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Biomedical subjects

E Crosby

Publications and source records attributed to E Crosby.

At least 19 recordsLinked to original sources
PubMed2001

Clinical case discussion: anesthesia for Cesarean section in a parturient with a large intrathoracic tumour.

PURPOSE: To report the anesthetic management of a parturient with a large intrathoracic tumour, presenting for Cesarean section. CLINICAL FEATURES: A 28-yr-old parturient, gravida 1, presented at 33 weeks gestation with a one month history of increasing cough and dyspnea. A computed tomography scan demonstrated a large mass filling the right hemothorax, causing mediastinal displacement to the left and carinal compression. Both mainstem bronchi were compressed and there was near total obliteration of the lumens of the right lobar bronchi. A decision was taken to expedite delivery to allow for staging and treatment of her disease and Cesarean section was scheduled. She was seen in consultation and prescribed oxygen by nasal prongs, dextromethorphan for cough and ranitidine the evening before and the morning of surgery. A subarachnoid block was performed and a block to the upper thoracic dermatomes was achieved; surgery proceeded uneventfully with the patient's head and upper body elevated about 15 degrees from the supine. The patient was discharged to the medical oncology service for evaluation and treatment. CONCLUSIONS: Intrathoracic tumours are uncommon in pregnancy. The physiological changes of pregnancy may mask not only the initial presentation but also, even advanced intrathoracic disease. Regional anesthesia is the anesthetic of choice and is rarely contraindicated by maternal condition.

Adult↗
PubMed1999

An assessment of the luminance and light field characteristics of used direct laryngoscopes.

PURPOSE: To determine luminance and light field characteristics and the effect of residual battery potential and luminance on light colour temperature in our used Macintosh #3 and #4 fibre-light (FLB) and bulb-light (BLB) laryngoscopes. METHODS: We used a power supply to provide laryngoscopes with potentials equivalent to those most commonly measured in the handles in use in our OR. Measurements were made under controlled, constant, conditions using a Pentax digital spotmeter (luminance) or a Minolta Color III colour temperature meter (light colour). Colour measurements were made while increasing the power source potential from 2-3 volts (v) in increments of 0.1 v. Light field measurements were made with a mm increment ruler mounted on the base of the test fixture. RESULTS: At 2.5 and 2.8 v respectively, the #3 FLB produced luminance values of 23.9 +/- 11.4 and 41.7 +/- 17.2 cd x m(-2) (mean +/- SD), and the #4 FLB produced 58.6 +/- 21.4 and 90.9 +/- 32.2 cd x m(-2). Increasing potential increased luminance values (P < 0.001) and the #4FLB produced higher luminance values (P < 0.001). BLB produced higher luminance values than did FLB across all comparisons (P < 0.001). As potentials and luminance values decreased, light temperature was reduced (P < 0.001). There were no differences in light field dimensions noted in any comparison. CONCLUSION: Fifteen percent of the BLB did not meet the minimum luminance for laryngoscopy of 100 cd x m(-2), 92% of the FLB did not meet that same standard.

Equipment Failure Analysis↗
PubMed1998

Comparison of epidural anaesthesia with ropivacaine 0.5% and bupivacaine 0.5% for caesarean section.

PURPOSE: To compare ropivacaine 0.5% with bupivacaine 0.5% for epidural anaesthesia for Caesarean section. METHODS: Healthy pregnant women, scheduled for elective Caesarean section were enrolled into this randomized, double-blind, parallel-group study. Epidural block was obtained with 20-30 ml of ropivacaine (group R) or bupivacaine (group B) and surgery started when anaesthesia was reached T6. Maternal heart rate and blood pressure and fetal heart rate were assessed before the test dose and at five minute intervals until the end of surgery. At the same intervals, sensory and motor block characteristics were determined. Apgar scores and Neurologic and Adaptive Capacity Scores (NACS) were determined after delivery. Adverse events were recorded. RESULTS: Sixty-five patients were enrolled and data from 61 were available for analysis; 30 ropivacaine and 31 bupivacaine. Time from the end of the last injection to the start of surgery was 46 +/- 13 min (mean +/- SD) in gp R and 53 +/- 25 min in gp B (P:NS). The median duration of analgesia varied between 1.7 and 4.2 hr in gp R and between 1.8 and 4.4 hr in gp B (P:NS). In patients who developed Bromage 4 block, it persisted longer in those in gp B (2.5 hr) than in gp R (0.9 hr) (P < 0.05). The quality of analgesia was satisfactory in 27/29 patients (93%) in gp R and 27/31 patients (87%) in gp B (P:NS), although supplemental i.v. opioid was required in ten and seven patients, respectively. The most common adverse events in the mother were hypotension (63% gp R and 61% in gp B) (NS) and nausea (30% and 58%, in group R and B, respectively) (P = 0.05). Apgar scores were 7 after five minutes in all neonates. CONCLUSION: Ropivacaine 0.5% and bupivacaine 0.5% provided effective epidural anaesthesia for Caesarean section although supplementation with i.v. opioid was commonly required.

Adolescent↗
PubMed1992

Obstetrical anaesthesia and analgesia in chronic spinal cord-injured women.

Improved acute and rehabilitative care and emphasis on integrating patients into society after spinal cord injury is likely to result in increasing numbers of cord-injured women presenting for obstetrical care. Anaesthetists providing care to these women should be familiar with the complications resulting from chronic cord injury and aware that many may be aggravated by the physiological changes of normal pregnancy. These complications include reduced respiratory volumes and reserve, decreased blood pressure and an increased incidence of thromboembolic phenomena, anaemia and recurrent urinary tract infections. Patients with cord lesions above the T5 spinal level are at risk for the life-threatening complication of autonomic hyperreflexia (AH) which results from the loss of central regulation of the sympathetic nervous system below the level of the lesion. Sympathetic hyperactivity and hypertension result in response to noxious stimuli entering the cord below the level of the lesion. Labour appears to be a particularly noxious stimulus and patients with injuries above T5 are at risk for AH during labour even if they have not had previous AH episodes. Morbidity is related to the degree of hypertension and intracranial haemorrhage has been reported during labour and attributed to AH. We report our experience in providing care to three parturients with spinal cord injuries. Two patients had high cervical lesions, one of whom experienced AH during labour and was treated with an epidural block. The second was at risk for AH having had episodes in the past and received an epidural block to provide prophylaxis for AH. In both cases epidural blockade provided effective treatment and prophylaxis for AH.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Acute epiglottitis in the adult: is intubation mandatory?

Acute epiglottitis (AE) in the adult results in inflammation of the supraglottic structures and carries the potential for complete airway obstruction. There is disagreement in the medical literature as to the appropriate management of the airway in the adult with AE. Some authors advocate intubation in all patients while others propose more selective intervention, intubating the trachea only in those patients presenting with airway compromise. We reviewed our institutional experience with 21 patients over the last seven years admitted with a proven diagnosis of AE. Six patients presented with respiratory distress, three in severe distress with symptoms and signs of upper airway obstruction. The three patients in severe distress were taken to the operating room, in two the tracheas were intubated and one underwent tracheostomy after failed intubation. All other patients were monitored but their tracheas were not intubated. The majority of the patients were monitored for 24 hr in the ICU before transfer to wards. No patient initially monitored required tracheal intubation for progression of disease. There were no deaths. Recommendations for the care of the airway in the adult with AE based on our experience and a review of approximately 1000 cases reported in the last ten years are presented. It is our opinion that adults presenting without respiratory symptoms may be safely monitored in an intensive care setting given that provision is made for tracheal intubation or tracheostomy should respiratory distress become evident.

Acute Disease↗
PubMed1990

Effectiveness of a hospital-based cooperative care model on patients' functional status and utilization.

The primary objective of this study was to test the hypothesis that inpatient care which emphasized structured, patient education, self-care and social support from a care partner (the Cooperative Care Program) is a cost-effective alternative to the more expensive staff-intensive, traditional hospital care; and that such care can be substituted without resulting in poorer outcomes with regard to subsequent health status or use of services. The effects of this program on patient and physician acceptance, patient knowledge and treatment and health status, were evaluated by means of an experimental design with comparable groups of patients assigned to experimental (cooperative care) or control (usual hospitalization) group status. Follow-up analyses of both groups of patients for a 12-month time period concluded that there were comparable and equally positive post-hospitalization experiences, with greater than 90% of both groups of patients functioning well with respect to a series of measures of functional status. There was no evidence that Cooperative Care patients were re-hospitalized more often or needed more emergency, home care or other types of services. There was, on the other hand, evidence of the positive effect on patient understanding, adherence to treatment, satisfaction, and self-management.

Female↗
PubMed1990

[Evaluation of the bone marrow in patients with brucellosis. Clinico-pathological correlation].

In the present study the 60 patients with brucellosis and evaluation of bone marrow aspirate seen at the Hospital Base Cayetano Heredia from 1980 to 1986 were included. Iron deficiency was found in the bone marrow in 34.5% of patients, 31% in males and 36% in females. No correlation was found between iron deficiency and severity of the hematological or non-hematological clinical features. Bone marrow cytophagocytosis was found in 28.3% of patients. All had moderate to severe clinical features, and it is postulated that this finding may be helpful as a severity marker in patients with brucellosis. Bone marrow cytophagocytosis was significantly associated with the presence of hematologic abnormalities in general; anemia was the most common of these, followed by thrombocytopenia. This finding suggests that cytophagocytosis is an important mechanism in the pathogenesis of these abnormalities in brucellosis. Bone marrow hypercellularity was present in 70% with normocellularity in 28.3% and one case of pure megakaryocytic aplasia. In thirty-five patients pathological study of bone marrow was carried out 10 of these (28.5%) had granulomas. Their presence was not correlated with the clinical severity. Peripheral blood finding were: anemia in 83.3%, with two cases of hemolytic anemia and positive direct Coombs test, one of them associated with thrombocytopenia (Evans syndrome); leukopenia in 21%, basically due to neutropenia; thrombocytopenia in 33.3%, in one case associated with positive antiplatelet antibodies and with pure megakaryocytic aplasia in others; pancytopenia in 13.5% of cases (8 patients) associated to bone marrow cytophagocytosis in 5 cases (64.5%) and thus suggesting that this might be the major underlying pathogenetic mechanism.

Acute Disease↗
PubMed1989

Hypoxemia after intraluminal oxygen line obstruction during cardiopulmonary bypass.

A patient sustained an episode of hypoxemia during cardiopulmonary bypass. Investigation of the extracorporeal circuit after successful resolution of the problem showed that a white, crystalline substance later identified as mannitol occluded the oxygen supply line to a bubble oxygenator. The management and subsequent investigation of the problem are presented.

Cardiopulmonary Bypass↗