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Biomedical subjects

D Olshwang

Publications and source records attributed to D Olshwang.

At least 19 recordsLinked to original sources
PubMed1990

[A device for monitoring respiration during anesthesia: the para-tracheal monitor].

The paratracheal audible respiratory monitor (PTARM) was assessed in anaesthetized patients who were not intubated. Its working principle is simple: the sound generated by the passage of air between the vocal cords is picked up by a microphone placed on the patient's neck; the electronic signal is then amplified and changed into an audible one. It can also be recorded. This monitor was compared to others already available, Transcor, which monitors breathing sounds using a stethoscope as transducer, and Thermistor, which monitors the changes in air temperature due to air movement during breathing. The PTARM does not tie the anaesthetist down to the patient's bed, as do the precordial or oesophageal stethoscopes. Its usefulness in detecting aspiration is under investigation. It is a reliable, noninvasive and cheap breath-to-breath respiratory monitor, which can also be used in intubated patients.

Anesthesia, General↗
PubMed1987

Pulmonary barotrauma during cardiopulmonary resuscitation.

Two cases are presented of pulmonary barotrauma developing during cardiopulmonary resuscitation. This was attributed to high airway pressures developed during ventilation. One patient was ventilated with a self-inflating bag and the second with the Robertshaw demand valve. Both devices were used appropriately. Three other cases of pulmonary barotrauma during resuscitation have been recorded with the use of the latter device during CPR by ambulance personnel in Israel. The Robertshaw demand valve may generate excessively high airway pressures during normal use or when malfunctioning. For these reasons, the use of the Robertshaw demand valve has been discontinued in the Israeli Emergency Medical Services ambulances.

Aged↗
PubMed1985

Continuous epidural narcotic analgesia for intractable pain due to malignancy.

Eighty consecutive cancer patients with severe pain, uncontrolled by conventional narcotic analgesics, received a 2-mg test dose of morphine epidurally. Thirty-four of them had significant pain relief and were thus selected to receive continuous treatment. This consisted of 2-6 mg of morphine administered every 8-24 hours through an indwelling epidural catheter. The duration of treatment was from 1 to 28 weeks with a median of 4 weeks. Twenty-five (76%) of the patients experienced complete relief of pain, while nine had only a partial analgesic response. Complications were minimal. No sepsis, hypotension, or respiratory depression occurred. It is recommended that cancer patients with intractable pain will be selected for continuous epidural analgesia by evaluating their response to a test dose of epidural morphine.

Adult↗
PubMed1985

Local anesthesia in carotid endarterectomy: an alternative method.

Results of carotid endarterectomy (41 operations) carried out under local anesthesia are presented. There were no deaths within 30 days. Three patients had undergone surgery with a temporary internal shunt, following signs of neurological changes (unconsciousness, aphasia, motor changes) during 1-min test cross-clamping. No neurologic deficits were observed, and only two patients (4.8%) experienced postoperative hypertension. These data support the view that simple neurological monitoring of awake patients enables accurate assessment of the need for an internal carotid shunt. Carotid endarterectomy under local anesthesia seems to be a very safe procedure. Use of this technique is especially appropriate for elderly patients with hypertension and ischemic heart disease.

Aged↗
PubMed1981

Postoperative analgesia by percutaneous electrical stimulation in gynecology and obstetrics.

Percutaneous electrical stimulation (PES) for relief of acute postoperative pain was applied in 10 patients after cesarean section and in 20 women who had undergone various gynecological operations. Thirty other women, subjected to identical surgical interventions, served as controls. In the latter group, the electrodes were attached to a nonfunctioning apparatus. In all patients, including the controls, the two electrodes were introduced intradermally, one on each side of the incision. Implantation was carried out at the end of the surgical procedure while the patient was still anesthetized, and stimulation was commenced immediately. The electrical stimulation was applied continuously for 1 to 3 postoperative days. The generation of pulses was perceived by the patients as a tingling sensation. Complete pain relief was obtained in 40% of the patients treated with PES, whilst in 27% the pain was markedly diminished. Postoperative analgesic medication in this group was reduced by 50-80% as compared to the analgesic requirements in the control group. Other beneficial effects observed in the treated patients included early ambulation, early peristalsis, postpartum uterine contractions and absence of respiratory complications.

Adnexa Uteri↗
PubMed1981

Spinal narcotics and central nervous system depression.

A case of central nervous system depression which developed 7 hours after an intrathecal injection of 4 mg of morphine is described. The patient lapsed into coma with bradypnoea and "pin-point' pupils and there was no response to naloxone 0.4 mg. Treatment was continued for 3 hours. No postoperative analgesics were required for 126 hours. The problems associated with the use of intrathecal opiates are reviewed, delay in onset being the usual feature. Use of hyperbaric solutions of the narcotic and maintenance of a head-up posture may protect against respiratory depression.

Adult↗
PubMed1980

Epidural morphine analgesia in second-trimester induced abortion.

Epidural administration of 2 mg of morphine to 16 patients who were undergoing induced abortion in the second trimester of pregnancy abolished labor pains in 10 of them within 10 to 20 minutes after treatment was begun. The pain did not recur until the abortion process started, sometimes hours later. In one patient, the relief of pain was achieved with an additional top up dose of 1 mg 15 minutes later. In the other five patients in whom the morphine had no appreciable effect, the addition of 4 ml of 0.5% bupivacaine hydrochloride, also injected epidurally, successfuly abolished pain. Because of the beneficial and prolonged action of morphine, as well as the lack of side effects, continuous epidural analgesia with low doses of it--supplemented, if necessary, with small quantities of bupivacaine--is effective for treatment of labor pains in induced abortion in the second trimester of pregnancy. The involvement of the anesthetist from the very beginning of the induction procedure is highly recommended.

Abortion, Induced↗
PubMed1980

Relief of pain by subcutaneous electrical stimulation after ocular surgery.

Electrical stimulation in the treatment of postoperative ophthalmologic pain was applied in 25 patients. In 21, stimulation was applied by means of subcutaneously implanted wires and in four patients the therapy was administered by externally placed electrodes. The subcutaneous electrodes were introduced near the supraorbital and infraorbital nerves at the end of the surgical procedures, and stimulation was immediately begun. Duration of treatment varied between one and three days. The nerve stimulator is a portable, battery-operated apparatus. The implanted electrodes avoid skin resistance and are extremely stable, thus affording uniform current intensity that does not change during sudden movements. As a result, the stimuli are perceived as a pleasant sensation. Complete pain relief was attained in nine patients, and in 13 patients the pain was diminished. The therapy is appropriate and effective in postoperative ocular pain, because the pain is restricted to a limited area, innervated by superficial nerves that are easily accessible to electrical stimulation.

Adolescent↗
PubMed1980

Effect of sodium bicarbonate on the kinetics of bupivacaine in i.v. regional anaesthesia in dogs.

Changes in pH studied in vitro affected considerably the distribution of bupivacaine between the erythrocyte and incubation medium: in an acidic medium, the uptake of bupivacaine by erythrocytes was decreased. The acidosis induced in vivo in dogs' limbs during i.v. regional anaesthesia (IVRA) with bupivacaine was corrected by injecting sodium bicarbonate into the occluded limb. The concentration of bupivacaine in the cephalic vein was measured in dogs under. IVRA. After removal of the tourniquet, the drug concentration-time relationship showed a biexponential pattern of decline. Injection of sodium bicarbonate into the limb 10 min before the release of the tourniquet suppressed the rate at which the concentration of bupivacaine decreased during the second phase. This slower rate of drug release from the tissues may prolong residual analgesia.

Anesthesia, Conduction↗
PubMed1980

Prolonged effect of bupivacaine hydrochloride after cuff release in i.v. regional anaesthesia.

Bupivacaine hydrochloride 0.25% and 0.50% solutions, were administered 115 times by the i.v. regional route to 64 surgical patients and in 38 subjects suffering from pain syndromes. The clinical effects were limb numbness up to 20 h following cuff release, while analgesia and weakness of the limb muscles were evident 5 h after the tourniquet. Clinical and electrophysiological findings revealed a dose relationship of the effects. Toxic signs were noted in three patients in whom the cuff was released in a one-step fashion. In 11 patients, mean arterial plasma concentrations of bupivacaine reached 3.7 micrograms ml-1 after administration of 0.5% bupivacaine 40 ml, 5 min after final cuff release, and decreased gradually thereafter. In selected conditions which do not require a bloodless field and in certain intractable pain states, i.v. regional anaesthesia with high-dose bupivacaine (200 mg of 0.5% solution) may be a simple and effective technique.

Adult↗