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Biomedical subjects

G F Khoury

Publications and source records attributed to G F Khoury.

14 recordsLinked to original sources
PubMed1992

Intraarticular morphine, bupivacaine, and morphine/bupivacaine for pain control after knee videoarthroscopy.

Evidence has accumulated that opioids can produce potent antinociceptive effects by interacting with opioid receptors in peripheral tissues. This study sought to compare the effects of morphine with those of bupivacaine administered intraarticularly upon pain following arthroscopic knee surgery. In a double-blind, randomized manner, 33 patients received either morphine (1 mg in 20 ml NaCl; n = 11), bupivacaine (20 ml, 0.25%; n = 11), or a combination of the two (n = 11) intraarticularly at the completion of surgery. After 1, 2, 3, and 4 h and at the end of the 1st and 2nd postoperative days, pain was assessed by a visual analogue scale, and supplemental analgesic requirements were recorded. Pain scores were significantly greater in the morphine group than in the other two groups at 1 h. There were no significant differences at 2 and 3 h. From 4 h until the end of the study period, pain scores were significantly greater in the bupivacaine group than in the other two groups. Analgesic requirements were significantly greater in the morphine group than in the other groups at 1 h but were significantly greater in the bupivacaine group than in the other groups throughout the remainder of the study period. We conclude that intraarticular morphine produces an analgesic effect of delayed onset but of remarkably long duration. The combination of these two drugs results in satisfactory analgesia throughout the entire observation period.

Adult↗
PubMed1992

Prostacyclin accumulation during orthotopic liver transplantation in man.

Significant hypotension commonly occurs upon reperfusion of the donor liver. In this study we tried to determine if there is accumulation of prostacyclin in the portal system. Blood samples for prostacyclin in twelve patients undergoing orthotopic liver transplantation were studied. Samples were collected at the beginning and end of portal vein anastomosis. Hemodynamic measurements were determined 1 min before and 3 min after portal revascularization. The results show an increase of prostacyclin from 524 +/- 134 pg/ml (n less than 72 pg/ml) to 1132 +/- 264 pg/ml. Eight patients had a decrease in systolic blood pressure from 98 +/- 5 mmHg to 61 +/- mmHg with concomitant significant increase in cardiac output (6.0) from 6.9 +/- 0.7 to 9.9 +/- 1.05 L/mm and significant decrease in systemic vascular resistance (SVR) from 724 +/- 130 dynes/sec/cm to 309 +/- 98. In conclusion, 60% of patients undergoing OLT accumulate prostacyclin in the portal vein, which could be one of the causes of hypotension seen at reperfusion of the donor liver.

Adult↗
PubMedDate not supplied

Hemodynamic changes with initiation of veno-venous bypass in orthotopic liver transplant patients.

Removal of the liver to start the anhepatic stage of liver transplantation requires cross-clamping of the portal vein, inferior vena cava, and hepatic artery. Adverse effects occur from engorged splanchnic beds and decreased venous return. A veno-venous bypass from the inferior vena cava and portal vein to the axillary vein is used in an attempt to ameliorate these changes. The purpose of this study was to evaluate the effect of institution of veno-venous bypass on hemodynamics. Eight randomly selected adult patients undergoing orthotopic liver transplantation had general anesthesia induced with thiamylal and maintained with nitrous oxide and isoflurane. Cardiopulmonary data and arterial and mixed venous blood gases were measured prospectively using radial artery and pulmonary artery catheters. Measurements were taken under four conditions: (1) 10 minutes before bypass; (2) after partial bypass (vena cava to the axillary vein); (3) after partial bypass with portal vein clamping; and (4) after full bypass (vena cava and portal vein to the axillary vein). Statistically significant changes seen were a 22% decrease in cardiac output and a 47% increase in systemic vascular resistance (SVR). Bypass flow was lower than predicted. Venovenous bypass ameliorates, but does not fully prevent, the reduction of cardiac output and rise in SVR seen with initiation of the anhepatic stage. However, bypass does prevent the hypotension experienced during cross-clamping and for these reasons should be used routinely.

Adult↗