Search PubMed⌕ Search

Biomedical subjects

M M Juneja

Publications and source records attributed to M M Juneja.

At least 19 recordsLinked to original sources
PubMed1993

Aortocaval compression in the sitting and lateral decubitus positions during extradural catheter placement in the parturient.

We prospectively studied the incidence of concealed aortocaval compression in parturients at term during identification of the extradural space. Forty ASA I or II parturients, at term and in active labour, who requested extradural analgesia were randomly allocated to one of two groups. Parturients in the first group (n = 22) were positioned in the left lateral decubitus position and those in the second group (n = 18) were in the sitting position. Cardiac output (CO) was recorded at one-minute intervals for five minutes before extradural catheter placement (supine position with a 15 degrees wedge under the right side), and during and thereafter for five minutes (in the supine wedged position), using the BoMED NCCOM3-R7 thoracic electrical bioimpedance (TEB) monitor. The average of five COTEB recordings before positioning the patient were compared with the average of five COTEB measurements during and after extradural space identification. A change of > 25% COTEB was considered beyond machine variability. Upper limb arterial pressure was recorded at one-minute intervals. In the left lateral decubitus position, 17 of 22 patients demonstrated a > 25% reduction in COTEB compared with five of 18 patients in the sitting position (chi 2, P < 0.01). The percentage change in COTEB in the lateral decubitus position (-29.8%, 95% CI -17% to -44%) was greater than the sitting position (-9.8%, 95% CI +36% to -32%) (P < 0.01). A decreased incidence of aortocaval compression during identification of the extradural space was demonstrated in the sitting position when compared with the left lateral decubitus position.

Adult↗
PubMed1993

Beneficial effect of epidural anesthesia on oxygen consumption in a parturient with adult respiratory distress syndrome.

Multifactorial increases in oxygen consumption during labor may exceed available oxygen supply. Cumulative subclinical oxygen debt could be clinically detrimental to both patient and fetus. We have reported the use of continuous mixed venous oxygen saturation monitoring to identify changes in oxygen consumption after painful uterine contractions in a critically ill parturient. We used continuous venous saturation monitoring to document the effects of epidural analgesia on oxygen balance in our patient. The absence of venous desaturation with contractions after abatement of labor pains confirmed that pain was the major cause of increased oxygen consumption in this critically ill parturient. Broader use of mixed venous saturation monitoring may allow detection of oxygen deficits during labor and direct appropriate therapy in other critically ill parturients. Similar applications and results have been noted for other disease states in nonpregnant patients.

Adult↗
PubMed1991

The management of oral mexiletine and intravenous lidocaine to treat chronic painful symmetrical distal diabetic neuropathy.

Intravenous local anesthestics administered to patients with chronic pain have been shown to provide significant levels of systemic analgesia. Furthermore, oral mexiletine which is similar in structure has been demonstrated to be efficacious in the treatment of diabetic neuropathy. It is recommended that this combined form of treatment be considered with those patients whose diabetic neuropathy is resistant to more conventional forms of treatment.

Chronic Disease↗
PubMed1991

Prevention of accidental injection of drugs in epidural tubing.

Numerous drugs have been injected into the epidural space unintentionally and different methods of prevention have been reported. This article describes the use of a needle cap as an available cost-effective alternative to prevent this mishap.

Anesthesia, Epidural↗
PubMed1991

Epidural morphine pruritus reduction with hydroxyzine in parturients.

A majority of patients experience pruritus, nausea and/or emesis following epidural morphine administration post-cesarean section. Naloxone or diphenhydramine are commonly used to treat these side effects. Prevention or reduction in the incidence of side effects of epidural morphine is a clinical goal. The purpose of the study was to observe the efficacy of prophylactic administration of hydroxyzine on the incidence and severity of pruritus following the epidural administration of morphine in 40 patients who requested epidural morphine for postoperative pain relief. Group I (n = 20) received saline, while Group II (n = 20) received 50 mg of hydroxyzine ten minutes after the administration of 5 mg epidural morphine. Both solutions were administered by deep intramuscular injection in the thigh area. The results of this investigation demonstrated that hydroxyzine was efficacious in attenuating the incidence of severe pruritus.

Adult↗
PubMed1990

Effect of position on the spread of buffered 2% chloroprocaine administered epidurally for the second stage of labor.

Increasing the pH of epidurally administered local anesthetics hastens their onset of action and improves the quality of neural blockade. The effect of body position on the epidural spread of alkalinized 2% chloroprocaine HCl for the second stage of labor has not been reported. We studied the epidural cephalad and caudad spread of 2% chloroprocaine buffered with sodium bicarbonate administered epidurally at the beginning of the second stage of labor. We randomly assigned 30 patients to one of two groups, each consisting of 15 patients. Group 1 received an epidural redose in the upright position, and the patients in group 2 received a redose in the supine position. There were no differences with respect to the sacral or cephalad spread. From the results of this study, we conclude that patients may receive epidurally administered 2% chloroprocaine late during the first stage of labor while in a supine position.

Adult↗
PubMed1990

Maternal paraparesis after epidural anesthesia and cesarean section.

Continuous epidural infusion of local anesthetics containing epinephrine has become increasingly popular. This technique has been associated with few, if any, complications. We have presented a case of anterior spinal artery syndrome with paraparesis after continuous lumbar epidural infusion of an anesthetic during labor and subsequent emergency cesarean section.

Adult↗
PubMed1989

A comparison of the incidence of pruritus following epidural opioid administration in the parturient.

Epidural morphine is associated with a high incidence of pruritus when used for pain control in the post-Caesarean section population. The purpose of this study was to compare the incidence of pruritus associated with epidural morphine, fentanyl, buprenorphine and butorphanol. Sixty healthy Caesarean section patients were studied in a double-blind randomized fashion. Patients were questioned at 1, 3, 12 and 24 hours postpartum for the incidence of pruritus. This study demonstrated that the incidence of pruritus was significantly higher following the use of epidural morphine and fentanyl. Even though epidural butorphanol and buprenorphine exhibited a low incidence of pruritus, their duration of analgesia was not long enough to make either attractive for single-dose administration.

Adult↗
PubMed1989

The effect of pH-adjusted 2-chloroprocaine on the onset of epidural analgesia in pregnant patients in the lying and sitting position during the first stage of labor.

The purpose of this prospective, randomized, double-blind study was to compare the epidural onset time of 2% 2-chloroprocaine with pH-adjusted 2-chloroprocaine administered in either the sitting or supine position in pregnant patients during the first stage of labor. Patients in Groups I and III received the control solution in the sitting and supine position, respectively. Patients in Groups II and IV received the buffered solution in the sitting and supine position, respectively. The pH and pCO2 of the control and buffered solutions differed significantly. The pH and pCO2 of the control and buffered solutions were 4.38 +/- 0.01, 18.4 +/- 2.2 mm Hg and 7.70 +/- 0.04, 114.9 +/- 3.0 mmHg, respectively. A statistically significant reduction in the time of onset of analgesia in the pH-adjusted groups was noted. Groups I and II had onset times of 4 +/- 1.2 and 4.3 +/- 1.0, whereas Groups II and IV had onset times of 2.6 +/- 0.9 and 2.7 +/- 0.6 min., respectively. There were no intergroup differences in the cephalad spread of analgesia or duration of analgesia. Position had no effect on the onset of analgesia at the S2-3 dermatomes nor on the bilateral cephalad spread of the epidural study solutions. Our results indicate that a pregnant patient may be dosed in the lateral supine position without adversely affecting the caudad or cephalad spread of plain or pH-adjusted 2% 2-chloroprocaine, which is clinically important because the incidence of aortocaval compression is increased in the supine position when compared with the lateral supine position.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

The effect of pH and PCO2 on epidural analgesia with 2% 2-chloroprocaine.

Increasing the pH of local anesthetics with sodium bicarbonate has been reported to hasten their onset of action. The purpose of this study was to compare the onset and duration of epidural analgesia with the use of sodium bicarbonate and tromethamine to increase the pH of 2% chloroprocaine (2CP). Five groups of patients were studied: Group I received 2CP; Group II received 2CP buffered to a pH of 7.1 with tromethamine; Group III received 2CP buffered to a pH of 7.1 with sodium bicarbonate; Group IV received 2CP buffered to a pH of 7.7 with tromethamine; and Group V received 2CP buffered to a pH of 7.7 with sodium bicarbonate. The final pH and PCO2 of each solution were measured. Time to onset of analgesia was significantly delayed with either of the tromethamine buffered groups (II [5.6 +/- 1.0 minutes] and IV [5.4 +/- 0.4 minutes]) when compared with data from the unbuffered control (I [4.4 +/- 0.1 minutes]) and the sodium bicarbonate buffered (III [4.5 +/- 0.8 minutes] groups and Group V [2.7 +/- 0.9 minutes]). Only when sodium bicarbonate buffer adjusted to pH 7.7 (Group IV) was onset significantly more rapid than the unbuffered 2CP (I) and tromethamine buffered 2CP (II and IV). Multiple regression analysis revealed that onset times were significantly related to both pH and PCO2. The coefficient of determination for this model was 0.5156.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗