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Biomedical subjects

T Ezri

Publications and source records attributed to T Ezri.

At least 55 records · Page 3Linked to original sources
PubMed1997

Spinal anesthesia speeds active postoperative rewarming.

BACKGROUND: Redistribution of body heat decreases core temperature more during general than regional anesthesia. However, the combination of anesthetic- and sedative-induced inhibition may prevent effective upper-body thermoregulatory responses even during regional anesthesia. The extent to which each type of anesthesia promotes hypothermia thus remains controversial. Accordingly, the authors evaluated intraoperative core hypothermia in patients assigned to receive spinal or general anesthesia. They also tested the hypothesis that the efficacy of active postoperative warming is augmented when spinal anesthesia maintains vasodilation. METHODS: Patients undergoing lower abdominal and leg surgery were randomly assigned to receive general anesthesia (isoflurane and nitrous oxide; n = 20) or spinal anesthesia (bupivacaine; n = 20). Fluids were warmed to 37 degrees C and patients were covered with surgical drapes. However, no other active warming was applied during operation. Ambient temperatures were maintained near 20 degrees C. After operation, patients were warmed with a full-length, forced-air cover set to 43 degrees C. Shivering, when observed, was treated with intravenous meperidine. RESULTS: The mean spinal analgesia level, which was at the sixth thoracic level during surgery, remained at the T12 dermatome after 90 min after operation. Core temperatures did not differ significantly during surgery and decreased to 34.4 +/- 0.5 degrees C and 34.1 +/- 0.4 degrees C, respectively, in patients given spinal and general anesthesia. After operation, however, core temperatures increased significantly faster (1.2 +/- 0.1 degrees C/h vs. 0.7 +/- 0.2 degrees C/h, mean +/- SD; P < 0.001) in patients given spinal anesthesia. Consequently, patients given spinal anesthesia required less time to rewarm to 36.5 degrees C (122 +/- 28 min vs. 199 +/- 28 min; P < 0.001). CONCLUSIONS: Comparable intraoperative hypothermia during general and regional anesthesia presumably resulted because the combination of spinal anesthesia and meperidine administration obliterated effective peripheral and central thermoregulatory control. Vasodilation increased the rate of core rewarming in patients after operation with residual lower-body sympathetic blocks, suggesting that vasoconstriction decreased peripheral-to-core heat transfer after general anesthesia.

Adult↗
PubMed1995

[Combined intrapleural and low epidural anesthesia for upper abdominal surgery].

Intrapleural administration of local anesthetics to achieve postoperative analgesia was recently described by Kvalheim and Reiestad. It has been stated that the intrapleural technique provides analgesia, but not surgical anesthesia. However, this method has been used recently for anesthesia during minor surgical procedures. We describe the use of combined, bilateral intrapleural and low epidural anesthesia in a woman with severe impairment of cardiopulmonary function who underwent combined splenectomy and cholecystectomy.

Abdomen↗
PubMed1994

Regional anaesthesia for circumcision in adults: a comparative study.

Penile block (PB) in adults is not a well-recognized technique. The aim of this study was to compare, in a randomized prospective manner, five different techniques of PB in 250 adults undergoing circumcision with regard to anaesthetic quality, complications and postoperative analgesia. Patients were divided into five groups (50 per group) according to the technique used: Group A--"10, 30-13, 30" approach; Group B--the subpubic approach; Group C--subcutaneous ring block; Group D--a combination of frenulum infiltration and the "10, 30-13, 30" approach; Group E--a combination of frenulum infiltration and the subpubic approach. The number of failed blocks in Groups A and B (41 and 43 respectively) was greater than in Groups C, D and E (2, 3 and 5 respectively) (P < 0.001). The five groups did not differ with regard to adverse effects or time until the onset of postoperative pain when the blocks were successful. It is concluded that good surgical anaesthesia, a low rate of adverse effects and prolonged postoperative analgesia can be achieved by the use of either subcutaneous ring block or a combination of dorsal nerve block (using the "10, 30-13, 30" or the subpubic approach) and infiltration of the frenulum. These approaches to the PB are effective anaesthetic techniques for circumcision in adults.

Adult↗
PubMed1994

[Benefits of perioperative hemodynamic monitoring in coronary patients].

During 1987-1991, 78 coronary patients were admitted to the intensive care unit (ICU) for noncardiac surgery. 40 were under invasive hemodynamic monitoring and treatment before operation (group A) and 38 were only admitted to the ICU postoperatively, since ICU beds were not available before surgery (group B). The overall incidence of the perioperative complications, ischemic heart, myocardial infarction and cardiac arrhythmias was significantly higher in group B than in group A (p < 0.01). 5% of group A and 11% of group B died in the ICU postoperatively. These data indicate the importance of preoperative hemodynamic and cardiac monitoring and treatment in coronary patients.

Aged↗
PubMed1994

Bronchiolitis obliterans--current concepts.

We review current concepts about the clinical manifestations, diagnosis and treatment of patients with bronchiolitis obliterans (BO) with emphasis on clinical/pathological correlations and recent developments. BO is a relatively rare disease, but its incidence is probably higher than generally believed and is continuously rising, partly because of better recognition, but also because of increased exposure to industrial fumes, and its occurrence in lung transplantation. BO is characterized histologically by varying degrees of obliteration of the lumen of the respiratory bronchioles by organizing connective tissue often extending into the alveoli ('proliferative' BO with organizing pneumonia--BOOP) or by more extensive fibrosis and scarring of the more proximal, conductive bronchioles ('constrictive' BO). Diverse clinical conditions have been associated with the development of BO, notably viral and mycoplasma infection, toxic fume exposure and immune reactions in the setting of a collagen vascular disease, drug reaction or organ transplantation. The clinical course and features of BO may vary considerably according to the aetiology, histological pattern and stage of the disease. The most common presentation is that of a progressive dry cough and dyspnea, associated with diffuse patchy interstitial lung infiltrates on chest X-ray. In the more advanced cases, lung function tests show either restrictive or obstructive defects, depending on the extent of alveolar involvement, and hypoxemia without CO2 retention. The diagnosis is often possible on clinical grounds, however, in a seriously ill patient uncertainty should be resolved by tissue diagnosis, preferably by open lung biopsy. Treatment is based on symptomatic therapy. The use of corticosteroids is controversial, but common. Patients with BOOP are exceptional, in that there may be no underlying condition ('idiopathic' BOOP or cryptogenic organizing pneumonia--COP), a restrictive ventilatory defect is usual and the response to corticosteroids often remarkable.

Adrenal Cortex Hormones↗
PubMed1993

Adult respiratory distress syndrome after radical neck dissection.

The clinical management of an unusual case of postoperative ARDS is reported. A few hours following neck surgery and septic insult, the patient developed unexpected ARDS. Aetiologic and supportive treatment were successfully instituted and after 72 hours of intensive therapy, the patient's clinical status improved. The very short time lapse between the septic insult and appearance of ARDS is emphasized. A brief literature review on aetiology, diagnosis and therapy of sepsis, as well as some pertinent aspects concerning the pathogenesis of ARDS and its linkage to sepsis are presented.

Aged↗