Biomedical subjects

B P Keller

Publications and source records attributed to B P Keller.

6 recordsLinked to original sources

PubMed2003

Comparison of end-tidal and transcutaneous measures of carbon dioxide during general anaesthesia in severely obese adults.

BACKGROUND: Patients with severe obesity (body mass index (BMI) greater than 35 kg x m(-2)) present difficulties for end-tidal carbon dioxide (FE'(CO(2))) monitoring. Previous studies suggest that transcutaneous (TC) carbon dioxide measurements could be valuable, so we compared FE' and TC measures with Pa(CO(2)) in severely obese patients during anaesthesia. METHODS: We studied patients with severe obesity (BMI >or=40 kg x m(-2)) undergoing gastric bypass surgery. Carbon dioxide was measured with both FE' and TC devices. The difference between each measure (FE'(CO(2)) and TC-CO(2)) and the Pa(CO(2)) was averaged for each patient to provide one value, and data compared with a non-paired, two-way t-test, Fisher's exact test. RESULTS: We studied 30 adults (aged 18-54 yr, mean 41, SD 8.0 yr; weight: 115-267 kg, mean 162, SD 35 kg). The absolute difference between the TC-CO(2) and Pa(CO(2)) was 0.2 (0.2) (mean, SD) kPa while the absolute difference between the FE'(CO(2)) and Pa(CO(2)) was 0.7 (0.4) kPa (P<0.0001). The bias and precision were +0.1 (0.3) kPa for TC vs arterial carbon dioxide and -0.7 (0.4) kPa for FE' vs arterial carbon dioxide. CONCLUSIONS: Transcutaneous carbon dioxide monitoring provides a better estimate of Pa(CO(2)) than FE'(CO(2)) in patients with severe obesity.

Adolescent↗

PubMed1996

Effect of desflurane anesthesia on transcortical motor evoked potentials.

The effect of the volatile anesthetic desflurane on motor evoked potentials was examined in male rats. Animals underwent cortical stimulation using small platinum ball stimulating electrodes secured on the motor cortex. To record evoked compound muscle action potentials (CMAPs), single-shock electrical stimulation was delivered to the forelimb representation of the motor cortex. Muscle responses were readily obtained in the contralateral extensor muscles. The effect of desflurane was examined at various concentrations ranging from 0.7 to 11.4%. With increasing concentrations of desflurane, there was a progressive decrease in the CMAP amplitude and systemic blood pressure over the baseline values. This decrease became statistically significant (p = 0.0078) at 5.7% [1 maximum alveolar concentration (MAC)] concentration of desflurane. Although there was a decrease in heart rate, the results were not statistically significant (p = 0.03). No significant difference in the onset latency or the duration of the CMAP was noted at different concentrations of the anesthetic. We conclude that desflurane anesthesia significantly alters the amplitude of the muscle response evoked by motor cortex stimulation in experimental animals.

Anesthetics, Inhalation↗

PubMed1996

Suppression of spinal and cortical somatosensory evoked potentials by desflurane anesthesia.

The effect of the volatile anesthetic desflurane on spinal and cortical somatosensory evoked potentials (SEPs) was examined in 11 Sprague-Dawley male rats. Platinum recording electrodes were placed stereotactically over the left somatosensory cortex and dorsal midline of the T11-12 spinal cord while the right posterior tibial nerve was stimulated at twice motor threshold. The effect of desflurane was examined at various concentrations ranging from 0.7 to 11.4% (2 MAC). Mean arterial blood pressure (MAP) decreased (p = 0.001) progressively with increasing end-tidal desflurane concentrations. Concentrations of 1.4% (1/4 MAC) and 2.8% (1/2 MAC) did not significantly affect the spinal SEP (SSEP) amplitude or the latency. With higher concentrations, there was a progressive decrease in amplitude of the cortical SEPs (CSEPs; p = 0.002) and SSEPs (p = 0.008). However, CSEP and SSEP latencies did not change. At 5.7% (1 MAC), three animals (33%) lost CSEPs while SSEPs remained intact. At 11.4% (2 MAC), the CSEPs were lost in all animals. Only one rat lost the SSEPs at the 2 MAC concentration of desflurane, indicating the resistance of the SSEPs to desflurane anesthesia. We conclude that desflurane anesthesia significantly alters the amplitude of SSEPs and CSEPs without a significant change in the peak latency.

Anesthesia, Inhalation↗

PubMed1995

Late outcomes of limb loss after failed infrainguinal bypass.

PURPOSE: Most reports regarding infrainguinal bypass surgical procedures demonstrate benefits well but pay less attention to adverse outcomes and consequences of failure for the patient. For a wider scope of infrainguinal bypass surgical procedures, we evaluated patient-oriented outcomes of limb loss occurring after failed infrainguinal bypass operations. METHODS: Eighty-one patients with vascular amputations were identified in a retrospective study. Follow-up was complete with a mean of 3.6 years. Life-table and multivariate analyses were used to assess factors influencing the desired outcome goals of rehabilitation. Mortality rates, social function, risk of contralateral amputation, and the ability to walk were used to measure the late outcome. RESULTS: The long-term survival rate was poor (72% at 1 year; 53% at 3 years) and was not related to traditional risk factors for atherosclerosis. Moreover the risk for contralateral amputation was 10% per year. One year after amputation 81% (47 of 58) of the surviving amputees were walking independently, and 73% (42 of 58) were living at home, 32 with their spouse. At 3 years these results were 73% (27 of 37) and 78% (29 of 37), respectively. In addition, the level of self-care changed significantly (p < 0.001) after amputation. Advanced age (older than 65 years), self-care performance, and living with someone were important predictors of late outcome. CONCLUSIONS: It is possible for a high percentage of patients with vascular amputations to return home successfully, either walking or in a wheelchair. Moreover this result can be predicted based on preoperative clinical variables. These data may be helpful to guide fitting of prosthetic devices, planning of discharge home, and use of health care resources.

Activities of Daily Living↗

PubMed1993

Motor-evoked potential changes during hypoxic hypoxia.

Motor-evoked potentials (MEPs) from forearm muscles were recorded in response to single-shock electrical stimulation of motor cortex of rats (n = 15) under pentobarbital anesthesia and controlled room air ventilation. In addition, electroencephalograms (EEGs) were recorded for all animals. Following baseline MEP recording in room air (21% O2), animals were subjected to graded hypoxia of either 15.75%, 10.5%, or 5.25% oxygen for 10 minutes, then followed by room air ventilation for 15 minutes. The mean baseline latency, amplitude, and duration of the evoked muscle response were 4.3 +/- 0.4 mseconds, 556 +/- 476 microV, and 9.6 +/- 2.3 mseconds, respectively. At moderate hypoxia (15.75%), the latency was 4.2 +/- 0.5 mseconds and the amplitude and the duration were 530 +/- 356 microV (n = 14), and 9.5 +/- 2.2 mseconds, (n = 14). These values did not deviate significantly from baseline (p > 0.56). Only one animal lost MEPs at the 15.75% hypoxia level. At 10.5% hypoxia, 27% of animals (n = 4) lost MEP within minutes. In the remaining animals (n = 11), there was a trend toward a prolongation of latency and a decrease of both amplitude and duration. All animals lost MEPs under extreme hypoxia (5.25%) within 2 minutes. No change was seen in the EEG recording until the level of extreme hypoxia was reached. The loss of MEPs at this level of hypoxia was concurrent with the loss of EEGs. We conclude that hypoxia effects MEPs in experimental animals.

Animals↗

PubMed1992

The effects of propofol anesthesia on transcortical electric evoked potentials in the rat.

The effects of halogenated anesthetic agents on somatosensory and motor evoked potentials (MEP) have been documented previously. Intravenous anesthetic propofol has not yet been used during MEP monitoring. This study investigates the effects of propofol on transcortical MEP in rats during bolus, infusion, and recovery conditions. After baseline MEP recordings, animals received a hetastarch bolus, followed by a propofol (10 mg/kg) bolus dose. A propofol infusion (10 mg/kg/h) and a hetastarch infusion were then begun. MEP recordings were obtained after the propofol bolus, during the infusion, and after a 30-minute recovery phase. Blood pressure readings remained stable. MEP onset latency increased, and amplitude decreased. Response duration diminished. All values returned towards the baseline during recovery. Our results show that the effects of propofol on MEPs are similar to its effects on somatosensory evoked potentials. Propofol seems to be a reasonable agent for use during intraoperative MEP monitoring and should be further investigated for use during spinal cord monitoring in humans.

Anesthesia, General↗