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Biomedical subjects

A Baraka

Publications and source records attributed to A Baraka.

At least 19 recordsLinked to original sources
PubMed1992

Onset of vecuronium neuromuscular block is more rapid in patients undergoing caesarean section.

This investigation was carried out in ten patients undergoing elective Caesarean section and the results were compared with those of a control group of ten nonpregnant females of the same age group. The study investigated the onset of vecuronium neuromuscular block and the conditions of tracheal intubation when ketamine (1.5 mg.kg-1)-vecuronium 100 micrograms.kg-1) sequence was used for rapid-sequence induction of anaesthesia. The ulnar nerve was stimulated supra-maximally at the wrist with train-of-four stimuli every 20 sec, and the electromyographic response of the adductor pollicis muscle was displayed. The onset of 50% neuromuscular block as monitored by electromyography was shorter in the Caesarean group (80 +/- 30 sec) than in the control group (144 +/- 43 sec). The conditions of intubation at 50% block were adequate in both groups. Also, the onset of 90% block was shorter in the Caesarean group. The time of recovery to T1/control ratio of 25% was longer in the Caesarean group (46 +/- 10 min) than in the control patients (28 +/- 10 min). The results show that administration of vecuronium according to body weight results in a more rapid onset and delayed recovery of neuromuscular block in pregnant women undergoing Caesarean section than in the nonpregnant control patients.

Adult↗
PubMed1992

Anaesthesia and myasthenia gravis.

Myasthenia gravis is an autoimmune disease, resulting from the production of antibodies against the acetylcholine receptors of the endplate. These antibodies reduce the number of active receptors, brought about either by functional block of the receptors, by increased rate of receptor degradation, or by complement-mediated lysis. In myasthenic muscles, the miniature endplate potential amplitude is decreased, and a large proportion of the endplate potentials are subthreshold. Repetitive nerve stimulation results in a decremental response. The disease is frequently associated with morphological abnormalities of the thymus. In young patients, thymic hyperplasia is common while thymoma is more frequent in elderly patients. Medical treatment of myasthenia gravis aims at improving of neuromuscular transmission by anticholinesterases, suppressing the immune system by corticosteroids and immunosuppressants, or by decreasing the circulating antibodies by plasmapheresis. Adults with generalized myasthenia should have a trans-sternal thymectomy. A balanced technique of general anaesthesia which includes the use of muscle relaxants can be safely used, provided neuromuscular transmission is monitored. Myasthenic patients are sensitive to nondepolarizing relaxants but intermediate-acting nondepolarizing relaxants such as atracurium and vecuronium are eliminated rapidly, and can be titrated to achieve the required neuromuscular block that can be completely reversed at the end of surgery. Postoperatively, ventilatory support may be required in high-risk patients. Also, medical treatment may be maintained, tapered or discontinued depending on the outcome of surgery. Thymectomy benefits nearly 96% of patients, 46% develop complete remission and 50% are asymptomatic or improve on therapy.

Adolescent↗
PubMed1992

Management of an unusual presentation of foreign body aspiration.

Foreign body aspiration is a very common problem in children and toddlers and still a serious and sometimes fatal condition. We are reporting on a 2-year-old white asthmatic male who choked on a chick pea and presented with subcutaneous emphysema, and on chest X-ray with an isolated pneumomediastinum but not pneumothorax. On review of the literature an isolated pneumomediastinum without pneumothorax was rarely reported. This presented a challenge in management mainly because of the technique that we had to use in order to undergo bronchoscopy and removal of the foreign body. Apnoeic diffusion oxygenation was used initially while the foreign body was removed piecemeal, and afterwards intermittent positive pressure ventilation was used. The child did very well, and his subcutaneous emphysema and pneumomediastinum remarkably improved immediately post surgery.

Bronchi↗
PubMed1992

Suxamethonium block in the myasthenic patient. Correlation with plasma cholinesterase.

The neuromuscular block of suxamethonium 1.5 mg.kg-1 was investigated in three myasthenic patients (Class IIA), undergoing thymectomy. Two of the patients were receiving pre-operative pyridostigmine therapy. In the three patients, plasma cholinesterase activity was determined on the morning of surgery and was correlated with the neuromuscular response to suxamethonium as monitored by electromyography. The results suggest that the response to suxamethonium in the myasthenic patients can show wide variations according to the level of their plasma cholinesterase activity. The degree and duration of suxamethonium block is inversely related to the plasma cholinesterase activity.

Adolescent↗
PubMed1992

Cimetidine-dobutamine interaction?

The report describes a patient during induction of anaesthesia for coronary artery by-pass grafting, in whom the infusion of dobutamine at a rate of 5 micrograms.kg-1.min-1 resulted in unanticipated severe hypertension. The exaggerated response may be attributed to cimetidine--dobutamine interaction.

Anesthesia, Intravenous↗
PubMed1992

Administration of vancomycin during cardiopulmonary bypass.

Vancomycin was given during cardiopulmonary bypass to 12 anaesthetised patients undergoing open heart surgery. Injection of vancomycin 1 g within 60 s via the venous inlet of the oxygenator resulted in a moderate and transient decrease of mean arterial pressure. This minimal reaction may be attributed to dilution of vancomycin by the extracorporeal circuit volume, to the bypassing of the lungs which are a major site of storage of vasoactive substances, or to the maintenance of adequate perfusion flow during cardiopulmonary bypass. The results suggest that the haemodynamic adverse reactions to vancomycin, given as antibiotic prophylaxis, may be decreased by its administration after initiation of cardiopulmonary bypass.

Adult↗
PubMed1991

Necrotizing fasciitis.

Ten cases of necrotizing fasciitis are reviewed. Three patients died but only two of these deaths were due to uncontrolled septicaemia. All isolated organisms were sensitive to a combination of piperacillin and ampicillin which we now regard as the initial antibiotic combination of choice. Prompt and aggressive surgical debridement remains the cornerstone of management.

Adult↗
PubMed1991

Comparison of flumazenil with aminophylline to antagonize midazolam in elderly patients.

We have compared, in a double-blind study, the efficacy of flumazenil with that of aminophylline in antagonizing the effects of midazolam in 60 patients (ASA I-II, mean age 66 yr) undergoing transurethral resection of prostate under spinal anaesthesia. All patients received midazolam 0.075 mg kg-1 i.v. and the test drugs were given 5 min after its administration. Patients were allocated randomly to receive i.v. flumazenil 0.01 mg kg-1, aminophylline 2 mg kg-1 or placebo saline 0.1 ml kg-1. One minute after administration, aminophylline caused 42% reversal of sedation, 66% of disorientation and 73% of lack of co-operation in comparison with placebo, although there was marked individual variation. Flumazenil caused complete and rapid antagonism of sedation, disorientation and lack of cooperation.

Aged↗