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Biomedical subjects

K B Lai

Publications and source records attributed to K B Lai.

26 records · Page 2Linked to original sources
PubMed1990

[Does flumazenil antagonize the anesthetic effect of ketamine, etomidate or thiopental?].

The effect of flumazenil, a benzodiazepine antagonist, was assessed in a random, double-blind clinical study in which each of the four groups of surgical outpatients comprising 20 in each was given either ketamine 100 mg (K), etomidate 20 mg (E), thiopental 300 mg (T) or flunitrazepam 4 mg (F) for induction of anesthesia. On emergence, patients in each group were randomly given 2cc of either 2 coded solutions, one of which contained 0.2 mg flumazenil and the other of which was normal saline. Following injection of coded solution, all patients were assessed at 0, 5, 15, 30, 60 and 120 min for wakefulness. All 10 patients of group F who received flumazenil were alert and able to recall at 5 min, whereas in group T this was noted from 15 to 30 min. Patients of group E and K responded alike in a manner as of those who received normal saline placebo with onset of wakefulness at 30 and 60 min respectively. These results confirm that flumazenil antagonizes flunitrazepam (within 5 min) and also indicate that the antagonizing effect occurs 30 min following injection for thiopental, suggestive of some cross-reactivity between these two drugs.

Adult↗
PubMed1990

[The effect of epidural anesthesia on tourniquet pain: a comparison of 2% lidocaine and 0.5% bupivacaine].

The incidence of tourniquet pain was evaluated in two groups of patients with 20 each undergoing orthopedic surgery of the lower extremities during epidural anesthesia using plain solution of either 2% lidocaine or 0.5% bupivacaine. The drugs were administered in a randomized fashion. Measurement of the levels of sensory loss to pinprick and incidence of tourniquet pain were made by blind-trust. The maximum analgesia level, time between 1st injection and onset of pain, time between tourniquet inflation and onset of pain were recorded similarly in both groups of patients. The incidence of tourniquet pain was significantly greater in patients given 2% lidocaine (40%) than in patients given 0.5% bupivacaine (10%). The incidence of pain was not related to the time of tourniquet inflation, because patients in the bupivacaine group had a significant longer duration of tourniquet inflation than did patients in the lidocaine group. The incidence of pain was also not related to tachyphylaxis, because 7 of 8 patients who complained tourniquet pain in lidocaine group received less than 3 injections for maintenance of analgesia when tourniquet pain started. In summary, it is apparent that tourniquet pain occurs less frequently when bupivacaine is employed for epidural anesthesia as compared to lidocaine.

Adult↗
PubMed1989

[Anesthetic considerations in complete obstruction of major veins of upper trunk--report of two cases].

This article presents two cases about complete obstruction of major veins of upper trunk. One was a 45 year-old woman who suffered from complete obstruction of superior vena cava due to bronchogenic carcinoma. Venous bypass grafting from left innominate vein to right atrium was performed. The other was a 41 year-old man. Both of his right and left, internal and external jugular veins were completely obstructed after radical laryngectomy and radiotherapy due to hypopharyngeal carcinoma. Venous bypass grafting from cerebral transverse sinus to right atrium was performed. In both cases, general anesthesia with neurosurgical anesthetic concepts were performed with continuous blood pressure monitoring, CVP monitoring, pulse oximetry, end-tidal CO2 monitoring, blood gas analysis, urine output and EKG monitoring. The outcome was satisfactory in both cases.

Adult↗
PubMed1989

[Pulmonary lavage for alveolar proteinosis. A case report].

Pulmonary alveolar proteinosis is characterized by an amorphous lipoproteinaceous material filling the acini of the lung, resulting in hypoxemia. At present, the most effective treatment for alveolar proteinosis is lung lavage. Here, we report the first case in Taiwan treated with this method. A 38-year-old male with a 6-month history of cough and increasing breathlessness was transferred from another hospital. On admission, his arterial oxygen tension was 51 mmHg when breathing room air. Chest X-ray films showed diffuse infiltration of both lung fields. Transbronchoscopic lung biopsy was consistent with alveolar proteinosis, therefore the patient was submitted to pulmonary lavage. Under general anesthesia, the patient was intubated with a left-sided double lumen endotracheal tube, and lavage of the right lung was repeated with 0.9% saline until the washing became clear. At the end of the procedure, the patient was extubated after making strong respiratory efforts. Several days later, the left lung was lavaged using the same technique. The mechanical washing of amorphous material from alveoli by pulmonary lavage is of great benefit in relieving hypoxemia. Judicious use of lung lavage is effective and safe for patient with alveolar proteinosis.

Adult↗
PubMedDate not supplied

Longitudinal study of peritoneal membrane function in continuous ambulatory peritoneal dialysis: relationship with peritonitis and fibrosing factors.

BACKGROUND: The peritoneal equilibration test (PET) is a useful assessment of peritoneal function in continuous ambulatory peritoneal dialysis (CAPD) patients. However, the natural course of longitudinal change in peritoneal transport is not well defined. PATIENTS: We studied 105 unselected CAPD patients. Average age at enrollment was 50.7 +/- 11.3 years. METHODS: A PET was performed at enrollment. Peritoneal transport was expressed as dialysate-to-plasma creatinine ratio at 4 hours (DIP). Fibrosing factors and mesothelial cell markers, including TGFbeta, epidermal growth factor (EGF), platelet-derived growth factor (PDGF), hyaluronan, and cancer antigen 125 (CA125), were measured in overnight peritoneal dialysate effluent (PDE). Patients were followed for two years. Peritonitis episodes were recorded. Severe peritonitis was defined as an episode that required catheter removal or antibiotic therapy for more than 3 weeks. After two years, 75 patients were still alive and on CAPD. RESULTS: The PET was repeated in 64 patients, of whom 35 were male and 9 had diabetes. The change in D/P over two years was represented as AD/P. No significant change in peritoneal transport was seen after two years (D/P: 0.56 +/- 0.12 vs 0.55 +/- 0.13). A centripetal pattern of change in D/P was observed. The deltaD/P had normal distribution and was inversely correlated with D/P at baseline (r = -0.427, p < 0.005). Both results suggest a regression-to-mean phenomenon. The deltaD/P had no significant correlation with the total number of peritonitis episodes (Spearman r = 0.052, p = 0.74), but after severe peritonitis, affected patients had higher deltaD/P than patients who experienced no severe infection (0.040 +/- 0.136 vs -0.032 +/- 0.120, p < 0.05). For patients with no episodes of severe peritonitis (n = 47), deltaD/P was weakly correlated with baseline TGFbeta level (r = -0.506, p < 0.01). No correlation was seen between the levels of other fibrosing factors and change in peritoneal transport. CONCLUSIONS: Our findings suggest that the centripetal change of peritoneal transport probably reflects a regression-to-mean phenomenon. Peritoneal transport increases after severe peritonitis. The role of TGFbeta levels in PDE with regard to longitudinal change in peritoneal transport requires further study.

Adolescent↗