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Biomedical subjects

M I Gold

Publications and source records attributed to M I Gold.

At least 19 recordsLinked to original sources
PubMed1991

Can esmolol manage surgically-induced tachycardia? Bolus esmolol treatment of intra-operative tachycardia due to surgical stimulation.

A double-blind, randomised study was conducted to examine the efficacy of a single bolus dose of esmolol in treating surgically-induced tachycardia. Anaesthetic technique was identical in all patients, and consisted of premedication with midazolam and glycopyrronium, induction with thiopentone followed by suxamethonium, tracheal intubation, and maintenance with isoflurane 0.6% (end-tidal) and 60% nitrous oxide in oxygen. Forty-eight patients developed a heart rate of greater than 95 beats/minute or 20% more than pre-induction values at an average time of 34 minutes after tracheal intubation and received placebo (15 patients), esmolol 50 mg (16 patients), or esmolol 100 mg (17 patients). Controlled intervention was instituted if heart rate or blood pressure was not adequate. Both 50 and 100 mg of esmolol resulted in lower heart rates compared to placebo (p less than 0.05), with no difference between the two esmolol groups (p greater than 0.05). Patients who received placebo had more episodes of medical intervention than those given esmolol (p less than 0.05). No adverse effects occurred in any patient.

Adrenergic beta-Antagonists↗
PubMed1991

Which drug prevents tachycardia and hypertension associated with tracheal intubation: lidocaine, fentanyl, or esmolol?

Eighty patients, ASA physical status II-IV, scheduled for noncardiac surgery, were randomly assigned in a double-blind, placebo-controlled manner to receive a preintubation dose of either placebo, 200 mg lidocaine, 200 micrograms fentanyl, or 150 mg esmolol. Induction of anesthesia was accomplished with 4-6 mg/kg thiopental IV followed immediately by the study drug; 1-1.5 mg/kg succinylcholine was given at minute 1. Laryngoscopy and intubation were performed at minute 2 with anesthesia thereafter maintained with 1 MAC (+/- 10%) isoflurane in 60% nitrous oxide in oxygen at a 5 L/min flow for 10 min. Heart rate was recorded every 15 s and blood pressure every minute from induction until 10 min after intubation. Maximum percent increases in heart rate (mean +/- SE) during and after intubation were similar in the placebo (44% +/- 6%), lidocaine (51% +/- 10%), and fentanyl (37% +/- 5%) groups, but lower in the esmolol (18% +/- 5%) group (P less than 0.05). Maximum systolic blood pressure percent increases were lower in the lidocaine (20% +/- 6%), fentanyl (12% +/- 3%), and esmolol (19% +/- 4%) groups than in the placebo (36% +/- 5%) group (P less than 0.05), but not different from each other (P greater than 0.05). Only esmolol provided consistent and reliable protection against increases in both heart rate and systolic blood pressure accompanying laryngoscopy and intubation.

Adrenergic beta-Antagonists↗
PubMed1989

Comparison of propofol with thiopental and isoflurane for induction and maintenance of general anesthesia.

Propofol, a phenol compound with a short elimination half-life, was compared with thiopental and isoflurane for induction and maintenance of general anesthesia in 60 consenting ASA I, II, and III patients. The study was randomized and open label in design. Hemodynamically, the propofol patients showed a mean +/- SEM decrease in systolic blood pressure in comparison with the thiopental/isoflurane group at 2 (115.1 +/- 4.9 vs. 136.6 +/- 6.0 mmHg), 3 (125.7 +/- 5.1 vs. 149.4 +/- 5.6 mmHg), and 5 min (126.6 +/- 3.8 vs. 144.4 +/- 6.1 mmHg) postinduction and at intubation (135.2 +/- 4.7 vs. 157.8 +/- 6.0 mmHg) (p less than 0.05). The heart rate was lower in the propofol group throughout the induction period (p less than 0.05). Patients who received propofol were ready for discharge from the recovery room sooner (67.9 +/- 4.0 vs. 80.0 +/- 3.6 min) than the thiopental/isoflurane-treated patients (p less than 0.05). Propofol is as safe and effective for induction and maintenance of general anesthesia as thiopental and isoflurane.

Anesthesia Recovery Period↗
PubMed1989

Preoxygenation.

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Anesthesia, General↗
PubMed1989

Use of esmolol during anesthesia to treat tachycardia and hypertension.

We evaluated the clinical effectiveness of esmolol, an ultra-short-acting, cardioselective beta-adrenergic receptor blocker, in controlling sinus tachycardia and increased systolic blood pressure occurring perioperatively in 30 ASA physical status II or III patients having elective, non-cardiac surgery. Esmolol 80 mg I.V. bolus (N = 15) or placebo (N = 15) followed by 12 mg/min or placebo were infused in 30 isoflurane-anesthetized patients using a randomized double-blind study design. The bolus plus infusions were given when surgical stimuli caused heart rate to exceed 95 bpm or systolic blood pressure 140 mm Hg. Esmolol significantly decreased heart rate (107 +/- 4, mean +/- SEM to 99 +/- 4, mean +/- SEM bpm) within 45 sec after starting the bolus plus infusion; the placebo had no effect, heart rate being 105 +/- 4 before and 106 +/- 3 bpm after the bolus plus infusion. Patients given esmolol continued to have heart rates significantly lower than patients given placebo injections throughout a six min infusion (Ex., at 5 min 81 +/- 3 vs 91 +/- 4 bpm). The study demonstrated no apparent effect of esmolol on blood pressure but that esmolol is effective in treating perioperative sinus tachycardia.

Adrenergic beta-Antagonists↗
PubMed1987

A controlled investigation of propofol, thiopentone and methohexitone.

This was a randomized study of 180 ASA physical status I and II patients, 60 in each group who received propofol (PROP), 2.5 mg . kg-1, thiopentone (THIO), 4 mg . kg-1, or methohexitone (METH), 1.5 mg . kg-1. Control values, followed by changes after induction and during a 3-min delay before intubation were recorded for the following parameters: heart rate (HR), systolic and diastolic blood pressures (SBP, DBP), respiratory rate (RR), end-tidal CO2 (PETCO2), and induction time (IT). In addition, the incidence of adverse reactions and time for recovery from anaesthesia were noted. The IT (mean +/- SE) was 35 +/- 1 sec for propofol, 35 +/- 1.2 sec for thiopentone and 34 +/- 1.4 sec for methohexitone. Ninety-three per cent of the PROP group fell asleep with one dose and required no additional doses. Fifty per cent of each of the THIO and METH groups required additional agents (p less than 0.05). METH was associated with the highest elevation in HR, PROP the least (p less than 0.05). PROP was associated with the most decrease in SBP and DBP and in addition respiratory depression (p less than 0.05). The incidence of injection pain or excitatory activity was equal in the three groups with the exception that 14 patients who received METH developed hiccoughs while none did in the other groups. PROP was associated with the most rapid recovery, particularly with respect to the orientation time. We conclude that PROP is an effective alternative to barbiturate induction and that the published recommended doses of THIO and METH are often ineffective.

Adult↗
PubMed1986

Heart rate and blood pressure effects of esmolol after ketamine induction and intubation.

Both ketamine and tracheal intubation are associated with increased heart rate (HR) and systolic blood pressure (SBP). Beta blockers prevent or attenuate this increase. Esmolol (E) is a new, intravenous, rapidly metabolized beta blocker. An open-label study was performed in 41 ASA Class II and III patients divided into groups 1-4: control, 100, 200, and 300 micrograms X kg-1 X min-1 (n = 10, 10, 11, and 10, respectively). E was infused over 10 min, the first one-fourth of which was a loading dose of 500 micrograms X kg-1 X min-1; at 4 min, ketamine was followed by succinylcholine, intubation, and enflurane-N2O-O2. HR, SBP, blood E, and plasma catecholamine levels were obtained during the 40 min of study. The control group had a baseline HR of 83 +/- 5 beats/min while esmolol groups 2-4 had an HR of 73 +/- 3, 72 +/- 3, and 68 +/- 4 beats/min, respectively (P less than 0.05). After ketamine, the control group HR increased to 93 +/- 6 beats/min and groups 2-4 remained at the baseline level, 73 +/- 3, 73 +/- 3 and 67 +/- 4 beats/min, respectively (P less than 0.05). Postintubation, the control increased further to 113 +/- 5 beats/min while groups 2-4 were significantly less, 91 +/- 5, 84 +/- 3, and 78 +/- 4 beats/min, respectively. The mean SBP in most E groups was less than the control within groups, but only in group 4 between groups was the SBP less at postintubation (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗
PubMed1979

Pulmonary mechanics during general anaesthesia. The influence of mechanical irritation on the airway.

The changes in pulmonary resistance (RL) and compliance (CL), following airway irritation and surgical stimulation, were investigated in 19 anaesthetized, paralysed patients. Thirteen were normal, while six had objective evidence of chronic obstructive pulmonary disease (COPD). Broncho-carinal irritation with a suction catheter produced a 27% increase in RL (0.58+/-0.32kPa litre-1 s to 0.74+/-0.40, P less than 0.01) and a 10% decrease in CL (0.87+/-0.19 litre kPa-1 to 0.81+/-0.22, P less than 0.01). These changes were associated with a significant increase in systolic arterial pressure and heart rate during clinical stages of anaesthesia (end-tidal enflurane, 1.3+/-0.4%, PaCO2 5.20+/-0.53 kPa). These changes did not correlate with depth of anaesthesia, but all returned to the pre-irritation value within 5 min. There was no difference in subjects considered normal and those with COPD. Surgical stimulation did not produce significant changes in pulmonary mechanics; however, repeated broncho-carinal irritation during surgery was associated with a transient increase in RL (P less then 0.01).

Adult↗
PubMed1978

Comparison of two methods of postoperative respiratory care.

After abdominal surgery, 64 patients were managed with one of the following two techniques of respiratory care: (1) deep breathing by way of a new device, an incentive spirometric three-ball, flow-measuring device (Triflo); and (2) standard episodic intermittent positive-pressure breathing (IPPB) every four hours. Both series of patients received therapy with a bronchodilator drug by nebulization. All patients had preoperative spirometric measurements followed by five consecutive days of therapy and spirometry. Chest x-ray films were obtained for all patients. There were no significant differences between the two methods of respiratory care, but 57 percent (17/30) in the group receiving therapy with IPPB developed pneumonia, atelectasis, or bronchitis, while only 29 percent (10/34) did so in the group using the incentive spirometric device (P less than 0.05). Spirometric differences were minimal, although the trend favored the incentive spirometric device. Principal conclusions were as follows: (1) deep breathing under the conditions of this investigation was equal to episodic therapy with IPPB; and (2) from an economic standpoint, IPPB, as it is currently practiced, may be disadvantageous when compared with the incentive spirometric device.

Abdomen↗
PubMed1975

The effects of anesthetics on an in-vivo oxygen electrode.

The IBC in-vivo oxygen electrode may be used during anesthesia. The possibility that three common inhalation anesthetics--halothane, enflurane, and methoxyflurane--might be reduced at the electrode, thereby changing the PO2 value, was tested. Enflurane and methoxyflurane do not affect the current produced at the electrode; halothane significantly increases PO2 readings at oxygen tensions below 105 torr. It is suggested that PaO2 readings below 105 torr be confirmed by the standard bench method.

Anesthetics↗
PubMed1975

A disposable in vivo oxygen electrode for the continuous measurement of arterial oxygen tension.

An evaluation of the accuracy, perdision, and clinical safety of the IBC indwellling catheter electrode for the continuous monitoring of arterial oxygen tension during and after general anesthesia was made in a total of 62 patients. A comparison of the standard bench-type electrode (Radiometer) with the International Biophysics Corporation (IBC) electrode for the measurement of oxygen tension in tonometered blood also was performed. Three hundred and fifty comparisons in 51 patients were made of the indwelling electrode with a standard Radiometer unit and, while there was good correlation, there also was ome scatter. An additional small series of 44 comparisons in 11 patients was performed, the primary difference being that the electrode was maintained intr-arterially for approximately 1 day. In both in vivo studies there was excellent correlation but questionable precidion. Four IBC electrodes and eight Radiometer Pao2 electrodes in an additional study were compared at 11 different tonometered oxygen tensions in blood. The IBC electrodes measured oxyygen tension more accurately than did the Radiometer, and standard deviations were consistently smaller at all of 11 different oxygen tensions for the IBC unit. The authors believe that the poor precision within both in vivo studies might be due to the fact that the IBC probe, which was of unknown accuracy and precision, was compared to a standard device (the Radiometer) which in the in vitro investigation proved to be less accurate and less precise. No complications due to the insertion and maintance of this in vivo electrode were encountered. The authors suggest that the IBC method for measuring Pao2 continuously in vivo be considered as an alternative to intermittent gas analysis of oxygen tension.

Anesthesia↗
PubMed1975

Continuous, simultaneous measurement of arterial oxygen tension and arterial blood pressure.

This is an investigation of a technique for simultaneously measuring arterial oxygen tension (PaO2) and blood pressure continuously during and after surgical anesthesia. In 27 patients, a special T attachment was placed on the end of an indwelling arterial catheter so that pressurized dilute heparin could be flushed through continuously while blood pressure was being recorded by means of a transducer-oscilloscope system and PaO2 was being recorded through an indwelling polarograph oxygen tension (PO2) readout device. The electrode was left in the artery for an average of 16 hours; the average PaO2 during mechanical ventilation with the patient breathing 50 per cent oxygen was approximately 200 torr at the beginning of anesthesia; it dropped to 158 torr 6 hours later. The average PaO2 in the recovery room 1 hour postoperatively, with the patient spontaneously breathing approximately 30 per cent oxygen, was 122 torr. No significant complications were encountered during this investigation. We believe this dual technique to be a valuable monitoring tandem in the anesthetized and surgical intensive care patient.

Anesthesia, General↗