Biomedical subjects
Publications and source records attributed to P Mundeleer.
The Wyeth company has developed a new vehicle for drugs allowing the immediate dissolving of the medication in contact with the saliva. A double-blind test with oxazepam confirms the value of this new vehicle. Moreover, contrarily to our fears, it also confirms that such dispensing had no secondary effects on the alimentary tract.
The "Chronicler" is made up of a microcomputer (the CPU is a Motorola 6809), an alphanumeric-graphic display with keyboard and a printer. The system is connected to several physiological signal monitors and in our application to a mechanical ventilator under electronic control. It collects every 5 seconds - or at each breathing cycle if required - all the data supplied by the various measuring devices including those in the mechanical ventilator. The time basis for displaying and storing the data is a multiple of the data acquisition time basis; it is selected interactively by the user during operation. Up to five raw analog curves (f.i. capnogram, pulmonary artery pressure curve) can be displayed and their morphology can then be examined. Manual data are entered or retrieved at any time. The system was designed by Dr. Demeester's team in order to help the anesthesiologist during and after anesthesia. Clinical use of the system by our staff has convinced us that indeed it is of great help in the control of general anesthesia: this results from the very clear and efficient presentation of the data both as numbers and curves; an alarm program under interactive control of the user makes surveillance still easier; furthermore the use of the system is simple and convenient. Finally, when surgery is over, a standard report is automatically printed; it is equivalent to a manually written anesthesia report. The data are stored on floppy disks and can be processed later for retrospective analysis in order to investigate, for instance, the influence of surgical maneuvers and of drugs on physiological parameters. The "Chronicler" is thus a tool for dynamic monitoring during anesthesia; it is also a powerful tool for clinical and physiological research.
In preoperative use, the administration of 2 mg of lormetazepam perorally to patients no doubt abnormally nervous in anticipation of a forthcoming operation has proved to be an excellent inducer of sound sleep. In postoperative use, a dose of 2 mg of lormetazepam has a positive effect compared with the placebo, both on sleep inducement and on quality and duration of sleep. However, the results of a small series of twelve patients indicate that for recently operated adults the administration of 3 mg of lormetazepam may be recommended. Indeed we believe 4 mg might not be excessive.
Our study show that lorazepam calms the child very well before his operation, as long as a minimum dose of 0.04 mg/kg is administered; if one wishes to increase the chances of provoking complete or incomplete amnesia, the dose must be increased to 0.05 mg/kg, administering a dose of 0.06 mg/kg does not increase the percentage of amnesia but provoked a side effect which is not very agreeable from the point of view of nursing and one to which our anesthetics technique has not accustomed us: sleepiness. Lastly the pre-operatory vomitting being almost certainly linked with the administration per os, an effort should be made to improve the presentation, so keeping the advantages of premedication without giving an injection to the child; furthermore as far as possible, the presentation should permit a sufficiently precise evaluation of the quantity to be administered, even though slight errors are here of no consequence due to the very large margin of security.
A new table on "Cardio-respiratory emergency," was designed for use mainly by occasional casualty doctors. It is printed in two colours, separating the diagnostic and therapeutic features. The general lay-out is from the top downward according to ABC sequence, and from the left to the right according to graduation. Also different varieties of shock are included in the table. A list with explaining key words is at the bottom of the table.
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Tonsillectomy under general anesthesia, one of the most commonplace operations there are, is more of a problem for the anesthetist than for the surgeon. Once intubated, the child or adult will be protected from any operative risks by correct ventilation and the protection of his upper airways. The only problem is that arising from the anesthesia required to carry out this intubation and from the consequences of this anesthesia on the waking period, which should be brief in order to avoid, after detubation, any reactions which might induce excessively deep sleep at that moment. In this respect we found etomidate, with its short duration of action, even after reinjection, just as interesting as methohexital. We should mention, however, that his product presents certain disadvantages the most troublesome of which seemed to be the pain provoked when this substance is injected. A new solution (of basic etomidate) still hardly presented this disadvantage.
Some interventions in ENT surgery are very difficult or are even impossible if the slightest bleeding occurs. Microsurgery of the ear is the best example. For this reason we choose this particular intervention to test different anesthesia techniques. Bleeding in the surgical field is followed, while simultaneously respiratory, venous and arterial pressure tracings are recorded. These parameters are followed and changes can be attributed directly to observations by microscope of the surgical field. Successively neuroleptanalgesia in its pure form or with help of several drugs (trimetaphan, furosemide, enflurane) is studied. One conclusion can probably be made of the analysis of our series: an anesthesia with "light" analgesia gives better results than an anesthesia protecting completely the patient.
Lorazepam is recognized as a tranquillizer. It is presented for intramuscular and intravenous injection. In a study of this drug's possible effects in premedication, its action was studied systematically when it was used for preoperative premedication. The drug has no side-effects other than drowsiness, which occurs in almost all cases. It produces very good premedication, sometimes with anterograde amnesia in the doses used. This anterograde amnesia is dependent on the dosage used but it is always accompanied by profound drowsiness, from which the patient can be roused verbally. The dose will be selected in relation to whether amnesia is desired or not. However, whatever the dose administered (over 2.5 mg), the tranquillizing effect is always of high quality.
In the field of research into new methods, we attempted to determine the primary effect, i.e. neuroleptic effects following the intensity of reactions to stimulation in patients undergoing microsurgery of the ear, comparing in particular the quantities of analgesic necessary and used during general anesthetic to ensure both clinically visible protection and, above all, suppression of the effects of stimulation at the level of recordings of arterial and venous pressures. This permits, in our opinion, one to evaluate the dose necessary but also, determine whether or not a drug belongs to the category of neuroleptics which are interesting for the anesthetist.
The structure of the respiratory monitoring system under construction in Brussels University Hospitals is described. It is modular and hierarchized. It is based on the observation of the lung mechanics, of the flows of inspired and expired gases and of continuous blood measurements in patients artificially ventilated. Respiratory monitoring may be confined to the continuous observation of the natural evolution of a large number of parameters and the extraction of the most possible information with the aid of automatic calculations effected in real time. The authors propose to add deliberate and controlled aggressions of the pulmonary system in order to observe its dynamic behavior. Practical function tests are described. They lead to the calculation of functional residual capacity, continuous distribution of tidal volume, and pulmonary capillary blood flow. These tests can be performed automatically by using a new electronic unit built in our laboratory. It enables a digital computer to control the functioning of a commercially available ventilator.
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Explore the source record for details and available documents.