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Biomedical subjects

E Alon

Publications and source records attributed to E Alon.

48 records · Page 3Linked to original sources
PubMed1988

[Epidural anesthesia in a patient with Friedreich's ataxia].

Friedreich's ataxia (FA), a hereditary disease with degenerative changes localized chiefly in the spinal cord and cerebellum, is characterized clinically by ataxia, absence of tendon reflexes, loss of proprioceptive sensation, and extensor plantar responses. There are only a few reports on anesthesia for patients with FA. General but not regional anesthesia is usually recommended because a persistent aggravation of symptoms is feared with regional anesthesia. We report a 31-year-old gravida 1 para 0 patient with FA who was admitted at the 20th week of gestation for induced abortion, curettage and tubal ligation. Familial FA was diagnosed at the age of 15, and since the age of 23 the patient had been confined to a wheelchair. As she strictly declined general anesthesia, epidural analgesia with 0.125% bupivacaine and morphine was used for 14 h, during which period induced abortion by prostaglandin was performed. This was followed by epidural anesthesia with 2% lidocaine for curettage and laparoscopic tubal ligation. A reduced dosage of local anesthetics, as commonly recommended during pregnancy, was used. Neurological consultation before and 1 day, 6 weeks, and 7 months after operation revealed no undue exacerbation of symptoms. Our case report suggests that epidural anesthesia can safely be administered to a patient with FA.

Abortion, Induced↗
PubMed1987

Double-blind study of the reversal of midazolam-supplemented general anaesthesia with Ro 15-1788.

The actions and side effects of the benzodiazepine antagonist Ro 15-1788 were evaluated in a randomized double-blind clinical study in which midazolam was used as an anaesthetic agent. Sixty women who underwent laparoscopy were treated with Ro 15-1788 or with placebo after the surgical procedure. Ro 15-1788 reversed the hypnotic effect of midazolam within a few minutes. The patients were alert, co-operative, oriented and had good recall of events after awakening. The effects were statistically better than placebo for up to 30 min after administration. Arterial pressure and heart rate remained stable and there were no significant side effects. The availability of Ro 15-1788 allows effective reversal of midazolam when this is used during general anaesthesia.

Adult↗
PubMed1982

[Domperidone after ether anaesthesia. Prevention of postoperative hyperemesis (author's transl)].

In catastrophe situations ether is an important alternative to the usual anaesthetics being easy to manage and economical. We wanted to study the effects of the new antiemetic Domperidone on vomiting after either anesthesia. Two groups of patients were anaesthetized for general surgical procedures by means of the EMO (Epstein-Macintosh-Oxford) Vaporizer. Half an hour before the end of the operation one group received 0.2 mg/kg domperidone while the randomized control group received no prophylactic antiemetic medication. The domperidone group showed better, statistically significant, results (p less than 0.05). Domperidone proved to have a good prophylactic antiemetic effect which does not cause side effects or circulatory alterations. In preparation for catastrophe situations ether anesthesia under improved conditions was again included in the regular training programme.

Adult↗
PubMed1981

[Buprenorphine and nicomorphine in a double-blind trial for the control of postoperative pain (author's transl)].

Analgesic effects as well as side effects, circulatory and respiratory parameters of 0.3 mg Buprenorphine (Temgesic) were compared to 10 mg Nicomorphine (Vilan) intramuscularly injected in a double-blind, randomized study for the relief of postoperative pain. Buprenorphine produced an equally potent but longer acting analgesic effect compared to Nicomorphine, although slight delayed. There were only few and slight side effects and no influence on the circulation and the respiration. In the search for a new long-acting and strong analgesic Buprenorphine proved to be superior to Nicomorphine in the control of postoperative pain.

Adult↗
PubMed1981

[A doubleblind comparison of tramadol and buprenorphine in the control of postoperative pain (author's transl)].

Analgesic effects as well as side effects, circulatory and respiratory parameters of 50 mg tramadol (Tramal) were compared with 0.3 mg buprenorphine (Temgesic) in a doubleblind, randomized study for the relief of postoperative pain. Buprenorphine produced a more potent and longer acting analgesic effect compared to tramadol, although slightly delayed. There were only few and slight side effects and no influence on the circulation and respiration. In the search for a new long-acting and strong analgesic Tramadol proved to be unable to replace buprenorphine in the control of postoperative pain.

Adult↗
PubMed1979

[Clinical application of a supplement to the extracorporal circulation to produce a pulsatile flow (author's transl)].

Two groups of patients with atherosclerotic coronary artery disease, who underwent aortocoronary bypass operation, were perfused with nonpulsatile flow during extracorporeal circulation (ECC) using membrane oxygenators. One group (MO) was used as a control, while for the other group (PAD) a Pulsatile Assist Device in the arterial line was employed. This apparatus consists of a balloon of 80 ml placed inside a rigid housing. The balloon is compressed by pressurized air or expanded by vacuum supplied by a driving console. The apparatus produced pulse amplitudes between 30 and 50 mm of mercury. Other than a very short-lasting fall in mean arterial pressure, thus showing diminished peripheral resistance, no perceptable advantages were found. Base excess and pH-changes showed no differences, also the given amount of sodium bicarbonate in both groups was the same. On the other hand significantly higher hemolyses took place, increasing with the duration of pulsation. The application of the apparatus as an arterial counterpulsator was possible with limitation in only 5 of 15 patients. In all other patients after a short time massive blood foaming developed in the PAD and the attempts had to be stopped because of the risk of gas embolism. In our opinion this apparatus is an unnecessary supplement to the ECC and as an arterial counterpulsator it seems too dangerous.

Adult↗
PubMedDate not supplied

Epidural anesthesia for a cesarean section in a patient with pulmonary atresia and ventricular septal defect.

The perioperative management and the pathophysiology of a parturient with pulmonary atresia, ventricular septal defect, patent ductus arteriosus Botalli (PDA), and pulmonary hypertension are described. The patient previously had a cesarean section under general anesthesia and was currently managed with an epidural block. The outcome was successful for the mother. The postoperative period of the premature infant was characterized by hyaline membrane disease, with its typical sequelae.

Abnormalities, Multiple↗
PubMedDate not supplied

Intercostal nerve block for lumpectomy: superior postoperative pain relief with bupivacaine.

STUDY OBJECTIVES: To investigate whether equipotent doses of lidocaine and bupivacaine were equally effective for intercoastal nerve blockade (ICNB) and whether a lower amount of lidocaine would be comparably effective. To see whether plasma levels of lidocaine with and without epinephrine and of plain bupivacaine would reach toxic ranges. Finally, to evaluate the duration of postoperative analgesia following general anesthesia and regional anesthesia with two different local anesthetics. DESIGN: Randomized, double-blind study, with control group administered general anesthesia. SETTING: Gynecologic operating room of a university hospital. PATIENTS: 48 adult ASA physical status I and II otherwise healthy patients undergoing lumpectomy. INTERVENTIONS: 36 patients received ICNB of T3-T6 unilaterally using either 4 ml/segment of 1.5% lidocaine with epinephrine 3.75 micrograms/ml (n = 10, Group A), 4 ml/segment of 2% lidocaine with epinephrine 5 micrograms/ml (n = 13, Group B), or 4 ml/segment of plain 0.5% bupivacaine (n = 13, Group C). The control group consisted of 12 patients (Group D) who received a general anesthetic using propofol, alfentanil, and nitrous oxide in oxygen for induction and maintenance of anesthesia. MEASUREMENTS AND MAIN RESULTS: In all three ICNB groups, the highest plasma concentrations were reached after 5 to 10 minutes following ICNB--i.e., a lidocaine plasma level of 2.77 +/- 0.5 micrograms/ml (mean +/- SEM) in Group A, a lidocaine plasma level of 2.78 +/- 0.2 micrograms/ml in Group B, and a bupivacaine plasma level of 1.44 +/- 0.2 micrograms/ml in Group C. There were no significant differences in plasma levels between 1.5% lidocaine and 2% lidocaine. For the first 90 minutes after surgery, higher postoperative pain scores were found in the control group than in the ICNB groups. Notably longer-lasting postoperative pain relief was achieved with plain bupivacaine. The number of women requiring postoperative analgesic medication, the time of first request, and the total amount of analgesic drugs administered during the 24 hours postoperatively were significantly lower in the regional anesthesia groups than in the general anesthesia group (p < 0.05). CONCLUSIONS: ICNB is an alternative to general anesthesia for female breast surgery. Both lidocaine with epinephrine and plain bupivacaine in the doses used did not raise venous plasma concentrations to levels considered potentially toxic. With respect to duration of postoperative pain relief and analgesic drug request, the local anesthetics (in particular, bupivacaine) were found to be superior to general anesthesia.

Breast Neoplasms↗
PubMedDate not supplied

Intercostal nerve block for minor breast surgery.

Two anesthetic procedures, intercostal nerve block (ICNB) and general anesthesia, were evaluated in 45 female patients scheduled for minor breast surgery. The study was designed to compare ICNB with general anesthesia for breast surgery with respect to efficacy, surgical stress and postoperative analgesia and to evaluate epinephrine and ornipressin as vasoconstrictors in the local anesthetic solution. Thirty patients received ICNB of T3-T7 unilaterally using 2% lidocaine plus epinephrine (15 patients, Group A) and 2% lidocaine plus ornipressin (15 patients, Group B). The control group consisted of 15 patients receiving a general anesthetic. The highest median lidocaine plasma level was 2.8 micrograms/ml in those patients who received epinephrine and 5.3 micrograms/ml in those who received ornipressin. There were statistically significantly higher lidocaine plasma levels in Group B than in Group A after 10, 30 and 60 minutes from injection while the two groups did not differ significantly at the 20- and 90-minute time intervals. Before and during surgery, epinephrine and norepinephrine plasma levels were highest in the epinephrine group, whereas, postoperatively, the plasma levels of both catecholamines were highest in the patients receiving general anesthesia. The latter patients experienced significantly more nausea and vomiting than the regional anesthesia groups. Patients with regional anesthesia required significantly less analgesics postoperatively than the patients receiving general anesthesia.

Adult↗