Biomedical subjects

S H Kalman

Publications and source records attributed to S H Kalman.

18 recordsLinked to original sources

PubMed1997

Intravenous versus intraperitoneal morphine before surgery to provide postoperative pain relief.

BACKGROUND: Opioid receptors have been demonstrated on peripheral afferent nerves throughout the body. The aim of the present study was to compare the effects of intravenous and intraperitoneal administration of morphine with regard to pain, postoperative morphine requirement, and recovery after major abdominal surgery, and to describe the pharmacokinetics of intraperitoneal morphine in humans. METHODS: In a double-blind manner, 30 patients scheduled for major abdominal surgery were randomized to either 50 mg of morphine intravenously (i.v.) or 50 mg of morphine intraperitoneally (i.p.) before operation. Pain was measured on a visual analogue scale and morphine requirements were registered for 3 days. Recovery was measured as time to oral intake of food, time to flatulence and days in hospital. Plasma morphine, morphine-3-glucuronide, and morphine-6-glucuronide concentrations were determined during the first 4 h after morphine administration. RESULTS: During the first postoperative hours there was less pain at rest (P = 0.02) and on coughing (P = 0.004) in the intravenous group. The requirement of additional morphine (P = 0.016) was lower in the intravenous group during the first postoperative day. No major differences in recovery were seen. The plasma concentrations of morphine measured as area under the curve (AUC) during the first 4 h were similar, but the intravenous group showed significantly higher concentrations of the active metabolite morphine-6-glucuronide, (P = 0.016), indicating a difference in pharmacokinetics after intraperitoneal compared to intravenous administration of morphine. CONCLUSION: Intraperitoneal administration of 50 mg of morphine before major abdominal surgery is less efficient in reducing pain and postoperative morphine requirements than the same amount of morphine given intravenously.

Adult↗

PubMed1995

Influence of halothane-diethyl-ether azeotrope and isoflurane on ventilation. Re-evaluation of an obsolete drug.

The azeotropic mixture of halothane and diethyl-ether has been claimed to be a suitable anaesthetic agent for use during difficult conditions because of its negligible effect on circulation and ventilation. The purpose was to evaluate the effect of halothane-diethyl-ether azeotrope (HE) and isoflurane (ISO) on ventilation. 12 patients scheduled to undergo minor orthopaedic surgery and belonging to ASA 1, were randomly allocated to the HE group or the ISO group. Evaluation of resting ventilation and ventilation stimulated by hypercarbia and hypoxaemia was done on three occasions: (A) before anaesthesia, (B) after inhalational induction of anaesthesia and intubation without muscle relaxants when the level of anaesthesia was 1 MAC and (C) half an hour after operation and during recovery. Resting ventilation and the ventilatory response to hypercarbia during anaesthesia were maintained in the HE group but not in the ISO group, whereas the ventilatory response to hypoxaemia during anaesthesia was absent in both groups. The responses had returned to normal values in both groups during recovery. We conclude that halothane-diethyl-ether azeotrope is comparatively safe during anaesthesia with spontaneous breathing provided arterial oxygenation is adequate. This makes this azeotrope suitable for use by anaesthetists with limited experience and during difficult conditions such as civil disaster or war.

Adolescent↗

PubMed1995

A comparison of propofol and isoflurane anaesthesia: the need for ephedrine and glycopyrrolate.

Sixty patients, ASA I-III, presenting for elective colonic surgery were studied to assess the stability of blood pressure and heart rate during anaesthesia with three equally potent anaesthetic techniques. Patients in group I (n = 20) received thiopentone induction, isoflurane and nitrous oxide; patients in group II (n = 20) received total intravenous anaesthesia with propofol; and patients in group III (n = 20) received intravenous propofol supplemented with nitrous oxide. Fentanyl and vecuronium were used in all three groups. The depth of anaesthesia was judged on clinical signs of adequate anaesthesia. Episodes of bradycardia (heart rate < 50 beats min-1), tachycardia (heart rate > 90 beats min-1), hypotension (mean arterial pressure > or = 30% below pre-operative blood pressure) or hypertension (mean arterial pressure > 30%, or systolic blood pressure > 15 mmHg, above pre-operative value) were recorded when lasting > 5 min. Any use of ephedrine or glycopyrrolate given to correct hypotension or bradycardia was documented: In group II, significantly more patients were given ephedrine (P < 0.01) to treat hypotension. The drug was administered after intubation but before skin incision in the majority of cases (9/11). Glycopyrrolate was given to significantly more patients in group III (P < 0.025) to treat bradycardia, and in 21 of a total of 34 patients given glycopyrrolate it was administered before surgery. With the use of these additional drugs, there were no differences in the number of patients with 5 min episodes of hypotension, hypertension, tachycardia or bradycardia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1995

Liver function and halothane-diethyl-ether azeotrope anaesthesia. Re-evaluation of an obsolete drug with special reference to early postoperative effects.

A general anaesthetic drug that fulfils requirements for use under difficult circumstances is the inhalation agent halothane-diethyl-ether (HE) azeotrope. Although both halothane and diethyl ether have been described in detail, their effect on the liver when given together as an azeotrope has not been systematically characterised. The effect on liver function was evaluated and compared with the effects of halothane anaesthesia (H) and spinal anaesthesia with tetracaine (S), the last named serving as controls. The series consisted of 33 healthy men (ASA 1-2) receiving no medication and scheduled for inguinal hernia repair. The patients were randomly allocated to receive HE, H or S. The following parameters were estimated the day before surgery and on the first postoperative day: liver cell metabolism (bile acids, unconjugated bilirubin), cell integrity (aminotransferases), synthesizing capacity (Prothrombin complex), cholestasis (conjugated bilirubin, alkaline phosphatase, gamma-glutamyl transpeptidase), and global liver function (chenodeoxycholic load test). No major differences emerged between the groups. Unconjugated bilirubin was increased in all groups. Prothrombin complex activity was reduced in all groups. Conjugated bilirubin was increased in the H group. The oral bile acid load test and the fasting bile acid were unaltered by anaesthesia in all groups. No major impact on liver cell function was seen in the early post-operative period after HE azeotrope anaesthesia. The findings support our view that HE azeotrope could be considered as an alternative anaesthetic agent under field conditions.

Adult↗

PubMed1993

Atelectasis and oxygenation in major surgery with either propofol with or without nitrous oxide or isoflurane anaesthesia.

Forty-two patients undergoing major colonic surgery were assigned at random to receive isoflurane-fentanyl anaesthesia with nitrous oxide in oxygen, propofol-fentanyl anaesthesia with air in oxygen or propofol-fentanyl anaesthesia with nitrous oxide in oxygen. The groups were comparable in demographic data. Atelectases were identified, and the area measured by computerised tomography of the chest 203 +/- 69 min after extubation, and oxygenation was determined by arterial blood gas samples taken during operation at 30, 60, 90 and 120 min after extubation and on postoperative days 1, 2 and 3. Atelectases were seen in all three groups with no differences in the mean area between groups. After operation, the effect of 4 l.min-1 of oxygen by nasal catheter on PaO2 was similar in all groups. A significant decrease in PaO2 was found during the first 3 days after surgery, and was also the same in all groups. There was no correlation between area of atelectasis and postoperative PaO2. We conclude there is no difference in the incidence of postoperative atelectasis or oxygenation when using propofol, with or without nitrous oxide or isoflurane.

Anesthesia, Inhalation↗

PubMed1993

Early and late recovery after major abdominal surgery. Comparison between propofol anaesthesia with and without nitrous oxide and isoflurane anaesthesia.

A comparison was made between early and late recovery after major abdominal surgery under intravenous anaesthesia with propofol (with and without nitrous oxide) or inhalational anaesthesia with isoflurane. Sixty patients were randomly allocated to one of three forms of anaesthesia: propofol, propofol/nitrous oxide, or isoflurane/nitrous oxide anaesthesia. All received fentanyl and vecuronium. Recovery was monitored during the first 2 h after extubation and on days 1, 2, 3, 7 and 30 after surgery. Every 30 min during the first 2 postoperative hours, the Steward recovery scale, sedation, orientation, collaboration, and comprehension were assessed by a blinded observer. Psychomotor function was evaluated by computerised simple reaction time and finger tapping speed in 32 patients. A scale of symptoms and mood check list were filled in by 35 patients on days 1, 2, 3, 7 and 30. The preoperative values for all tests were collected 1-4 days before surgery. The time between end of surgery and extubation was longer in the propofol group, but early and late recovery of psychomotor function were similar in the three groups. Patients anaesthetised with isoflurane reported more vegetative symptoms than those who received propofol (P < 0.03). The addition of nitrous oxide to propofol did not change the reported degree of symptoms. The difference in vegetative symptoms between groups was most obvious on day 7. Patients anaesthetised with propofol reported better subjective control (P < 0.02) and were more socially oriented (P < 0.05) than patients anaesthetised with isoflurane. We conclude that early recovery was similar in the three groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗

PubMed1993

Halothane-diethyl ether azeotrope anesthesia under primitive conditions: guidelines for neuromuscular blockade with vecuronium.

The dose-response relationship for vecuronium during anesthesia with the azeotropic mixture of halothane and diethyl ether (HE) (66 ml of halothane mixed with 34 ml of ether in the same bottle)/oxygen was compared with halothane/nitrous oxide/oxygen anesthesia. The HE is not explosive and has preserved many of the advantageous properties of diethyl ether, making it an attractive anesthetic drug under difficult circumstances such as war or civil disaster. If muscular relaxation is needed in military anesthesia, it is essential to use a short- to medium-acting compound that can be stored without refrigeration. Vecuronium bromide fulfills these criteria. The study was conducted on 20 young (mean 24 years, range 18-31), ASA I patients. Using adductor pollicis mechanomyography and a cumulative dose technique, individual dose-response curves for vecuronium were constructed. Care was taken to keep peripheral and core temperatures normal and the times of exposure to inhalational gases equal. The results were analyzed by the log-probit method. During HE anesthesia, ED50 for vecuronium was 22 +/- 2 micrograms kg-1 (mean +/- SE) and ED90 was 49 +/- 8 micrograms kg-1. During halothane/nitrous oxide anesthesia, ED50 for vecuronium was 18 +/- 2 micrograms kg-1 (mean +/- SE) and ED90 was 39 +/- 7 micrograms kg-1. The dose-response relationships for vecuronium were similar during HE anesthesia and halothane/nitrous oxide anesthesia.

Adolescent↗

PubMed1992

Anaesthetic technique does not influence postoperative bowel function: a comparison of propofol, nitrous oxide and isoflurane.

The aim of this study was to evaluate the influence of propofol, nitrous oxide and isoflurane on recovery, postoperative bowel function and postoperative complications after major gastrointestinal surgery. Sixty patients undergoing elective colonic operations were included in the study. They were randomly allocated to anaesthesia with isoflurane-nitrous oxide, propofol-air, or propofol-nitrous oxide, with fentanyl and vecuronium being used in all three groups. The same anaesthetic and surgical teams performed all the operations. The postoperative course was judged once each day by the Acute Physiology Score (APS) based on the Apache II classification, passage of gas, tolerance of enteral feeding, hospital stay and complications up to 30 days after surgery. The demographic data, magnitude of operation, duration of operation, intraoperative blood loss, and post-operative analgesic needs were similar in the groups. In all groups the APS was normal by median day 1 (range 1-7). A similar impairment of bowel function after operation, with passage of gas median 3 (1-6) days after surgery and tolerance of enteral intake median day 5 (1-10), was found in all groups. The incidence of complications and the length of postoperative hospital stay, median 11 (6-45) days, did not differ among the groups. It is concluded that overall recovery, bowel function, postoperative hospital stay, and complications were not influenced by the anaesthetic technique.

Adolescent↗

PubMed1984