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Biomedical subjects

M Naguib

Publications and source records attributed to M Naguib.

At least 91 records · Page 5Linked to original sources
PubMed1990

Cardiopulmonary resuscitation skills of medical professionals.

This study examined the theoretical knowledge and practical skills of different medical profession personnel and medical students in Basic Cardiac Life Support (BCLS). Two hundred twenty-four candidates who attended a BCLS course were tested in their theoretical knowledge of BCLS with 15 multiple choice questions (MCQs) as a pre-test. The same questions were included in the post-test but with a different sequence. We also evaluated each candidate during performance of single-rescuer CPR on a recording manikin, using a checklist and the recording strip from the manikin for evaluation of CPR steps and manikin performance respectively. Anesthesiologists and cardiologists demonstrated the best performance in the theoretical knowledge test followed by GPs and paramedics. In contrast, physicians, surgeons, pediatricians and medical students had comparable scores. No candidate performed all CPR steps correctly in the proper sequence. In addition, the manikin performance of all groups was poor. Nevertheless, the course significantly improved the theoretical knowledge (P less than 0.0001) and performance in both CPR steps (P less than 0.0005) and manikin performance (P less than 0.0005). The multivariate discriminant analysis identified that experience and prior CPR training influenced significantly (P less than 0.001) the degree of retention of theoretical knowledge only, but not the actual performance of basic resuscitation. It is concluded that no assumption based on previous clinical knowledge should be made for the expected CPR performance of all doctors, regardless of speciality. Formal training programs in medical schools should be considered. Our data also indicate that training is the only objective way to improve performance of all the candidates including the medical students.

Allied Health Personnel↗
PubMed1989

Atropine-neostigmine mixture: a dose-response study.

The dose-response relationship and the doses of atropine required to prevent neostigmine from lowering heart rates below baseline in 50 per cent (ED50) and 95 percent (ED95) of patients after antagonism of pancuronium-induced neuromuscular blockade were determined in 70 patients with neostigmine-atropine mixtures. Neostigmine 0.04 mg.kg-1 (group A, n = 35) or 0.06 mg.kg-1 (group B, n = 35) was randomly mixed with one of seven doses of atropine (ranging from 0.014 to 0.04 mg.kg-1) in group A and from 0.02 to 0.04 mg.kg-1 in group B), with dose-response curves for atropine being constructed for both groups 5 and 10 min after injection of the mixture. These dose-response curves were found to be parallel in both groups. The calculated ED50 and ED95 values of atropine were similar in both groups. The estimated ED50 doses of atropine in groups A and B at 5 min were 0.031 and 0.033 mg.kg-1 respectively, and at 10 min the ED50 doses were 0.037 and 0.037 mg.kg-1 respectively. The calculated ED95 doses of atropine in groups A and B at 5 min were 0.05 and 0.046 mg.kg-1, and at 10 min the ED95 doses were also similar, being 0.06 and 0.055 mg.kg-1 respectively. Under the conditions employed in this study it would seem that in order to prevent late reductions in heart rates, the appropriate doses of atropine when used with neostigmine should be greater than that commonly used.

Adult↗
PubMed1989

Train-of-four ratio after antagonism of atracurium with edrophonium: influence of different priming doses of edrophonium.

This study was designed to investigate the effect of different priming doses of edrophonium on the relationship between the the recovery of the first twitch of the train-of-four (T1) and train-of-four (TOF) ratio. This relationship was studied after the administration of the full dose of the antagonist in all groups. Edrophonium 1.0 mg.kg-1 was administered either in a single bolus dose (Group I, controls) or in an initial dose of 0.05, 0.1, 0.15 or 0.2 mg.kg-1 followed one minute later by the remainder of the 1.0 mg.kg-1 dose in Groups II to V. Reversal was attempted at the ten per cent spontaneous recovery of twitch height (T1) from atracurium-induced neuromuscular blockade. Of all the groups studied, Group V had a significantly greater recovery in the TOF ratio at any given T1 value. When first twitch tension (T1) had recovered to 100 per cent of the control, it was found for the same tension that the TOF ratio was greater in Group V, being 0.75 compared to 0.63, 0.65, 0.65 and 0.64 in Groups I to IV respectively. The implication is that this differential ability to reverse fade (or prejunctional activity) may be involved in the acceleration of recovery.

Adult↗
PubMed1988

Priming with anti-cholinesterases--the effect of different combinations of anti-cholinesterases and different priming intervals.

This study was designed to investigate the effect of different combinations of neostigmine and edrophonium when administered in divided doses and the effect of different intervals (priming intervals) between the doses. Seventy-two patients divided into 12 groups (n = 6 in each) were included in the study. An initial dose of neostigmine 0.012 mg.kg-1 or edrophonium 0.2 mg.kg-1 was administered, followed at different priming intervals (1, 2 or 3 min) by either edrophonium 0.8 mg.kg-1 or neostigmine 0.048 mg.kg-1 for antagonism of atracurium-induced neuromuscular blockade. Reversal was attempted at 10 per cent spontaneous recovery of twitch height. Adequate reversal of neuromuscular block (train-of-four ratio of 0.75) was achieved in all patients. Significant (p less than 0.05) acceleration of the recovery index (time taken for the twitch height to recover from 25 to 75 per cent of control) and reversal time (time taken from the end of injection of the priming dose until TOF ratio value had reached 0.75) was obtained in groups which received edrophonium-edrophonium combination. Recovery indices and reversal times were found to be significantly shorter (p less than 0.05) with a 1 min priming interval. In two additional groups of patients premedicated and anaesthetized as the others equipotent mixtures of the antagonists were administered as a single bolus dose. Reversal times were significantly longer (p less than 0.05) when compared to those given the same amounts of the combination but in divided doses with a 1 min priming interval.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Priming with anti-cholinesterases--the effect of different priming doses of edrophonium.

The effect of different priming doses of edrophonium were studied in 77 patients divided into seven groups (n = 11 in each). Edrophonium 1.0 mg.kg-1 was administered either in a single bolus dose (Group I; controls) or in an initial dose of 0.05, 0.1, 0.15, 0.2, 0.25 or 0.3 mg.kg-1 followed one minute later by the remainder of the 1.0 mg.kg-1 dose in Groups II to VII respectively. Reversal was attempted at ten per cent spontaneous recovery of twitch height (T1) from atracurium-induced neuromuscular blockade. Increasing the size of the priming dose from 0.05 to 0.2 mg.kg-1 resulted in a stepwise increase (p less than 0.05) in recovery of T1 and train-of-four (TOF) ratio. Higher priming doses (0.25 and 0.3 mg.kg-1) were not associated with further improvement in T1 and TOF recovery. Reversal time, that is the time taken from the first injection of edrophonium until the TOF ratio value had reached 0.75 was significantly faster (p less than 0.01) following priming with edrophonium 0.2 mg.kg-1 (Group V) when compared to Groups I, II, III, IV and VI. Reversal times were also significantly faster in Groups IV and VI when compared to the control group. It is concluded that 0.2 mg.kg-1 appears to be the optimal priming dose for administration of edrophonium in divided doses.

Adult↗
PubMed1988

Pharmacokinetic profile of epidural meperidine with and without dextran 70.

To evaluate the effect of dextran 70 on the kinetics of epidural meperidine, 10 female patients anesthetized with nitrous oxide and halothane were studied. Meperidine, 1 mg.kg-1, was administered epidurally in either 10 ml dextran 70 in saline solution (group I) or 10 ml saline solution (group II, control subjects). Plasma concentration of meperidine was determined for 10 hours after its administration with GC. Meperidine plasma concentration-time curves could be best resolved into three exponential terms with a lag time in both groups of patients. The disposition kinetics were described adequately by a three-compartment model. This study demonstrated that apart from a significantly longer lag time and smaller k10 (apparent first-order rate constant for elimination of meperidine from the central compartment), the addition of dextran did not alter significantly the kinetic parameters of epidural meperidine.

Adult↗
PubMed1988

The response of a patient with von Recklinghausen's disease to succinylcholine and atracurium.

The anesthetic management of a 17-year-old female with von Recklinghausen's disease (multiple neurofibromatosis) is described. Multiple neurofibromatosis is a rare syndrome characterized by abnormal cutaneous pigmentation and numerous skin tumors. In addition to the usual stigmata of the syndrome, patients with neurofibromatosis have been reported to be either sensitive or resistant to succinylcholine. Further, all reports indicate that response to nondepolarizing muscle relaxants is exaggerated. In this patient, the nerve conduction studies were within limit of normal values. During surgery, neuromuscular function was monitored throughout using the train-of-four mechanical twitch response. The response of this patient to succinylcholine was normal and the response to atracurium was slightly prolonged. It is concluded that atracurium offers advantages over the other nondepolarizing muscle relaxants in patients with von Recklinghausen's disease.

Adolescent↗
PubMed1988

Failure of lidocaine to modify suxamethonium induced biochemical changes.

Twenty patients were studied in a prospective double-blind randomized trial to determine the effects of intravenous lidocaine pretreatment on suxamethonium induced biochemical changes. Lidocaine 1 mg. kg-1 failed to attenuate changes in serum potassium, significantly decreased serum calcium, and prolonged duration of suxamethonium blockade. There were no significant changes in plasmacholinesterase activity or other biochemical parameters. It is concluded that pretreatment with 1 mg. kg-1 lidocaine failed to attenuate suxamethonium induced biochemical changes.

Adult↗
PubMed1988

Atropine-edrophonium mixture: a dose-response study.

The dose-response and the doses required to prevent bradycardia in 50% (ED50) and 95% (ED95) of patients were determined for atropine after antagonism of pancuronium-induced neuromuscular blockade in 72 patients with edrophonium-atropine mixtures. Edrophonium 0.67 mg/kg (group A, n = 37) or 1.0 mg/kg (group B, n = 35) was randomly mixed with one of seven doses of atropine (ranging from 0.0125 to 0.0215 mg/kg in group A and from 0.02 to 0.04 mg/kg in group B); with dose-response curves for atropine being constructed for both groups 5 and 10 minutes after the injection of the mixture. These dose-response curves were found to be parallel in both groups. The calculated ED50 values of atropine were 1.6-2 times greater in group B, compared with those in group A. The estimated ED50 doses of atropine in groups A and B at 5 minutes were 0.018 and 0.029 mg/kg, respectively, and at 10 minutes, the ED50 doses were similar, being 0.016 and 0.032 mg/kg, respectively. The calculated ED95 doses of atropine in groups A and B at 5 minutes were 0.024 and 0.055 mg/kg, and at 10 minutes, the ED95 doses were also similar, being 0.027 and 0.05 mg/kg, respectively.

Adult↗
PubMed1987

Multiple electrocardiographic anomalies during anaesthesia in an athlete.

A 22-year-old athlete was scheduled for a minor surgical procedure under general anaesthesia. During anaesthesia, his electrocardiogram demonstrated multiple episodes of dysrhythmias including complete bundle branch block, atrioventricular (AV) block, isorhythmic atrioventricular dissociation with junctional rhythm. Administration of atropine 1.0 mg IV terminated the last episode of dysrhythmias. Postoperatively, a resting 12-lead electrocardiogram showed first degree AV block, ST-segment elevation and prominent U waves. A 24 hour Holter recording demonstrated first degree atrioventricular block, episodes of marked sinus arrhythmias and one episode of sinus tachycardia at a rate of 152 beats X min-1. Treadmill stress testing revealed peak achieved heart rate of 200 beats X min-1 without ischaemia. These findings collectively indicated athletic heart syndrome. Implications of athletic heart syndrome for the anaesthetist are reviewed and discussed.

Adult↗
PubMed1987

Cannulation of the radial and dorsalis pedis arteries.

The complications inherent in cannulation of the radial (group I) and dorsalis pedis (group II) arteries were studied in 46 patients. All the local and systemic variables which might be considered to contribute to damage of the artery were studied, from which it appeared that only the duration of cannulation, prothrombin time and partial thromboplastin time were significant in determining post-cannulation blood flow. A 20-gauge Teflon cannula was used in all patients and velocity of flow measured with a Doppler velocimeter probe. A majority of arteries showed a reduction of flow velocity for 24-72 h after the removal of the cannula, with evidence of improvement at 120 h. In six arteries--three in each group--flow ceased altogether after 24-72 h. No disability of either hand or foot resulted.

Adult↗
PubMed1987

Effect of pre-treatment with lysine acetyl salicylate on suxamethonium-induced myalgia.

The hypothesis that prostaglandin inhibitors might reduce the incidence and severity of suxamethonium-induced myalgia was investigated using lysine acetyl salicylate (LAS) 13 mg kg-1 i.v. 3 min before the administration of suxamethonium in 20 patients. A comparison was made with atracurium 0.09 mg kg-1 (and placebo) in a double-blind prospective randomized trial. LAS and atracurium were effective in reducing the incidence and severity of postsuxamethonium myalgia and the increases in serum potassium concentration. There were no appreciable changes in serum calcium, sodium, chloride, phosphate, magnesium, creatinine, creatine phosphokinase concentrations or plasmacholinesterase activity. Atracurium caused a delay in the onset of action and a decrease in the intensity of suxamethonium-induced neuromuscular block. It is concluded that LAS pretreatment might have a place in suitable patients in the prevention of suxamethonium-induced myalgia and increases in serum potassium concentration.

Adult↗
PubMed1987

Genetic markers in late paraphrenia: a study of HLA antigens.

Patients with late paraphrenia were typed for HLA-A, -B and -C. Increased frequencies of BW55 (P = 0.036), B37 (P = 0.008) and CW6 (P = 0.056) were found relative to controls. Unlike findings in paranoid schizophrenia, there was no HLA-A9 association, suggesting that paraphrenics may be genetically distinct from schizophrenics. The primary association seems to be with B37, which has the lowest corrected P value and highest relative risk; if this were replicated, it would make possession of this antigen a strong risk factor for developing the disorder.

Aged↗
PubMed1987

The pattern of train-of-four fade after atracurium: influence of different priming doses.

This study was designed to investigate the effect of three different priming doses of atracurium--0.06, 0.07, and 0.08 mg/kg--followed 3 min later by the remainder of a 0.5 mg/kg dose on the relationship between the depression in the first twitch of the train-of-four (T1) and train-of-four (TOF) fade. This relationship was studied after the administration of the full dose of the relaxant in all groups. Of all the priming doses, 0.08 mg/kg atracurium, when followed 3 min later by 0.42 mg/kg atracurium, had a significantly greater fade in the TOF ratio at any given T1 value. This may indicate significant prejunctional activity. Acceleration of the onset of neuromuscular blockade was, however, evident in all groups that received atracurium in divided doses. The implication is, therefore, that prejunctional activity may not contribute significantly to the acceleration of onset of neuromuscular blockade after administration of atracurium in divided doses, as described in this study.

Atracurium↗
PubMed1987

Anesthetic considerations in Beckwith-Wiedemann syndrome.

The anesthetic management of a thirty-month-old male with Beckwith-Wiedemann Syndrome is described. The presentation and features of this syndrome are described and the problems of providing anesthesia in such patients are discussed.

Anesthesia, General↗