PubMed Health⌕ Search

Biomedical subjects

D S Klein

Publications and source records attributed to D S Klein.

14 recordsLinked to original sources
PubMed1991

Low-volume ulnar nerve block within the axillary sheath for the treatment of reflex sympathetic dystrophy.

A case is described of reflex sympathetic dystrophy (RSD) of the upper limb following cerebral arteriography via the subclavian artery. The pain started in the hand and forearm but, over several weeks, spread to involve the whole arm. After identifying the ulnar nerve in the axillary bundle with a stimulator, a series of small volume injections (bupivacaine 0.5% with epinephrine 2.5 ml and methyl-prednisolone 40 mg) was given. These relieved the pain and reversed the trophic changes of RSD. It is suggested that this approach is a useful alternative treatment in cases of RSD of the upper extremity.

Axilla↗
PubMed1991

Intermittent interpleural injection of bupivacaine and methylprednisolone for analgesia in metastatic thoracic neoplasm.

Three patients with intractable chest wall pain due to diffusely metastatic thoracic neoplasm were successfully treated with intermittent interpleural steroid injections. Intermittent administration of 0.5% bupivacaine mixed with methylprednisolone suspension (Depo-Medrol) was effective in controlling intractable pain due to metastatic cancer. Pain relief with this technique lasted for periods in excess of 3 weeks between injections. Intermittent interpleural block may be a useful addition to the therapeutic armamentarium in dealing with chronic pain due to metastatic neoplasm.

Breast Neoplasms↗
PubMed1986

Nalbuphine and droperidol in combination for sedation and prevention of nausea and vomiting during intra-carotid BCNU infusion.

A therapeutic regimen is described for sedative, analgesic, and anti-emetic effect in patients receiving intra-arterial carmustine (BCNU) for malignant gliomas. This regimen consists of nalbuphine, 30 mg, i.v., and droperidol, 2.5 mg, i.v., given immediately prior to intra-carotid BCNU infusion. Droperidol, 2.5 mg, i.v., is then administered on four hour intervals for sixteen hours post-procedure. This combination provided excellent effect in nine patients treated for twelve intra-carotid infusions. None of the nine patients experienced vomiting, one experienced mild nausea several hours post-infusion, and non complained of severe pain or discomfort. Thirteen additional patients received diazepam, 10 mg, P.O., prior to the intra-carotid BCNU infusion, with fentanyl, 100 mcg, i.v., and prochlorperazine, 10 mg, i.m. at the onset of infusion. All thirteen patients suffered from severe nausea, vomiting, and orbital pain. The nalbuphine/droperidol combination is thought to provide a superior alternative to the traditional narcotic/pheonothiazine/benzodiazepine combination for carotid BCNU infusion. This combination has theoretical advantages for the patient with intracranial mass lesions by providing analgesia and sedation with minimal potential for respiratory depression and carbon dioxide retention.

Adult↗
PubMed1983

Pulmonary toxicity of antineoplastic agents: anaesthetic and postoperative implications.

Agents commonly used in the treatment of neoplastic diseases may impair pulmonary function, and a wide spectrum of agents are currently implicated as toxic to the pulmonary system. Agents most commonly implicated are bleomycin, carmustine, busulfan, methotrexate, and thoracic radiotherapy. Less commonly implicated agents include mitomycin, procarbazine, melphalan, chlorambucil, and cyclophosphamide. Therapeutic interactions at time of operation and postoperatively may exacerbate existing pulmonary damage. It is imperative for the physicians treating patients receiving antineoplastic therapy to recognize potentially dangerous therapeutic interactions, and adjust the therapeutic regimen accordingly. Concentrations of inspired oxygen must be maintained as low as is safely possible. Intraoperative monitoring of arterial and mixed venous oxygen tensions will enable the clinician to adjust inspired oxygen concentrations to the lowest possible level while maintaining adequate oxygen tensions to the tissues. A systematic review of antineoplastic agents currently implicated, drug-oxygen interactions, and a review of the pathophysiology are presented.

Anesthesia↗