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Biomedical subjects

D Niv

Publications and source records attributed to D Niv.

At least 37 records · Page 2Linked to original sources
PubMed1994

Epidural morphine pretreatment for postepisiotomy pain.

OBJECTIVE/DESIGN: A randomized double-blind controlled study was conducted on two groups of 45 parturients to evaluate the importance of the timing of epidural morphine administration for the relief of postepisiotomy pain. Both groups had preemptive analgesia by continuous lumbar epidural bupivacaine blockade. Upon completion of the episiotomy repair and before the onset of pain, the patients received epidural injections of 3 ml saline with or without 2 mg morphine in groups A and B respectively. When pain appeared, group A patients received an epidural injection of 3 ml saline while group B patients received 2 mg morphine in 3 ml saline. Postepisiotomy pain level was evaluated by a visual analogue scale. RESULTS: The incidence of pain in group B women following epidural morphine administration was 68.6%. This was significantly higher than that of group A at 15.6% (p < 0.01). Furthermore, group B showed that the rate of effective pain relief after 2 mg epidural morphine significantly decreases as the level of pain intensity rises (p < 0.01). CONCLUSION: Epidural morphine for postepisiotomy pain is much more effective if administered before the onset of pain.

Analgesia, Epidural↗
PubMed1994

Oligohydramnios: maternal complications and fetal outcome in 145 cases.

One hundred and forty-five cases of oligohydramnios in the second and third trimester were diagnosed by ultrasonography out of 25,000 obstetrics patients (0.58%). In this group, pregnancy complications included hypertension (22.1%) and bleeding in the second trimester (4.1%). We found a high incidence of meconium-stained amniotic fluid (29.1%), fetal distress (7.9%) and premature placental separation (4.2%). IUGR occurred in 24.5% of cases. Asphyxia during labor occurred in 11.5% and different other perinatal problems in 23.5%. Cesarean section was performed in 35.2% of these pregnancies. Seventeen percent of the cases presented as breech. Intrauterine fetal death occurred in 5.5% of these pregnancies. The gross perinatal mortality was 16% and the corrected perinatal mortality was 10.7%. The overall rate of fetal malformations was 11% and that of lethal malformations 4.8%. The skeletal (7.6%) and urinary system (4.1%) were the predominant systems affected. Oligohydramnios is associated with a higher rate of pregnancy complications and increased fetal morbidity and mortality, and thus termination should be considered when pulmonary maturity is present or in cases of fetal distress.

Abortion, Spontaneous↗
PubMed1994

Epidural morphine bupivacaine combination for the control of autonomic hyperreflexia during labor.

The improvement in rehabilitation of young women with spinal cord lesions, combined with the fact that libido, fertility and child bearing remain intact, enables more such patients to conceive. The obstetric team is therefore bound to meet with such patients. Among the various complications of this condition during pregnancy is an acute life-threatening syndrome called autonomic hyperreflexia (AH), caused by an uncontrolled massive sympathetic discharge, which occurs in response to stimuli that reach the spinal cord below the lesion. Most authors agree that the best method of controlling AH during labor is by an epidural block which impends stimuli from reaching the spinal cord and thus provoking AH. Most authors could not completely abolish AH episodes using different medication epidurally. Herein we present a successful delivery using a combination of morphine bupivacaine epidurally.

Adult↗
PubMed1994

The effects of perioperative ketorolac infusion on postoperative pain and endocrine-metabolic response.

We designed a randomized, double-blind study to assess the analgesic efficacy and safety of perioperative ketorolac infusion in 95 patients undergoing cholecystectomy. The ketorolac group (n = 48) received premedication, combined with ketorolac 30 mg intramuscularly (IM), followed by a ketorolac continuous infusion (2 mg/h). The control group (n = 47) received an IM bolus of NaCl 0.9% (1 mL) followed by continuous saline infusion (2 mL/h) for 24 h. Operative blood losses, postoperative pain, sedation, and on-demand morphine consumption (patient-controlled analgesia [PCA]) were measured. The effects on plasma catecholamines, cortisol, potassium, creatinine, skin bleeding time, prothrombin time (PT), and partial thromboplastin time (PTT) were also evaluated. Ketorolac improved pain scores (P < 0.05) and reduced plasma cortisol concentrations between 2 and 6 h (P < 0.05). No significant differences were observed concerning operative blood losses, glucose concentration, and renal and hemostatic functions. The ketorolac group required less morphine (not significant [NS]) than the control group and had less adverse effects (P = 0.002). Thus, perioperative ketorolac infusion improved the quality of postoperative pain relief, and had no major influence on endocrine-metabolic response and no negative influences on hemostatic and renal functions. This study suggests that preventive ketorolac administration, followed by a continuous infusion, is an easy, useful, and safe method for pain control after abdominal surgery.

Analgesics↗
PubMed1994

Outpatient versus inpatient cervical cerclage.

The outcomes in 125 cases of elective, outpatient cerclage placement were compared to those in 101 cases of elective, inpatient cerclage placement with the same technique at the same institution. There was no difference between the two groups in the rates of early and late complications or in the effect of the procedure on the duration of gestation. As expected, a statistically significantly shorter hospital stay occurred in the outpatient group. The outpatient procedure is as effective as the inpatient one, with no increased risk of early and late complications, and offers patients a shorter absence from home, thus possibly decreasing their anxiety, and considerable financial savings.

Adult↗
PubMed1992

Ventilatory effects of subarachnoid fentanyl in the elderly.

Twenty-eight elderly patients scheduled for urological surgery were randomly assigned to receive, in a double-blind study, subarachnoid hyperbaric bupivacaine 15 mg with 50 micrograms (group A, n = 7), 25 micrograms (group B, n = 7), or 12.5 micrograms (group C, n = 7) of fentanyl or 1 ml of saline (group D, n = 7) in a total volume of 4 ml. The pattern of breathing and the ventilatory response to CO2 were studied before and 90, 150 and 480 min after the subarachnoid injection. In group A, mild pruritus and sedation occurred in five patients, while nausea, vomiting and periodic breathing occurred in two. In group B, mild pruritus and sedation were observed in four patients, while nausea and vomiting occurred in two. No significant differences in minute ventilation, respiratory drive and respiratory timing were observed between the groups. Patients receiving fentanyl 50 micrograms showed a percentual change from baseline values as function of time (slope VE/PE'CO2) significantly below baseline at 90 and 150 min (p less than 0.05). However, the baseline values in this group reverted after 480 min. No side effects were observed in groups C or D. It is concluded that subarachnoid fentanyl 50 micrograms can cause an early respiratory depression and its use as a postoperative analgesic should be avoided in the elderly.

Aged↗
PubMed1991

Endoscopic sclerotherapy in extrahepatic portal hypertension in pregnancy.

Extrahepatic portal hypertension usually occurs during childhood, but a substantial number of patients may reach adult life. There is a general agreement that pregnancy may become hazardous to these patients, and some authors even consider this condition as a contraindication to conceiving. A case of endoscopic sclerotherapy in such a patient is herein presented, and the approach to such patients is discussed.

Adult↗
PubMed1991

Cardiorespiratory effects of antagonism of diazepam sedation with flumazenil in patients with cardiac disease.

The specific benzodiazepine antagonist flumazenil is currently under intense study. Despite much clinical experience, no detailed invasive hemodynamic studies of its use in cardiac patients have been published. In the present study, hemodynamic and respiratory variables were measured in 10 cardiac patients undergoing catheterization of the right and left sides of the heart, before and after sedation with intravenous diazepam, and after reversal of sedation with flumazenil. A sleep dose of diazepam (12.2 +/- 5.1 mg, mean +/- SD) caused only slight decreases in mean arterial pressure (103 +/- 12 to 98 +/- 14 mm Hg; P less than 0.05), pulmonary capillary wedge pressure (13.2 +/- 6.3 to 11.7 +/- 6.6 mm Hg; P less than 0.05), and left ventricular end-diastolic pressure (20.8 +/- 7.5 to 17.3 +/- 10.0 mm Hg; P less than 0.05), with no significant changes in respiratory gas homeostasis. Intravenous flumazenil (0.22 +/- 0.07 mg) resulted in spontaneous awakening and return to full orientation, yet caused no significant alteration in either hemodynamic or respiratory variables measured. Reversal of diazepam-induced sedation by flumazenil in cardiac patients appears safe and effective.

Aged↗
PubMed1990

Postoperative injuries of upper limb nerves.

Three cases of different types of nerve injuries following orthopedic and chest surgery are described. Recovery from these nerve injuries was prolonged and incomplete. By constant awareness of potential nerve damage during operation, it is possible to prevent such injuries.

Angina Pectoris↗
PubMed1989

Acute poisoning treated in the intensive care unit: a case series.

A retrospective study on patients with acute poisoning admitted to the Intensive Care Unit (ICU) of the Ichilov Hospital over a 3-year period (1982-84) is presented. Of 419 patients seen in the Emergency Room for intoxication during these years, 71 (17%) required intensive care upon admission. Suicide attempts accounted for 90% of the ICU admissions, with drugs of the benzodiazepine (BDZ) group being the most commonly used (51%). Mixed-drug overdose was seen in 55% of the patients. There was a poor correlation between the drugs suspected on admission and those actually detected in the blood. Although the total number of admissions due to poisoning increased in 1984 (21 in 1982 vs. 37 in 1984), mechanical ventilation was required by fewer patients (92% in 1982 vs. 51% in 1984) and for a shorter period of time (3.1 days in 1982 vs. 2.1 days in 1984), which resulted in a shorter ICU stay (4.8 days in 1982 vs. 3.1 days in 1984). The introduction of the new BDZ antagonist flumazenil may have partially accounted for this positive trend.

Acute Disease↗
PubMed1989

Postherpetic neuralgia: clinical experience with a conservative treatment.

Ninety-seven consecutive cases of postherpetic neuralgia (PHN) were retrospectively reviewed. Patients comprised 49 women and 48 men with a mean age of 71.6 years. The most common painful locations were the chest and upper back (34%), abdomen and lower back (25.2%), and face (20.2%). Burning pain was the most common type of pain (61.3%). Lancinating pain was reported by 40% and throbbing pain by 22.6%. Treatments included drugs (mainly tricyclic antidepressant, anticonvulsant, and neuroleptic drugs), transcutaneous electrical nerve stimulation (TENS), and dry needling of muscles in the affected dermatomes. Positive response to treatment occurred in 18.5% of the patients after one visit. In 9.3% of the patients, the pain still could not be controlled after 10 visits of 2-week intervals. TENS proved to be effective in patients whose skin sensation was preserved. It was concluded that in most PHN cases, pain can be effectively controlled by conservative noninvasive therapy.

Adult↗
PubMed1988

RO 15-1788 produces naloxone-reversible analgesia in the rat.

Intraperitoneal and intracerebroventricular administration of the benzodiazepine antagonist RO 15-1788 produced analgesia to both thermal and mechanical pain. This effect was reversed by pretreatment with the opioid antagonist naloxone but was unaffected by pretreatment with the benzodiazepine agonist midazolam. Furthermore, administration of the benzodiazepine antagonist RO 15-3505 was without analgesic effect. It is, therefore, proposed that the intrinsic action induced by RO 15-1788 is exerted via the indirect activation of endogenous opioid systems and that the observed effect is not due to the action of the antagonist on the benzodiazepine receptor.

Analgesics↗
PubMed1988

Early clinical experience in reversing benzodiazepine sedation with flumazenil after short procedures.

Flumazenil (Flu) (Ro 15-1788, Anexate) is a newly synthetized specific benzodiazepine (BZD) antagonist which was recently introduced for clinical study. The drug was intravenously injected, in titrated doses, to patients undergoing diagnostic or therapeutic procedures in order to reverse the sedative effects of BZDs. A total of 63 patients undergoing hand surgery under i.v. regional block, lower abdominal surgery under epidural anesthesia, cardiac catheterization, intracardiac catheter ablation, cardioversion, gastroscopy and bronchoscopy were studied. Flu in a dose ranging from 0.1 to 0.42 mg effectively reversed BZD-induced sedation in all patients 1-2 min following i.v. injection. Patients were fully awake and oriented yet calm and in good mood. Flu was well tolerated even in the high risk cardiac patients, with no significant changes in vital signs nor any sign of local irritation at the site of Flu injection. No significant resedation was observed. Thus Flu was very useful in reversing BZD-induced sedation or unconsciousness in a variety of clinical situations.

Aged↗
PubMed1988

The use of flumazenil in the treatment of 34 intoxicated patients.

The efficacy and safety of the newly available benzodiazepine (BDZ) antagonist flumazenil (Ro 15-1788, Anexate) was prospectively evaluated in the treatment of 34 intoxicated patients. Twenty-three patients had attempted suicide with various drugs, and 11 suffered iatrogenic BDZ overdose. Following 0.2 mg i.v. flumazenil (Flu) injection, 22 patients intoxicated mainly with BDZ (11 iatrogenic and 11 intentional) regained full consciousness within two minutes, enabling even extubation of two. Eight patients required repeated boluses or continuous infusion of Flu to maintain alertness. Five patients with mixed drug intoxication awakened only briefly and relapsed into unconsciousness. In spite of Flu doses of up to 20 mg, no effect on consciousness was observed in 7 patients, intoxicated mainly with non-BDZ drugs. No significant side effects were noted attributable to Flu which has proved to be a safe and effective drug. It may be employed to achieve complete reversal of pure BDZ overdose, or for 'unmasking' the relative action of BDZ in mixed drug overdose. The danger of complications from drug overdose may thus be lessened, obviating the need for invasive interventions such as mechanical ventilation and invasive hemodynamic monitoring, at the same time decreasing risk and expense.

Adolescent↗
PubMed1988

Analgesic and hyperalgesic effects of midazolam: dependence on route of administration.

The effects of intraperitoneal (IP) and lumbar intrathecal (IT) midazolam (MID) on nociception was studied in 38 male albino rats using the noxious tale-flick and hot-plate tests. Four groups received IP 0.1, 1, and 10 mg/kg MID or an equal volume of its vehicle benzyl alcohol 0.1 mg in 1 ml saline, while the other three groups received IT 10 and 100 micrograms MID or 0.5 microgram benzyl alcohol in 5 microliter saline. The two higher doses of IP MID produced statistically significant decrease of tale-flick latencies (P less than 0.005 and 0.05 at 10 and 100 mg/kg MID, respectively). This hyperalgesic effect could be seen, although the animals appeared highly sedated with reduced motor activity and relatively unresponsive to non-noxious stimuli. In contrast, IT injections of 10 micrograms MID produced moderate but statistically significant prolongation of tail-flick latencies (P less than 0.05) without noticeable change in motor activity. This analgesic effect could not be observed with the higher dose of IT MID until an hour after its administration. The almost complete immobility and ataxia seen after the high doses of IP and IT MID (animals lying on their sides) precluded reliable hot plate testing in these animals. Apparently part of the high IT dose of MID diffused into the brain, as observed after high-dose IP administration. We therefore propose that the analgesic effect of midazolam stems from its action at the spinal level, while its sedative and hyperalgesic effects are a function of its supraspinal action.

Analgesia↗