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Biomedical subjects

D J Birnbach

Publications and source records attributed to D J Birnbach.

At least 19 recordsLinked to original sources
PubMed1998

Povidone iodine and skin disinfection before initiation of epidural anesthesia.

BACKGROUND: Povidone iodine (PI) solution is used commonly for skin disinfection before epidural and spinal anesthesia. Although there have been reports indicating the presence of microbial contaminants in PI solution, none have evaluated the prevalence of PI contamination. The aims of this study were to assess the frequency of bacterial contamination of previously opened bottles of PI solution and to compare the effectiveness of new and previously opened bottles of PI solution for skin disinfection. METHODS: Twenty previously opened and ten previously unopened multiple-use bottles of PI solution were evaluated for microbial contamination. In addition, final swabs and PI solution used for skin disinfection in 80 patients undergoing elective epidural analgesia were evaluated. RESULTS: The inside of the bottle cap or the PI solution from 40% of the multiple-use PI bottles in use were contaminated. There was no growth from any previously unused PI bottles. Povidone iodine from newly opened bottles provided more effective skin decontamination than did solution from previously opened bottles. CONCLUSIONS: Multiple-use PI bottles in normal use may become contaminated by bacteria. In addition, PI solution from previously opened bottles was less effective than PI from previously unopened bottles. Based on these findings, if PI solution is chosen for skin antisepsis before initiation of epidural and spinal anesthesia, only single-use containers should be used.

Anesthesia, Epidural↗
PubMed1997

Cocaine screening of parturients without prenatal care: an evaluation of a rapid screening assay.

Illicit drugs are used widely by inner city patients in our society. Because cocaine ingestion can produce life-threatening arrhythmias and interact with anesthetic drugs, it is potentially useful for the anesthesiologist to know a high-risk patient's cocaine status before administering anesthesia. The commonly used methods to detect cocaine abuse, however, often require 1-3 days for laboratory processing. With these tests, anesthesiologists are unable to test for recent cocaine use in an emergency setting. A new rapid latex agglutination assay for urinary metabolites of cocaine (OnTrak Abuscreen; Roche Diagnostic Systems Inc., Branchburg, NJ) was compared with an assay used by many hospital laboratories. The prevalence of cocaine abuse in the group of unregistered parturients was found to be 68%, with the latex agglutination results exactly matching the hospital laboratory results (kappa = 1.0). A sensitive and specific method now exists that allows anesthesiologists to assess cocaine use rapidly, so that they can use this information when planning a patient's anesthetic.

Adult↗
PubMed1997

Acupressure versus intravenous metoclopramide to prevent nausea and vomiting during spinal anesthesia for cesarean section.

Nausea and vomiting occur frequently during cesarean section under spinal anesthesia. Metoclopramide reduces intraoperative nausea and vomiting, but not without potential side effects. Acupressure, a noninvasive variation of acupuncture that involves constant pressure on the wrist, has been suggested as an alternative method to prevent nausea and vomiting. The aim of this study was to compare acupressure and intravenous (IV) metoclopramide for the prevention of nausea and vomiting during elective cesarean section under spinal anesthesia. Seventy-five patients were studied in a randomized, prospective, double-blind comparative trial. Group I patients received acupressure bands + 2 mLIV saline, Group II patients received placebo wrist bands + 10 mg IV metoclopramide, and Group III patients received placebo wrist bands + 2 mL IV saline. Patients who received either acupressure or metoclopramide prior to initiation of spinal anesthesia for cesarean section had much less nausea than patients in the placebo group. Acupressure is an effective, non-pharmacologic method to reduce intraoperative nausea during elective cesarean section in the awake patient.

Acupressure↗
PubMed1996

Anesthesia for the parturient with sickle cell disease.

A brief overview of the genetics, transmission, pathophysiology, and clinical manifestations of sickle cell disease is presented. Issues and management dilemmas specific to the parturient with sickle cell disease are discussed, along with recommendations regarding preoperative, operative, and postoperative care. Three case reports from our institution are used to illustrate problems that may occur in these patients.

Adult↗
PubMed1995

Anaesthetic management of caesarean section in a patient with active recurrent genital herpes and AIDS-related dementia.

We report the anaesthetic management of a pregnant patient with multiple manifestations of HIV infection who underwent Caesarean section. A 30-yr-old, HIV-positive, Haitian woman presented with acute psychosis at 28 weeks' gestation. A diagnosis of HIV dementia complex was made and haloperidol therapy was started. Five days after admission the patient was found to be in labour and tocolytic therapy with terbutaline was commenced. A vaginal lesion compatible with herpes simplex virus was observed which was treated with acyclovir. After 3 days of tocolytic therapy there were no further signs of preterm labour. Two weeks later, at 30 weeks' gestation, the patient's membranes ruptured spontaneously. The herpes labialis lesion was still present and urgent Caesarean section was begun using subarachnoid 0.75% bupivacaine 1.5 ml. The patient had no intraoperative problems and a 1700-g healthy male child was delivered.

AIDS Dementia Complex↗
PubMed1989

Fetal surgery and general anesthesia: a case report and review.

Fetal surgery, in utero, is now a viable option for some congenital conditions due to recent advances in ultrasound and microsurgical technology. Previous reports of anesthesia for such procedures have focused on spinal or epidural conduction techniques. General endotracheal anesthesia may have several advantages in this setting. In addition to maternal anesthesia, general anesthesia can provide fetal neuromuscular block (without direct fetal injection of blocking agents) and uterine relaxation. It may also blunt fetal response to surgical stimulation.

Adult↗
PubMed1979

Reticuloendothelial system (RES) hyperfunction and erythropoietin (Ep) production in the regenerating liver.

Hepatic cells in rats were evaluated after subtotal hepatectomy using scintillation scanning with technetium sulfur colloid (TSC), autoradiography, and microstereology techniques. The ability of the liver to accumulate TSC increased during the course of the regeneration as did the labeling of Kupffer and parenchymal cells with tritiated thymidine (3H-tdR). Kupffer to parenchymal cell number ratios and Kupffer cell relative areas were also elevated, attaining peak values at 72 hours post-hepatectomy. This period corresponds to the time of peak erythropoietin (Ep) production in rats with regenerating livers after nephrectomy and exposure to hypoxia. These findings suggest that the Kupffer cell may function as a cellular site of Ep formation.

Animals↗
PubMed1977

Age-related variations in hepatic regeneration and erythropoietin production in the rat.

Erythropoietin (Ep) is produced mainly by the liver and spleen during fetal and neonatal periods and by the kidney during adolescent and adult life. The liver is also an important extrarenal producer of Ep in the hypoxic, anephric adult animal. Subtotal hepatectomy results in a substantial elevation in serum Ep levels at 30-72 hours after hepatectomy in rats subsequently nephrectomized and rendered hypoxic. Ep production is related to the mass of regenerating liver with peak Ep production occurring during times of greatest tissue proliferation. Regenerative and erythropoietic responses to hepatectomy decline with advancing age. Rats undergoing repeated hepatectomies do not recover full liver mass but the initial rate of regeneration increases following each successive hepatectomy. Ep levels decline in anephric hypoxic rats undergoing multiple hepatectomies when compared to sham-operated controls.

Age Factors↗
PubMedDate not supplied

Does metoclopramide supplement postoperative analgesia using patient-controlled analgesia with morphine in patients undergoing elective cesarean delivery?

BACKGROUND AND OBJECTIVES: Recent studies have shown that metoclopramide may decrease postoperative narcotic requirements in patients undergoing second-trimester induced abortions or prosthetic hip surgery. It is often used to decrease the incidence of nausea and vomiting in the patient undergoing cesarean delivery under regional anesthesia. If metoclopramide were found to be an analgesic adjunct in these patients, it would offer an additional impetus for its routine use. METHODS: After elective cesarean delivery under spinal anesthesia, 32 patients were monitored for initial and 24-hour postoperative morphine requirements via intravenous patient-controlled analgesia. These patients were divided into two groups. Prior to spinal block, group 1 (n = 17) received 10 mg intravenous metoclopramide, and group 2 (n = 15) received an intravenous saline placebo. RESULTS: No differences were found between groups in the time from spinal placement to the time of pain onset, the amount of morphine necessary to initially achieve comfort, or 24-hour postoperative morphine requirements. (P > .05). CONCLUSIONS: This study demonstrates that metoclopramide decreases intraoperative nausea but does not supplement analgesia in patients undergoing elective cesarean delivery.

Adult↗
PubMedDate not supplied

Lumbar epidural anesthesia initiated in the knee-chest position.

The knee-chest position may become necessary in labor to mitigate fetal heart rate decelerations. This position may also prove advantageous for initiation of lumbar epidural anesthesia. This case report demonstrates a clinical situation in which lumbar epidural anesthesia was initiated in the knee-chest position. A description of the technique is included.

Adolescent↗