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Biomedical subjects

R A Moore

Publications and source records attributed to R A Moore.

At least 181 records · Page 10Linked to original sources
PubMed1985

Comparison of radial and femoral arterial blood pressures in children after cardiopulmonary bypass.

We compared radial and femoral arterial blood pressures in 29 patients, ranging in age from 1.25 to 17 years, during and after cardiopulmonary bypass for repair of congenital heart disease. Radial mean arterial pressure (MAP) was more than 10% lower than femoral MAP in 17 patients (58%), and in 7 of these patients (24%) radial MAP was more than 20% lower than femoral MAP. In 27 of 29 patients (93%) systolic radial pressure was 10% lower than systolic femoral pressure, and in 20 of these (69%) it was more than 20% lower. The ratio of radial to femoral pressure correlated with MAP (i.e., lower MAP produced greater differences), and the ratio of systolic radial to systolic femoral pressure inversely correlated with systemic vascular resistance index. We found no correlation between femoral-minus-radial pressure difference and postoperative course. These data demonstrate that radial arterial pressure may be misleadingly low in children undergoing operation for correction of congenital cardiac defects.

Adolescent↗
PubMed1985

Effect of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and fasting on body weight and lipid parameters in rats.

This study compared the effect of fasting (feed deprivation) and the effect of exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) on body weight and on key lipid parameters. The time-course study indicated a statistically significant (p less than 0.05) body weight loss in the TCDD-exposed rats 5 days after the oral administration of corn oil with TCDD (60 micrograms/kg body wt). Animals demonstrated a 10% body weight decrease either 1 week after this TCDD administration or after 72 hr of fasting. Marked increases in serum triglyceride and cholesterol were observed only in the TCDD-exposed rats, but not in the 0- or 72-hr fasted control rats. These results indicated that some body weight loss and decreased feed consumption occurred after TCDD exposure, but that the metabolic response, with respect to serum lipid metabolism, was not that of a control rat that had lost a similar amount of body weight due solely to fasting.

Administration, Oral↗
PubMed1985

Effect of hypothermic cardiopulmonary bypass on nitroprusside metabolism.

At a rectal temperature of 25 degrees C, six patients undergoing hypothermic cardiopulmonary bypass received intravenous infusions of sodium nitroprusside (SNP) at a rate of 7.3 +/- 1.7 micrograms/kg/min for 20 minutes. Total SNP dose per patient was 11.0 +/- 1.1 mg. Blood samples for serum cyanide (CN-), red blood cell cyanide (RBC CN-), and thiocyanate (SCN-) determinations were drawn immediately before SNP infusion. These determinations were repeated at the end of the infusion, at the start of rewarming, and at a rectal temperature greater than 34 degrees C and 1, 4 (five subjects), and 24 hours (three subjects) thereafter. Extracorporeal blood flow was held constant at 2.4 L/min/m2 and mean arterial pressure was maintained between 50 to 100 mm Hg with phenylephrine (3.62 +/- 0.75 mg) during SNP infusion and trimethaphan (37.8 +/- 15.6 mg) after the end of the infusion. There was a significant increase in RBC CN- after the SNP infusion that lasted until the subjects were rewarmed. One subject developed a peak RBC CN- level of 0.8 microgram/ml. Plasma CN- levels changed little throughout and SCN- levels were elevated only after rewarming. The nonenzymatic release of free CN- from SNP was not inhibited by hypothermia, while the enzymatic detoxification of CN- to SCN- may have been delayed.

Aged↗
PubMed1985

Zomepirac, dihydrocodeine and placebo compared in postoperative pain after day-case surgery. The relationship between the effects of single and multiple doses.

Zomepirac 100 mg and dihydrocodeine 30 mg were compared with placebo in a controlled randomized, double-blind, single-dose postoperative study. Patients continued to receive either zomepirac or dihydrocodeine for pain relief for 5 days at home in a double-blind study, being allowed to titrate the consumption of tablets to their degree of pain. The efficacy and side effects of the medication were evaluated. In the single-dose phase, both active treatments were significantly better than placebo. In the multiple dosing phase, zomepirac was statistically better than dihydrocodeine. Non-parametric statistical tests indicated highly significant correlations between single- and multiple-dose analgesic measurements for both zomepirac and dihydrocodeine.

Administration, Oral↗
PubMed1985

Hemodynamic and anesthetic effects of sufentanil as the sole anesthetic for pediatric cardiovascular surgery.

The efficacy, safety, and hemodynamic response to 5 micrograms/kg, 10 micrograms/kg, or 20 micrograms/kg of sufentanil and 0.1 mg/kg pancuronium was evaluated in children between 4 and 12 years of age scheduled for open heart surgery. Systolic time intervals, 2-D echocardiograms, systolic blood pressures (SBP), diastolic blood pressures (DBP), and heart rates (HR) were recorded before and after induction of anesthesia. Significant changes 10 min following induction of anesthesia but before intubation included increases in SBP in the 5 micrograms/kg group (P less than 0.01) and in the ratio of preejection period to left ventricular ejection time in the 20 micrograms/kg group (P less than 0.05). Instances of myoclonic jerking and coughing episodes were observed in all three study groups. Following intubation there were significant (P less than 0.05) increases in SBP in all groups, in DBP in the 5 micrograms/kg group, and in HR in the 5 micrograms/kg and 10 micrograms/kg groups. Smaller increases in SBP, DBP, and HR were seen in all groups after skin incision and sternotomy. Mean plasma catecholamine levels showed nonsignificant increases following periods of intraoperative stimulation with wide patient variations. Recovery of responsiveness to command occurred in all groups within one hour from the end of surgery but extubation was impeded by shallow periodic breathing and hypercapnea. The authors conclude that for children undergoing open heart surgery use of sufentanil as a sole anesthetic in bolus form did not provide a reliable depth of anesthesia with any of the induction doses studied.

Anesthesia, Intravenous↗
PubMed1985

Effects of advanced age on extravascular lung water accumulation during coronary artery bypass surgery.

Pulmonary extravascular thermal volume (ETVL) accumulation during aortocoronary bypass grafting (CABG) was compared between nine patients (group 1) aged 49 +/- 2 (SEM) yr and nine patients (group 2) aged 65 +/- 1.2 yr, using the thermal-dye technique. Before extracorporeal bypass (ECB), ETVL was significantly correlated with age and mean ETVL was significantly lower in group 1 (3.93 +/- 0.48 ml/kg body weight) than group 2 (5.93 +/- 0.38 ml/kg). During ECB, ETVL rose to 5.15 +/- 0.65 ml/kg in group 1 (p less than .05) and to 6.38 +/- 0.56 ml/kg in group 2. By the next morning, ETVL had returned to pre-ECB levels. Post-ECB, cardiac index decreased in group 1 and colloid osmotic pressure decreased in both groups, but all values returned to pre-ECB levels by the next morning. Although PaO2 had decreased and pulmonary shunt fraction had increased by this time, changes in these variables did not correlate with changes in ETVL. During ECB, ETVL increased transiently but returned to pre-ECB levels by the next morning.

Aged↗
PubMed1985

Comparison of internal and external jugular cannulation of the central circulation in the pediatric patient.

Percutaneous catheterization of the central circulation via the internal jugular vein was compared to cannulation via the external jugular vein, in a retrospective review of 200 pediatric patients. The internal approach resulted in an 86% rate of successful cannulations with 99.9% of the catheters positioned in the thorax; this technique was accompanied by an 8% incidence of carotid artery puncture. The external jugular route eliminated the risk of carotid artery puncture; however, it was successful in only 65% of the attempts, and 14% of the successful cannulations had catheter tips incorrectly positioned outside the thorax.

Age Factors↗
PubMed1985

Peri-operative endocrine effects of etomidate.

This study investigated the effects of etomidate on endocrine responses to anaesthesia and surgery. Patients undergoing abdominal hysterectomy received standard anaesthetics of either etomidate for induction with etomidate infusion, or thiopentone and halothane. Etomidate suppressed the secretion of cortisol and aldosterone for between 8 and 22 hours after the end of the etomidate infusion; 11-deoxycortisol secretion was not suppressed during the etomidate infusion, but rose postoperatively; 17 alpha-hydroxyprogesterone suppression also lasted only as long as the etomidate infusion. There were no effects on plasma oestradiol, ACTH, or prolactin, but growth hormone concentrations were elevated in the etomidate group. Etomidate was concluded to have influenced adrenocortical function only, where it probably inhibits 11 beta-hydroxylation, 17 alpha-hydroxylation and other intramitochondrial hydroxylation reactions. There were no clinical sequelae attributable to adrenocortical suppression. The relationship of chemical structure of etomidate and other phenylated imidazoles to inhibition of steroidogenesis is discussed.

17-alpha-Hydroxyprogesterone↗
PubMed1985

Ethics in the practice of psychiatry: update on the results of enforcement of the code.

From 1950 to 1973, 82 charges of unethical conduct were made against APA members; of the 12 (15%) members who were found unethical, six were expelled. From 1972 to 1983, 382 members were charged; 86 (23%) were found unethical and 27 of them were expelled. The charges most often involved patient exploitation and illegal conduct. The proportion of the membership charged in each APA area varied by as much as 3:1; some district branches had many charges (69 was the most), and many had none. With all the limitations, the system of enforcement is valuable, but there is much room for improvement.

American Medical Association↗
PubMed1985

A simple, rapid and cheap radioimmunoassay for plasma digoxin.

A radioimmoassay for digoxin is described which uses commercially available reagents. Two assay procedures are used, one for batch assays, and another, which needs a 5 minute incubation only, for 'stat' assays. The methods are shown to be simple, rapid, precise and inexpensive and the batch procedure compared well with the Amerlex digoxin method for 63 patient samples.

Costs and Cost Analysis↗
PubMed1985

Systemic availability of oral slow-release morphine in man.

In a within-patient crossover study on twelve patients we investigated plasma morphine concentrations for 48 hours after administration of intravenous morphine sulphate followed 24 hours later by oral MST Continus [MST]. Patients received either 10 mg i.v. morphine followed by 10 mg MST or 20 mg i.v. morphine followed by 2 X 10 mg MST tablets. Systemic clearance of morphine was low, being about 3 ml/min/kg after both intravenous and oral administration. The ratio of the areas under the concentration-time curve for MST relative to that for i.v. morphine was about 1:1 for 20 mg doses, but was significantly greater than 1:1 for 10 mg doses. The results suggest high oral systemic availability for morphine and low hepatic morphine metabolism.

Administration, Oral↗
PubMed1985

Effects of colloid or crystalloid administration on pulmonary extravascular water in the postoperative period after coronary artery bypass grafting.

The effect of postoperative fluid management on pulmonary extravascular thermal volume (ETVL) as in index of pulmonary extravascular water after coronary artery bypass grafting was compared, using the thermal-dye technique, among five patients who received 5% albumin (group A), five patients who received 6% hydroxyethyl starch (group H), and five who received lactated Ringer's solution (group C). Intraoperatively, all patients received lactated Ringer's solution intravenously, and the cardiopulmonary bypass (CPB) circuit prime included 5% albumin. No statistically significant changes in ETVL occurred postoperatively in any group, nor did ETVL differ significantly between groups. After CPB, colloid osmotic pressure (COP) significantly decreased and pulmonary artery wedge pressure (WP) and the WP-COP gradient significantly increased in each group, implying an increase in transcapillary fluid flux. Cardiac index changed variably. Pulmonary shunt fraction (Qsp/Qt) did not change in groups A and C but decreased during CPB in group H (from 0.22 +/- 0.03 to 0.16 +/- 0.11). Postoperatively, patients in the three groups received similar volumes of fluids and had similar perioperative weight gains. By the next morning (AM1), COP increased in all groups, returning to levels noted before CPB in group C, and exceeding these levels in groups A and H. Wedge pressure was similar in all three groups on AM1. PaO2 decreased significantly, and alveolar-arterial oxygen partial pressure difference increased significantly in all groups on AM1. In Group H, Qsp/Qt returned to levels observed before CPB by AM1 (0.27 +/- 0.09). We conclude that in patients without postoperative increases in WP, ETVL changes minimally during CPB and is not influenced by the type of fluid administered as the primary volume replacement in the postoperative period.

Aged↗
PubMed1985

The effect of ventilation on systemic blood gases in the presence of left ventricular ejection during cardiopulmonary bypass.

The effect of pulmonary ventilation upon systemic arterial blood gases during cardiopulmonary bypass in the presence of left ventricular ejection was evaluated in 20 adult male patients undergoing coronary artery bypass grafting. Following rewarming, establishment of a sinus rhythm, and production of a pulse pressure of at least 20 mm Hg on the arterial pressure trace caused by left ventricular ejection, arterial blood gases were obtained from the arterial and venous extracorporeal circuits and the radial arterial cannula. Patients were then randomly assigned to a nonventilation (n = 10) or a ventilation (n = 10) group. The ventilation group was given 10 breaths/min with 100% oxygen at a tidal volume of 10 ml/kg. Whereas the nonventilation group received apneic oxygenation at zero end-expiratory pressure. After 5 minutes the arterial blood gas data were again obtained. Significant findings (p less than 0.05) included decreases in systemic carbon dioxide tension and increases in systemic pH in the ventilation group and decreases in systemic oxygen tension in the nonventilation group. Although the changes in the arterial blood gases were significant, these changes occurred well within the limits of clinical acceptability. It is concluded that left ventricular ejection for short periods during full cardiopulmonary bypass does not necessitate pulmonary ventilation.

Aged↗