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Biomedical subjects

G M Gurman

Publications and source records attributed to G M Gurman.

27 records · Page 2Linked to original sources
PubMed1994

Assessment of depth of general anesthesia. Observations on processed EEG and spectral edge frequency.

The daily use of muscle relaxants and the lack of correlation between the hemodynamic behavior and stages of general anesthesia represent the main obstacles in defining the level of cortical activity depression by the anesthetic drugs. Since classical EEG is cumbersome in the operating room, and demands special knowledge, computerized methods of EEG wave analysis have more or less replaced the 'raw' display of the electrical activity of CNS. The paper describes the place of spectral edge frequency (SEF), one of the parameters obtained by processing the EEG waves, in the list of variables which could be monitored during general anesthesia. Besides, our preliminary observations on a combination of mean blood pressure variations and SEF value are presented. In fact, we designed a hypothetical matrix of those two parameters, which seems to be a useful tool for guiding the general anesthesia. SEF kept in a pre-established range (usually 8-12 Hz) seems to be linked with a more evident hemo-dynamic stability. Some data also suggested that a stable SEF on that range contributed to a higher degree of immediate postoperative analgesia after Cesarean section. The limits of SEF oblige the scientists to go on looking for other monitored parameters, to be studied in correlation with processed EEG. Further studies are needed, in order to improve the anesthesiologist's capabilities to define correctly the stage of general anesthesia.

Anesthesia, General↗
PubMed1994

Use of EEG spectral edge as index of equipotency in a comparison of propofol and isoflurane for maintenance of general anaesthesia.

Propofol and isoflurane were compared for haemodynamic stability and recovery time as main anaesthetic agents for maintenance in a total of 43 ASA I and II patients in uncomplicated operations lasting at least 30 min. The premedication (oral diazepam), induction (thiopentone-fentanyl-suxamethonium) and maintenance protocol (N2O-O2 2:1 litre min-1, fentanyl and vecuronium in incremental doses) were identical for all patients. In one group of 20 patients, propofol was used in continuous intravenous (i.v.) infusion (starting dose 3 mg kg-1 h-1), while in the second group of 23 patients, isoflurane was administered in a starting concentration of 1%. To improve the equipotency of the two agents in all cases the dose of the main anaesthetic was titrated to keep the EEG 90% spectral edge frequency (SEF-recorded by processed EEG monitor) between 8 and 12 Hz. Mean blood pressure (BP) and heart rate (HR) deviations of +/- 20% from the baseline were recorded. The incidence of mean blood pressure deviations/case in the propofol group was less than half of those occurring in the isoflurane group (0.45 vs. 0.96 P = 0.04). The mean duration of blood pressure deviation from baseline value was 5.5 min in the propofol group vs. 16.8 min in the isoflurane group (P = 0.01). The recovery intervals were significantly shorter in the propofol group (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Toward a unified monitoring system during anesthesia.

A conceptual framework is proposed for the selection of monitored parameters during anesthesia, and a new device for monitoring the parameters in a unified manner is briefly presented. A 'basic set' of 6 parameters is proposed to cover the needs of most routine anesthesia: Blood Pressure, ECG/Heart Rate, Temperature, FiO2, FetCO2, and, Cortical Activity (by EEG spectral analysis). Additional parameters are added in accordance with specified factors such as patient status and complexity of the surgical procedure. An initial version of a new monitor, 'Cerebro Trac', designed for neurosurgery and cardiovascular surgery, is briefly presented, along with planned future capabilities and directions for its use.

Anesthesia↗
PubMed1985

Cannulation of big arteries in critically ill patients.

A retrospective evaluation of 350 axillary and femoral artery cannulations in ICU patients revealed a 6.3-day mean duration of catheterization. Minor incidents such as hematoma (3.7%), catheter malfunction (5.1%), and local inflammation (2.5%) were noticed. The catheter was removed in 25 patients in whom it was suspected of causing sepsis. Six septic patients had the same organism in catheter and arterial blood cultures (with a negative venous blood culture), probably denoting an infected, catheter-linked thrombus. In 241 cases the catheter was removed at the end of the monitoring period. In only 21 of these cases did an organism grow in the catheter culture, but in 18 of these cases, the same organism was found in previous blood, sputum, and/or urine cultures. Thus, in only six patients (of 266 survivors) could arterial cannulation be held responsible for generalized sepsis. However, because no bacteriologic study was performed on catheters removed after the patient's death, this number could have been higher. Percutaneous axillary and femoral artery cannulation is highly recommended for extended monitoring because of its low incidence of minor complications, and no evident danger of tissue ischemia.

Adolescent↗
PubMedDate not supplied

Does supplemental perioperative oxygen administration reduce the incidence of wound infection in elective colorectal surgery?

AIM: An association has been proposed between perioperative administration of 80% oxygen and a lower incidence of wound infection after colorectal surgery. The present study was conducted to assess this hypothesis. METHODS: Thirty-eight patients (ASA classification 1 and 2) undergoing elective colorectal cancer surgery were allocated at random to 2 groups. Group 1 consisted of 19 patients who received an admixture of 80% oxygen and 20% nitrogen during anesthesia through an orotracheal tube and during the 2 first hours in the recovery room through a tight facemask with reservoir. Group 2 consisted of 19 patients who received an admixture of 70% nitrous oxide and 30% oxygen during anesthesia, followed by administration of 30% oxygen delivered by a blender through a tight facemask with reservoir in the same manner than group 1, during the first 2 hours in the recovery room. Wound infection was evaluated daily during hospital stay and after 7 days, 2 weeks, and 1 month. RESULTS: The incidence of wound infection was 12.5% in group 1 and 17.6% in group 2 (p=0.53). CONCLUSIONS: The results of this study showed no reduction in the incidence of wound infection following elective colorectal surgery in patients receiving 80% oxygen during the perioperative period.

Aged↗
PubMedDate not supplied

Laryngeal mask airway and the Robinow syndrome.

The Robinow syndrome is an extremely rare congenital syndrome that causes facial malformations, as well as genital, cardiac and skeletal abnormalities. Patients with this syndrome undergo several operations during their life. Because of the facial abnormalities they carry a potential risk for difficult intubation. We describe the case of a boy who underwent several operations with documented difficult intubation. The laryngeal mask airway provided a good solution for airway control and afforded adequate ventilation under both controlled mechanical ventilation and spontaneous breathing.

Abnormalities, Multiple↗