Biomedical subjects
J Matjasko
Publications and source records attributed to J Matjasko.
Enhancement of bupivacaine cardiotoxicity with cardiac glycosides and beta-adrenergic blockers: a case report.
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Preparation of xenon-133 in a lipid emulsion for tissue perfusion studies.
A simple, inexpensive technique for concentrating xenon-133 in a medium suitable for intravenous use is reported. The method uses a 20% lipid emulsion, standard syringes, an oscillating motor, and xenon-133, which is available commercially. Typically, 43% of the xenon-133 combines with the lipid emulsion and remains stable for more than 24 hours in vitro.
Quantitative monitoring of brain function, vital signs, and hormonal response during acute insulin-induced hypoglycemia.
Acute insulin-induced hypoglycemia provokes changes in central nervous system activity and release of counterregulatory hormones. The clinical relationship between central nervous system activity, hormone secretion, and vital signs has not to our knowledge been previously reported. We used computerized electroencephalographic (CEEG) analysis to monitor 5 nondiabetic subjects during acute insulin-induced hypoglycemia (0.75 U/kg intravenous push). Their glucose nadir was 38 +/- 6 mg/dl (mean +/- 1 SD). A three-phase pattern of change in CEEG power in response to hypoglycemia was observed: phase 1 was characterized by an increase in total CEEG power (natural log of activity = 9.1 +/- 1.3 microV2) over baseline (8.7 +/- 1.2 microV2) in the theta, delta, and beta frequency bands. This phase preceded and coincided with the glucose nadir. During phase 2, power in all frequency bands fell significantly below baseline. A nadir in CEEG power (8.0 +/- 1.6 microV2) occurred 40 to 55 minutes after insulin injection as glucose levels were rising. During phase 3 there was a return to baseline in CEEG power and frequency spectra. Heart rate increase just before phase 1; peak heart rate (91 +/- 8 beats/min) coincided with peak CEEG power and was significantly higher than basal rate (71 +/- 11, P less than 0.05). A significant increase in respiratory rate occurred during phase 1 of the CEEG and persisted through phase 2. A significant decrease in mean blood pressure (nadir = 73 +/- 6 mm Hg) below preinsulin blood pressure (81 +/- 8 mm Hg, P less than 0.05) coincided with the nadir of CEEG power in phase 2.(ABSTRACT TRUNCATED AT 250 WORDS)
Successful surgical and anesthetic management of vein of Galen aneurysm in a neonate in congestive heart failure.
A 12-day-old infant in intractable cardiac failure due to a vein of Galen malformation was treated successfully with serial ligation of the majority of the vessels feeding the malformation. Despite some residual vascular supply to the malformation, the congestive heart failure has disappeared and growth and development have been normal over a 3-year follow-up period.
Economic impact of low-flow anesthesia.
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Nonrebreathing valve competence.
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Sources of nitrogen in the anesthesia circuit.
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Sensitivity of end-tidal nitrogen in venous air embolism detection in dogs.
Embolized nitrogen appears in alveolar gas during clinical and experimental venous air embolism (VAE). Since early detection of VAE is believed to reduce morbidity and mortality, this study was done to compare the sensitivity of end-tidal nitrogen (ETN2) monitoring with other detection methods in current clinical use--precordial Doppler (PD), end-tidal CO2 (ETCO2), and pulmonary artery pressure (PAP). Ten mongrel dogs (10-17 kg) were anesthetized, placed in the supine position, immobilized, and ventilated (FIO2 1.0; PaCO2 35-40 mmHg). Anesthesia and muscle relaxation were maintained with constant infusions of thiamylal and pancuronium. Maintenance fluids were administered at 5 ml X kg-1 X h-1. Mean arterial pressure (MAP), PAP, and ETN2 and ETCO2 (Medspec II mass spectrometer) were displayed on a strip chart recorder. The dogs were divided into two equal groups and given either a step-wise sequence of 1-min air infusions (0.1-1.5 ml X kg-1 X min-1) or 5-s bolus air injections (0.25-1.0 ml X kg-1). Changes in PD sounds occurred in all animals at all air doses. Changes in cardiovascular variables and PaO2 were minimal. The threshold dose for ETCO2 and ETN2 to reach significance was 0.1 and 0.25 ml X kg-1, respectively, while PAP increases were significant at greater than 0.5 ml X kg-1 air doses. The time to maximum change (delta max) ETN2 was 30-90 s earlier than delta max ETCO2 (P less than 0.05) and 6-105 s earlier than delta max PAP. The delta max for all variables was dose related and statistically significant except for the smallest infusion VAE, where only ETCO2 was significantly changed.(ABSTRACT TRUNCATED AT 250 WORDS)
Anesthesia and surgery in the seated position: analysis of 554 cases.
Because controversy exists regarding continued use of the seated position for neurosurgical procedures, this prospective (1981-1983) and retrospective (1972-1981) analysis of 554 seated patients was done to establish the incidence and severity of venous air embolism (VAE) related to type of surgical procedure and anesthetic technique; to examine the impact of specific monitoring practices on detection, morbidity, and mortality; and to establish the incidence of other complications related to the seated position (hypotension, quadriplegia, and arterial air embolism (AAE)). The overall morbidity and mortality related to the seated position was 1% (2 VAE, 1 AAE, 2 hypotension, 1 myocardial infarction) and 0.9% (1 VAE, 1 AAE, 2 hypotension, 1 quadriplegia), respectively. There has been no mortality since 1975. N2O did not seem to increase the incidence or severity of VAE. The seated position is safe in experienced hands if appropriate surgical and anesthetic skills are exercised in patient selection and management. Caution is advised in patients with atherosclerotic cardiovascular disease, severe hypertension, cervical stenosis, and right to left intracardiac shunts.