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Biomedical subjects

B Jawan

Publications and source records attributed to B Jawan.

At least 91 records · Page 5Linked to original sources
PubMed1994

Outcome of surgery and anesthesia in patients 80 years of age and older.

We studied retrospectively the outcome of surgery and anesthesia in 294 patients aged 80 and older who underwent 362 surgical procedures. Of these, 52 cases (14.4%) were admitted to intensive care unit (ICU) post-operatively. The 48-hour, 48-hour-to-30-day and overall mortality rates were 0.8%, 3.8% and 5.2% respectively. ICU. admission and mortality rate were closely associated with the ASA physical status classification. The overall mortality rates were 1.3%, 5.7% and 27% in class II, III and IV respectively. The respective ICU admission rates were 3%, 20% and 56%. ICU admission rate and mortality rate were 42.5% and 13.8% in emergency surgery vs. 5.8% and 2.5% in elective surgery. Patients with 3 or more co-existing diseases had the mortality rate of 23% and the rates of ICU admission and mortality for those with 3 or more peri-operative complications were 22% and 16% respectively vs. 11% and 4% for those with 2 or less peri-operative complications. General surgery was associated with the highest mortality rate (15%) than other type of procedures. 22 of 74 cases who underwent intra-abdominal surgery required controlled ventilation for more than 24 hours post-operatively. 59% (13 cases) of such cases could not weaned successfully from ventilators and died subsequently. Only 2.5% (7 cases) of cases who underwent extra-pleural and extra-peritoneal procedures required controlled ventilation for more than 24 hours post-operatively. Of these, 2 died subsequently. For comparison, the study were artificially divided into two phases, each of three years long: they were the period from 1986-1988 and the period from 1989-1992.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Effects of magnesium sulfate pretreatment on succinylcholine-facilitated tracheal intubation.

Magnesium sulfate may prevent increase in serum potassium produced by succinylcholine and cause transient hypotension. The present study was designed to evaluate the effect of magnesium sulfate on heart rate, blood pressure and hyperkalemic response following succinylcholine injection during tracheal intubation. Twenty patients, ASA class I-II, scheduled for elective surgery were equally and randomly allocated to two groups. Heart rate, blood pressure, venous and arterial potassium levels were measured immediately before intubation. Induction was achieved with fentanyl 2 ug/kg and thiopental 5 mg/kg i.v., and intubation was facilitated with succinylcholine 1.0 mg/kg i.v. In the magnesium group (group I), 60 mg/kg of magnesium sulfate was infused intravenously in 1-1.5 min immediately before succinylcholine injection. The control group (group II) received an equal volume of normal saline in the same way. Heart rate, blood pressure, venous and arterial potassium levels were measured at 1, 3, 5 and 10 minutes after intubation. The results showed that magnesium sulfate could attenuate the hypertensive response at 1 minute and the hyperkalemic response at 1 and 3 minutes following succinylcholine-facilitated intubation; the tachycardiac response at 1 minute after intubation could not be reduced by this agent. We concluded that bolus infusion of magnesium sulfate may be of help in reducing the hypertensive response during laryngoscopy and intubation.

Adult↗
PubMed1993

Spread of spinal anaesthesia for caesarean section in singleton and twin pregnancies.

We have compared the spread of spinal anaesthesia in parturients with singleton and those with twin pregnancies. Fifty-five unpremedicated patients with uncomplicated pregnancy scheduled for Caesarean section were allocated to two groups: group I = 35 singleton mothers; group II = 20 with twin pregnancy. Both groups received spinal anaesthesia with hyperbaric bupivacaine 10 mg (2 ml of 0.5%). Mean birthweight was 3290 (SD 452) g and 5008 (495) g in groups I and II (combined birthweights), respectively. We found a statistically significant difference in onset and maximal cephalad spread of spinal anaesthesia (group I median T5, range T8-T4; group II T3, range T6-T2). The mechanisms of higher cephalad spread of spinal anaesthesia in parturients may be a decrease in cerebrospinal fluid volume secondary to shunting of blood from the obstructed inferior vena cava to the extradural venous plexus and increased nerve sensitivity to local anaesthetics because of increased concentrations of progesterone. The twin pregnancy group had heavier, larger uteri and greater daily production of progesterone.

Adult↗
PubMed1993

Comparison of P6 acupoint injection with 50% glucose in water and intravenous droperidol for prevention of vomiting after gynecological laparoscopy.

Postoperative vomiting causes patients distress and delays discharge after outpatient surgery. Although P6 electroacupuncture is recognized as having an antiemetic effect, its inconvenient instrumentation may limit its clinical applicability. The purpose of this study was to explore a simple and effective alternative method for control of postoperative vomiting in outpatient surgery. We prospectively compared the effect of P6 acupoint injection with 0.2 ml 50% glucose in water (G/W) and intravenous injection of 20 micrograms/kg droperidol for prevention of vomiting in 120 consecutive outpatients undergoing gynecological laparoscopy with general anesthesia. Patients were randomly allocated to receive P6 acupoint injection, i.v. droperidol, or nothing as control group. Both P6 acupoint injection and i.v. droperidol 20 micrograms/kg were found to have a significant antiemetic effect when compared with the control group. We conclude that P6 acupoint injection with 50% G/W is a simple and effective method for reducing the incidence of postoperative emesis in outpatient surgery.

Acupuncture Points↗
PubMed1990

Cardiac arrest caused by an incorrectly filled oxygen cylinder: a case report.

One hundred percent carbon dioxide was administered accidentally to a child aged 21 months during anaesthesia; this was caused by unauthorized filling of an oxygen cylinder with carbon dioxide. Cardiac arrest ensued, but was detected and treated promptly and no neurological deficit was detectable following recovery. The case demonstrates a typical preventable anaesthetic mishap and emphasizes the importance of monitoring oxygen supply and delivery.

Accidents↗
PubMed1990

Electro-acupuncture and postoperative emesis.

One hundred unpremedicated female patients of ASA grade 1 or 2 who underwent laparoscopy as outpatients were allocated randomly to one of four groups. All patients received general anaesthesia with fentanyl, thiopentone, halothane, nitrous oxide and oxygen; suxamethonium was given to facilitate tracheal intubation. In the recovery room, group 1 (control) received no treatment; group 2 received electro-acupuncture at the P6 point (Neiguan) on the right side for 15 minutes, group 3 received transcutaneous electrical nerve stimulation at the P6 point on the right side for 15 minutes and group 4 received prochlorperazine 5 mg intravenously. Any act of vomiting, including dry retching, during the first 3 postoperative hours was regarded as postoperative emesis. The incidence of postoperative emesis was 11/25 (44%) in group 1, 3/25 (12%, p less than 0.05) in group 2, 9/25 (36%) in group 3, and 3/25 (12%, p less than 0.05) in group 4. Our results suggest that electro-acupuncture is as effective as prochlorperazine, and may be better than transcutaneous electrical nerve stimulation, in reducing postoperative emesis.

Adolescent↗
PubMed1990

The effect of removal of cerebrospinal fluid on cephalad spread of spinal analgesia with 0.5% plain bupivacaine.

Increased intraabdominal pressure is well known to cause higher cephalad spread of spinal analgesia. The reason for this is believed to be a decrease in the cerebrospinal fluid (CSF) volume. If this mechanism is correct, then the cephalad spread of local anesthetic solutions should also be facilitated when the CSF volume is intentionally reduced without increasing the intraabdominal pressure. Sixty-six patients without evidence of increased intraabdominal pressure and undergoing urological procedures were randomly allocated to three groups. All received 10 mg 0.5% bupivacaine for spinal anesthesia. In Group I, the anesthetic was injected after free drops of CSF. In Groups II and III, three and five ml were removed, respectively, before injecting bupivacaine. Mean cephalad spread of analgesia 20 min after injection in the three groups was T10.2 +/- 2.0, T9.4 +/- 1.8 and T7.0 +/- 2.1, respectively. When CSF was reduced by 5 ml, the level of spread not only showed a statistically significant difference from that of the control group, but also from that of Group II (P less than 0.05). Our results show that higher cephalad spread of spinal anesthetic is possible by reducing the CSF volume without evidence of increased intraabdominal pressure.

Abdomen↗
PubMed1990

Assessment of atracurium during anesthesia and surgery.

Atracurium is a competitive neuromuscular blocking agent which goes through Hofmann elimination. It does not accumulate even after several bolus doses or infusion lasting several hours. The purpose of this study was to evaluate the effectiveness of atracurium on bolus injection for intubation and continuous infusion for subsequent surgery with the manufacturer's suggested dose. Forty-six patients (23-78 yr, ASA I-IV) undergoing laparotomy were included in the study. The patients were induced with Thropental and fentanyl, then a bolus of atracurium (0.5 mg/kg) was given and intubation done 90 sec later. Anesthesia was maintained with nitrous oxide, oxygen and isoflurane. Twenty minutes later atracurium 0.3 mg/kg/hr was infused continuously. The infusion continued until skin closure or an estimated 20-30 min before the end of the operation. Quality of muscle relaxation for intubation and surgery was evaluated by the surgeons and the anesthesiologists. Train-of-four (TOF) count was also recorded in the beginning and at the end of infusion. After extubation, residual curarization was evaluated clinically and with the TOF count method in the recovery room. Intubation quality was rated fair to poor in 67% of cases. Muscle relaxation assessed by the surgeons as excellent to good amounted to 96% of cases. All patients were extubated within 30 min after completion of surgery except for five patients who had poor postoperative conditions because of underlying diseases. No patient showed residual curarization or complication in the recovery room. With doses suggested by the manufacturer, our study indicated that intubation was not satisfactory while continuous infusion for muscle relaxation during surgery was acceptable.

Adult↗
PubMed1989

Antagonism of the respiratory and analgesic effect of fentanyl produced by aminophylline.

Low-dose aminophylline may reverse the respiratory depression caused by morphine and fentanyl. High-dose aminophylline may decrease an animal's tolerance to painful stimulation. We postulated that fentanyl combined with low-dose aminophylline could result in adequate analgesia without the side-effect of respiratory depression. Twelve healthy volunteers were randomly divided into group A and group B each consisting of six persons. Group A received fentanyl 3 ug/kg and group B received fentanyl 3 ug/kg plus aminophylline 3 mg/kg iv. Arterial carbon dioxide tension (PaCO2) was taken as an index of respiratory status and the analgesic effect of fentanyl was estimated by measuring changes in maximum pain tolerance (MPT) using a pressure clamp device. The results showed that 3 mg/kg of aminophylline significantly alleviated the respiratory depression effect of fentanyl 15 and 25 min post-injection (P less than 0.05), without attenuation of its analgesic effect. The severe hemodynamic disturbance and acute reversal of analgesia, which may be induced by naloxone, were not observed. Our results suggest that aminophylline safely reverses the respiratory depression caused by fentanyl.

Adult↗
PubMed1989

The effect of warm irrigating fluids on the incidence of shivering during transurethral resection of the prostate (TURP).

Twenty-four unpremedicated patients of ASA class II or III undergoing TURP were given esia with 10 mg of tetracaine at level L3-4 or L4-5. These patients were randomly given "warm" or "ambient temperature" irrigating fluids. Those with irrigating fluids of temperature between 25.5 degrees C and 33 degrees C were arranged as Group 1 and those of temperature between 21.5 and 23 degrees C as Group 2. The results failed to show that the incidence of shivering could be decreased by the use of warm irrigating fluids.

Aged↗
PubMed1989

Effect of preoperative fasting time on gastric volume and pH.

In order to asses the effect of preoperative fasting time on gastric volume and pH, sixty elective surgical patients, ASA physical status I or II, were divided into group A (NPO less than 10 h) and group B (NPO more than 10 h). No premedication was given. Immediately following induction and intubation, the residual gastric fluid was obtained by suction using a No. 16 Sakem samp tube and its volume and pH measured. Residual gastric fluid volumes showed no statistically significant differences between the two groups (Group A: 31.76 +/- 21.51 mL Group B: 25.93 +/- 13.51 mL; T = 1.236, T less than T 0.05 = 1.96). Values for pH between the groups were also similar (Group A: 1.65 +/- 1.12; Group B: 1.52 +/- 0.73; T = 0.53, T less than T 0.05 = 1.96). Our study suggests that a significant number of patients are at risk for aspiration of acidic gastric contents and that this risk is not lowered by additional preoperative fasting time in excess of 10 h.

Adult↗