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Biomedical subjects

J F Crul

Publications and source records attributed to J F Crul.

At least 19 recordsLinked to original sources
PubMed1995

Intubating conditions and neuromuscular effects of mivacurium during propofol-alfentanil anaesthesia.

In three groups of 20 patients, anaesthetized with propofol and alfentanil, tracheal intubation conditions and the onset of neuromuscular blockade after administration of three different doses of mivacurium chloride (0.11, 0.15, and 0.19 mg/kg = 1.5 x ED95, 2 x ED95, and 2.5 x ED95) were assessed. Intubation conditions were found to be clinically acceptable (good or excellent) in 83% of patients. Eighty-two per cent of patients were successfully intubated on the first attempt after 60-90 s. No difference in intubation scores or number of intubation attempts among the three dosage groups were found. We conclude that mivacurium chloride allows smooth intubation in most patients within 60-90 s, even with the lowest dose (0.11 mg/kg), after a propofol-alfentanil induction of anaesthesia. However, because there were a few patients in whom intubating conditions were inadequate at 60-90 s, we are reluctant to advocate the preference of mivacurium chloride over suxamethonium for rapid sequence induction in emergency situations.

Adolescent↗
PubMed1995

Rocuronium with alfentanil and propofol allows intubation within 45 seconds.

Following induction with alfentanil (20 micrograms kg-1) and propofol (2.0-2.5 mg kg-1), four groups of patients were given rocuronium to determine conditions for rapid sequence intubation. Two groups received 0.9 mg kg-1 and two groups received 0.6 mg kg-1. In one of each dose groups, intubation was attempted after 45 s and in the other after 60 s. Intubating conditions were scored on a four point scale but all were rated as excellent or good. Almost all intubating conditions were excellent in the 0.9 mg kg-1 groups.

Androstanols↗
PubMed1993

Muscle paralysis by rocuronium during halothane, enflurane, isoflurane, and total intravenous anesthesia.

We determined the dose-response relationship, the onset time, the duration, and the recovery time of a rocuronium neuromuscular block under four anesthesia techniques. Patients were equally randomized to four different groups (n = 20) receiving 0.5%-1% halothane, 1.5%-2% enflurane, 1.2%-1.8% isoflurane end-tidal concentration in 34%/66% O2/N2O, or 6.0 mg.kg-1 x h-1 propofol without N2O for anesthesia and alfentanil for analgesia. Strength of thumb adduction in response to single and train-of-four stimulation of the ulnar nerve was quantitated. Rocuronium 0.15, 0.2, 0.25, and 0.3 mg/kg were given intravenously. When maximal depression of twitch tension occurred, supplemental doses up to a total of 0.5 mg/kg were given. If required, additional doses of 0.15 mg/kg were given at 25% recovery of control twitch tension. Standard hemodynamics, end-tidal CO2, and anesthetic gas concentrations were monitored continuously. The mean ED50 (SD) was 0.133 (+/- 0.009) mg/kg for the halothane group, 0.118 (+/- 0.012) mg/kg for the enflurane group, 0.069 (+/- 0.026) mg/kg for the isoflurane group, and 0.167 (+/- 0.007) mg/kg for the total intravenous anesthesia (TIVA) group, respectively. There was a statistically significant difference between the halothane and TIVA, and between the enflurane and TIVA groups (P < 0.05). Rocuronium has a short onset time and an intermediate duration of action. The neuromuscular blocking potency and pharmacodynamic profile are moderately influenced by volatile anesthetics.

Adult↗
PubMed1992

A scoring system for basic cardiac life support skills in training situations.

A valid and reproducible system for determining basic cardiac life support (BCLS) skills can help to evaluate the effect of instruction courses and to estimate the results of educational activities. The aim of this study was to develop and test such a system in accordance with the Standards and Guidelines of the American Heart Association (AHA). Five criteria were defined in advance towards such a system (1) Inadequate techniques must be reflected by a fail score. (2) Skilled persons should achieve a pass score. (3) The effect of training must be reflected by an improvement of the score. (4) Inter- and intra-observer variability must be negligible. (5) The system should be simple to apply. The system was developed, and in order to test the system, the BCLS skills of 40 ambulance nurses were tested once and those of 148 lay people twice. All cardiopulmonary resuscitation (CPR) attempts were performed on a mannequin. The relevant parameters of the attempt were continuously recorded and printed. Penalty points were assigned in a predefined way for aberrations of the techniques advised in the Standards and Guidelines. The system satisfied the five criteria mentioned above. It therefore offers a reliable and reproducible evaluation of BCLS skills.

Allied Health Personnel↗
PubMed1991

The effects of a 16-N-homopiperidino analogue of vecuronium on neuromuscular transmission in anaesthetized cats, pigs, dogs and monkeys, and in isolated preparations.

Org 9991, a 16-N-homopiperidinium substituted vecuronium analogue, has been tested for neuromuscular blocking activity in anaesthetized cats, pigs, dogs and monkeys, and in isolated nerve-muscle preparations. Org 9991 exhibited non-depolarizing neuromuscular blocking activity of the competitive type, being reversible by neostigmine and showing no endplate channel blocking action in isolated preparations. In cats, 50% vagal block was observed at doses of Org 9991 approximately 10 times those producing 50% neuromuscular block; no ganglion block was seen at these doses. Effects on blood pressure or heart rate at 90% twitch blocking doses were either minor or absent. The potency and time course of action of Org 9991 remained similar in all four species: i.e. 90% block at ca 200-300 micrograms kg-1; onset time ca 1.2-1.9 min; duration 90% ca 4.5-8.9 min. This study suggests that 16-N-homopiperidinium analogues of vecuronium may provide leads in the quest for a potent non-depolarizing replacement for suxamethonium.

Androstanols↗
PubMed1990

Cardiopulmonary resuscitation on the general ward: no category of patients should be excluded in advance.

In this study 91 consecutive CPR cases in 90 patients on general wards were evaluated during 18 months. Fifteen patients (16.5%) could be discharged, which is relatively favourable in comparison to the literature. Children proved to have a better chance to leave the hospital alive than adults (6/18 vs. 9/72; P less than 0.05). No factors with negative predictive value before the cardiopulmonary arrest could be isolated. Even oncological patients, often described as a prognostically poor category, with a success rate of 27% (6/22) did not differ from other categories. Patients with isolated respiratory arrest, ventricular tachycardia or ventricular fibrillation at the arrival of the CPR-team had a better chance to be discharged from the hospital. A rapid decrease in survival was noted if a CPR attempt lasted longer than 10 min (P less than 0.001). When there is no return of vital signs within 30 min the CPR attempt can be stopped. During follow-up period (mean 6 month) 2 of the 15 survivors (13.3%) died from a non-cardiopulmonary cause. It is concluded that no category of patients can be excluded from CPR in advance. Although ultimate success rate for CPR in the general wards will rarely exceed 15%, CPR has to be initiated in most cases of cardiopulmonary arrest.

Adolescent↗
PubMed1990

The efficacy and safety of nalbuphine (NUBAIN) in balanced anesthesia. A double blind comparison with fentanyl in gynecological and urological surgery.

In a prospective double blind study the efficacy and safety of nalbuphine as an analgesic in balanced anesthesia has been compared to fentanyl. In 63 patients, ASA class I-III, major gynecological or urological surgical procedures were performed under balanced anesthesia. Analgesia could be satisfactory maintained in all cases, but in cases of nalbuphine more hypnotics were necessary to keep the patients unconscious. The ratio of fentanyl and nalbuphine consumption was 1:200 (by weight). The nalbuphine cases can be distinguished by: more stable but higher arterial pressures and absence of arrythmia; lower incidence of nausea and vomiting in the postoperative period; less respiratory depression at the end of anesthesia, not needing antagonists, as compared to 11 patients needing antagonization in the fentanyl group; and a larger incidence of minor local allergic reactions at the injection site. Awareness was not observed in any patient of either group. Although nalbuphine has a weaker analgesic and hypnotic effect, it is perfectly possible to provide balanced anesthesia in combination with a hypnotic and a muscle relaxant. Advantages are the absence of respiratory depression as well as nausea and vomiting in the postoperative period.

Adolescent↗
PubMed1989

Oxygen desaturation following sedation for regional analgesia.

Moderate to severe arterial oxygen desaturation (SaO2 75-88%) occurred in three of four patients who were given sedation during regional conduction block without the administration of oxygen. No desaturation occurred in six patients given oxygen 2 litre min-1 via a nasal catheter during similar procedures. It is concluded that patients undergoing regional conduction block with concurrent sedation should receive additional oxygen routinely unless a pulse oximeter is available for monitoring.

Aged↗
PubMed1989

Pulse oximetry in the recovery room.

Haemoglobin oxygen saturation (SO2) was measured percutaneously with a pulse oximeter, in a group of 150 healthy ambulant volunteers to determine the range of normal values. The measuring site was not arterialised in advance. SO2 was below 94% in 13.3% of cases, while in no case was it below 90%. SO2 was then measured in 350 patients in the recovery room after a variety of surgical and anaesthetic procedures. Only 1.1% of patients who received additional oxygen following general anaesthesia exhibited an SO2 below 90%, compared to 16.7% of similar cases who did not receive additional oxygen. Administration of additional oxygen raised the SO2 above 90% in all the latter cases. In only 55.3% of those who did not receive additional oxygen was the SO2 above 94%, compared to 86.7% of normal volunteers and 73.9% of patients who received additional oxygen. This study reiterates the need to administer supplemental oxygen to all patients in the recovery room, unless facilities are available to measure SO2. A lower alarm limit of 90% is appropriate for the peri-operative period when using the Criticare Systems 501 oximeter.

Adolescent↗
PubMed1988

Automated charting of physiological variables in anesthesia: a quantitative comparison of automated versus handwritten anesthesia records.

Eight physiological variables--tidal volume, breathing rate, end-tidal carbon dioxide fraction, oxygen fraction in the anesthetic circuit, oxygen saturation by pulse oximetry, systolic and diastolic blood pressure, and heart rate--recorded on-line by a commercially available automated system were compared with the same variables recorded on handwritten anesthesia records. We quantified the differences between the automated and handwritten records generated from the same 30 patients (2,412 minutes of general anesthesia for elective eye surgical procedures). Considering the design of the study, we claim that the differences between both records were caused by the incompleteness or inaccuracy of the handwritten records, except in two instances. The amounts of missing or erroneous data for these eight physiological variables were expressed as fraction ("error fractions") of the time being recorded, designated EFm and EFe, respectively. For the first five variables the EFm on the handwritten records ranged between 0.23 and 0.31, and the EFe ranged between 0.01 and 0.06. For the last three variables the EFm range was 0.08 to 0.13, and the EFe range was 0.05 to 0.11. Most of these missing or erroneous data occurred during the period of induction (first 15 minutes) and at the end of the case (last 10 minutes). The EFm and EFe during induction had increased to 0.62 and 0.26, respectively, and to 0.76 and 0.06, respectively, at the end of the case. Erroneous data were observed on the automated records for the tidal volume during induction (EFe = 0.0044) and for the oxygen fraction during maintenance (EFe = 0.0024). The effect of averaging by the recordkeeper is discussed. The results of this study indicate the clinical relevance of automated record keeping.

Anesthesia↗
PubMed1988

Early postoperative hypoxia during transport.

The incidence of immediate postoperative hypoxaemia following general anaesthesia was studied using a pulse oximeter in 120 ASA category I and II patients during transport to the recovery room. Thirty-two percent of those not given oxygen during transport developed desaturation (SaO2 less than 90%) in spite of receiving 100% oxygen for 5 min before transport. In 14.3% of patients SaO2 decreased to less than 85%. None of the patients given oxygen 2 litre min-1 via a nasopharyngeal catheter during transport exhibited an SaO2 less than 90%. The only variable which correlated with the development of desaturation was the duration of anaesthesia.

Adult↗
PubMed1987

The clinical use of the Ohmeda Automated Anesthesia Record Keeper integrated in the Modulus II Anesthesia System. A preliminary report.

While performing his complex array of tasks, the anesthesiologist is also responsible for maintaining an anesthetic record. Up to now, this has been done by hand. The clinical use of automated anesthesia record keeping is presently evaluated. The anesthesia records generated by the Ohmeda Automated Anesthesia Record Keeper integrated in the Modulus II Anesthesia System is compared to hand written records. The differences between the two records of identical patients are quantified as erroneous or missing data. With the criteria adapted, we found significant and clinically relevant differences which stress the importance of automated record keeping.

Anesthesiology↗
PubMed1987

Comparison of etomidate and propofol for anaesthesia in microlaryngeal surgery.

Propofol and etomidate were compared as hypnotics in total intravenous anaesthesia for microlaryngeal surgery combined with jet ventilation. Two groups of 15 patients were studied. In group 1, propofol 2.0 mg/kg was used for induction. For maintenance a continuous infusion of 12 mg/kg/hour was used for the first 10 minutes, followed by 9 mg/kg/hour for the next 10 minutes and 6 mg/kg/hour thereafter. In group 2, the induction dose of etomidate was 0.3 mg/kg followed by continuous infusion of 1.8 mg/kg/hour for 10 minutes, 1.5 mg/kg/hour for the next 10 minutes and 1.0 mg/kg/hour thereafter. Alfentanil was given for analgesia and suxamethonium for muscle relaxation. The propofol group showed better surgical conditions, more stable anaesthesia and better recovery according to the Steward score. Recovery times to opening eyes on command were comparable for both groups.

Adult↗
PubMed1987

Anaesthesia for laparoscopy. A comparison of five techniques including propofol, etomidate, thiopentone and isoflurane.

This is a report about five anaesthetic techniques for laparoscopy. Propofol and etomidate were used for total intravenous anaesthesia. Propofol, etomidate and thiopentone were used as induction agents prior to inhalational anaesthesia with isoflurane and nitrous oxide. Fentanyl was used for analgesia. Induction with propofol and thiopentone was rapid. Etomidate induction was characterised by myoclonus. Maintenance was smooth with inhalational anaesthesia. Of the groups that received total intravenous anaesthesia, propofol provided stable anaesthesia but required extra bolus doses. Recovery was the most rapid following total intravenous anaesthesia with propofol. Postoperative side effects were much lower after propofol. No difference was observed between the groups with regard to changes in arterial blood pressure and heart rate.

Adult↗
PubMed1987

Propofol emulsion for induction and maintenance of anaesthesia. A combined technique of general and regional anaesthesia.

To provide general anaesthesia with endotracheal intubation during regional blockades, three dose regimens of propofol emulsion were studied: induction 2 mg kg-1, infusion rate 9 mg kg-1 h-1 (Group 1); induction 2.5 mg kg-1, infusion rate 12 mg kg-1 h-1 (Group 2); induction 2.5 mg kg-1, infusion rate 9 mg kg-1 (Group 3). Each group comprised 10 healthy (ASA class 1 or 2) unpremedicated patients. The induction times measured from the start of injection until counting ceased (+/- 50 s) and until eye-lash reflex disappeared (+/- 80 s) showed no statistical differences between groups. In five patients in Group 1 and one patient in each of Groups 2 and 3 the induction dose was too low for intubation. Pain on injection was seen in 13 cases (mild 6, moderate 6 and severe 1). Cough accompanied by hypersalivation was the most important side-effect. Recovery times varied widely and showed no statistical differences. Answering simple questions was possible after 14 min in Group 1, 23 min in Group 2 and 19 min in Group 3. Apart from a short period of euphoria, recovery was uneventful. There was no tendency to fall asleep again. None of the combinations of induction doses and infusion rates provided good anaesthesia conditions for an acceptable number of patients.

Adult↗