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Biomedical subjects

B Fredman

Publications and source records attributed to B Fredman.

At least 19 recordsLinked to original sources
PubMed1997

Prehospital cricothyroidotomy by physicians.

To evaluate cricothyroidotomy in the field and the influence of physicians' medical specialty or previous experience on the success rate of this procedure, a retrospective study was conducted. Between October 1991 and April 1995, 29 cricothyroidotomies were performed in the prehospital setting in Israel. Twenty-six (89.6%) cricothyroidotomies were successfully performed. There was no evidence of higher success rate when the performers were surgeons, anesthesiologists, or intensive care specialists (100% success), compared to that of all other specialties (83.33%). All physicians had successfully completed the Advanced Trauma Life Support (ATLS) course, but only three had previously performed cricothyroidotomy. Acute complications included failure to establish an airway in 3 cases, minor bleeding in 2 cases, and an air leak around the cannula in 1 patient. These results show that following brief training (eg, the ATLS course) physicians are capable of performing emergency cricothyroidotomy in the field with a high success rate and minimal complications, regardless of medical specialty.

Adult↗
PubMed1997

The antinociceptive effect of epidural lignocaine and fentanyl during lithotripsy.

To determine the antinociceptive effect of combining epidural fentanyl with lignocaine during non-immersion lithotripsy, 56 healthy patients were enrolled into a prospective, randomized, double-blind study. Epidural anaesthesia was induced with either lignocaine 300 mg alone, or lignocaine 300 mg, or 200 mg in combination with fentanyl 100 micrograms. Throughout the procedure analgesia was assessed by comparing the incidence of (a) spontaneous complaints of pain, (b) patients' attempts to withdraw from the painful stimulus, (c) supplemental epidural lignocaine requirements, (d) the haemodynamic response to lithotripsy and (e) the time to first postoperative pain. The patients who received the fentanyl-lignocaine 300 mg combination required no supplemental lignocaine, experienced marginally less intraoperative pain and recorded lower mean arterial blood pressures when compared with lignocaine 300 mg alone. However, when the combination of lignocaine 200 mg and fentanyl 100 micrograms was administered, patients experienced significantly more pain, withdrew from the painful stimulus more often and received more supplemental lignocaine when compared with the other two treatment groups. No difference was found in the time to the first complaint of postoperative pain. Similarly, discharge times were unaffected by treatment modality. We conclude that despite the addition of fentanyl, adequate analgesia during lithotripsy is dependent upon the dose of local anaesthetic administered.

Analgesia, Epidural↗
PubMed1997

Intravenous line diameter: is bigger really better?

OBJECTIVE: To determine whether the size of an intravenous catheter influences the cannulation success rate and procedure duration among military medics. METHODS: According to a prospective, randomized, controlled crossover study design, 114 military medic cadets were paired and inserted 14-gauge (14G) and 16G intravenous catheters into veins in the antecubital fossa. Success rate and procedure duration were determined. RESULTS: The overall success rate for 14G and 16G catheters was 80 and 86%, respectively. Average procedure duration was 33 +/- 14.7 and 35.2 +/- 14.9 seconds, respectively. No significant differences were found in either success rate or procedure duration between the examined catheter sizes. CONCLUSION: Successful intravenous cannulation was unaffected by catheter size. Therefore, 14G intravenous catheters are recommended for use by military medics on the battlefield.

Adult↗
PubMed1996

Ketorolac does not decrease postoperative pain in elderly men after transvesical prostatectomy.

PURPOSE: To assess the postoperative analgesic efficacy and morphine-sparing effect of ketorolac in elderly patients. METHODS: Sixty ASA-physical status I to III men, aged 60-88 yr, undergoing transvesical prostatectomy were studied according to a randomized, placebo controlled, double-blind study protocol. A standard general anaesthetic was administered. Thirty minutes before concluding the surgical procedure either ketorolac 60 mg or an equal volume of saline was administered, im. Postoperative pain was assessed hourly for six hours using a 100 mm visual analog score (VAS) and a patient-controlled analgesia (PCA) device. RESULTS: Hourly PCA-demands, actual morphine delivered, and patient generated VAS pain scores were unaffected by the treatment modality. On conclusion of the study the total PCA morphine delivered was 11.9 mg +/- 1.38 and 10.8 mg +/- 1.52 for the saline and ketorolac groups, respectively. CONCLUSION: The intraoperative administration of ketorolac, 60 mg, im, was not associated with postoperative morphinesparing or improved analgesia in this elderly population.

Aged↗
PubMed1995

Alfentanil suppresses coughing and agitation during emergence from isoflurane anesthesia.

STUDY OBJECTIVE: To evaluate the effectiveness of alfentanil in suppressing coughing and agitation during emergence from isoflurane anesthesia. DESIGN: Randomized, double-blind, placebo-controlled study. SETTING: Operating rooms at a university medical center. PATIENTS: 34 healthy ASA physical status I and II adult patients scheduled to undergo oral surgical procedures. INTERVENTIONS: During emergence from anesthesia, patients received either alfentanil 15 micrograms/kg (in 10 ml) or saline (10 ml) when the end-tidal isoflurane concentration reached 0.3%. MEASUREMENTS AND MAIN RESULTS: Hemodynamic variables were measured at one-minute intervals following administration of the study medication. A blinded observer recorded the time for patients to spontaneously open their eyes and to follow commands after discontinuing the isoflurane. The occurrence of coughing and agitation prior to extubation was noted. Patients in the alfentanil treatment group exhibited a reduced incidence of coughing prior to extubation (6% vs. 83%, respectively) and a longer time interval until the onset of spontaneous movements (21.1 +/- 2.6 min vs. 14.6 +/- 1.7 min, respectively). The interval between the onset of movement and orientation was shorter in the alfentanil-treated patients, resulting in similar extubation times for both groups. Alfentanil administration was also associated with lower heart rate, systolic diastolic, and mean arterial pressure values during the emergence period. CONCLUSION: Alfentanil decreased coughing, agitation, and cardiovascular stimulation during emergence from isoflurane anesthesia without prolonging the time of extubation.

Adult↗
PubMed1995

Tracheal anaesthesia for transthoracic endoscopic sympathectomy: an alternative to endobronchial anaesthesia.

When using endobronchial anaesthesia for the management of transthoracic endoscopic sympathectomy (TES), excessive insufflation of carbon dioxide into the pleural space may cause haemodynamic instability, hypoxaemia and tension pneumothorax. We prospectively studied an alternative technique using a tracheal tube, i.v. fentanyl, propofol, atracurium and nitrous oxide in 82 consecutive healthy patients (31 male, 51 female; mean age 26.48 (range 14-50) yr, weight 61.26 (33-100)kg.) They were suffering from severe palmar hyperhidrosis and they underwent bilateral TES (mean duration of operation 34.57 (15-90) min). After being placed in a 30-40 degree head-up position, three patients required ephedrine to treat arterial hypotension. A capnograph was used to confirm correct placement of the Verres needle in the pleural space. In two groups of 13 patients undergoing ventilation with an FlO2 of either 0.3 or 0.4, during partial collapse of the operative lung, PaO2 and the PaO2:FlO2 ratio decreased significantly (P < 0.001). TES was unsuccessful in three patients because of pleural adhesions. After operation five patients required chest drains; two for haemothorax and three for pneumothorax. Seventy-seven patients without complications were discharged from hospital within 24 h.

Adolescent↗
PubMed1995

Sevoflurane for outpatient anesthesia: a comparison with propofol.

Three different anesthetic techniques were compared in 146 healthy outpatients undergoing ambulatory surgery. In Groups I and II, anesthesia was induced with propofol (1.5-2.0 mg/kg, intravenously [iv]) and maintained with nitrous oxide (N2O) 60% in oxygen and either a propofol infusion, 75-160 micrograms.kg-1.min-1 IV, or sevoflurane, 1%-2% end-tidal, respectively. In Group III, anesthesia was induced and maintained with sevoflurane, 1%-4% end-tidal and N2O 60% in oxygen. In addition to 60% N2O in oxygen at a total gas flow of 3 L/min, all patients received fentanyl, 2-3 micrograms/kg IV, and vecuronium, 0.1 mg/kg IV. IV induction of anesthesia with propofol (90 +/- 53 s and 94 +/- 48 s in Groups I and II, respectively) was significantly faster than inhalation induction with sevoflurane (153 +/- 100 s). There were no significant differences in the incidence of coughing, airway irritation, or laryngospasm during induction of anesthesia. Although the mean arterial blood pressure values were similar in all three groups, the use of sevoflurane was associated with consistently lower heart rate values during the early maintenance period. Early and intermediate recovery times were the same in all three treatment groups. The use of sevoflurane for induction and/or maintenance of anesthesia was associated with a higher incidence of postoperative emetic sequelae compared with propofol. Finally, the times at which patients were considered "fit for discharge" and the actual discharge times were similar in all three groups. Sevoflurane is an acceptable alternative to propofol for induction and maintenance of outpatient anesthesia.

Adult↗
PubMed1995

Sevoflurane versus desflurane for outpatient anesthesia: a comparison of maintenance and recovery profiles.

The recovery characteristics of desflurane and sevoflurane were compared when used for maintenance of ambulatory anesthesia. After obtaining informed consent, 42 healthy, unpremedicated women undergoing laparoscopic sterilization procedures were studied. Anesthesia was induced with propofol, 1.5-2.0 mg/kg, and maintained with either desflurane 3%-6% (n = 21) or sevoflurane 1%-2% (n = 21) with 60% nitrous oxide in oxygen. Intraoperative analgesia and neuromuscular block was achieved using fentanyl and vecuronium, respectively. The inhaled anesthetics were titrated to achieve an adequate clinical "depth of anesthesia" and to maintain mean arterial pressure (MAP) within 20% of the preinduction baseline values. Visual analog scales (VAS) and the digit-symbol substitution test (DSST) were performed preoperatively and at 30-min intervals during the recovery period. There were no differences between the two groups in the total doses of propofol, fentanyl, or vecuronium. Heart rate (HR) values were lower in the sevoflurane group during the induction-to-incision period. However, HR and MAP were otherwise similar during the maintenance and recovery periods. Use of desflurane led to a more rapid emergence (4.8 +/- 2.4 vs 7.8 +/- 3.8 min) and shorter time to extubation (5.1 +/- 2.2 vs 8.2 +/- 4.2 min) compared to sevoflurane (mean values +/- SD). Intermediate recovery times, postoperative VAS and DSST scores, and side effects were similar in the two treatment groups. Although sevoflurane was associated with a slower emergence from anesthesia than desflurane after laparoscopic surgery, recovery of cognitive function and discharge times were similar in the two anesthetic groups. Thus, it would appear that sevoflurane is an acceptable alternative to desflurane for maintenance of outpatient anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

A comparative study of ketorolac and diclofenac on post-laparoscopic cholecystectomy pain.

In a randomized, double-blind, placebo-controlled study designed to assess the post-operative analgesic efficacy and cost-effectiveness of ketorolac and diclofenac 60 ASA I and II patients undergoing laparoscopic cholecystectomy were studied. Prior to concluding the operative procedure, an injection (i.m.) of an equal volume of either saline 3 mL, ketorolac 60 mg, or diclofenac 75 mg was administered. All patients received intravenous morphine via a patient-controlled analgesia device (PCA). Post-operative pain intensity was assessed hourly for 4 h, by recording visual analogue score (VAS) for pain, PCA demands and actual morphine administered. PCA demands (mean +/- SD) were greater in the saline treatment group (115 +/- 90) when compared with both the ketorolac (42 +/- 44) and diclofenac groups (74 +/- 77). Furthermore, the saline treatment group received significantly (P < 0.05) more PCA morphine compared with both the ketorolac and diclofenac groups (12.2 mg +/- 5.0 vs. 8.6 mg +/- 5.2 vs. 8.9 mg +/- 4.8). Improved pain scores were demonstrated in both the ketorolac and diclofenac groups compared with the saline group. PCA demands and post-operative morphine requirements were similar in the ketorolac and diclofenac groups. Diclofenac has the added advantage, in our institution, of being 60% less expensive than ketorolac. We conclude that both ketorolac and diclofenac are effective post-operative analgesic drugs. However, economic considerations may favour diclofenac administration.

Aged↗
PubMed1994

Use of mivacurium during laparoscopic surgery: effect of reversal drugs on postoperative recovery.

We studied the influence of mivacurium on the recovery profile following outpatient laparoscopic tubal ligation in 60 healthy, nonpregnant women. After administration of midazolam 2 mg intravenously (IV), anesthesia was induced with fentanyl, 2 micrograms/kg, and thiopental, 4 mg/kg, IV. When the patient became unresponsive (loss of eyelid reflex), either succinylcholine 1 mg/kg, IV (Group I), or mivacurium 0.2 mg/kg, IV (Groups II and III), was administered to facilitate tracheal intubation. Anesthesia was maintained with isoflurane (0.5%-2% inspired concentration) in combination with 67% N2O in oxygen. Muscle relaxation was maintained in all three groups with intermittent bolus doses of mivacurium, 2-4 mg, IV. In Group III, residual neuromuscular block was reversed with a combination of neostigmine, 2.5 mg, and glycopyrrolate, 0.5 mg, IV, at the end of the operation. In the postanesthesia care unit (PACU), patients in Group III had a significantly increased incidence of postoperative nausea and vomiting compared to Group II. The use of succinylcholine (versus mivacurium) was also associated with more frequent postoperative nausea and vomiting. However, these emetic sequelae did not delay postoperative recovery times. In addition, a comparable number of patients in each treatment group required analgesic medication for postoperative pain. Although patients who received succinylcholine complained of significantly more neck pain during the 24-h period after discharge, nausea, vomiting, and shoulder pain were similar in all three groups during this period. We conclude that neostigmine and glycopyrrolate may contribute to the development of postoperative emesis when used for reversal of residual neuromuscular block.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Anaesthesia for electroconvulsive therapy: use of propofol revisited.

In three clinically depressed patients undergoing repeated electroconvulsive therapy (ECT) with either propofol or methohexitone, dose-dependent decreases in the duration of motor and EEG seizure activity were noted. Use of a 'minimally' hypnotic dose of propofol (0.75-1.0 mg kg-1) was associated with a seizure duration which was comparable to standard hypnotic doses of methohexitone. We conclude that doses of propofol < 1.5 mg kg-1 are associated with a clinically acceptable duration of EEG seizure activity (> 30 s) during ECT.

Adult↗
PubMed1994

Residual pneumoperitoneum: a cause of postoperative pain after laparoscopic cholecystectomy.

After laparoscopic cholecystectomy, residual gas is inevitably retained in the peritoneal cavity. An active attempt is not always made to remove it. Using a double-blind prospective protocol in 40 healthy patients, we evaluated the effect of residual pneumoperitoneum on post-laparoscopic cholecystectomy pain intensity. On completion of surgery, prior to removal of the surgical instruments, the patients were randomly divided into two groups: in the active aspiration (AA) group an active attempt was made to remove as much gas as possible from the peritoneal cavity, while in the nonactive aspiration (NAA) group no such effort was made. Postoperative pain was assessed hourly over a 4-h period with a visual analog scale (VAS) and a patient-controlled analgesia (PCA) device. During the first postoperative hour, the NAA patients made significantly (P < 0.05) more demands (mean +/- SD) for morphine than those in the AA group (31.3 +/- 26.2 vs 15.3 +/- 15.7) and also received a borderline significantly (P = 0.056) larger dose (mean +/- SD) of PCA morphine (3.9 +/- 1.9 mg vs 2.7 +/- 1.3 mg). The VAS scores (mean +/- SD) over the 4-h study period were similar in both groups, being high during the first postoperative hour (AA = 5.1 +/- 2.1 vs NAA = 6.1 +/- 2.2) and then decreasing. We conclude that residual pneumoperitoneum is a contributing factor in the etiology of postoperative pain after laparoscopic cholecystectomy.

Cholecystectomy, Laparoscopic↗
PubMed1994

Anesthesia for electroconvulsive therapy: effects of propofol and methohexital on seizure activity and recovery.

The influence of methohexital and propofol on seizure activity and recovery profiles was assessed in a randomized, crossover study involving 13 adult outpatients undergoing electroconvulsive therapy (ECT). Arterial blood pressure, heart rate, hemoglobin oxygen saturation, and electroencephalogram (EEG) activity were monitored during the ECT procedure. After premedication with glycopyrrolate, 0.2 mg intravenously (i.v.), and labetalol 20-30 mg i.v. hypnosis was induced with a bolus injection of either methohexital or propofol, 0.75 mg/kg. Muscle paralysis was achieved by administering succinylcholine, 1.4 mg/kg i.v. Ventilation was assisted using a face mask while administering 100% oxygen. Thereafter, an electrical stimulus was administered and the length of the resulting motor and EEG seizures was measured. Mood level and cognitive function were assessed prior to induction of anesthesia and after ECT. A total of 72 treatment sessions were evaluated. Each patient underwent a minimum of four treatments and received both induction drugs equally. Although the use of propofol was associated with significantly shorter motor and EEG seizure durations (mean +/- SEM) compared with methohexital (34 +/- 1.6 s and 52 +/- 2.9 s vs 39 +/- 1.5 s and 61 +/- 3.0 s, respectively), this difference was not clinically significant because the durations exceeded 30 s in both groups. Although awakening times were similar, both hemodynamic stability and cognitive recovery were more favorable after propofol. Compared with methohexital, the use of propofol was associated with a clinically insignificant decrease in seizure duration. However, propofol was associated with improved hemodynamic stability and an earlier return of cognitive function after ECT.

Anesthesia↗
PubMed1993

Use of ketorolac and fentanyl during outpatient gynecologic surgery.

In healthy outpatients undergoing minor gynecologic surgery, the analgesic efficacy of ketorolac was compared to fentanyl and to a combination of the two analgesics. One hundred and nine patients were randomly selected to receive fentanyl 50-100 micrograms, ketorolac 30-60 mg, or a combination of fentanyl 50-100 micrograms and ketorolac 30-60 mg, intravenously (IV). Anesthesia was induced with midazolam 2 mg IV and propofol 1 mg/kg, IV, and maintained with propofol, 50-160 micrograms.kg-1.min-1, IV, and nitrous oxide 67% in oxygen via a face mask. Intraoperative anesthetic conditions, recovery times, and postoperative pain and side effects were evaluated. In the ketorolac group, 75% of patients required supplemental fentanyl intraoperatively (mean dose +/- SD, 47 +/- 54 micrograms), compared to only 19% (13 +/- 30 micrograms) and 18% (6 +/- 15 micrograms) of patients in the fentanyl and combination groups, respectively. In the ketorolac group, 74% of patients moved in response to surgical stimulation compared to only 16% and 19% of patients in the fentanyl and combination groups, respectively. Although there were no significant differences in intraoperative mean arterial pressure, heart rate, and oxygen saturation of hemoglobin values among the three treatment groups, the ketorolac group manifested significantly more rapid respiratory rates throughout the procedure compared with the fentanyl and combination groups. Recovery times, postoperative side effects, and pain scores, as well as postoperative analgesic and antiemetic requirements, were similar in all three treatment groups. However, the ketorolac group reported significantly higher pain scores in the early postoperative period.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗