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Biomedical subjects

S Gelman

Publications and source records attributed to S Gelman.

99 records · Page 6Linked to original sources
PubMed1977

Electroenterography after cholecystectomy. The role of high epidural analgesia.

The electrical activity of the stomach and intestine was monitored during the postoperative period in 30 patients who underwent cholecystectomy. All patients received standard general anesthesia with artificial ventilation during operation; some received high epidural analgesia during surgery and postoperatively, and others, fentanyl analgesia during surgery and nicomorphine afterwards. Electroenterography (EEnG) showed that electrical activity decreased following surgery and returned to base line on the third or fourth day after operation. A marked increase in amplitude and frequency of EEnG oscillations was recorded in 80% of the patients who received bupivacaine injections into the epidural space. A decrease was almost always recorded after nicomorphine injections. During the postoperative period, eating caused a considerable increase in the amplitude and frequency of the electrical activity of the stomach and intestine in patients treated by epidural analgesia, whereas no observable change was recorded in patients treated by nicomorphine injections. It appears that high epidural analgesia may be useful in the treatment of postoperative adynamic ileus.

Adult↗
PubMed1976

Influence of enteral oxygen administration on the slow electrical activity of the intestine and stomach.

Thirty-eight starved cats, anesthetized with pentobarbital (Nembutal) sodium, received enteral administration of oxygen and other gases; the effect on intestinal motility as expressed by electrical activity was measured. Oxygen caused a notable increase in amplitude and frequency of slow electrical waves, while carbon dioxide and nitrogen caused no visible alterations. Phentolamine hydrochloride and propranolol hydrochloride together with atropine sulfate decreased the amplitude and frequency of oscillations to near zero; subsequent administration of enteral oxygen caused a notable increase in electrical activity, while enteral carbon dioxide produced no alterations. On the basis of our previous observations that enteral oxygen enhances oxygen and blood delivery to the gut wall, we suggest that the rise in stomach and intestinal electrical activity during enteral oxygen administration in conditions of surgical stress may be associated with an increase in oxygen and blood delivery to the gut wall.

Animals↗
PubMedDate not supplied

Middle cerebral artery transcranial Doppler velocity monitoring during orthotopic liver transplantation: changes at reperfusion--a report of six cases.

STUDY OBJECTIVE: To determine the effect of reperfusion of the grafted liver on transcranial Doppler blood flow velocity in the middle cerebral artery in humans during orthotopic liver transplantation. DESIGN: Clinical study. SETTING: University hospital. PATIENTS: 6 patients scheduled for orthotopic liver transplantation. INTERVENTIONS: Middle cerebral artery blood flow velocity (MCAVm) was monitored continuously using a transcranial Doppler (TCD) probe. The TCD measurements were noninvasive. MEASUREMENTS AND MAIN RESULTS: The EME TC2000S TCD probe (Nicolet, Inc., Memphis, TN) was secured to the head using a strap providing continuous measurement of MCAVm. All other data were recorded by a patient monitoring system and a respiratory gas analyzer. Averaged MCAVm increased significantly in 5 of 6 patients (p < 0.001) when pre-reperfusion and post-reperfusion values were compared. Maximum post-reperfusion values for MCAVm, pulsatility index (PI), and systolic Doppler velocity (Vs) were greater than the corresponding immediate pre-reperfusion values (p < 0.05, p < 0.05, and p < 0.001, respectively). The increases in MCAVm cannot be explained on the basis of hypercarbia alone and were observed in the presence of systemic arterial hypotension and abrupt increases in central venous pressure, particularly at the time of graft reperfusion. CONCLUSIONS: MCAVm increased with reperfusion of the grafted liver. These data suggest that multiple factors--including hypercarbia, lactic acidosis, or multiple vasoactive substances released by the grafted liver--may contribute to the observed increases in MCAVm, Vs, and PI.

Adult↗
PubMedDate not supplied

Lack of immediate effects of wound excision on the hyperdynamic circulation of burned patients.

The high cardiac output (CO) observed during the chronic phase in burned patients has been ascribed, among other factors, to the elevated blood flow in the burn wound. The hemodynamic effects of wound excision to fascia have been studied in eight patients with second- and third-degree burns ranging from 42% to 70% total body surface area (TBSA) undergoing debridement and skin-grafting procedures. The study was performed on the 4th to the 51st postburn day when all patients were in a hyperdynamic state. Serial hemodynamic measurements, including arterial and mixed-venous blood O2 saturation and content, were made before induction of anesthesia, during surgery both before and after wound excision, and in the recovery room a few hours after surgery. During anesthesia, the elevated CO decreased probably as a consequence of decreased metabolic requirements, but no further hemodynamic change was observed following wound excision. The size of burn wound excised to fascia averaged 24% TBSA and ranged from one-third to more than one-half of the initial burn. With discontinuation of anesthesia, CO rose rapidly above preoperative values, apparently to meet a similar increase in oxygen consumption. The excision of large areas of burned tissue did not attenuate the hyperdynamic circulation in burned patients, at least during and immediately after surgery. The data suggest that the elevated blood flow in the burn wound does not play a significant role in the pathogenesis of the hyperdynamic state.

Adult↗
PubMedDate not supplied

Transcranial Doppler and rCBF compared in carotid endarterectomy.

In eight patients undergoing carotid endarterectomy, the mean velocity and an index of pulse amplitude in the middle cerebral artery were monitored continuously by transcranial doppler ultrasound. rCBF was measured by intracarotid injection of 133 Xenon shortly before and at the time of the carotid artery occlusion, and again a few minutes after carotid flow was reestablished. Comparison of the mean velocity in the MCA and the cortical convexity rCBF revealed relatively little hysteresis in their relationship from prior to after the occlusion. There was however, considerable variability in this relationship among patients. Both the rCBF and the velocity decreased substantially at occlusion in three cases, neither changed very much in three. While in two, though the rCBF decreased significantly, the velocity did not change. The index of pulse amplitude was somewhat more sensitive to the occlusion, decreasing in the seven cases in which it was recorded, including one in which the rCBF did not change.

Aged↗