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Biomedical subjects

A Shroff

Publications and source records attributed to A Shroff.

5 recordsLinked to original sources
PubMed1997

Effects of intrathecal opioid on extubation time, analgesia, and intensive care unit stay following coronary artery bypass grafting.

STUDY OBJECTIVE: To determine if intrathecal opioid decreases time to extubation after coronary artery bypass surgery without compromising postoperative analgesia. DESIGN: Prospective randomized trial. SETTING: Veterans Affairs Hospital. PATIENTS: 21 ASA physical status III and IV men scheduled for elective coronary bypass surgery, who had not received medications that would impair anticoagulation at the time of surgery. INTERVENTIONS: Patients were randomized to receive 10 micrograms/kg morphine and 25 micrograms fentanyl intrathecally preoperatively (n = 12) or no intrathecal opioid (n = 9). The latter group received 25 to 50 micrograms/kg fentanyl and 0.05 to 0.1 mg/kg midaxolam intraoperatively, whereas the intrathecal opioid group received intravenous (i.v.) fentanyl and midazolam only as needed. Both groups were administered i.v. morphine and midazolam postoperatively as needed by intensive care unit (ICU) personnel who were blinded to the treatment group. MEASUREMENTS AND MAIN RESULTS: For the first 24 hours postoperatively, pain levels (0 = none, to 10 = most severe) and sedation levels (1 = none, to 5 = unconscious) were measured hourly. The time to extubation and discharge from the ICU was recorded. ECG evidence of myocardial ischemia was noted. Pain scores were low for both groups (1.5), but the intrathecal opioid subjects exhibited less sedation than the high-dose fentanyl subjects [means +/- standard deviation (SD) of 2.3 +/- 0.4 vs. 2.8 +/- 0.5, p = 0.03]. Extubation time was 12 hours shorter in the intrathecal opioid group (2.9 +/- 5.3 vs. 14.7 +/- 6.8, p = 0.001). The five subjects with a one day ICU stay were all in the intrathecal opioid group (p = 0.04). The incidence of myocardial ischemia did not differ between the two groups. CONCLUSIONS: Intrathecal opioid can facilitate early extubation and discharge from the ICU without compromising analgesia or increasing myocardial ischemia.

Aged↗
PubMed1997

Myocardial ischemia and adverse cardiac outcomes in cardiac patients undergoing noncardiac surgery with sevoflurane and isoflurane. Sevoflurane Ischemia Study Group.

UNLABELLED: Sevoflurane is associated with less tachycardia and coronary vasodilation than isoflurane and thus might be associated with less myocardial ischemia. This multicenter study examined the incidence of myocardial ischemia and adverse cardiac outcomes in adults (40-87 yr) with cardiac disease having elective noncardiac surgery. Patients were randomized to receive either sevoflurane (S) (n = 106) or isoflurane (I) (n = 108) in conjunction with sodium thiopental, vecuronium, fentanyl, and 50%-70% N2O. Intraoperative hemodynamics were maintained within 20% of awake baseline with standard drugs. A Holter monitor was applied 3-24 h before surgery and maintained until 48 h after surgery. Electrocardiograms and blood samples for analysis of the MB isoenzyme fraction of creatine phosphokinase were obtained preoperatively and daily for 48 h postoperatively. Anesthetic exposure (1.79 +/- 0.15 [mean +/- SE] minimum alveolar concentration-hour) and duration of surgery (219 +/- 13 min) did not differ between groups. The incidence of ischemia in the pre-, intra- and postoperative periods, adverse cardiac outcomes (18% occurrence), intraoperative hemodynamic variations (+/-20% change from ward baseline), and administration of adjunct cardiovascular medications were similar between groups. In cardiac patients having noncardiac surgery, sevoflurane was comparable to isoflurane with respect to the incidence of intra- and postoperative myocardial ischemia and in the frequency of adverse cardiac outcomes. IMPLICATIONS: Surgical patients with heart disease are at risk of heart complications, some of which could be induced by an anesthetic. We compared the incidence of cardiac complications between patients receiving sevoflurane and isoflurane. We found that the frequency of additional heart problems in cardiac patients receiving sevoflurane was not different from that associated with isoflurane.

Adult↗
PubMed1994

Functional activity of antibodies to the group B polysaccharide of group B streptococci elicited by a polysaccharide-protein conjugate vaccine.

Group B streptococci (GBS) are a major cause of sepsis and meningitis in infants. While antibodies directed to the type-specific GBS capsule have been shown to be protective, it is less clear whether antibodies to the group B polysaccharide, a noncapsular, cell wall-associated antigen, may play a role in immunity. To investigate the functional activity of group B polysaccharide-specific antibodies, we tested sera from rabbits vaccinated with group B polysaccharide coupled to tetanus toxoid (B-TT). Anti-B-TT was weakly opsonic in vitro for a highly encapsulated type III strain, while antiserum elicited by vaccination with type III capsular polysaccharide linked to tetanus toxoid (III-TT) was a very effective opsonin. In contrast to anti-III-TT, anti-B-TT given before or after bacterial challenge was only marginally effective in protecting newborn mice against lethal infection with type III GBS. The number of C3 molecules bound to type III GBS was augmented by anti-III-TT but not by high antibody concentrations of anti-B-TT. These results suggest that the difference in opsonic activity between anti-B-TT and anti-III-TT may be due to a difference in their ability to deposit C3. In addition, the maximum number of antibody molecules bound to the bacterial surface was greater for anti-III-TT than for anti-B-TT. That anti-B-TT binds to fewer sites than anti-III-TT may explain the differences in complement activation and in opsonic and protective efficacy of antibodies to group B polysaccharide compared with antibodies to the type-specific capsular polysaccharide.

Animals↗