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Biomedical subjects

H Turndorf

Publications and source records attributed to H Turndorf.

213 records · Page 12Linked to original sources
PubMedDate not supplied

Accidental needlesticks: do anesthesiologists practice proper infection control precautions?

Anesthesiologists as well as patients are at risk for acquiring blood-borne infections such as hepatitis and AIDS. We surveyed 2,530 anesthesiologists, a 10% random sample of the members of the American Society of Anesthesiologists, with a response rate of 57.1%, to determine the incidence of accidental needlestick exposure among anesthesia personnel and whether anesthesiologists are adhering to infection control guidelines to protect themselves and their patients from exposure to infectious diseases. Eighty-eight percent of respondents reported at least 1 accidental needlestick in the past 10 years; 21% received a needlestick from a high-risk patient and 4.5% a needlestick from a known HIV-positive patients. Residents reported significantly more accidental needlesticks from known HIV-positive patients (8.5%). Mucous membrane, open cut, eye, or other significant exposure to HIV-contaminated blood or body fluids was sustained by 8.34% of respondents in the past 10 years. Sixty percent of respondents reported they almost never reuse common syringes now compared with a 40.8% non-reuse rate (P < 0.001) in a similar survey on infection control practices conducted in 1990. Sixty-three percent reported they almost never reuse a vasopressor syringe compared with the 1990 non-reuse rate of 52.5% (P < 0.001). In the current survey, 39% of anesthesiologists reported reusing syringes from one patient to another and 36% reported reusing the same vasopressor syringes for different patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesiology↗
PubMedDate not supplied

Distribution of 3H-morphine after lumbar epidural administration in unanesthetized rabbits.

BACKGROUND AND OBJECTIVES: This study focused on the distribution of 3H-morphine in the spinal cord, roots, urine, and blood, after epidural administration in rabbits. METHODS: Under nitrous oxide, halothane, and oxygen endotracheal anesthesia, the cisterna magna of New Zealand albino rabbits was cannulated for cerebrospinal fluid sampling, and catheters were placed in the lumbar epidural space. Through the epidural catheter, 200 pmol of 3H-morphine contained in 500 microliters of 1.3 mM (0.21 mg) morphine was injected. Arterial blood and cisternal CSF were sampled at 0, 5, 15, 30, 45, 60, 90, and 120 minutes after injection. Animals were killed with intravenous pentobarbital at the end of 120 minutes (n = 3), 6 hours (n = 4), and 12 hours (n = 2). In each animal the brain, spinal cord, spinal roots, liver, kidneys, and urinary bladder were removed. RESULTS: The injection site over the cord was identified and all tissues were immediately frozen at -70 degrees C. Two-mm thick cross-sections, were taken from every centimeter of the spinal cord. Radioactivity in the series of sections was determined by scintillation spectroscopy. At 2 hours, 4.2% +/- 1.1% of the injected radioactivity was recovered, and at 6 hours 1.6% +/- 0.6% was recovered. Radioactivity was concentrated mainly around the lumbar injection site, and it decreased as the distance increased from the injection site and coincided with elapsed time after the injection. CONCLUSION: Multiple linear regression analysis of radioactive labels showed the significant effect of time, distance from the injection site, and the time-distance interaction on the distribution of 3H-morphine in the spinal cord (p < 0.0001 for time and rostral and caudal distance from the injection site; and p < 0.0001 for interaction between time and distance.) A major portion of the injected radioactivity was recovered in the urine and a small amount in other tissues and body fluid: bladder, liver, spinal roots, kidney, plasma, and cerebrospinal fluid.

Analgesia, Epidural↗
PubMedDate not supplied

"Twitch box": a new device to monitor neuromuscular blockade.

It is proposed that this "twitch box" be used whenever monitoring of neuromuscular transmission is indicated, since it is simple to use under clinical conditions, does not require critical placement or adjustment of the hand, produces quantitative information comparable to the force transducer, and is safe.

Humans↗
PubMedDate not supplied

Cardiovascular effects of morphine during hypothermia.

The cardiovascular effects of morphine were determined in anesthetized dogs at 37 and 30 degrees C. Intravenous (i.v., 1 mg/kg) but not intracisternal (i.c., 0.1 mg/kg) morphine produced a significant cardiovascular depression only at 30 degrees C. These effects were antagonized by i.v. naloxone (1 mg/kg) suggesting a peripherally mediated opiate mechanism. Moreover, hypothermia significantly increased plasma and cerebrospinal fluid morphine levels and enhanced the morphine-induced histamine release. The results suggest that opiates could have detrimental effects in patients with poor cardiovascular reserve in which high doses of opiates and hypothermia may be used concomitantly.

Animals↗
PubMedDate not supplied

An infant circuit with a water vaporizer warmed by carbon dioxide neutralization.

A pediatric anesthesia system was constructed by connecting the machine end of a modified Mapleson D system to a soda lime canister containing a water vaporizer heated through the reaction of neutralization of the lime by the CO2 emerging from the breathing tube. The vaporizer was placed in line with the fresh-gas delivery tube of the circuit. The humidity output of the system varied from 15 +/- 1 mg H2O/L with a CO2 output of 15 ml/L to 27 +/- 1.5 mg H2O/L with a CO2 output of 60 ml/min. Rebreathing of CO2 was within acceptable limits as long as fresh-gas inflow remained at 5 L/min. The system compares favorably in respect to its humidity output with all other circuits availabe on the market for pediatric anesthesia.

Anesthesiology↗
PubMedDate not supplied

Prolonged analgesia with liposomal bupivacaine in a mouse model.

BACKGROUND AND OBJECTIVES: Currently available local anesthetics have relatively limited duration of action and some may cause severe systemic toxicity. An ultralong lasting local anesthetic would be useful to produce prolonged intraoperative anesthesia and extended postoperative analgesia. The goal of this study was to synthesize a sustained release local anesthetic formulation that would produce prolonged sensory block and decrease the possibility of systemic toxicity. METHODS: The effect of liposomes containing 1.1% bupivacaine on duration of sensory block of the mouse tail was compared with equivalent concentrations of bupivacaine with and without epinephrine. Analgesia was assessed using the tail flick test. Systemic toxicity (LD50) was assessed after intraperitoneal injection and in vitro release rates were compared by dialysis technique for liposomal and plain bupivacaine. RESULTS: Sensory block was significantly prolonged with liposomal bupivacaine (130 +/- 38 minutes) compared to plain bupivacaine (46 +/- 11 minutes, P < .01) or bupivacaine with epinephrine (81 +/- 28 minutes, P < .05). The LD50 was significantly lower for plain bupivacaine (61 mg/kg, 95% confidence intervals 47-79) than for liposomal bupivacaine (291 mg/kg, 95% confidence intervals 201-422). The time to 50% in vitro release through a dialysis membrane for liposomal bupivacaine (28 +/- 9 minutes) was markedly prolonged compared to plain bupivacaine (7 +/- 1 minutes). CONCLUSIONS: This study shows that liposomal encapsulation of bupivacaine significantly prolongs duration of action and greatly decreases systemic toxicity of the drug. These findings may be promising for the future production of formulations of ultralong lasting local anesthetics with enhanced efficacy and safety.

Analgesia↗
PubMedDate not supplied

Thoracic versus lumbar administration of epidural morphine for postoperative analgesia after thoracotomy.

BACKGROUND AND OBJECTIVES: The purpose of this study was to compare the effects of thoracic and lumbar epidural morphine on pulmonary function and analgesia after thoracotomy for pulmonary resection. METHODS: Twenty-seven patients were randomized into two groups to receive either thoracic or lumbar epidural morphine as needed for postoperative analgesia. Postoperative pain was assessed hourly on a 10-cm visual analog scale (VAS), and epidural morphine was administered in 3 mg doses for a VAS score > 2 cm. Patients underwent pulmonary function tests (forced vital capacity, forced expiratory volume at 1 second, peak expiratory flow) preoperatively, and 24 hours postoperatively. Results were expressed as mean +/- 1 SE and analyzed using Student's t-test and Student-Newman-Keuls test at p < 0.05. RESULTS: Twenty patients completed the study (n = 10 per group). Patients in the thoracic group required 3.1 +/- 0.4 injections to a total morphine dose of 11.9 +/- 1.4 mg during the first 24 hours postoperatively, and those in the lumbar group required 4.7 +/- 0.4 doses to a total 24-hour morphine dose of 16.4 +/- 1.2 mg (p < 0.05). Median hourly VAS scores were similar in both groups. Postoperative pulmonary function decreased in both groups without intergroup differences. CONCLUSIONS: The authors conclude that thoracic epidural morphine administration in patients after thoracotomy results in decreased morphine requirements and the same degree of analgesia as does lumbar administration.

Aged↗