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Biomedical subjects

D C Tyler

Publications and source records attributed to D C Tyler.

14 recordsLinked to original sources
PubMed1991

Postoperative pain management in children.

Postoperative pain management in children is a topic that has been neglected in the past but is currently an active field of interest and effort. Clearly, the child's cognitive understanding of and emotional response to pain are different than an adult's, and these differences make pain assessment and control more difficult. Ongoing work to develop more accurate techniques of estimating pain intensity in children may have helpful results. The effects of untreated pain in children are similar to those in adults but may have more long-term consequences in children. In the past, postoperative pain treatment in children was often inadequate, but newer techniques, such as continuous infusion of opioids, patient-controlled analgesia, epidural administration of opioids, and regional analgesia, hold promise for improved care in the future.

Analgesia, Epidural↗
PubMed1990

Patient-controlled analgesia in adolescents.

Patient-controlled analgesia (PCA) is a method of administering narcotics in which the patient activates a machine to administer a small bolus of narcotic. In the first year of PCA use in our hospital, 26 patients used PCA. We suggest a dose volume of 0.015 mg/kg/dose and a 4-hour limit of 0.25 mg/kg/4 hr, with a lock-out of 10 minutes. Patients used approximately equivalent amounts to standard parenteral narcotics, but there was a wide interpatient variability in the amount of narcotic used. No clinical respiratory depression was noted, and patients did not titrate themselves to complete analgesia. PCA is an effective means of pain control in adolescent patients.

Adolescent↗
PubMed1989

Epidural opioids in children.

Experience with spinal opioids in children is limited but is expanding. Anatomy, pharmacology, technique, and results are reviewed. Complications and side effects are described.

Analgesia, Epidural↗
PubMed1989

The dose response of caudal morphine in children.

The authors compared the duration of analgesia and the frequency of side effects of three doses of caudal epidural morphine in children aged 1.2-7.9 yr. Caudal catheters were inserted in 32 children, randomly assigned to receive 0.033 mg.kg-1, 0.067 mg.kg-1, or 0.10 mg.kg-1 of preservative-free morphine for analgesia after major surgical procedures below the diaphragm. The first dose of caudal morphine was mixed with 0.25 ml.kg-1 of 1% lidocaine to confirm correct caudal catheter placement. By assessment of periodic pain scores and the time intervals between administration of caudal morphine and the recurrence of pain, the authors found that the mean (+/- SD) duration of analgesia was significantly longer after 0.10 mg.kg-1 (13.3 +/- 4.7 h) than after either 0.033 mg.kg-1 or 0.067 mg.kg-1 (10.0 +/- 3.3 and 10.4 +/- 4.2 h, respectively) (P less than 0.02). The frequency of vomiting, pruritus, and urinary retention was similar in each group. Vomiting was less common in patients who had nasogastric drainage than in patients who were fed soon after surgery (P less than 0.05). Delayed respiratory depression occurred in one child after 0.10 mg.kg-1 of caudal morphine. Caudal morphine, 0.033-0.10 mg.kg-1, provided prolonged analgesia in children. The authors recommend 0.033 mg.kg-1 of caudal morphine as an initial dose for children.

Child↗
PubMed1989

Assessment and management of recurrent pain in adolescence.

The pediatrician presented with an adolescent complaining of recurrent or chronic pain should assess the antecedents, sustainers and consequences of the pain syndrome. Particular attention should be paid to the developmental tasks of adolescence and the presence of psychosocial stress in the adolescent's family, school, peer relationships or community. Regardless of its etiology, effective management of recurrent or chronic pain in adolescence involves a balance of cognitive, behavioral and pharmacologic interventions.

Abdomen↗
PubMed1987

Brain death?

Explore the source record for details and available documents.

Brain Death↗
PubMed1987

Caudal morphine for postoperative analgesia in children: a comparison with caudal bupivacaine and intravenous morphine.

We compared the efficacy, duration, and side effects of preservative-free morphine injected into the caudal space in children, with caudal bupivacaine and with intravenous morphine administration for relief of postoperative pain. Forty-six children, ages 1-16 yr, were randomly assigned to receive intravenous morphine (control group), caudal bupivacaine (0.25%, 1 ml/kg), or caudal morphine (0.5 mg/ml, 0.1 mg/kg). In half the patients given caudal morphine, the morphine was mixed with a dose of lidocaine adequate to produce sacral analgesia, to confirm correct caudal injection of the morphine. Caudal injections were performed at the end of surgery. Time until the first required postoperative intravenous morphine dose was recorded for each patient. The duration of analgesia was significantly greater with caudal morphine (median 12 hr, P less than 0.02) than with caudal bupivacaine (median 5 hr), and both were greater than with intravenous morphine in control patients (median 45 min). Urinary retention, pruritus, and nausea appeared with slightly greater frequency in the caudal morphine group, but no delayed respiratory depression occurred. Caudal morphine (0.5 mg/ml, 0.1 mg/kg) provided 8-24 hr of analgesia in children without a significantly greater incidence of side effects than caudal bupivacaine or intravenous morphine.

Adolescent↗
PubMed1986

Childhood near-death experiences.

We nonselectively interviewed 11 patients aged 3 through 16 years who had survived critical illnesses, including cardiac arrests and profound comas. Any memory of a time they were unconscious was considered to be a near-death experience (NDE) and was recorded. Seven of these children had memories that included being out of the physical body (six patients), entering darkness (five patients), being in a tunnel (four patients), and deciding to return to the body (three patients). We also interviewed 29 age-matched survivors of illnesses that required intubation, narcotics, benzodiazepines, and admission to an intensive care unit. None of them had any memories of the time they were unconscious. In our study population, NDEs were clearly associated with surviving a critical illness. The elements of NDEs reported are similar to those previously described in adults. No children described elements of depersonalization as part of their NDEs. A core NDE, triggered by the process of dying or resuscitation efforts, may be a natural developmental experience. We present a neurophysiologic hypothesis as to the cause of NDEs.

Adolescent↗
PubMed1985

Isolated deafness following recovery from neurologic injury and adult respiratory distress syndrome. A sequela of intercurrent aminoglycoside and diuretic use.

We report two children who survived neurologic injury (near-drowning and Reye's syndrome) and adult respiratory distress syndrome and who required prolonged ventilatory support. Follow-up examination in both children showed steady neurologic recovery, but five months following discharge from their acute illness, profound hearing loss was diagnosed in both children. A review of the literature is reported and the hypothesis that combined aminoglycoside antibiotic and loop diuretic therapy caused the hearing loss is presented. Recommendation is made for audiologic assessment within six months of recovery from critical illness of pediatric patients in whom therapy has included loop diuretic and aminoglycoside antibiotic therapy.

Aminoglycosides↗
PubMed1985

Laryngeal cleft: report of eight patients and a review of the literature.

Eight cases of laryngeal cleft are presented and the literature on this topic is reviewed. Patients most frequently present with stridor, respiratory distress, or a history of choking while feeding. A number of cases are found at autopsy or surgery. Laryngeal cleft frequently is found associated nonspecifically with tracheoesophageal fistula, cleft lip and cleft palate, and congenital heart defects. Laryngeal cleft may be a component manifestation of several syndromes, eg, the G syndrome, and the Pallister-Hall syndrome of congenital hypothalamic hamartoblastoma, hypopituitarism, imperforate anus, and postaxial polydactyly. Surgical treatment is successful in more than 50% of the reported cases, depending on the extent of the cleft. Cleft larynx is most likely a developmental field defect, occurring coincidentally with separation of larynx and esophagus and closure of the larynx.

Abnormalities, Multiple↗
PubMed1978

Mechanical and chemical damage to lung tissue caused by meconium aspiration.

We investigated the effects of meconium on the lungs of an adult rabbit model to distinguish between mechanical obstruction of airways and chemical pneumonitis. After the rabbits were anesthetized and intubated, 20% human meconium in saline was instilled into the trachea. Arterial and mixed venous blood gases, functional residual capacity, cardiac output vascular pressures, calculated venous admixture, and pulmonary vascular resistance were measured. Sections of affected lung tissue were examined microscopically. The results were consistent with an early mechanical obstruction of airways with gradual development of chemical pneumonitis over 48 hours.

Airway Obstruction↗
PubMedDate not supplied

Oxygen and resolution of lung injury.

We investigated the effects of varying inspired oxygen concentrations on the resolution of oleic acid-induced lung injury in rabbits. Rabbits were injected intravenously with oleic acid and maintained in room air, or exposed to 60, 70, or 80% oxygen for periods of 7 or 10 days. Oleic acid caused hemorrhagic pulmonary edema with hypoxemia. Hypoxemia was more profound in the oxygen-treated animals, a difference that was significant after 7 days' exposure to 60 and 70% oxygen, and after 4 days to 80% oxygen. Mortality was increased in the animals maintained in 80% oxygen. The data suggest that environmental oxygen concentrations greater than 60% interfere with the return to normal lung function following oleic acid injury in rabbits. The hypoxemia may be due to either mismatching of ventilation and perfusion or to a diffusion block resulting from the increased septal width. There was no evidence of massive pulmonary edema as a cause of the hypoxemia. It was not possible to distinguish between injury primarily caused by oxygen and its interference with the healing process.

Animals↗
PubMedDate not supplied

Comparison of positive end-expiratory pressure and inspiratory positive pressure plateau in ventilation of rabbits with experimental pulmonary edema.

We investigated the effects of an inspiratory positive pressure plateau produced by a high (4/1) inspiratory-expiratory (I/E) ratio in rabbits with pulmonary edema induced with oleic acid. With an inspiratory pressure plateau, intrapulmonary shunt was significantly reduced compared to a standard 1/2 I/E ratio. Reduction in shunt was also obtained when positive end-expiratory pressure (PEEP) was added to the 1/2 I/E ratio ventilatory pattern. Since the improvement in shunt could have been caused by either recruitment of alveoli or by maintenance of lung volume at end exhalation we measured tidal volume and thoracic gas volume to distinguish between the two. With both patterns, improvement in shunt was associated with an increase in thoracic gas volume. The increase in thoracic gas volume was greater with PEEP than with 4/1 for an equivalent increase in mean airway pressure. The results suggest that an inspiratory pressure plateau improves gas exchange in pulmonary edema, but that this improvement occurs because of an increase in end-expiratory lung volume. Positive end-expiratory pressure is a preferable method of increasing end expiratory lung volume because a greater increase occurs for the same change in airway pressure.

Animals↗