Biomedical subjects
Publications and source records attributed to S Isserles.
We present a technique of retrosternal block for symptomatic treatment for dyspnoea of various aetiologies. In our experience with 20 patients, a retrosternal block using lignocaine improved symptoms within minutes. The block was easy to perform and was helpful when the patients' symptoms were not relieved by conventional therapy. Prospective controlled studies are needed to further assess this simple and promising treatment.
A total of 859 patients presenting for outpatient rhinoplasty were divided into two groups that received intravenous sedation of midazolam 0.1 mg/kg either with or without ketamine 0.4 to 0.5 mg/kg immediately prior to conduct of the local anesthetic injections and surgery. Additional midazolam was given intraoperatively as needed. No patient received narcotic either as premedication or intraoperatively. Patients were evaluated by the surgeon on their response to the injections and surgery, and patients were given a questionnaire 1 week postoperatively to examine their response to and recall of the procedure. Scoring by both the surgeon and patients revealed that the great majority of patients in both groups had adequate "sedation." Patients from both groups related a high degree of satisfaction (> 90 percent) with the technique of sedation. The differences between the two study groups achieved statistical significance only on 4 of the 12 parameters investigated. Those who had received only midazolam were less likely to vocalize during the surgery or to experience the procedure as being of undue duration. Those who had also received ketamine had a lesser chance of remembering the local anesthetic injections (11.1 versus 19.8 percent) and a lesser likelihood of being dissatisfied with their surgical experience (3.3 versus 7.4 percent). In conclusion, the use of an opioid-free sedative technique of intravenous midazolam was highly successful in meeting the needs of both patients and surgeons. The addition of a single preblock dose of intravenous ketamine to intravenous midazolam sedation for rhinoplasty does not improve intraoperative conditions for the surgeon in terms of patient behavior.(ABSTRACT TRUNCATED AT 250 WORDS)
A two-year-old patient had an atrial septal defect associated with a remnant of the valve of the sinus venosus which produced an unusual drainage of the inferior caval vein. The preoperative knowledge of the unusual anatomy allowed the surgeon to repair the anomaly without difficulties.
A transvector, a highly efficient flow amplifier, until present in use only in industry, has been adapted to the ventilation of patients during fiberoptic bronchoscopy under intravenous general anesthesia. The transvector is connected directly to an endotracheal or tracheostomy tube and provides an open unobstructed passage of the instrument into the patient's airways. The method combines safety with ease of instrumentation and uniformly satisfactory ventilation has been obtained in 25 patients.
We describe a reliable, simple, and safe method of monitored anesthesia care, with local anesthesia, which was used for 4500 patients undergoing facial rejuvenation procedure, without major complications and with minor side effects. All procedures were performed in a setup of a private clinic not affiliated with any hospital. The disadvantages of general anesthesia were avoided. Using careful monitoring and drug titration, even aged patients with medical problems, can benefit from this method. We are using classical, inexpensive, and safe compounds, which cope with all goals of anesthesia for aesthetic facial surgery.