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Biomedical subjects

C A Moote

Publications and source records attributed to C A Moote.

13 recordsLinked to original sources
PubMed1996

Postoperative cognitive impairment in the elderly. Choice of patient-controlled analgesia opioid.

This study evaluated the safety and cognitive impact of patient-controlled analgesia with fentanyl compared to patient-controlled analgesia with morphine among elderly postoperative patients. In addition, two screening tests for cognitive impairment, the Mini Mental Status Exam and the Short Portable Mental Status Questionnaire, were compared. Ninety-six elderly patients were randomly allocated to receive patient-controlled analgesia with either fentanyl or morphine following hip or knee arthroplasty. Patients were evaluated postoperatively for clinical confusion, cognitive function test results, adequacy of analgesia, drug use and complications. Fentanyl produced less depression in postoperative cognitive function compared to morphine. The incidence of clinical confusion was not statistically different between groups (4.3% for fentanyl versus 14.3% for morphine). Fentanyl patients used more opioid based on a dose ratio of 100:1 suggesting that this dose ratio is inadequate. The incidence of urinary retention was lower in the fentanyl group. A poor agreement between the two tests of cognitive impairment mandates caution when peri-operative cognitive function is compared using different tests.

Aged↗
PubMed1995

Postoperative pain management--back to basics.

Butscher describes a common-sense approach to pain management which is simple, safe and effective. A wide variety of national and international organization devoted to the management of pain have universally adopted these simple measures. Current guidelines advocate both regular dosing and rescue analgesia. These guidelines were produced by an army of international experts and have been available for a decade. Although the information is widely published, it is rarely adopted in clinical practice. It is any wonder that leaders in the field of pain management ask: "Is education enough?" "Will guidelines make a difference?" They continue to lament the "tragedy of needless pain" and in despair they have called for "national initiatives on pain." Bonica stated so elegantly, "for nearly 30 yr I have studied the reasons for inadequate management of postoperative pain, and they remain the same...inadequate or improper application of available information and therapies is certainly the most important reason for inadequate analgesia does not require futuristic high tech solutions. In fact, as the economic crunch continues we may find that we cannot afford some of these new, improved and more expensive techniques. If we can provide safe and effective analgesia for only pennies a day, this option cannot be ignored. The new way may be the old way.

Analgesia, Patient-Controlled↗
PubMed1994

The prevention of postoperative pain.

Patients want safe and effective analgesia. Our goal is to prevent postoperative pain in an efficient and cost effective manner. For most patients, the pain can be managed using simple, non-invasive and inexpensive analgesic techniques. Given the current economic climate, cost will become increasingly important. There will be financial pressure to expand the scope of ambulatory surgery. There will be pressure to discharge patients as soon as they are able to take oral medications. Outpatient analgesia is the oldest and most widespread form of patient-controlled analgesia--We already have the knowledge and the analgesics necessary to prevent postoperative pain. What we need now is logical, rational, and universal application of this information.

Analgesia↗
PubMed1991

Comparison of integrated evoked EMG between the hypothenar and facial muscle groups following atracurium and vecuronium administration.

In 17 healthy patients undergoing O2.N2O.isoflurane anaesthesia, following atracurium or vecuronium administration, we compared simultaneous integrated evoked electromyograms (IEEMGs) during spontaneous recovery of the adductor digiti minimi (ADM) and orbicularis oris (OOM) muscle groups in response to train-of-four (TOF) stimulation of the ulnar and facial nerves, respectively. In all patients, the onset of neuromuscular recovery occurred first in the OOM. The time required to recover to a T4/T1 = 0.70 +/- 0.01 (SD) was earlier in the OOM compared with the ADM muscles in both the atracurium (33.4 +/- 5 vs 46.5 +/- 8, P less than 0.005) and vecuronium (46.5 +/- 12 vs 60.3 +/- 20, P less than 0.005) groups. When the OOM attained a T4/T1 = 0.70 +/- 0.01, the simultaneous T4/T1 in the ADM was 0.29 +/- 0.15 (P less than 0.05) in the atracurium group and 0.41 +/- 0.16 (P less than 0.01) in the vecuronium group. We conclude that (1) the facial muscles (OOM) recover earlier than the hypothenar muscles (ADM) and (2) an EMG T4/T1 = 0.70 in the facial muscles may not indicate adequate recovery of neuromuscular function.

Adolescent↗
PubMed1991

Low-dose bupivacaine does not improve postoperative epidural fentanyl analgesia in orthopedic patients.

Epidural infusions of 10 micrograms/mL fentanyl combined with low-dose bupivacaine (0.1%) were compared with epidural infusions of fentanyl alone for postoperative analgesia after total knee joint replacement. There were no detectable differences between the two groups in analgesia (visual analogue scale ranging between 15 and 40 mm), infusion rates (which averaged 7-9 mL/h), or serum fentanyl levels (which reached 1-2 ng/mL). The incidence of side effects, including nausea, vomiting, and pruritus, was also similar. Of the patients receiving fentanyl and low-dose bupivacaine, one developed a transient unilateral motor and sensory loss, and one developed significant hypotension and respiratory depression. The addition of low-dose bupivacaine does not improve epidural fentanyl infusion analgesia after knee surgery and may increase morbidity.

Aged↗
PubMed1990

Anesthesia with abdominal surgery leads to intense REM sleep during the first postoperative week.

Characteristics of nocturnal sleep were investigated in six patients after anesthesia and cholecystectomy and in another six after anesthesia and gastroplasty. All night polysomnographic recordings were obtained while each patient slept in a private surgical ward room through two nights before and five or six nights after operation. Anesthesia included thiopental, N2O, isoflurane, and fentanyl. Postoperative analgesia was provided with parenteral morphine. Other aspects of care were routine. Nocturnal sleep was markedly disturbed after both surgical procedures. Throughout the operative night and subsequent one or two nights, sleep was highly fragmented with the usual recurring cycles of sleep stages completely disrupted. Slow wave sleep was suppressed and rapid eye movement (REM) sleep virtually eliminated. During the following 2-4 nights, as other aspects of sleep recovered, REM sleep reappeared and then increased to greater than the preoperative amount. This increased REM sleep was marked by a heavy density of eye movement activity along with frequent patient reports of unusually distressing dreams or vivid nightmares. It is concluded that anesthesia with upper abdominal surgery leads to a severe disruption of nocturnal sleep followed by the release of highly intense REM sleep about the middle of the first postoperative week.

Adult↗
PubMed1990

Perioperative monitoring of the electrocardiogram during cerebral aneurysm surgery.

Electrocardiographic (ECG) abnormalities occur frequently following a subarachnoid hemorrhage and may also occur intraoperatively and postoperatively in patients undergoing neurovascular procedures. The aim of this study was to assess the relationship between ECG changes and the neurological status of the patient, the size and the location of the aneurysm, and the influence of these changes on the cardiac and neurological outcome. The preoperative ECG was analyzed in 270 patients. Forty-five patients had intraoperative Holter monitoring. An immediate postoperative ECG was recorded in 120 patients and 60 patients had three consecutive postoperative ECGs. Preoperatively, 52% of the patients had an abnormal ECG and the incidence was highest in patients with a poorer neurological status. Most of the ECG changes involved the T wave or the ST segment. Intraoperative and postoperative changes occurred in 35 and 65% of the patients, respectively, and were independent of the studied factors. There were no documented cardiac events. The presence of an abnormal preoperative ECG did not influence the neurological outcome of the patient, but fluctuating postoperative changes were associated with a worse outcome.

Journal Article↗
PubMed1988

Isoflurane anesthesia causes a transient alteration in nocturnal sleep.

Nocturnal sleep was studied in eight healthy young volunteers before and after isoflurane anesthesia. All night polysomnographic recordings were obtained for seven consecutive nights from approximately 2300 to 0700 h. On the morning after the third night each subject was anesthetized with isoflurane 1.1 MAC for approximately 3 h. The stages and indices of nocturnal sleep were calculated for each night of study according to standard criteria. The effects of anesthesia on nocturnal sleep were confined to the first postanesthetic night. Slow wave sleep (Stages 3 and 4) was moderately suppressed from 16 +/- 1% to 6 +/- 1%, and Stage 2 sleep reciprocally increased from 52 +/- 2% to 60 +/- 2% (mean +/- SEM, P less than 0.05). There were no detectable changes in the sleep onset latency, the total quantity of sleep, or the proportion of rapid eye movement (REM) sleep. Anesthesia was followed by daytime napping in six of the eight volunteers. Nocturnal sleep was similar in the subjects who napped and those who did not. It is concluded that anesthesia with isoflurane leads to a modest and a transient change in the architecture of nocturnal sleep.

Adult↗
PubMed1986

Ventilatory compensation for continuous inspiratory resistive and elastic loads during halothane anesthesia in humans.

Inspiratory mechanical loads were applied to the airway continuously for 5 min in healthy young adult volunteers maintained in a near steady-state of halothane anesthesia 1.1 MAC. The loads, both flow resistive and elastic in nature, had been selected to reduce the first loaded tidal volume approximately 10, 30 or 50%--these being designated "small," "medium," and "large" loads, respectively. The actual magnitudes of resistive load were 8 +/- 1, 21 +/- 3, and 48 +/- 6 cmH2O X l-1 X s, and of elastic load 6 +/- 1, 18 +/- 1, and 41 +/- 5 cmH2O X l-1 (mean +/- SEM). All loads caused an immediate reduction of ventilation proportional to the size of the load. This was followed by a gradual recovery of ventilation toward control values over approximately 2 min and then nearly stable ventilation for the rest of the loading period. Respiratory frequency was unchanged throughout. At 5 min of loading, ventilation and PaCO2 had been nearly steady for 3 min and O2 uptake and CO2 output at the airway were unchanged from control, suggesting the establishment of a near steady respiratory state. With the small and medium loads of both types, ventilation and PaCO2 in this near steady-state were not detectably different from control. With the large loads, however, ventilation was significantly reduced and PaCO2 slightly increased. The end-expiratory position of the chest wall and the relative contributions of the rib cage and abdomen-diaphragm to ventilation, as estimated by anteroposterior chest wall magnetometers, were not consistently altered by any load.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Muscles↗