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Biomedical subjects

P Szmuk

Publications and source records attributed to P Szmuk.

At least 19 recordsLinked to original sources
PubMed2006

Anaesthetic management of thoracopagus twins with complex cyanotic heart disease for cardiac assessment: special considerations related to ventilation and cross-circulation.

We describe the anaesthetic management of a pair of thoracopagus twins of 14 months of age undergoing complex cardiac evaluation. Synchronous ventilation of the twins, needed for the ECG-gated magnetic resonance imaging-angiography, was achieved through a Carlens (Y) adaptor during procedures and transport. The complex logistical implications are obvious. We also describe the first use of bispectral index monitor for detection of cross-circulation in conjoint twins.

Anesthesia, General↗
PubMed2005

Use of a new supraglottic airway device--the CobraPLA--in a 'difficult to intubate/difficult to ventilate' scenario.

A 67-year-old male was scheduled for cadaveric renal transplant. Following rapid sequence anaesthesia, only the tip of the epiglottis was visualized. Mask ventilation was difficult, and therefore an alternative airway device was considered. A size 4 CobraPLA (Engineered Medical System, Indianapolis, IN) was inserted into the hypopharynx, and ventilation was easily accomplished. Then, a size 7 endotracheal tube was threaded over a fiberoptic bronchoscope, through the CobraPLA, into the trachea. The description and insertion technique of the CobraPLA, a new supraglottic airway device is shortly discussed. This is the first report of successful management of difficult mask ventilation with the new CobraPLA, supraglottic airway device.

Aged↗
PubMed2004

Anesthesia for restrictive bariatric surgery (gastric bypass not included): laparoscopic vs open procedures.

UNLABELLED: Publications regarding anesthetic management for weight reduction surgery are scarce. We reviewed the records of 234 patients who underwent bariatric restrictive procedures (gastric bypass not included) from May 1999 to September 2000. Variables analyzed included demographics, anesthetic data and perioperative course. Patients were allocated into two groups: laparoscopic (LPG) and open procedures (OPG), comprising 167 and 67 patients respectively. Obstructive sleep apnea was present in 4.8% in LPG vs 6.1% in OPG. Awake fiberoptic intubation was performed in 3.6% in LPG and 1.5% in OPG. The other patients were anesthetized with rapid sequence induction (classic or modified). Grade III laryngoscopy was present in 6% in LPG and 7.1% in OPG. No intraoperative complications were encountered. Postoperative PACU follow-up time was similar. In both groups, i.v. meperidine was most frequently used for postoperative analgesia (in the PACU), as compared to the other analgesics employed (P<0.03). Early postoperative complications (prolonged mechanical ventilation, unplanned ICU admission, sepsis, re-operation) occurred more frequently in OPG, but the difference between the two groups was statistically insignificant (P<0.08). The length of hospitalization was 3.8+/-1.4 days in LPG and 6.2+/-6.6 in OPG (P<0.01). Mortality was zero. Anesthesia for restrictive bariatric surgery (both open and laparoscopic approaches) was associated with few complications. SUMMARY STATEMENT: We reviewed the records of 234 patients who underwent restrictive bariatric procedures (gastric bypass not included) from May 1999 to September 2000, in regard to perioperative complications. Anesthesia was associated with no intraoperative and few postoperative complications.

Adult↗
PubMed2003

Difficult airway management patterns among attending anaesthetists practising in Israel.

BACKGROUND AND OBJECTIVE: In recent years, a large number of airway devices have been introduced into clinical practice as adjuncts to the management of the difficult airway. The purpose of this study was to evaluate the practices of Israeli anaesthetists in specific clinical situations and their familiarity with the use of a variety of airway devices and techniques. METHODS: A survey developed in our institution was sent to 300 attending anaesthetists representing all board-certified anaesthetists practising in Israel. RESULTS: Of the 153 respondents, 75% belonged to university hospitals. Ninety-six percent were skilled with laryngeal mask airways and 73% with fibreoptics. Seventy percent preferred regional anaesthesia with anticipated difficult intubation, continuation of anaesthesia with a laryngeal mask with failed intubation and a laryngeal mask for impossible mask ventilation. For the airway scenarios, awake fibreoptic, awake direct laryngoscopy, intubation under inhalation anaesthesia and tracheostomy were shared equally. CONCLUSIONS: There is a high degree of adherence by Israeli anaesthetists to the American Society of Anesthesiologists' difficult airway algorithm. Current airway management practice patterns in Israel are presented.

Airway Obstruction↗
PubMed2003

Changes in onset time of rocuronium in patients pretreated with ephedrine and esmolol--the role of cardiac output.

BACKGROUND: We investigated the hypothesis that manipulation of cardiac output (CO) with esmolol (Es) or ephedrine (E) affects the onset time of rocuronium. METHODS: Following anesthesia induction, 33 patients received E (70 micro g kg-1), Es (500 micro g kg-1) or placebo (P) 30 s before rocuronium (0.6 mg kg-1) administration. Cardiac output was measured non-invasively after intubation every 3 min. The interval from the end of rocuronium administration to the disappearance of all twitches was considered to be the onset time. RESULTS: Onset time was shorter after E (52.2 +/- 16.5 s) and longer after Es (114.3 +/- 11.1 s) compared with P (87.4 +/- 7.3 s) (P < 0.0001). Cardiac output increased (P < 0.05) in group E for 15 min after rocuronium. In group Es, CO decreased (P < 0.05) at 3 and 6 min. Cardiac output was higher in group E vs. group Es, 3-6 min post administration of rocuronium (P=0.015). CONCLUSION: Pretreatment with E or Es appears to affect the onset time of rocuronium by altering CO as measured with the NICO (Non-Invasive Cardiac Output) monitor (Novametrix Medical Systems Inc., Willingford, CO).

Adolescent↗
PubMed2003

Prediction of difficult laryngoscopy in obese patients by ultrasound quantification of anterior neck soft tissue.

In 50 morbidly obese patients, we quantified the soft tissue of the neck from the skin to the anterior aspect of the trachea at the vocal cords using ultrasound. Thyromental distance, mouth opening, limited neck mobility, modified Mallampati score, abnormal upper teeth, neck circumference and sleep apnoea were assessed as predictors of difficult laryngoscopy. Of the nine (18%) cases of difficult laryngoscopy, seven (78%) had a history of obstructive sleep apnoea, compared with two of the 41 patients (5%) in whom laryngoscopy was easy (p < 0.001). Patients in whom laryngoscopy was difficult had more pretracheal soft tissue (mean (SD) 28 (2.7) mm vs. 17.5 (1.8) mm; p < 0.001) and a greater neck circumference (50 (3.8) vs. 43.5 (2.2) cm; p < 0.001). None of the other predictors correlated with difficult laryngoscopy. We conclude that an abundance of pretracheal soft tissue at the level of the vocal cords is a good predictor of difficult laryngoscopy in obese patients.

Adult↗
PubMed2002

[The significance and cost of preoperative laboratory screening in young healthy patients in a public hospital in Israel].

UNLABELLED: We evaluated the clinical significance and cost of routine preoperative laboratory screening in young healthy patients in a public hospital. Three hundred consecutive young (aged 18-40 years), healthy (ASA I) patients undergoing minor elective surgical procedures were enrolled in this prospective study. A preoperative test was considered to be significant if its result lead to a new diagnose or to cancellation of surgery. The lab tests revealed only one new diagnosis. None of the procedures were cancelled. The total cost of the lab tests was NIS 114,000. Of this amount, NIS 104,000 could have been saved if the tests were ordered as required by the patients medical history and physical examination and not performed routinely. CONCLUSION: This study suggests that routine preoperative laboratory screening is not recommended prior to minor, elective surgery in young, healthy patients.

Adolescent↗
PubMed2001

Antinociceptive and cardiovascular properties of esmolol following formalin injection in rats.

PURPOSE: To assess the role of esmolol, a beta1 receptor blocker, in the modulation of pain in the absence of anesthesia. METHODS: Rats were chronically instrumented to record mean arterial blood pressure (MAP) and heart rate (HR). Animals were divided into three groups. Group 1 [esmolol high (EH) 150 mg x kg(-1) x hr(-1); n = 9], Group 2 [esmolol low (EL) 40 mg x kg(-1) x hr(-1); n = 7] and Group 3 saline (n = 9). Formalin 5% was injected in the rat hind paw. Formalin-induced lifting, MAP and HR were recorded at five minute intervals for 35 min after formalin injection. RESULTS: Formalin was associated with an early (Phase 1; 0-5 min) and late nociceptive response (Phase 2; 10-35 min). Esmolol did not affect Phase 1. Although low dose esmolol had minimum effects on nociceptive Phase 2, it was diminished with high dose esmolol. Formalin induced biphasic increases in MAP and HR. Although esmolol did not affect the initial increase in MAP, high dose esmolol blunted the secondary increase in MAP Both low and high doses of esmolol inhibited formalin-induced tachycardia during the first 30 min. CONCLUSION: Our data suggest that esmolol leads to analgesia and reduction of cardiovascular responses to pain.

Adrenergic beta-Antagonists↗
PubMed2001

Celite-activated thrombelastography in children.

STUDY OBJECTIVE: To quantify global coagulation and establish normal ranges for the celite-activated thrombelastograph (TEG) in healthy pediatric patients. DESIGN: Prospective observational study. SETTING: Operating suite of a university-based hospital. PATIENTS: 110 healthy pediatric patients in four age groups and 25 healthy adult patients. INTERVENTIONS: Blood sampling for the celite-activated TEG was carried out after anesthetic induction. MEASUREMENTS: TEG indices: R time (reflecting time to fibrin formation), K time and alpha angle (fibrinogen-platelet interaction), maximum amplitude (reflecting maximal clot strength, platelet and fibrinogen function), TEG index (mathematical incorporation of the prior four measurements), and percent fibrinolysis at 30 minutes, were all recorded. MAIN RESULTS: Statistically significant differences between <12-month group in angle (compared to 25-48 month group) and % fibrinolysis (compared to all other pediatric groups). Significant differences in angle between two pediatric groups and adult group, and in the TEG index between three pediatric groups and adult group (all differences p < 0.05). CONCLUSIONS: These data identify changes of small magnitude in three celite-TEG parameters in healthy children compared to adults, without implication of abnormal coagulation between groups. Changes do not seem to be consistently related to age and will be useful for clinicians using the TEG to monitor (ab) normal coagulation in pediatric patients.

Adult↗
PubMed2001

Use of a ventilating tube exchanger in patients undergoing tracheostomy: report of two cases.

Two case reports in which a ventilating tube exchanger was used during tracheostomy in patients with potential for difficult reintubation are presented. We recommend leaving the ventilating tube exchanger in place for 48 hours to allow reintubation from above in the event of inadvertent decannulation in cases where difficult intubation is anticipated. Ventilating tube exchangers have been used to assist in the management of difficult airways in a variety of ways. These methods include the use of ventilating tube exchangers as malleable stylets, endotracheal tube exchangers and conduits through which oxygen can be delivered. We present two cases in which a ventilating tube exchanger was used as an adjunct to airway management in a novel fashion.

Adult↗
PubMed2001

Sonoclot analysis in healthy children.

UNLABELLED: Although use of the Sonoclot device (Sienco, Inc., Morrison, CO) has been reported in isolated pediatric cases and in small reports in neonates, there are no published data for normal pediatric patients. As the device is used in situations of abnormal coagulation, such as cardiac and liver transplantation surgery, our aim was to determine normal data ranges in healthy pediatric surgical patients. Blood was withdrawn after anesthetic induction, and the Sonoclot activated clotting time, rate of clot formation, time to peak amplitude, and peak amplitude was compared among four pediatric groups (< 12 mo, 13-24 mo, 25-48 mo, 49 mo-9 yr) and an adult group. The Sonoclot activated clotting time in the < 12-mo and the Adult groups were shorter than the oldest group of children (P < 0.05), although all were within the anticipated normal range, and there were no significant differences in clot rate, peak amplitude, and time to peak amplitude among groups without apparent trends with increasing age. These Sonoclot variables quantify adequate global clot formation in pediatric patients and will facilitate clinical coagulation management with appropriate pediatric normal ranges, avoiding the application of extrapolated adult data to children. IMPLICATIONS: Sonoclot variables are presented for 95 healthy pediatric surgical patients in four age groups, with small differences found in the Sonoclot (Sienco, Inc., Morrison, CO) activated clotting time between two groups and no significant differences in three other variables among groups.

Aging↗
PubMed2001

The incidence of class "zero" airway and the impact of Mallampati score, age, sex, and body mass index on prediction of laryngoscopy grade.

IMPLICATIONS: In an earlier study we proposed the addition of a new airway class, zero (visualization of the epiglottis), to the four classes of the modified Mallampati classification. In this prospective study, 764 surgical patients were assessed with regard to their airway class (including class zero), laryngoscopy grade, and the effect of the airway class and other predictors on the laryngoscopy grade.

Adult↗
PubMed2001

A randomized multicenter study of remifentanil compared with halothane in neonates and infants undergoing pyloromyotomy. I. Emergence and recovery profiles.

UNLABELLED: Pyloric stenosis is sometimes associated with hemodynamic instability and postoperative apnea. In this multicenter study we examined the hemodynamic response and recovery profile of remifentanil and compared it with that of halothane in infants undergoing pyloromyotomy. After atropine, propofol, and succinylcholine administration and tracheal intubation, patients were randomized (2:1 ratio) to receive either remifentanil with nitrous oxide and oxygen or halothane with nitrous oxide and oxygen as the maintenance anesthetic. Pre- and postoperative pneumograms were done and evaluated by an observer blinded to the study. Intraoperative hemodynamic data and postanesthesia care unit (PACU) discharge times, PACU recovery scores, pain medications, and adverse events (vomiting, bradycardia, dysrhythmia, and hypoxemia) were recorded by the study's research nurse. There were no significant differences in patient age or weight between the two groups. There were no significant differences in hemodynamic values between the two groups at the various intraoperative stress points. The extubation times, PACU discharge times, pain medications, and adverse events were similar for both groups. No patient anesthetized with remifentanil who had a normal preoperative pneumogram had an abnormal postoperative pneumogram, whereas three patients with a normal preoperative pneumogram who were anesthetized with halothane had abnormal pneumograms after. IMPLICATIONS: The use of ultra-short-acting opioids may be an appropriate technique for infants less than 2 mo old when tracheal extubation after surgery is anticipated.

Analgesics, Opioid↗