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Biomedical subjects

D J Sage

Publications and source records attributed to D J Sage.

10 recordsLinked to original sources
PubMed1991

The rationale for pulse oximetry and capnometry in anaesthesia and sedation.

The monitoring of sedated or unconscious patients always requires a trained clinician. Extra vigilance and information can be provided by numerous electronic aids that also introduce error, distraction and cost. Particularly for pulse oximetry and capnography, however, these negative factors are offset by the benefits of accurate blood-gas information obtained continuously and non-invasively. The photometric principles common to pulse oximetry and infrared capnometry are examined in detail. Accuracy and sources of error are discussed and applications and limitations outlined. Evidence of the beneficial impact of these two instruments is presented from published experience with both unconscious and sedated patients.

Anesthesia, Dental↗
PubMed1990

Epidurals, spinals and bleeding disorders in pregnancy: a review.

Paraplegia caused by spinal haemorrhage is a very rare but disastrous complication of spinal or epidural insertion. The risk in uncomplicated surgical and obstetric patients is outlined. Bleeding disorders in pregnant patients may prevent the use of major regional anaesthesia. Factors which influence the choice of anaesthetic technique for patients with pregnancy-induced hypertension, von Willebrand's disease, and anticoagulation therapy, are discussed.

Adult↗
PubMed1988

Reversal of sedation with flumazenil in regional anaesthesia: a review.

Five authors have described safe and effective sedation-reversal with flumazenil in 150 patients where a benzodiazepine (BZ) was used to supplement regional anaesthesia. Problems of post-reversal anxiety seen with high-dose bolus flumazenil (0.1 mg kg-1) were not seen when flumazenil was titrated to effect and 1.0 mg not exceeded. Efficacy was also demonstrated in reversing amnesia, disorientation and other measures of cognitive function. Resedation that occurred was not clinically important, but prevention of resedation should be by repeated small flumazenil doses, or infusion, rather than a very large initial dose. The use of flumazenil is indicated where BZ sedation during regional anaesthesia has become excessive or suddenly unnecessary, for example BZ paradoxical excitement, and where prompt return to full consciousness is required in day-stay surgery. Further research is required to compare the quality of BZ sedation and reversal with sedation and recovery from propofol.

Aged↗
PubMed1987

Reversal of midazolam sedation with anexate.

Anexate (Ro 15-1788) a specific benzodiazepine antagonist, was assessed for its action in reversing midazolam-induced sedation. Sixty-five patients undergoing prostatic surgery under subarachnoid anaesthesia received midazolam for intraoperative sedation (mean dose 16 mg) followed by either active drug (anexate) or placebo given as a randomized, double-blind i.v. injection. The anexate dose sufficient to reverse sedation (0.36 +/- 0.09 mg), produced immediate and dramatic improvements in ability to comprehend and obey commands, in orientation in time and space and in degree of anterograde amnesia. These changes remained significantly different from the control group for 60 min after injection. There was no effect on arterial pressure, heart rate or ventilatory rate and no anxiety states were observed. After initial complete awakening, sedation increased gradually in drug-treated patients, while in the control group, sedation scores and cognitive testing scores all diminished over the 4-h study period. Anexate used in doses up to 0.5 mg provided safe and effective antagonism of midazolam-induced sedation in a clinical setting.

Aged↗
PubMed1985

Management of acute anaphylactoid reactions.

It must be emphasized that successful treatment of a severe anaphylactoid reaction requires rapid diagnosis and initiation of the resuscitation ABC. Intravenous volume infusion and epinephrine are the mainstays of treatment, and antihistamines are useful. Bronchospasm and persistent hypotension will require specific measures, and the overall intensity of treatment needs to be frequently and critically assessed. Identification of the offending drug and appropriate patient follow-up are essential sequelae of successful resuscitation.

Acute Disease↗
PubMed1984

Influence of lidocaine and bupivacaine on isolated guinea pig atria in the presence of acidosis and hypoxia.

In an isolated guinea pig atrial preparation, the bathing solution pH, PO2, and PCO2 were manipulated to mimic normal, acidotic, and hypoxic conditions. The effect of lidocaine and bupivacaine on spontaneous heart rate (HR) and contractile force (CF) was determined for 60 min under conditions of normal pH, PO2, and PCO2. Lidocaine (50 micrograms/ml) reduced HR by a maximum of 34.2 +/- 1.5% and CF by 38.9 +/- 8.1% (mean +/- SEM). Bupivacaine (5 micrograms/ml) reduced HR by a maximum of 30.1 +/- 1.9% and CF by 48.0 +/- 6.5%. Bupivacaine (10 micrograms/ml) caused a maximum HR reduction of 61.7 +/- 9.5% and CF reduction of 66.0 +/- 8.6%. Hypoxia or metabolic or respiratory acidosis did not further enhance the local anesthetic induced atrial depression. However, conditions of combined acidosis/hypoxia, while not significantly altering the HR and CF depression caused by lidocaine, did enhance bupivacaine-induced depression of HR and CF (93.6 +/- 6.3% and 95.2 +/- 4.8%, respectively). The effect of a protein-free bathing solution on the relative toxicities of lidocaine and bupivacaine is discussed.

Acidosis↗
PubMed1977

Detection of subarachnoid blood clot and other thin, flat structures by computed tomography.

Eight cases of subarachnoid hemorrhages are reported to illustrate the ability of CT to demonstrate thin, flat collections of subarachnoid blood clots and the importance of CT in localization of the bleeding site, especially in cases of multiple aneurysms. The major factors in the detection of these lesions are discussed on the basis of partial volume phenomenon.

Adolescent↗