antacid-treated group received 30 ml of Mylanta-II orally on both occasions. Gastric volume, 30 min after induction of anesthesia and 30 min before response to oral commands, was less in the cimetidine-treated group. Gastric pH 30 min after induction was greater in the cimetidine-treated group. The maternal serum level of cimetidine at birth was 1.31 +/- 0.12 micrograms/ml and the umbilical venous level was 0.78 +/- 0.05 micrograms/ml. The neonatal gastric acidity, Apgar scores, and Early Neonatal Neurobehavioral Scale (ENNS) scores were similar in both groups. No maternal or neonatal complication was attributed to treatment.

Adolescent↗
PubMed1983

Augmentation of surviving flap area by intraarterial vasodilators administered through implantable pumps.

Using the implantable Infusaid Model 300 pump, several vasodilators (prostaglandin E1, isoxsuprine, bradykinin, trimethaphan, and reserpine) were infused intraarterially into an abdominal island flap in the rabbit. All produced a large increase in flap surviving area over saline controls at forty-eight hours, measuring as high as a 2.8-fold increase in random portions of the flap with prostaglandin E1. The agents possessed differing modes of action but had the common property of vasodilatation. The results raise questions concerning the possible physiological role of endogenous prostaglandins in the surgical delay phenomenon. The Infusaid pump was a valuable tool in the study and was well tolerated by the animals.

Alprostadil↗
PubMed1982

Emergency cimetidine prophylaxis against acid aspiration.

Preoperative cimetidine (300 mg IV) was given to assess timing and efficacy of prophylactic cimetidine to increase gastric pH in emergency surgical patients. Two-thirds had an initial gastric pH less than or equal to 2.5, with a mean pH of 2.13 +/- 0.60 as a group. Cimetidine administration resulted in a significant increase in mean pH at intubation (3.25 +/- 0.90), with a mean preoperative premedication interval of 59 +/- 20 minutes. However, 20% failed to achieve a gastric pH greater than 2.5 prior to intubation. The mean gastric pH at extubation (5.09 +/- 1.55) was also significantly increased compared to precimetidine and preintubation levels. Prophylactic cimetidine might protect many, but not all, emergency patients from acid-induced aspiration pulmonary injury at intubation or extubation.

Adolescent↗
PubMed1982

Implanted continuous epidural morphine infusion system. Preliminary report.

A number of reports have shown that epidural or intrathecal administration of morphine provides pain relief. Since February, 1981, the authors have used an implantable pump and epidural catheter for continuous epidural morphine infusion in patients with chronic pain. This system has functioned well, without respiratory or infectious complications. Functional characteristics of the system, technique of implantation, and preliminary results in two patients treated by this method are presented.

Adenocarcinoma↗
PubMed1982

Epidurally administered morphine for postcesarean analgesia.

A double blind study was performed to evaluate analgesia from epidurally injected morphine sulfate in 30 mothers after cesarean section following similar regional anesthetics. When compared with a saline placebo and 2 milligrams of epidurally injected morphine, a 4.5 milligram epidurally administered morphine dose resulted in a highly significant reduction in the initial 24 hour parenterally administered narcotic requirement, p less than 0.001, and a significantly greater duration of analgesia after epidural injection, p less than 0.0003. The mean duration of analgesia following 4.5 milligram epidural injection of morphine sulfate was 26.7 +/- 4.72 hours. A 2 milligram epidural dose reduced the initial 24 hour narcotic requirement, p less than 0.05, but the duration of analgesia did not significantly differ from that of placebo injection. No significant side-effects were noted. Epidurally administered morphine appears promising as a potent analgesic approach of extended duration with potential advantages for early maternal mobilization, improved fetal maternal interaction and reduced fetal narcotic exposure in the breast fed infant.

Analgesia↗
PubMed1982

Intraspinal narcotic tolerance: preliminary experience with continuous bupivicaine HCL infusion via implanted infusion device.

Spinal opiate receptor tolerance is the major limitation of continuous intraspinal narcotic analgesia delivered by implanted reservoir pump. Six intractable pain patients receiving continuous epidural morphine were given trials of low dose bupivicaine HCL in order to assess the effects on implanted reservoir function, analgesia, and safety. Daily infusion of 2.6-18.8 mg bupivicaine HCL had no consistent effect on flow rates. Subjectively, three patients had at least partial relief of pain while their intraspinal morphine doses were weaned. No sympathectomy was appreciated at these doses. The future of continuous intraspinal analgesia might require further advances in implantable infusion pump technology to allow manipulation of both daily infusion doses and multiple intraspinal analgesics. Further study is needed to assess the safety and effectiveness of higher continuous intraspinal bupivicaine doses for chronic pain relief.

Artificial Organs↗
PubMed1981

Cimetidine as a prophylactic against acid aspiration at tracheal extubation.

Gastric acidity was studied immediately after induction of balanced anaesthesia and again just before extubation of the trachea in 76 elective surgical patients. In 26 patients who were not given cimetidine before operation, the mean gastric [H+] at intubation was 2.6 x 10(-2) +/- 2.3 x 10(-2) mEq/l (pH 2.02 +/- 0.22) and was more than 3.16 x 10(-3) mEq/l (pH less than 2.5) in 53 per cent at extubation (mean [H+] 3.0 x 10(-2) +/- 2.2 x 10(-2) mEq/l; pH 1.83 +/- 0.22). In contrast, of those premedicated with intravenous cimetidine 45 minutes before tracheal intubation, none had a gastric [H+] more than 3.16 x 10(-3) mEq/l (pH less than 2.5) irrespective of the duration of the operation (15-180 minutes). However, of those patients receiving cimetidine 15 minutes before intubation, one-third failed to achieve a gastric [H+] less than 3.16 +/- 10(-3) mEq/l (pH greater than 2.5) at the time of extubation. Properly timed premedication with intravenous cimetidine will reduce the risk of acid-related pulmonary damage if aspiration occurs at the time of intubation or extubation. Repeated administration should be considered when the interval between premedication and extubation exceeds four hours.

Adolescent↗