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Biomedical subjects

T E Oh

Publications and source records attributed to T E Oh.

At least 73 records · Page 4Linked to original sources
PubMed1991

Resistance of humidifiers, and inspiratory work imposed by a ventilator-humidifier circuit.

The pressures and resistances of a bubble humidifier (Bennett Cascade) and a blow-by humidifier (Fisher and Paykel) were measured and computed at gas flow rates from 4.5 to 100 litre min-1. Pressures increased with flows, with the Bennett pressures being greater at all flows. The resistance of the Fisher-Paykel increased with flows, but remained less than that of the Bennett. An inverse resistance-flow relationship was seen with the Bennett up to a flow of 35 litre min-1. The work of breathing through a Servo 900C ventilator-humidifier circuit was computed, using a lung model. Work was performed by the Servo 900C on the lung, especially with the Fisher-Paykel circuit. The Bennett circuit required considerably greater (3.7 times more) inspiratory work. Thus the Bennett Cascade humidifier may present an unacceptable inspiratory load during spontaneous breathing.

Anesthesiology↗
PubMed1991

Systems analysis applied to intracranial pressure waveforms and correlation with clinical status in head injured patients.

Intracranial pressure waveforms (ICPWF) in head injured patients vary with the nature and severity of injury. Clinical interpretation of ICPWF shape is not defined. Spectral analysis provides an objective method of measuring changes in waveform shape, but the indices most suitable for clinical use remain unknown. Spectral analysis has been applied to ICPWF recorded from 30 patients with head injury, classified on clinical grounds into good, poor and intermediate groups. Normalized indices derived from ratios of certain characteristics of the ICP waveform to those of the arterial pressure (AP) waveform, were different (P less than 0.05) in all groups. A simple index examined was the harmonic count ratio (Nc:Na) which decreased with increasing severity of injury. ICP/AP harmonic transfer functions were derived, and demonstrated a peaked response in the range 10-12 Hz. Increasing attenuation of this peaked response occurred with increasing severity of injury. These results suggest that transfer functions may be a clinically useful index of intracranial conditions.

Blood Pressure↗
PubMed1991

Propofol for induction and maintenance of anaesthesia at caesarean section. A comparison with thiopentone/enflurane.

A propofol infusion regimen and a standard general anaesthetic were compared in 40 Chinese women undergoing elective Caesarean section. Twenty patients received propofol 2 mg/kg for induction of anaesthesia followed by propofol 6 mg/kg/hour, while 20 patients received thiopentone 4 mg/kg with enflurane 1% for maintenance of anaesthesia. All patients were given atracurium and their lungs ventilated with nitrous oxide 50% in oxygen until delivery of the neonate. The hypertensive response after intubation was of shorter duration in the propofol group compared with the thiopentone group. Induction to delivery times ranged from 5 to 14 minutes and neonates from both groups had similar and satisfactory Apgar scores. Neurologic and Adaptive Capacity Scores and umbilical cord blood gas analysis. However, a prolonged propofol infusion time before delivery may cause lower Neurologic and Adaptive Capacity Scores. There were no differences in maternal recovery times or psychomotor performance.

Adult↗
PubMed1991

Inspiratory work imposed by demand valve ventilator circuits.

The inspiratory work (WI) imposed by three commonly used demand valve ventilator circuits was studied using a lung model to simulate spontaneous ventilation. The CPU-1 and Engstrom Erica circuits recorded WI of 379 mJ/l and 190 mJ/l respectively. A negative WI of -32 mJ/l was recorded for the Servo 900C, denoting that the circuit performed work on the lung. The demand valves recorded a time delay between inspiratory effort and onset of gas flow, of 300 ms (CPU-1), 190 ms (Servo 900c) and 160 ms (Engstrom Erica). Both the Servo 900C and Engstrom Erica demand valves were able to generate a high inspiratory gas flow response, but the CPU-1 lacked such a flow compensation. Expiratory work was also greatest with the CPU-1 (156 mJ/l) with 141 mJ/l and 90 mJ/l recorded for the Servo 900C and Engstrom Erica. Of the three ventilators studied, the Servo 900C appears to be the ventilator circuit of choice for spontaneous ventilation.

Humans↗
PubMed1991

Gastric emptying in the postpartum period.

We measured gastric emptying, using the technique of paracetamol absorption, in eight women on their first and third postpartum day. Gastric emptying was rapid and there was no difference between the first and third day in the time to peak plasma concentration of paracetamol. Six women returned after six weeks for a further study. Gastric emptying was still rapid but the metabolism of paracetamol appeared to be slower than that found during the immediate postpartum period. These findings suggest that fluid fasting guidelines in patients more than one day postpartum need not be different from those in non-pregnant patients.

Absorption↗
PubMed1990

Propofol infusion anaesthesia for caesarean section.

Two propofol infusion regimens and a standard general anaesthetic were compared in thirty Chinese women undergoing elective Caesarean section. After induction of anaesthesia with propofol 2 mg.kg-1, ten patients received propofol 6 mg.kg-1.hr-1 and nitrous oxide 50 per cent in oxygen while ten were given propofol 9 mg.kg-1.hr-1 with 100 per cent oxygen. The other ten patients received thiopentone 4 mg.kg-1 and nitrous oxide 50 per cent in oxygen with enflurane one per cent. Maternal recovery times and psychomotor performance were recorded. Neonates were assessed by Apgar scores, neurologic and adapative capacity scores (NACS) and umbilical cord blood gas analysis. Haemodynamic changes were similar immediately following induction but the low propofol infusion group had the best haemodynamic stability subsequently. Recovery times were fastest in the low-infusion group but there were no differences in later postbox testing. Neonatal Apgar scores and umbilical blood gas analysis were similar but NACS at two hours were poorer in the high infusion group. A propofol infusion coupled with nitrous oxide appears to be a satisfactory technique for Caesarean section.

Adult↗
PubMed1990

Pharmacokinetics of propofol in women undergoing elective caesarean section.

We have compared the pharmacokinetics of a bolus induction dose of propofol 2 mg kg-1 in 10 Chinese women undergoing elective Caesarean section with those in six non-pregnant Chinese women having laparoscopic sterilization. Blood propofol concentrations were measured using high pressure liquid chromatography with fluorimetric detection. Pharmacokinetic data were analysed by a model independent method based on statistical moment theory. Data from the laparoscopy group also underwent compartmental analysis, which produced similar kinetic results. Non-compartmental analysis estimated that the women undergoing Caesarean section had a similar elimination half-life (mean 81.27 (SD 18.87) min) and apparent volume of distribution at steady state (2.66 (0.63) litre kg-1) as non-obstetric patients (99.45 (29.40) min and 3.36 (1.87) litre kg-1). Clearance was more rapid in the Caesarean section group (39.32 (8.07) ml min-1 kg-1 vs 29.40 (8.72) ml min-1 kg-1) (P less than 0.05). The increased total body clearance may result from blood loss and delivery of the fetus and placenta at operation, although an increase in extrahepatic clearance is also possible.

Adult↗
PubMed1990

Effect of adrenaline on venous plasma concentrations of bupivacaine after interpleural administration.

Bupivacaine 2.5 mg kg-1 (0.5 ml kg-1 of 0.5% solution), with or without adrenaline 5 micrograms ml-1, was administered by interpleural injection to 12 patients after elective cholecystectomy. Noncompartmental analysis indicated that the addition of adrenaline had no effect on total body clearance, apparent volume of distribution at steady state or elimination half-life of bupivacaine. However, peak plasma concentrations were lower in the adrenaline group (mean (SD) [range]: 2.57 (0.61) [1.52-3.11] vs 3.22 (0.27) [2.84-3.53] micrograms ml-1, P less than 0.05) and the time to maximum concentration was delayed (median [range]: 25 [15-30] vs 15 [10-20] min, P less than 0.05). Analgesia was variable and no differences were detected between the two groups. The addition of adrenaline appears prudent to minimize possible bupivacaine toxicity.

Analgesia↗
PubMed1990

Effect of oral omeprazole on intragastric pH and volume in women undergoing elective caesarean section.

We have studied in obstetric patients the efficacy of omeprazole in increasing intragastric pH to more than 2.5 and reducing volume to less than 25 ml. Omeprazole 40 mg was given orally the night before and again on the morning of surgery to 30 Asian women scheduled to undergo elective Caesarean section. After induction of anaesthesia, a gastric tube was inserted and intragastric contents aspirated. Volume and pH were recorded and measurements were repeated on completion of surgery. The median (range) volume was 2 (1-13) ml before surgery and 4 (0-14) ml at the end of surgery. There was insufficient volume to measure pH in all patients. The median (range) pH was 6.7 (4.6-7.4) before surgery in 20 patients and 6.6 (4.6-7.8) at the end of surgery in 28 patients. No adverse drug reactions were noted in mothers or neonates. Omeprazole 40 mg orally twice before elective Caesarean section appeared to be effective in reducing intragastric volume and acidity to acceptable values.

Administration, Oral↗
PubMed1990

Factors influencing humidification in high-frequency jet ventilation.

A new method of water nebulization for high-frequency jet ventilation (HFJV) using a coaxial saline infusion is described. A bench study was performed to investigate how alteration of the HFJV variables affects humidity using this method of humidification. The variables examined included the water flow rate (0.1, 0.25, 0.5, and 1.0 ml/min), cannula OD 2.1 mm (14 ga) and 1.4 mm (17 ga), ventilation rate (60, 80, 100, and 120 beat/min), inspiratory/expiratory (I/E) ratio (0.25, 0.67, and 1.5), and driving pressure (600, 900, 1200, and 1500 torr). Increasing water flow rate increased humidity. Humidity decreased with increased driving pressure, I/E ratio, and cannula OD. Humidity is not much affected by ventilation rate.

Evaluation Studies as Topic↗
PubMed1990

Detecting awareness during general anaesthetic caesarean section. An evaluation of two methods.

Seventy-four patients received general anaesthesia for Caesarean section. Seven percent of the elective group and 28% of the emergency patients reported dreaming or recall of voices during the procedure (p less than 0.05) at postoperative interview. One patient from each group reported feeling pain or suffocation. All patients were monitored for awareness using the isolated forearm technique and lower oesophageal contractility. Provoked lower oesophageal contractility was the most effective of the different indices. A value greater than 35 mmHg on at least one occasion had a false negative rate of 33%, a false positive rate of 28% and a predictive value of 25%. A value greater than 13 mmHg picked up all patients who dreamed, with a false positive rate of 68%. Both of the 'aware' patients had provoked lower oesophageal contractility response of greater than 70 mmHg, an attribute shared by only 8% of the rest. The isolated forearm was particularly ineffective.

Anesthesia, General↗
PubMed1990

A comparison of the effects of omeprazole and ranitidine on gastric secretion in women undergoing elective caesarean section.

This study compares the efficacy of omeprazole and ranitidine at reducing gastric secretion in obstetric patients. Sixty-five women scheduled to undergo elective Caesarean section under general anaesthesia were randomly allocated to receive either omeprazole 40 mg or ranitidine 150 mg orally at 2200 hours the night before and at 0600 hours on the morning of surgery. Intragastric pH and volume were measured immediately after induction of anaesthesia and on completion of surgery. All patients had gastric aspirates less than 25 ml. None of the omeprazole group had an aspirate of pH less than 3.5. Six patients (19%) in the ranitidine group had aspirates of pH less than 3.5, a significant difference from the omeprazole group (p less than 0.05). Of these six, two (6%) had aspirates of pH less than 2.5. Hence this study showed that omeprazole was more effective and consistent than ranitidine at maintaining gastric pH greater than 3.5.

Adult↗
PubMed1990

Obstetric epidural analgesia with mixtures of bupivacaine, adrenaline and fentanyl.

We performed a double-blind comparison of six solutions for epidural analgesia in 90 healthy Chinese women with uncomplicated pregnancies. Patients were randomly allocated to receive 10 ml bupivacaine 0.125% or 0.25% plain, bupivacaine 0.125% with adrenaline 1.25 micrograms/ml, bupivacaine 0.25% with adrenaline 2.5 micrograms/ml or the latter two solutions with added fentanyl 50 micrograms. Analgesia was unsatisfactory in 30% of the bupivacaine 0.125% groups without fentanyl. The addition of adrenaline, compared with bupivacaine 0.25% plain, gave faster onset and longer duration of analgesia (p less than 0.05) which was similar to that found in both fentanyl groups. There were no differences in method of delivery or neonatal Apgar scores among groups. The least concentrated mixture that gave the best analgesia was the combination of bupivacaine 0.125% with adrenaline 1.25 micrograms/ml and fentanyl 50 micrograms.

Adult↗
PubMed1990

The haemodynamic effects of propofol and thiopentone for induction of caesarean section.

Forty Chinese women for elective caesarean section received either propofol 2 mg.kg-1 or thiopentone 4 mg.kg-1 for induction of general anaesthesia. Systolic, mean and diastolic arterial pressures and heart rate were recorded non-invasively every minute for ten minutes. Post-induction arterial pressures were similar to pre-induction values with no differences between thiopentone and propofol. Following intubation, the rise in systolic arterial pressure was greater in the thiopentone group, 32.1 mmHg (SD 23.7) compared with the propofol group, 17.4 mmHg (SD 23.8), (P less than 0.05). In the thiopentone group, arterial pressures were slower in returning to baseline values. Heart rate was initially elevated in both groups to the same degree. At caesarean section, induction with propofol causes less variation in arterial pressure than thiopentone. Hypotension is probably prevented by the coincident stimulus of rapid sequence induction. Neonatal Apgar scores were similar between the two groups.

Adult↗