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D M Rothenberg

Publications and source records attributed to D M Rothenberg.

23 records · Page 2Linked to original sources
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Isotonic hyponatremia following transurethral prostate resection.

The proper treatment of hyponatremia during transurethral resection of the prostate continues to be controversial. Two cases of isotonic hyponatremia are reported here, and the literature regarding the incidence and treatment of hyponatremia during transurethral resection of the prostate is reviewed. In each case, the patient developed neurologic changes during complicated transurethral prostate resection. Despite the rapid decrease in the serum sodium concentration, serum osmolality remained normal due to the resorption of the bladder irrigant glycine. Therefore, etiologies other than cerebral edema are postulated as the cause of the neurologic manifestations. Also, the role of the osmolar gap in directing appropriate therapy is emphasized in an effort to avoid unnecessary use of hypertonic saline. Finally, an appropriate differential diagnosis of the neurologic changes seen during the transurethral resection of the prostate syndrome is discussed.

Aged↗
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A single bolus dose of esmolol in the prevention of intubation-induced tachycardia and hypertension in an ambulatory surgery unit.

The efficacy of a single bolus dose of esmolol in the prevention of intubation-induced tachycardia and hypertension was studied in a double-blind manner. Thirty patients from the Ambulatory Surgery Unit at Rush-Presbyterian-St. Luke's Medical Center were prospectively randomized to receive a placebo, 100 mg of esmolol, or 200 mg of esmolol immediately prior to induction (2.5 to 3.0 minutes before intubation). The groups were similar in demographic characteristics and with regard to preoperative blood pressure (BP) and heart rate (HR). Anesthetic management was standardized for all patients. Esmolol 100 mg (1.4 +/- 0.3 mg/kg) and 200 mg (2.6 +/- 0.7 mg/kg) significantly (p less than 0.05) blunted the maximum increases in HR and BP following intubation. The average maximum HR increase in the placebo group was 40% as opposed to 16% in the esmolol 100 mg group and 14% in the esmolol 200 mg group. Both esmolol groups blunted the tachycardic response over a 4-minute postintubation time period. The average maximum BP increase was 47% in the placebo group versus 22% and 19% in the esmolol 100 mg and esmolol 200 mg groups, respectively. There were no significant differences between the two esmolol groups. This study demonstrates the efficacy of a single bolus dose of esmolol in blunting the tachycardic and hypertensive responses to laryngoscopy and intubation in an ambulatory surgery setting.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Do-not-resuscitate orders in the presurgical patient.

STUDY OBJECTIVE: To assess the policy and practice of anesthesiology departments in regard to their management of the presurgical do-not-resuscitate (DNR) patient. DESIGN: Questionnaire distributed to the program directors of 156 accredited residency programs in anesthesiology in the contiguous United States. SETTING: University hospital. MEASUREMENTS AND MAIN RESULTS: One hundred twelve of the 156 accredited U.S. programs responded to the questionnaire. The majority (81%) of programs that have a DNR policy for the presurgical patient suspend the order prior to surgery. However, only 50% of the institutions responding have standing policies, and of those that do not, only 40% plan to initiate such a policy. CONCLUSIONS: The need for a written policy for the DNR patient undergoing surgery is exemplified by the low percentage of institutions that have existing policies.

Anesthesia Department, Hospital↗