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Biomedical subjects

J P Abenstein

Publications and source records attributed to J P Abenstein.

11 recordsLinked to original sources
PubMed1997

The incidence of artery puncture with central venous cannulation using a modified technique for detection and prevention of arterial cannulation.

BACKGROUND: Cannulation of the central circulation is essential for management of patients who require major surgery, and for patients who are critically ill. Arterial puncture is the most frequent complication associated with central venous cannulation, and is potentially fatal. Detection of arterial puncture can be problematic, especially in patients with cyanotic congenital heart disease. METHODS: One thousand eleven consecutive cardiothoracic and vascular surgical patients who required central venous cannulation were studied using a new technique for detection of arterial puncture and prevention of arterial cannulation. This technique involves continuous pressure transduction of the steel introducer needle. Central venous cannulation was attempted in all patients. The sites of attempted catheterizations, number of arterial punctures and cannulations, and the number of successful catheterizations were noted. All patients were treated in accordance with standard anesthetic and surgical techniques in the institution. RESULTS: One thousand one hundred seventy-two central venous catheters were placed. The overall success rate was 99.6%. The incidence of arterial puncture was 9.3% for central venous cannulation attempts of the internal jugular, subclavian, and femoral veins. No arterial cannulation occurred, and none of the patients had significant complications. Congenital heart disease patients had a higher incidence of arterial puncture (14.1%) and a lower rate (96.8%) of successful cannulation. CONCLUSION: Pressure transduction of the steel needle is a useful technique for detecting arterial puncture and preventing arterial cannulation during attempts to achieve central venous cannulation.

Adolescent↗
PubMed1993

Comparison of axillary artery or brachial artery pressure with aortic pressure after cardiopulmonary bypass using a long radial artery catheter.

Arterial pressure measured in a peripheral artery may significantly underestimate central arterial pressure after discontinuation of cardiopulmonary bypass (CPB). Arterial pressure measured with a 50 cm radial artery catheter advanced into the brachial or axillary artery was compared to ascending aortic pressure in 31 patients before and after discontinuation of CPB. The radial artery catheter extended proximally into the brachial artery in 8/31 patients, and into the axillary artery in 23/31 patients. The patient's age, pre-CPB cardiac ejection fraction, and surgical procedures were similar in both groups. The systolic arterial pressure measured in the ascending aorta was found to be significantly different from that in the axillary artery after CPB, whereas the mean and diastolic pressures were not. The average aorta-to-axillary artery systolic pressure gradient was -3.0 +/- 4.0 mmHg, with no patient having a gradient greater than 10 mmHg. The systolic and mean arterial pressures measured in the ascending aorta were found to be significantly different from that in the brachial artery after discontinuation of CPB, whereas the diastolic pressure was not. The average aorta-to-brachial artery systolic pressure gradient was 6.9 +/- 6.9 mmHg, with 3/8 patients having a gradient greater than 10 mmHg. Long radial artery catheters, placed using the Seldinger technique, provide an accurate estimate of central aortic pressure after CPB when they are advanced into the axillary artery. Sites more distal than the axillary artery may result in significant underestimation of the central aortic pressure in these patients.

Aged↗
PubMed1992

Eight year's experience with automated anesthesia record keeping: lessons learned--new directions taken.

For the past eight years, an automated anesthesia record keeping system, COMANDAS (COMputerized ANesthesia Data Acquisition System) has been used in the cardiovascular operating rooms at Mayo Clinic. The automated anesthesia record is designed to match the traditional hand-written record and becomes part of the official medical record. COMANDAS is interfaced with the physiologic monitor and mass spectrometer in each OR, and a number of other computers within the Mayo Medical Center. Since the introduction of COMANDAS over 24,000 surgical procedures have been charted. The anesthesia record is more complete, consistent in organization, and legible when compared to a hand-written record. Recently, it was determined that the computers and peripherals that make up COMANDAS were wearing out and that the vendors would no longer support or replace the equipment. A process to find a replacement for COMANDAS was then begun. Although the cardiovascular anesthesia group was satisfied with the automated anesthesia record, there were a number of areas in which improvement was desired. A systematic evaluation of the system was begun with a survey of the users. The majority of those surveyed felt that COMANDAS was a useful system which made parts of their job easier. The user interface, method of manual data entry, time to produce the record and difficulty learning the system were the source of the greatest dissatisfaction. Artifacts, networking, interfacing with other devices and computers were also issues for the replacement system. Most commercial systems were found wanting in one or more areas of significance. The most practical solution appeared to be the modification of a currently available intensive care unit patient data management system.

Anesthesiology↗
PubMed1991

An evaluation of an automated anesthesia record keeping system.

Mayo Clinic makes use of an automated anesthesia record keeping system in its cardiovascular operating rooms. Over 20,000 anesthesia records have been recorded with this system since its installation in 1983. How successful is this system? Does it meet the needs of the anesthesiologist? What are their attitudes towards the computer? A questionnaire survey was conducted to solicit the experiences, opinions, and recommendations of the users of this system. The results are described in this paper. The feedback will be used to determine the tasks and their priority for improving the current system, and to define the requirements for future computerization to meet the needs of the anesthesiologist in the operating room.

Anesthesiology↗
PubMed1989

Effectiveness of triazolam, diazepam, and placebo as preanesthetic medications.

Eighty-three ASA Physical Status 1-2 patients were orally premedicated with triazolam (0.125, 0.25, or 0.5 mg), diazepam (5, 10, or 15 mg), or placebo to evaluate the effectiveness of these drugs and doses in reducing preoperative anxiety, providing sedation, and producing amnesia. The drug treatments were administered in a randomized, double-blind manner. The results obtained with each drug (dose) group were compared against those of the placebo group as a control. Changes in anxiety at 60 min after drug administration were evaluated: 1) by a trained anesthesia nurse clinician using an analog scale, 2) by the patient using the same analog scale, and 3) by the patient with the Multiple Affect Adjective Check List (MAACL). Changes in sedation at 60 min were also evaluated by the patient and nurse clinician using an analog scale. Amnesia was assessed by postoperative recall of picture cards shown to the patient 1 h after receiving preanesthetic medication. There were no significant differences between any drug (dose) and placebo for changes in patient-evaluated anxiety or sedation on the analog scale. With the other measures of anxiety, only triazolam (0.5 mg) reduced anxiety more than did placebo on both the patient (MAACL) and the nurse (analog) scales. With the nurse (analog) measure of sedation, only the highest doses of triazolam and diazepam were more sedating than placebo. Triazolam (0.5 mg) was the only drug dose that produced significant amnesia. The authors conclude that drug effects on anxiety, sedation, or amnesia that are statistically significant versus placebo effect are seen at only the highest doses of triazolam (0.5 mg) and diazepam (15 mg).

Adult↗