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Biomedical subjects

D W Eastwood

Publications and source records attributed to D W Eastwood.

13 recordsLinked to original sources
PubMed1989

Is there a place for parents in the operating room?

The presence of a parent in the operating room (OR) during induction of anesthesia is controversial. In order to assess the feasibility, safety, and acceptance of this practice, we evaluated a near-4-year experience with 3,086 patients less than 15 years of age, who were operated on at a free-standing ambulatory surgical center. The age distribution was: 1 to 23 months, 790; 2 to 5 years, 1,190; 6 to 10 years, 775; and 10 to 15 years, 331. The distribution of patients by service was: otorhinolaryngology, 1,597; pediatric surgery, pediatric urology, and plastic surgery, 948; ophthalmology, 443; orthopaedics, 72; and dental, 26. No premedication was employed. Anesthetic gases were delivered via a mask while the parent held or remained close to the child. Vascular access was established after the induction. Only five patients (tonsillectomy, four; circumcision, one) were admitted to the base hospital and subsequently discharged. Advantages of parental presence in the OR during anesthesia induction are decreased psychological trauma (child), smoother induction (child), and decreased parental anxiety. Possible disadvantages include disruption of OR routine, unpredictability of parental behavior, and increased time and cost. Because of careful preoperative preparation of parents by the nurses and anesthetists, the first three problems rarely occurred. The cost of supplies used by each parent was minimal. Practically all parents chose to accompany the child to the OR. The feedback during follow-up from those parents has been excellent. Nurses, anesthesiologists, and surgeons are enthusiastic about the program. In the examined setting, this approach has proven safe, simple, and effective.

Adolescent↗
PubMed1984

Improved technique for CT-guided celiac ganglia block.

Celiac nerve blocks have been performed without radiologic guidance, but recently several groups have reported computed tomography (CT)-guided techniques. The authors present a new technique of CT-guided celiac nerve block using an 18 gauge Teflon catheter, which permits a test block dose and permanent alcohol block with one procedure. The results of this new technique were very encouraging. Of nine cancer patients who had the test block, seven had good pain relief; these same patients had good pain control with the permanent block. Of six patients with pancreatitis, six had good pain relief from the test block, and three had some long-term relief from the permanent block.

Ganglia, Sympathetic↗
PubMed1982

Pain relief and plasma concentrations from epidural and intramuscular morphine in post-cesarean patients.

In a double-blind study of post-cesarean analgesia, a single dose of 4 mg epidural morphine sulfate (EMS), with and without epinephrine, was compared with an equal dose of intramuscular morphine (IMS). Postoperative pain was assessed by visual analogue scores and the frequency of patient requests for subsequent meperidine injections. Plasma concentrations of morphine base after EMS and IMS were contrasted. Clinically apparent adverse effects were recorded. The stability of the preservative-free morphine preparation was substantiated. Pain indices after EMS were improved significantly over those after IMS. Pain scores and requests for intramuscular meperidine indicated that the onset of effective EMS analgesia was delayed. The duration of EMS analgesia was about 20 h. No significant difference between the effect of EMS with and without epinephrine was demonstrated. No circulatory or respiratory depression was attributed to the use of 4 mg EMS. The mean peak plasma morphine concentration after 4 mg EMS was significantly lower and later than the mean peak after 4 mg IMS. No correlation was observed between plasma morphine concentration and analgesic effect. These results support the view that epidural administration delivers more of a given dose of morphine directly (rather than via the bloodstream) to the spinal site of action than does intramuscular administration.

Cesarean Section↗
PubMed1980

Dextrose affects gravitational spread of epidural anesthesia.

Chloroprocaine, 0.5 per cent, with physiologic saline solution, has a specific gravity of 1.007 and a osmolarity of 283 mOsm/l, which increase to a specific gravity of 1.025 and an osmolarity of 542 mOsm/l when chloroprocaine is prepared in dextrose, 5 per cent. Chloroprocaine, 2.7 per cent, shows similar increases in specific gravity and osmolarity with dextrose 5 per cent. The highest sensory anesthesia level attained in pregnant patients following epidural injection of 10 ml of each of these solutions was determined. Chloroprocaine in dextrose, 5 per cent, produced a significant lowering of the highest sensory anesthesia level attained, compared with solutions to which dextrose was not added.

Anesthesia, Epidural↗