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Biomedical subjects

B van Dijk

Publications and source records attributed to B van Dijk.

28 records · Page 2Linked to original sources
PubMed1978

Venous pain and involuntary muscular movements during and after administration of etomidate. A comparison of two different formulations.

Anaesthesia was induced in 209 patients with etomidate, using either the two vidal formulation, i.e. a solution of 30 mg etomidate sulphate in 20 ml phosphate buffered solution or the new formulation i.e. 5ml ampoules containing 2% etomidate base in polyethylene glycol 1000 (PEG 1000), a ready-for-use solution. Amongst patients who received the two vial formulation of etomidate (n = 105), 26 reported pain on injection as compared with six patients who received etomidate in PEG 1000 (n = 104). In the former group, involuntary muscle movements were reported in 12 patients, three of them being disturbing. In the latter group slight involuntary muscle movements occurred in 15 patients, but were never disturbing.

Adolescent↗
PubMed1977

Appraisal of the dislocation of central venous catheter tips using subclavian and arm veins.

The most dramatic of the complications resulting from central venous catheterization is perforation of the heart. We studied the complications reported in the literature and undertook an original investigation of the dislocations of peripherally and infraclavicularly inserted catheters while moving the arm and shoulder in patients during autopsy. In a postmortem examination of three patients it was found that the greatest displacement, up to eight centimetres, of the tips of the catheters occurred when they were inserted through the basilic vein. The tips of infraclavicular inserted catheters did not move at all during movements of the arm. Only by extreme movements of the shoulder we were able to show a maximal displacement of two centimetres. Advancement of the catheter tip occurred during adduction and flexion of the elbow joint and not during abduction. Our experimental evidence suggests that the best site for a catheter tip is the upper part of the right atrium. We therefore recommend the subclavian route for in-dwelling central venous catheters rather than insertion through an arm vein, as this minimizes the risk of cardiac perforation due to its great stability.

Arm↗
PubMedDate not supplied

The length-tension diagrams of human oblique muscles in trochlear palsy and strabismus sursoadductorius.

We determined the relation between length and tension in detached oblique muscles of 16 strabismus patients that underwent surgery, before and during contraction evoked by intravenous administration of succinylcholine. We frequently found a nonlinear relation between length and tension, unlike our previous findings in recti. In superior oblique palsies, the superior oblique was found, before injection of succinylcholine, to be stiff after elongation, and did not contract after injection of succinylcholine, while the ipsilateral inferior oblique contract after injection of succinylcholine, but with a higher spring constant than did usual. In 3 cases the superior oblique contracted vividly after administration of succinylcholine despite the presence of excyclotropia, stereopsis, torticollis (2 cases) and a hypertropia that increased in adduction, in downgaze, in adduction-and-downgaze and on ipsilateral head-tilt. The finding of a vividly contracting superior oblique is incompatible with the diagnosis of a complete superior oblique palsy. We conclude that some of the cases diagnosed as congenital superior oblique palsy, having a hypertropia increasing in adduction, in downgaze, in adduction-and-downgaze and on ipsilateral head-tilt, are in fact cases of unilateral strabismus sursoadductorius (upshoot in adduction), a non-paretic motility disorder.

Adolescent↗
PubMedDate not supplied

Central venous catheter placement using the ECG-guided Cavafix-Certodyn SD catheter.

STUDY OBJECTIVE: To evaluate the clinical use of a new ECG-guided central venous catheter with regard to positioning in the superior vena cava (SVC). DESIGN: Prospective study. SETTING: Operating rooms of a university hospital and a general hospital. PATIENTS: 89 elective and emergency adult surgical patients requiring central venous catheterization perioperatively. INTERVENTIONS: We performed ECG-guided placement of the central venous catheter from several insertion sites. After we observed an intra-atrial p-wave (p-atriale), the catheter was withdrawn 3 cm back into the SVC. Postoperative anterior-posterior chest radiographs were performed for verification of tip localization. MEASUREMENTS AND MAIN RESULTS: In all 81 patients who exhibited a p-atriale that reverted to a normal-size p-wave (p-SVC) after withdrawal of the catheter 3 cm, the tip was located in the SVC or the SVC-right atrial junction on the chest radiograph. In 7 of the 8 cases without a p-atriale, the catheter tip was shown to be located at an incorrect position on the chest radiograph. The size of the p-atriale was always at least twice that of the p-SVC. CONCLUSIONS: Use of this wire-conducted intravascular ECG signal is a reliable tool for positioning the central venous catheter via various insertion sites. The technique proved to be an inexpensive, easy, and clear method. When a p-atriale is seen, uncomplicated insertions do not require radiologic guidance to control catheter tip position.

Adult↗
PubMedDate not supplied

The PENCAN 25-gauge needle: a new pencil-point needle for spinal anesthesia tested in 1,193 patients.

BACKGROUND AND OBJECTIVES: The PENCAN 25-gauge spinal needle is a new pencil-point needle with an inner diameter of 0.32 mm resulting in a relatively high cerebrospinal fluid (CSF) flow. The PENCAN 25-gauge needle was tested for ease of identification of a successful dural puncture, the failure rate of spinal anesthesia, and the incidence of postdural puncture headache (PDPH). METHODS: In a multicenter trial, the needle was tested in patients undergoing spinal anesthesia. A questionnaire evaluated the characteristics of the dural puncture. A second questionnaire was used to assess postspinal side effects (PDPH, atypical headache, audiovisual disturbances). RESULTS: In 1,193 patients, dural puncture was evaluated as easy in 85.2%, as moderate in 6.2%, as difficult in 6.7%, and as impossible in 1.9%. Needle performance was assessed as excellent or satisfactory in 96.9%. In 95.9% of patients, CSF appeared within 2 seconds. A perceptible "click" was noticed in 78.4% of patients. In 1.9%, CSF could not be obtained, because of spine deformities, obesity, or bending of the needle. In 1,166 patients, postpuncture complaints were evaluated, involving 635 women (54.5%), 773 patients (66.3%) under the age of 50 years old, and 170 (14.6%) cesarean deliveries. The overall incidence of PDPH was 1.3% (n = 15). A bloodpatch was needed in five patients. After cesarean delivery the incidence of PDPH was 3.4%, all responding to conservative treatment. Atypical headache and isolated audiovisual disturbances occurred in 7.5% and 1.5% of patients, respectively. CONCLUSIONS: A failure rate of 1.9% together with a 1.3% incidence of PDPH were comparable to other 25-gauge pencil-point needles. The rapid appearance of CSF and a perceptible "click" made prompt recognition of successful dural puncture possible.

Anesthesia, Spinal↗