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Biomedical subjects

L Strunin

Publications and source records attributed to L Strunin.

At least 73 records · Page 4Linked to original sources
PubMed1985

Respiratory effects of epidural fentanyl. Changes in end-tidal CO2 and respiratory rate following single doses and continuous infusions of epidural fentanyl.

Respiratory function following single bolus doses as well as continuous infusions of epidural fentanyl were studied in 21 patients. Respiratory rate decreased significantly and end-tidal CO2 showed a non-significant increase following single doses of epidural fentanyl (1.5 micrograms/kg). These changes occurred within minutes of injection, but could not be attributed solely to rapid systemic absorption of fentanyl from the epidural space. Prior administration of parenteral morphine resulted in significantly higher end-tidal CO2 concentrations and lower respiratory rates following epidural fentanyl. Continuous epidural fentanyl infusion (0.5 micrograms/kg/hour) started 60 minutes after the bolus dose had no effect on end-tidal CO2 concentration or respiratory rate for up to 18 hours. Infusions were continued after the study terminated for up to 9 days, during which there was no clinically significant respiratory depression.

Adult↗
PubMed1985

Pre-operative intramuscular ranitidine and cimetidine. Double blind comparative trial, effect on gastric pH and volume.

A controlled trial was carried out on 120 healthy patients presenting for elective surgery. The patients were divided randomly into three groups, which received respectively, 50 mg ranitidine, 100 mg ranitidine, or 300 mg cimetidine intramuscularly at least 45 minutes before operation. Following induction of anaesthesia, a nasogastric tube was passed, the stomach contents aspirated and analysed for volume and pH. Thirteen per cent of cimetidine-treated patients had a gastric pH of 2.5 or less, compared to 8% of those given ranitidine 50 mg and 3% of those given ranitidine 100 mg; however, these differences were not statistically significant. No side effects attributable to the administration of either drug were observed. It is concluded that intramuscular administration of ranitidine or cimetidine is an effective method of reducing the number of patients at risk of acid aspiration during anaesthesia. However, neither drug eliminates the risk of acid aspiration in all patients, and thus careful anaesthetic technique to protect the airway remains essential.

Adolescent↗
PubMed1984

Anesthesia in 1984: how safe is it?

The methods of gathering information to determine the safety of anesthesia and to establish the risk of mortality and morbidity include anecdotal tales, in-hospital audit and peer review, reports to medical protective societies, retrospective studies, reviews of specific problems and prospective studies. All these methods have limitations and, in particular, do not readily differentiate the anesthetic from the surgical contributions. However, it appears that over the past 30 years the risk of death directly attributable to anesthesia has decreased from 1 in 2680 to about 1 in 10 000. The main causes of death are faulty anesthetic techniques due to human error, drug overdose, coexistent disease and failure of immediate postoperative care. Equipment failure, poor preoperative assessment, halothane-associated hepatitis and malignant hyperthermia, although often cited in the literature, are rarely the cause of problems associated with anesthesia.

Anesthesia↗
PubMed1984

Clinical experience with alfentanil for induction of anaesthesia; a comparison with thiopentone.

Alfentanil, a new short-acting narcotic was clinically evaluated as an intravenous anaesthetic induction agent in 19 patients and compared to 20 patients receiving thiopentone. Alfentanil was superior to thiopentone in cardiovascular stability, both during induction of anaesthesia and tracheal intubation. However, alfentanil does not behave like a typical induction agent, time to unconsciousness is longer and more variable and is often accompanied by muscle rigidity. The results of this study suggest that alfentanil is more difficult to use as an induction agent than thiopentone, but alfentanil is recommended for short procedures when haemodynamic stability is important.

Alfentanil↗
PubMed1984

Anaesthetic considerations for microsurgical repair of limbs.

With the advent of surgery under the operating microscope microvascular surgical techniques requiring prolonged anaesthesia have greatly increased in number. Local anaesthetic techniques, whilst often producing excellent surgical conditions, are limited by the duration of action of the anaesthetic agents and by the ability of the patient to remain still, often in uncomfortable positions, for periods of up to twenty hours. The use of indwelling catheters as a means of prolonging the duration of nerve blocks is discussed along with methods of sedation or general anaesthesia to enable the patient to tolerate lengthy surgical intervention. Present general anaesthetic techniques may not be ideally suited to long surgical procedures. The problems and possible alternatives are discussed. Sympathetic ganglion blockade, intravenous regional blockade and systemic vasodilator therapy are discussed as a means of improving the success rate of these procedures. The general principles of patient management such as fluid balance, temperature control, patient positioning and control of the operating room environment assume a much greater significance when related to the provision of prolonged general anaesthesia, whilst the effect of extended periods of work on operating personnel must also be considered.

Anesthesia↗
PubMed1984

Anaesthesia for a patient with Down's syndrome and Eisenmenger's complex.

A patient with Down's syndrome and Eisenmenger's complex presented for orthopaedic surgery on the elbow under general anaesthesia. During pre-oxygenation, in order to prevent a subsequent fall in systemic vascular resistance, metaraminol 1 mg was administered intravenously. The patient immediately developed bradycardia, mild hypertension and became deeply cyanosed. His condition rapidly improved after atropine 0.6 mg was given intravenously. Following induction of anaesthesia with thiopentone and tracheal intubation facilitated by suxamethonium, anaesthesia was maintained by mechanical ventilation of the lungs with nitrous oxide and oxygen (40%) with intravenous increments of fentanyl for analgesia and pancuronium for muscle relaxation; residual neuromuscular blockade was reversed with neostigmine. The patient made an eventful recovery. Although general anaesthesia is tolerated by patients with Eisenmenger's complex, powerful vasoactive drugs should not be administered unless specifically indicated.

Adolescent↗
PubMed1983

Measurement of plasma fentanyl concentration: comparison of three methods.

The measurement of plasma fentanyl concentration by radioimmunoassay (RIA) and gas liquid chromatography (GLC) using either a flame ionization detector (FID) or nitrogen/phosphorus detector (NPD) has been compared. RIA is a satisfactory but expensive method of measuring plasma fentanyl concentration. GLC using an FID is not as satisfactory as RIA, but when an NPD is used the results are equal to those of RIA. In addition, other analgesics which are chemically similar to fentanyl, such as alfentanil, may also be measured by the GLC/NPD combination using the same set of operating conditions. By contrast, an RIA method is usually specific for only one compound, and measurement of additional drugs would almost certainly necessitate the development of new assay kits for each one.

Chromatography, Gas↗