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Biomedical subjects

A P Rubin

Publications and source records attributed to A P Rubin.

At least 19 recordsLinked to original sources
PubMed1999

A comparison of 1% ropivacaine with a mixture of 0.75% bupivacaine and 2% lignocaine for peribulbar anaesthesia.

In a single centre, randomised, double-blind study, 54 patients underwent intraocular surgery under peribulbar anaesthesia with either ropivacaine 1% or a mixture of bupivacaine 0.75% and lignocaine 2%, both with hyaluronidase 7.5 iu.ml-1. There were no significant differences in volume of anaesthetic required, time to onset of block, peri-operative pain scores or frequency of adverse events between the ropivacaine group and the lignocaine and bupivacaine group.

Aged↗
PubMed1998

Comparison of 0.75% levobupivacaine with 0.75% racemic bupivacaine for peribulbar anaesthesia.

In a single centre, randomised, double-blind study 50 patients scheduled for intra-ocular surgery received 0.75% levobupivacaine or 0.75% racemic bupivacaine for peribulbar anaesthesia. There were no significant differences in the mean (SD) volume of levobupivacaine (11 (2.7) ml) or racemic bupivacaine (10 (2.6) ml) required, time to satisfactory block (levobupivacaine-13 (5.6) min; racemic bupivacaine-11 (4.4) min), peri-operative pain scores or frequency of adverse events between levobupivacaine and racemic bupivacaine. The safer side-effect profile of levobupivacaine may offer significant advantages in the elderly population undergoing cataract extraction in whom intercurrent disease is common.

Aged↗
PubMed1996

An assessment of intraocular pressure during fractionated peribulbar anaesthesia.

This study of 20 patients undergoing elective cataract surgery was performed to investigate the change in intraocular pressure that accompanies extraconal peribulbar anaesthesia. We have demonstrated that each injection during peribulbar anaesthesia causes a small rise in intraocular pressure. The routine use of conventional external ocular compression overcomes this pressure rise and safely provides a satisfactory and progressive reduction in intraocular pressure prior to surgery. Our findings suggest that the volumes of anaesthetic solutions used in fractional peribulbar anaesthesia, if used in conjunction with external compression devices, result in intraocular pressures acceptable for intraocular surgery.

Aged↗
PubMed1995

Comparison of different methods of administering droperidol in patient-controlled analgesia in the prevention of postoperative nausea and vomiting.

We performed a double-blind, placebo-controlled study to evaluate the different methods of administering droperidol in patients using patient-controlled analgesia (PCA) with morphine. Eighty patients undergoing major orthopedic procedures received temazepam 0.2 mg/kg orally followed by induction of general anesthesia with propofol 2.5 mg/kg, fentanyl 2 micrograms/kg, and vecuronium 0.1 mg/kg. Anesthesia was maintained with nitrous oxide, oxygen, and enflurane. At the end of surgery, all patients received PCA with morphine (0.5 mg/mL, bolus dose 1 mg, and lockout interval 5 min. Before commencement of PCA, patients were randomized to receive droperidol 1.25 mg immediately and, in addition, droperidol 0.16 mg with each PCA dose (Group 1), droperidol 1.25 mg immediately (Group 2), droperidol 0.16 mg with each PCA dose (Group 3), and no droperidol (Group 4). Incidence of nausea and vomiting, request for rescue antiemetics, sedation score, and side effects were recorded every 4 h. Droperidol significantly reduced the incidence of postoperative nausea and vomiting (PONV) (P < 0.01) and request for rescue antiemetic (P < 0.01) compared to placebo. However, there was no difference in the incidence of PONV between droperidol given either as a single dose at the end of surgery (Group 2) or mixed in morphine PCA (Group 3). The addition of droperidol in PCA after an initial dose (Group 1) should be avoided, as it resulted in more sedation and no further reduction in the incidence of PONV compared to Groups 2 and 3.

Adolescent↗
PubMed1994

Comparison of a bupivacaine-clonidine mixture with plain bupivacaine for caudal analgesia in children.

In a randomized, double-blind study in children undergoing elective orthopaedic surgery, we have assessed the clinical value of combining clonidine with bupivacaine for caudal analgesia. Forty-six children, aged 1-10 yr, were allocated randomly to two equal groups to receive 0.25% bupivacaine 1 ml kg-1 combined with either normal saline 1 ml (group A) or clonidine 2 micrograms kg-1 in normal saline 1 ml (group B). Mean (SD) duration of caudal analgesia for groups A and B were 5.2 (1.2) h and 9.8 (2.1) h, respectively (P < 0.0001). Group B required significantly less supplementary analgesia after operation (P < 0.01). There was no significant difference in the incidence of side effects between the two groups. The longer duration of sedation in group B (9.1 (2.5) h) resulted partly from the sedative effect of clonidine and partly from the longer duration of analgesia provided by clonidine. We conclude that, when added to bupivacaine, clonidine improves the efficacy of caudal analgesia in children.

Acetaminophen↗
PubMed1993

Breast feeding and anaesthesia.

Anaesthetists require a good knowledge of the excretion of drugs in breast milk and the potential hazards to suckling infants of drug ingestion via breast milk. A brief account of the physiology of lactation is given. The mechanisms of drug passage into breast milk are discussed followed by a review of the excretion in breast milk of drugs used in anaesthetic practice. Suggestions for the management of anaesthesia in breast feeding mothers are offered.

Anesthesia↗
PubMed1993

A comparison of epidural 1% ropivacaine and 0.75% bupivacaine for lower abdominal gynecologic surgery.

A randomized double-blind study was performed to compare ropivacaine and bupivacaine in epidural anesthesia for intraperitoneal surgery. Forty-four patients undergoing epidural anesthesia for intraperitoneal lower abdominal gynecologic surgery received 20 mL of either 1% ropivacaine or 0.75% bupivacaine via an epidural catheter. There was no difference between the two drugs in the onset, extent, and duration of sensory and motor block. Satisfactory conditions for surgery were produced in the same number of patients in each group. The cardiovascular changes and the overall incidence of adverse reactions were similar for both drugs. It is concluded that ropivacaine is an effective and safe alternative to bupivacaine when used in epidural anesthesia for lower abdominal, intraperitoneal surgery.

Adult↗
PubMed1989

Effect of fluid preloading on cardiovascular variables after spinal anaesthesia with glucose-free 0.75% bupivacaine.

We studied the effect on systemic arterial pressure of fluid preloading with 1 litre of crystalloid fluid before spinal anaesthesia in 40 patients undergoing minor lower abdominal or lower limb surgery. Fluid was given at a rate of either 1 ml min-1 (no preload group), or 1000 ml in the 15 min (preload group) immediately before induction of spinal anaesthesia with 3 ml of 0.75% glucose-free bupivacaine. There was no difference between the groups in the character of anaesthesia or motor block in the lower limbs. The cephalad spread of analgesia ranged from L1 to C8. Analgesia was insufficient for surgery without supplementary analgesia in three patients in each group. The group not given a fluid preload had significantly lower arterial pressures (P less than 0.05) when anaesthesia extended above the T5 dermatome. The mean time before the lowest arterial pressure was recorded was twice as long in the preloaded group as in the non-preloaded group. Glucose-free 0.75% bupivacaine did not give a reliable extent of anaesthesia for lower abdominal surgery.

Abdomen↗
PubMed1987

Subarachnoid block with hyperbaric lignocaine. A comparison with hyperbaric bupivacaine.

A double-blind study was carried out in 20 patients to compare 5% hyperbaric lignocaine and 0.5% hyperbaric bupivacaine for subarachnoid block. The injections were made in the lateral position and the patients turned supine immediately. The onset, extent and duration of sensory and motor blockade, the quality of anaesthesia, cardiovascular effects and the frequency of side effects were studied. Cephalad spread of analgesia was high (T4-5) with both solutions. Bupivacaine produced a longer duration of action in the lumbar and sacral segments but the duration in the thoracic segments was similar. There was a considerable degree of hypotension in both groups but this responded readily to ephedrine. Hyperbaric lignocaine is an alternative to hyperbaric bupivacaine and its shorter duration of action in the lumbar and sacral segments is advantageous when a fast recovery is desirable.

Adult↗
PubMed1986

Intrathecal morphine and heroin in humans: six-hour drug levels in spinal fluid and plasma.

Lumbar spinal fluid and plasma concentrations of morphine were measured by radioimmunoassay after intrathecal administration of 1 mg of morphine (n = 13) or heroin (n = 10). Plasma levels of morphine were measured regardless of 'whether heroin or morphine was injected intrathecally, because of the rapid biotransformation of heroin to morphine in plasma. Significant drug concentrations appeared in plasma after intrathecal heroin (peak concentration 47.8 +/- 9.0 nmol/L, time to peak concentration 10 +/- 2.4 min); after intrathecal morphine plasma drug concentrations were significantly lower (8.1 +/- 1.0 nmol/L; P less than 0.002) and significantly later (216 +/- 39 min; P less than 0.002). Elimination half-life of heroin from spinal fluid (43 +/- 5 min) was significantly shorter than for morphine (73 +/- 5 min; P less than 0.02).

Aged↗
PubMed1984

Subarachnoid blockade with bupivacaine. A comparison with cinchocaine.

Subarachnoid anaesthesia was induced in 40 patients with 0.5% bupivacaine 3 ml with no glucose, 5% glucose or 8% glucose, or with hyperbaric cinchocaine . The injections were made in the lateral position and the patients turned supine immediately. The onset, extent and duration of sensory and motor blockade, the quality of anaesthesia, cardiovascular effects, and the frequency of side-effects were studied. The hyperbaric solutions produced a greater cephalad spread (T6-T7) than the glucose-free solution (T10-T11). Cinchocaine produced a longer duration of action at T10 and T12 than the hyperbaric bupivacaine solutions. No advantage was seen when 8% rather than 5% glucose was used. The glucose-free bupivacaine produced intense blockade of long duration and was suitable when a lower level of blockade was adequate for the proposed surgery.

Adolescent↗
PubMed1983

Superficial acupuncture in the relief of chronic low back pain.

A single-blind, randomised, placebo-controlled trial of superficial acupuncture in the treatment of low back pain was carried out by comparing 8 patients treated by acupuncture with 9 patients treated by placebo. In all five measures of efficacy chosen for study the acupuncture group achieved better responses than the placebo group; four of the five inter-group differences were statistically significant. In addition, an overall mean for all five measures combined showed significant superiority of acupuncture over placebo.

Acupuncture Therapy↗