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Biomedical subjects

D Amar

Publications and source records attributed to D Amar.

At least 19 recordsLinked to original sources
PubMed1992

Use of propofol for the prevention of chemotherapy-induced nausea and emesis in oncology patients.

Nausea and vomiting associated with antineoplastic chemotherapy are distressing and may keep patients from complying with chemotherapy protocols. No drug has emerged among many as an effective antiemetic. It has been speculated that propofol may have intrinsic antiemetic properties. We report the use of low-dose continuous infusion propofol in three oncology patients to treat chemotherapy-associated nausea and vomiting. A bolus of 0.1 mg.kg-1 followed by a continuous infusion of 1 mg.kg-1.hr-1 was effective in both prevention and treatment of nausea and vomiting. All three patients were alert, reported low nausea scores by visual analogue scale, and had no episodes of vomiting. When the infusion was discontinued, nausea and vomiting were noted in two patients. Propofol, given in a subanaesthetic infusion, was safe and effective as an antiemetic in these three patients.

Adolescent↗
PubMed1992

Epidural patient-controlled analgesia after cesarean section: buprenorphine-0.015% bupivacaine with epinephrine versus fentanyl-0.015% bupivacaine with and without epinephrine.

We compared the analgesia, side effects, and plasma concentrations of buprenorphine and fentanyl in a double-blind study of 78 parturients receiving one of these drugs by patient-controlled epidural infusion after elective cesarean section with epidural anesthesia. Patients were randomized to three epidural infusion groups: group 1 (n = 26), 3 micrograms/mL buprenorphine with 0.015% bupivacaine and 1 microgram/mL epinephrine; group 2 (n = 26), 3 micrograms/mL fentanyl with 0.015% bupivacaine and 1 microgram/mL epinephrine; and group 3 (n = 26), 3 micrograms/mL fentanyl with 0.015% bupivacaine. Plasma for determination of opioid concentrations was obtained in some subjects in each group at intervals up to 48 h during the infusion and in some subjects from each group at intervals after the infusion was stopped. Pain relief was similar and satisfactory in all three groups. The median overall satisfaction scores were high for all three groups. Pruritus was more common in the fentanyl groups (P less than 0.05). However, vomiting was more disturbing to the patients and seen only with buprenorphine. No patient had a respiratory rate less than 12 breaths/min. Epinephrine use was associated with a slower infusion rate (P less than 0.05, group 2 vs 3). All patients were able to ambulate without difficulty. Mean opioid plasma concentrations did not exceed 1.5 ng/mL. Thus, epidural patient-controlled analgesia in all three groups provided excellent analgesia, permitted ambulation, and was without serious side effects. Epidural buprenorphine offered no advantages over epidural fentanyl.

Analgesia, Epidural↗
PubMed1992

An updated cross-referenced filing system for anesthesiologists.

A filing system that provides a medical-information retrieval system is useful for medical students, physicians-in-training, and practicing physicians. The present system is an expansion and update of the one proposed by Petty and Carden in 1973. This filing system for anesthesiologists contains a simple numerical index of the major categories in the anesthetic, medical, and surgical literatures. The organ system and the anesthetic considerations are combined. A cross-reference index is provided as well. This system allows the user to cross-file reprints, locate ones that have been loaned, and keep track of references that may be found in personal bound volumes. The files may be expanded over the years to any desired degree. Finally, this system may be of use either to the individual anesthesiologist or to a department's library.

Anesthesiology↗
PubMed1992

Adverse effects of epidural 0.03% bupivacaine during analgesia after cesarean section.

To develop a regimen that would provide good analgesia after cesarean section with minimal side effects in the setting of prolonged (> 24 h) epidural infusion, buprenorphine or fentanyl was combined with 0.03% bupivacaine in a double-blind study of 23 parturients. Patients were randomly assigned to two groups: group I (n = 12), patient-controlled analgesia by epidural infusion of buprenorphine (3 micrograms/mL) with 0.03% bupivacaine; group II (n = 11), patient-controlled analgesia by epidural infusion of fentanyl (2 micrograms/mL) with 0.03% bupivacaine. Plasma for determination of opioid concentrations was obtained at intermittent intervals. Pain relief was similar and satisfactory in both groups. The median overall satisfaction score was higher (10.0 vs 7.5; P < 0.03) for group II. Pruritus was mild in most patients. Nausea and vomiting, which were most disturbing to the patients, were seen only with buprenorphine. No patient had a respiratory rate of < 12 breaths/min. Mean plasma opioid concentrations did not exceed 1 ng/mL during the study. However, four patients (33%) in group I and six patients (55%) in group II experienced sensory loss in the lower extremities, which made ambulation difficult. One patient in each group developed extensive pressure blisters on both heels. These complications led us to terminate the study. We conclude that 0.03% bupivacaine used in combination with an opioid in prolonged epidural infusions produces a high incidence of sensory loss in the lower extremities and is unsuitable for situations in which early ambulation is desired.

Analgesia, Epidural↗
PubMed1991

An alternative oxygen delivery system for infants and children in the post-anaesthesia care unit.

This randomized controlled trial compared the compliance of a blow-by oxygen method with the standard face mask by children recovering from anaesthesia. The rate at which a face mask was rejected when applied to infants and children in PACU was compared with that of a proposed "hose" method. The efficacy of the "hose" as a method of oxygen supplementation in children at low and high risk for developing postoperative hypoxaemia was also compared with the face mask. Using a Nellcor N-200 pulse oximeter, 66 infants and children (mean age 2.3 yr, range 2 mo-6 yr) were continuously monitored for 30 min upon arrival in the PACU. Patients were randomized to receive oxygen supplementation with either the face mask or the proposed "hose" method. The results showed a greater than 80 per cent rejection of the face mask in contrast to 100 per cent compliance with the "hose" method. The SaO2 measurements following 5, 15 and 30 min of O2 supplementation with the hose were all significantly higher than the SaO2 measurements obtained on room air upon arrival to the PACU. Patients with pre-existing cardiopulmonary disease had a 20 per cent incidence of arterial oxygen desaturation upon arrival to the PACU versus 2.1 per cent of patients with no pre-existing disease. It is concluded that the "hose" is associated with high patient compliance and is effective in the PACU in increasing the SaO2 in children at low or high risk of developing postoperative hypoxaemia.

Anesthesia Recovery Period↗
PubMed1991

Effects of labetalol on perioperative stress markers and isoflurane requirements.

We have studied the effect of labetalol on anaesthetic requirements, cardiac and humoral responses in 16 healthy women during elective abdominal surgery. The experimental group (n = 8) received increments of i.v. labetalol 0.15-0.3 mg kg-1 to reduce mean arterial pressure (MAP) by 15% from values obtained before anaesthesia. All patients received thiopentone 6 mg kg-1 and anaesthesia was maintained with isoflurane and nitrous oxide. In the placebo group, tracheal intubation provoked a 33% increase in heart rate (HR) and a 52% increase in MAP (P less than 0.001 vs baseline for both). In contrast, pretreatment with labetalol resulted in a 7.3% increase in HR and a 21.3% increase in MAP (P less than 0.05 vs baseline for MAP). Two patients treated with labetalol had a reduction in MAP to 50-60 mm Hg during surgery. After tracheal extubation, the labetalol group had a significantly slower HR than the placebo group (P less than 0.05). The cardiovascular response to tracheal intubation was associated with an increase in plasma noradrenaline concentration in both groups. Labetalol did not affect isoflurane requirements, plasma concentrations of adrenaline, cortisol and aldosterone or arterial PO2, but prevented the decrease in plasma concentration of potassium which occurred in placebo treated patients (P less than 0.05) in early recovery. We conclude that preanaesthetic administration of labetalol attenuated the perioperative hypertensive and tachycardic responses, but was accompanied by intraoperative hypotension when given in doses greater than 0.5 mg kg-1, despite an increase in plasma noradrenaline concentrations.

Abdomen↗
PubMed1991

Extradural block in obstetric patients: review of experience with gravity administration.

Charts of 2284 obstetric patients who received extradural block with gravity administration of local anaesthetic were evaluated retrospectively. Despite a 1.3% incidence of vascular puncture and a 1.8% incidence of dural puncture, accidental intravascular or intrathecal injection of local anaesthetic did not occur. We propose that this method may be safer than the traditional "injection by needle" technique, and has a high degree of "visualization" of the otherwise "blind" extradural block procedure.

Anesthesia, Epidural↗
PubMed1989

Fluorescent light interferes with pulse oximetry.

Arterial oxygen saturation (SaO2) values displayed on the pulse oximeter dropped dramatically in 3 children undergoing neurosurgical procedures when a hand-held fluorescent light was used to observe the patients. Pulse rates were unchanged on both the electrocardiograph and pulse oximeter. Electromagnetic interference was excluded as the cause of desaturation. A great deal of energy was emitted by the hand-held light in the 660-nm region, which is one of the wavelengths used by the oximeter. False readings of pulse rate and SaO2 values caused by ambient light could be avoided if oximeter probes were manufactured of black opaque material that does not transmit light or enclosed in an opaque plastic housing.

Child, Preschool↗
PubMed1989

Anaphylactoid reactions to protamine: an often lethal complication in insulin-dependent diabetic patients undergoing vascular surgery.

Protamine is used routinely at our institution during arterial surgery to reverse the anticoagulant effect of heparin. Adverse fatal reactions to protamine are generally believed to be rare. However, major anaphylactoid reactions occurred in 11 of the last 1150 patients receiving this drug at our institution. Nine of these reactions occurred in 325 insulin-dependent diabetic patients (incidence, 3%), whereas only two occurred in the 825 patients not receiving insulin (incidence, 0.2%) (p less than 0.001). Ten of these reactions occurred within 10 minutes of protamine administration (15 to 35 mg), whereas one reaction occurred immediately after administration of a 5 mg test dose of protamine. Systolic blood pressure fell below 60 mm Hg in all of the 11 patients, and three patients had to be resuscitated with closed-chest massage. Initial treatment with epinephrine and steroids was successful in seven cases. Four patients required further resuscitative measures, including closed-chest massage. However, one of the patients died as a result of ventricular fibrillation resistant to treatment. Ten of the 11 patients, including the patient who died, had significant preexisting cardiac disease; six of the surviving 10 patients (60%) had perioperative myocardial infarctions and three died. Thus the total mortality rate was 36% (4/11). These data support the implication that neutral protamine Hagedorn (NPH) insulin produces an adverse reaction through immunologic presensitization of the patient. These data also show that, in the older vascular surgery population with a high incidence of significant cardiac disease, protamine reactions can be potentially lethal. Thus routine use of protamine should be avoided in diabetic patients receiving insulin.

Aged↗