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F J Spielman

Publications and source records attributed to F J Spielman.

At least 37 records · Page 2Linked to original sources
PubMed1987

Local versus general anesthesia for laparoscopic sterilization: a randomized study.

Despite the contention by some that local anesthesia is a preferred alternative to general anesthesia for laparoscopic sterilization, there have been no randomized studies comparing these techniques. To better characterize the relative safety and acceptability of these techniques for laparoscopic sterilization, we randomly assigned 100 women undergoing bipolar electrocoagulation or spring clip application to either local or general anesthesia. Of the 53 women assigned local anesthesia, four had their procedures completed using another technique because of technical problems related to obesity. Thirteen other obese women, however, underwent successful surgery with local anesthesia. Women undergoing local anesthesia had a slightly shorter anesthesia time (30 versus 36 minutes) and recovery room stay (65 versus 78 minutes). Women having general anesthesia were 2.3 and 1.5 times more likely to have maximum systolic and diastolic blood pressures above 160 and 90 mmHg, respectively. They were also 5.7 times more likely to have a maximum heart rate 110 or higher. Patient movement was reported to be a concern in five women undergoing general anesthesia, but in none having local anesthesia. An equal percentage (80%) of women in each group expressed satisfaction with their anesthetic technique.

Adolescent↗
PubMed1986

Prevention of fetal movement during invasive procedures with pancuronium bromide.

The use of fetal intramuscular pancuronium (0.5 mg) to temporarily arrest fetal movement during antenatal intervention in six instances is reported. Successful arrest of movement without adverse side effects was observed. The use of this technique eliminates the need for the excessive and potentially dangerous maternal sedation currently used to minimize fetal movement.

Female↗
PubMed1985

Problems associated with epidural anesthesia in obstetrics.

Toxic reactions to bupivacaine and 2-chloroprocaine recently have been reported in parturients receiving epidural analgesia. Neurotoxicity has occurred after the accidental subarachnoid injection of large doses of 2-chloroprocaine. Cardiac arrest and death have occurred after the accidental intravascular injection of bupivacaine. Obstetricians should be aware of these hazards and how to avoid them by the use of proper technique.

Anesthesia, Epidural↗
PubMed1985

Sodium citrate pretreatment in elective cesarean section patients.

Thirty-two healthy term parturients undergoing elective cesarean section randomly received either no antacid (n = 10), 30 ml of 0.3 molar sodium citrate less than 60 min preoperatively (n = 11), or 30 ml of 0.3 molar sodium citrate longer than 60 min preoperatively (n = 11). Immediately after delivery, the stomach was emptied as completely as possible through a #18 Salem Sump tube passed orally. Mean gastric pH in the three groups was 1.8 +/- 2.7 (SD), 5.0 +/- 1.5, and 2.7 +/- 1.2, respectively. Gastric pH was significantly higher in the short interval group than in either the control group or in patients receiving their sodium citrate more than 60 min in advance. Gastric volumes were similar. All control patients had a gastric pH less than 2.5. Nine percent of patients receiving sodium citrate less than 60 min in advance and 50% of patients receiving their sodium citrate longer than 60 min in advance had a pH of less than 2.5. Volumes exceeding 25 ml occurred with equal frequency. No patient in the short interval group had a combination of both pH of less than 2.5 and a volume exceeding 25 ml. This combination occurred with equal frequency in control patients (64%) and in those patients receiving their sodium citrate more than 60 min in advance (50%). We conclude that sodium citrate effectively increases gastric pH when given less than 60 min prior to the induction of anesthesia.

Adult↗
PubMed1985

Advantages and disadvantages of regional anesthesia for cesarean section. A review.

Both epidural and spinal anesthesia have advantages and disadvantages for cesarean section. Compared to general anesthesia, regional offers reduced maternal mortality, the ability to use fewer drugs, more direct experience of childbirth and the capability to decrease blood loss and provide excellent postoperative pain control. The disadvantages of regional anesthesia include hypotension, intraoperative discomfort, post-lumbar-puncture headache and the potential for neurologic and cardiac toxicity from local anesthetics. The choice of which anesthetic technique to employ must depend on maternal preference, the experience and skills of the anesthesiologist, and the obstetric indication for the cesarean section.

Acid-Base Equilibrium↗
PubMed1984

Subarachnoid and epidural anaesthesia for patients with epidermolysis bullosa.

Successful anaesthetic management of two patients with severe epidermolysis bullosa was accomplished using subarachnoid and epidural blockade. In order to avoid complications of regional anaesthesia, antiseptic preparation of the skin should not involve scrubbing nor should adhesive tape be used to secure catheters. In addition local infiltration of the skin is best avoided. The potential complications of skin and oral mucosal damage associated with mask or endotracheal inhalation anaesthesia was avoided.

Adult↗
PubMed1984

Benzocaine-induced methemoglobinemia during general anesthesia.

A case is reported in which a patient developed cyanosis under general anesthesia due to methemoglobinemia. The cause of the methemoglobinemia was benzocaine applied topically to the pharynx and trachea. When confronted with cyanosis in the absence of cardiac or pulmonary disease, one must seriously consider the diagnosis of methemoglobinemia. Supplemental oxygen should be administered and methylene blue given intravenously. If possible, determination of arterial blood gases should be made to obtain the methemoglobin concentration. Finally, all medical and dental personnel using benzocaine should be aware of the recommended dose and the possible complications of overdosage.

Adult↗
PubMed1984

Anaesthesia for fetal surgery.

Anaesthesia for fetal surgery is described as used for thirteen procedures in seven patients. Analgesia was accomplished by local infiltration of lignocaine 1% by the surgeons and small incremental doses of intravenous medication by the anaesthetist as needed to make the mother comfortable and reduce fetal movement. There were no maternal or fetal complications. Ethical issues of this therapy are described.

Adult↗
PubMed1984

Anesthesiologists' practice of obstetric anesthesiology.

Physicians trained in obstetric anesthesia and no longer practicing it were questioned regarding conditions that were responsible for their leaving the field. A questionnaire was prepared to determine whether the physicians' activity in obstetric anesthesia continued after fellowship training. The survey yielded a response rate of 76%. Forty-two percent of the respondents spend more than 40% of their clinical anesthesia time in obstetric anesthesia, and 58% spend less than 40% in it. The reasons for less of an emphasis on obstetric anesthesia were finances, personal matters, lack of recognition, long hours and too much call, and lack of stimulation.

Anesthesia, Obstetrical↗
PubMed1983

Pharmacokinetics and pharmacodynamics of local analgesia for laparoscopic tubal ligations.

The pharmacokinetics and pharmacodynamics of lidocaine and bupivacaine, when used for laparoscopic sterilization under local anesthesia, are described in 21 patients. Under direct vision with the use of a laparoscope, local anesthetic solution was sprayed onto the fallopian tubes. Nine patients were administered 12 ml of lidocaine 2% (240 mg), and 12 patients received 20 ml of bupivacaine 0.5% (100 mg). Samples of venous blood were drawn at 0, 5, 10, 15, 20, 30, 60, and 120 minutes after the intraperitoneal placement of local anesthetic. Drug assays were performed by means of gas chromatography. The peak concentration of lidocaine was detected within 30 minutes. The mean concentration was 1.70 +/- 0.34 micrograms/mg (range, 1.19 to 2.07 micrograms/ml; convulsive level, 18 to 26 micrograms/ml). The peak concentration of bupivacaine was not evident until 60 minutes after injection. The mean concentration was 0.44 +/- 0.15 micrograms/ml (range, 0.20 to 0.77 micrograms/ml; convulsive level, 4.5 to 5.5 micrograms/ml). These findings may justify the use of larger volumes of these local anesthetics for more painful diagnostic laparoscopies whenever adhesions and/or extensive manipulation is anticipated.

Anesthesia, Local↗
PubMed1983

Spinal anesthesia.

Explore the source record for details and available documents.

Anesthesia, Obstetrical↗
PubMed1983

Medical student education in life-support skills.

A life-support skills course designed to facilitate competent decision making during emergency care situations has been developed for third-year medical students at the University of North Carolina at Chapel Hill School of Medicine. The objective of the one-week course is to combine the knowledge acquired in the basic sciences with the performance skills required in the clinical setting. This is achieved through the use of a variety of instructional strategies, including lectures, reading periods, and laboratory exercises. A scientific approach to the teaching of life-support skills is incorporated, educational objectives are defined, methods of achieving the educational objectives are provided, and an evaluation system is used to determine the effectiveness of teaching. After successful completion of the training program, the student is better able to deliver competent emergency medical care.

Clinical Competence↗