PubMed Health⌕ Search

Biomedical subjects

E Alon

Publications and source records attributed to E Alon.

17 recordsLinked to original sources
PubMed1992

Effects of single-dose intravenous omeprazole and ranitidine on gastric pH during general anesthesia.

We conducted a comparative trial of the gastric proton pump inhibitor omeprazole and the H2-receptor antagonist ranitidine on gastric pH in 50 adult patients scheduled for elective gynecologic surgery. The drugs were administered intravenously in random fashion after induction of general anesthesia and placement of a gastric electrode for continuous pH monitoring. The two drugs caused significant increases in gastric pH that did not differ significantly when compared with one another, yet there were significant differences from the control group, which did not receive either of the two drugs. A gastric pH of 2.5 was reached within median 34 and 26 min after administration of omeprazole (40 and 80 mg, respectively) and within median 32 and 26 min after administration of ranitidine (50 and 100 mg, respectively). After injection of omeprazole, a gastric pH of 3.5 was reached after median 41 and 34 min; injection of ranitidine (50 and 100 mg) produced a pH of 3.5 after median 43 and 48 min, respectively. We conclude that the intravenous administration of a single dose of omeprazole or ranitidine causes a similar increase, both in magnitude and time of onset, in gastric pH during general anesthesia.

Adult↗
PubMed1992

Ondansetron in the treatment of postoperative vomiting: a randomized, double-blind comparison with droperidol and metoclopramide.

The prophylactic antiemetic efficacy of ondansetron was evaluated in a randomized, double-blind comparison with droperidol and metoclopramide in 66 patients undergoing general anesthesia for dilatation and curettage. Ten minutes before induction of anesthesia, 22 patients received a single intravenous dose of 8 mg of ondansetron, 22 others received 1.25 mg of droperidol, and the remaining 22 received 10 mg of metoclopramide. Anesthesia was induced with 3.3-5 mg/kg of intravenous thiopental and maintained with 65% nitrous oxide in oxygen and 2%-3% enflurane. Postoperatively, the incidence of vomiting was 13% with ondansetron, 45% with droperidol, and 54% with metoclopramide (P less than 0.05; overall chi 2 test). There was no statistically significant difference in the incidence of nausea among the groups. Postoperative sedation and well-being scores were not significantly different among the groups. We conclude that preoperative prophylactic administration of ondansetron is superior to droperidol or metoclopramide in the prevention of emetic sequelae after general anesthesia for dilatation and curettage.

Adult↗
PubMed1992

[Intravenous postoperative pain management using nalbuphine and tramadol. A combination of continuous infusion and patient-controlled administration].

UNLABELLED: The aim of the study was to examine the analgesic efficacy and applicability of the two analgesic drugs nalbuphine and tramadol, administered by continuous i.v. infusion combined with a patient-controlled analgesia device (PCA). METHODS: With informed consent and approval of the ethical committee, 40 patients were studied after abdominal hysterectomy in a randomized, double-blind order. Twenty received an initial postoperative dose of 10 mg nalbuphine followed by a continuous infusion of 5 mg/h and the possibility of an additional 5 mg every 30 min. The other 20 received equipotent analgesia consisting of an initial bolus of 50 mg tramadol i.v. followed by a continuous infusion of 25 mg/h and the possibility of an additional 25 mg every 30 min. Analgesia, sedation, general well-being, and acceptance of the patients as well as blood pressure, heart rate, respiratory rate, and pulse-oximetric O2 saturation were measured regularly during a 5-h postoperative period. Data were analyzed using the Mann-Whitney test, with P less than 0.05 considered significant; results were expressed as mean +/- standard deviation. RESULTS: The postoperative pain score on the visual analogue scale (0 to 10) fell with nalbuphine from 7.14 +/- 3.45 to 2.03 +/- 1.25 and with tramadol from 7.81 +/- 2.85 to 1.57 +/- 1.40. There were no significant differences between the two groups. PCA supplements were requested 21.7 times in the nalbuphine group and 27.3 times in the tramadol group. General well-being of the patients on a 4-point scale (0 to 3) improved for the nalbuphine group from 0.70 +/- 0.92 to 2.11 +/- 0.49 and for the tramadol group from 0.62 +/- 0.67 to 2.33 +/- 0.50, which was significantly better in the nalbuphine group after 45, 60, and 90 min.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Intravenous tramadol for post-operative pain--comparison of intermittent dose regimens with and without maintenance infusion.

Thirty-five ASA Grade I-II females received tramadol 150 mg intravenously followed randomly and double-blind by an infusion of either tramadol 15 mg h-1 (Group I) or saline (Group II) and tramadol 100 mg bolus on demand for the treatment of post-operative pain. Patients in Group I required 60% less tramadol on demand (P less than 0.01) and had better pain relief after operation (P less than 0.05) than those in the group given saline. Total tramadol consumption, however, was about 30% higher in Group I (P less than 0.05) and was associated with an increased incidence of minor side-effects. In both groups median serum tramadol concentrations peaked at 15 and 60 min and decreased after the second peak steadily (P less than 0.001). Tramadol failed to relieve pain within 2 h after the beginning of treatment in 6% (Group I) and 20% (Group II) of the patients. It is suggested that use of an i.v. maintenance tramadol infusion in addition to on-demand i.v. tramadol boluses is a safe and recommended mode of post-operative intravenous pain therapy.

Adult↗
PubMed1991

[Current developments in postoperative pain management].

The aim of the postoperative pain therapy is besides the amelioration of the patients well-being, also lessening of unwanted vegetative reactions and avoidance of the need for excessive care situations. There are numerous ways of therapy and medication at our disposal for this purpose. The first line of drugs are the analgesically most active opiates; they can be combined with antiphlogistics and antipyretics, in order to decrease the specific opiate-induced side effects. Besides the parenteral way the epidural application is being used. Local anesthetics are a valuable alternative to the systemic pain relief therapy and can postoperatively be combined with opiates. By this combination the total dose and the relevant side effects can be reduced. During the last years patient-controlled analgesia was the modern way and the nearest approach to ideal dosing. In comparison to the conventional way, its therapeutic success was described as convincing, even overwhelming. Difficulties or deficiencies in the postoperative pain therapy are mostly caused by lack of time and insufficient knowledge and experience of the personnel, on the other hand also by limited technical possibilities of monitoring the patient. A possible solution may be the setting-up of a special service for the treatment of postoperative pain.

Analgesia, Epidural↗
PubMed1990

Epidural anesthesia for cesarean section in a patient with severe pulmonary hypertension.

The case of a parturient previously operated on for transposition of the great arteries is reported. On account of Eisenmenger's syndrome with high pulmonary vascular pressures, she was admitted to hospital with hemoptysis in the 27th week of gestation. At the end of the 34th week the child was delivered by elective cesarean section under epidural block. Bupivacaine 0.75% was administered as local anesthetic, and small incremental doses of local anesthetic proved capable of maintaining hemodynamic stability for the duration of the operative procedure.

Adult↗
PubMed1990

Effect of epidural anesthesia for cesarean delivery on maternal femoral arterial and venous, uteroplacental, and umbilical blood flow velocities and waveforms.

The effect of epidural anesthesia on the maternal femoral arterial and venous, uteroplacental, and umbilical circulations was studied by the pulsed Doppler technique in 13 women undergoing elective cesarean delivery. Resistance and pulsatility indices of umbilical arterial velocity waveforms did not change with the use of epidural anesthesia. In the uteroplacental circulation, these indices increased in 11 patients, suggesting an increase in resistance. Reduction of sympathetic tone in resistance and capacitance vessels was reflected in the femoral artery by an increase in systolic and end-diastolic velocities, a reversal of the post-systolic backward flow, and an increase in mean velocity. The latter also occurred in the femoral vein. The diameters of these large maternal vessels did not change. This study suggests an impairment in uteroplacental circulation associated with a drop in peripheral vascular resistance and an increase in leg blood flow after epidural anesthesia.

Anesthesia, Epidural↗
PubMed1989

[Major gynecologic surgery in the geriatric patient].

A retrospective analysis of 256 important interventions in geriatric gynecologic patients (over 70 years of age) was carried out. There were 77 vaginal, 86 abdominal, 9 combined abdomino-vaginal and 82 breast operations. Minor (131) and major (31) complications are described in detail. Two postoperative deaths accounted for a mortality rate of 0.8% in these patients. It is emphasized, that on the premises of a thorough evaluation of the possible treatments, a modern anesthesiologic technique, a well devised operative strategy and the modern postoperative care we can nowadays justify extensive surgery even in the very old gynecologic patient.

Aged↗
PubMed1988

[Anesthesiologic management of cesarean section in a patient with transposition of the great vessels].

The maternal mortality associated with cesarean section in the presence of congenital cyanotic heart disease is high. We report the anesthetic management of a 26-year-old pregnant patient with transposition of the great vessels and a functional single ventricle whose child was delivered by elective cesarean section under continuous epidural anesthesia. There were no hemodynamic problems and the outcome was successful for both mother and child, who could be discharged from the hospital on the 17th postoperative day. Elective cesarean section may be an acceptable method of delivery, and lumbar epidural block proved to be an appropriate procedure for this patient. The cooperation of cardiologists, anesthesiologists, and obstetricians was necessary to assure maternal and fetal survival. Continuous invasive hemodynamic monitoring and use of small epidural top-up doses (2-3 ml) of local anesthetic were of utmost importance in maintaining the hemodynamic stability.

Adult↗
PubMed1988

[Epidural anesthesia in a patient with Friedreich's ataxia].

Friedreich's ataxia (FA), a hereditary disease with degenerative changes localized chiefly in the spinal cord and cerebellum, is characterized clinically by ataxia, absence of tendon reflexes, loss of proprioceptive sensation, and extensor plantar responses. There are only a few reports on anesthesia for patients with FA. General but not regional anesthesia is usually recommended because a persistent aggravation of symptoms is feared with regional anesthesia. We report a 31-year-old gravida 1 para 0 patient with FA who was admitted at the 20th week of gestation for induced abortion, curettage and tubal ligation. Familial FA was diagnosed at the age of 15, and since the age of 23 the patient had been confined to a wheelchair. As she strictly declined general anesthesia, epidural analgesia with 0.125% bupivacaine and morphine was used for 14 h, during which period induced abortion by prostaglandin was performed. This was followed by epidural anesthesia with 2% lidocaine for curettage and laparoscopic tubal ligation. A reduced dosage of local anesthetics, as commonly recommended during pregnancy, was used. Neurological consultation before and 1 day, 6 weeks, and 7 months after operation revealed no undue exacerbation of symptoms. Our case report suggests that epidural anesthesia can safely be administered to a patient with FA.

Abortion, Induced↗
PubMed1987

Double-blind study of the reversal of midazolam-supplemented general anaesthesia with Ro 15-1788.

The actions and side effects of the benzodiazepine antagonist Ro 15-1788 were evaluated in a randomized double-blind clinical study in which midazolam was used as an anaesthetic agent. Sixty women who underwent laparoscopy were treated with Ro 15-1788 or with placebo after the surgical procedure. Ro 15-1788 reversed the hypnotic effect of midazolam within a few minutes. The patients were alert, co-operative, oriented and had good recall of events after awakening. The effects were statistically better than placebo for up to 30 min after administration. Arterial pressure and heart rate remained stable and there were no significant side effects. The availability of Ro 15-1788 allows effective reversal of midazolam when this is used during general anaesthesia.

Adult↗
PubMed1979

[Clinical application of a supplement to the extracorporal circulation to produce a pulsatile flow (author's transl)].

Two groups of patients with atherosclerotic coronary artery disease, who underwent aortocoronary bypass operation, were perfused with nonpulsatile flow during extracorporeal circulation (ECC) using membrane oxygenators. One group (MO) was used as a control, while for the other group (PAD) a Pulsatile Assist Device in the arterial line was employed. This apparatus consists of a balloon of 80 ml placed inside a rigid housing. The balloon is compressed by pressurized air or expanded by vacuum supplied by a driving console. The apparatus produced pulse amplitudes between 30 and 50 mm of mercury. Other than a very short-lasting fall in mean arterial pressure, thus showing diminished peripheral resistance, no perceptable advantages were found. Base excess and pH-changes showed no differences, also the given amount of sodium bicarbonate in both groups was the same. On the other hand significantly higher hemolyses took place, increasing with the duration of pulsation. The application of the apparatus as an arterial counterpulsator was possible with limitation in only 5 of 15 patients. In all other patients after a short time massive blood foaming developed in the PAD and the attempts had to be stopped because of the risk of gas embolism. In our opinion this apparatus is an unnecessary supplement to the ECC and as an arterial counterpulsator it seems too dangerous.

Adult↗
PubMedDate not supplied

Epidural anesthesia for a cesarean section in a patient with pulmonary atresia and ventricular septal defect.

The perioperative management and the pathophysiology of a parturient with pulmonary atresia, ventricular septal defect, patent ductus arteriosus Botalli (PDA), and pulmonary hypertension are described. The patient previously had a cesarean section under general anesthesia and was currently managed with an epidural block. The outcome was successful for the mother. The postoperative period of the premature infant was characterized by hyaline membrane disease, with its typical sequelae.

Abnormalities, Multiple↗
PubMedDate not supplied

Intercostal nerve block for minor breast surgery.

Two anesthetic procedures, intercostal nerve block (ICNB) and general anesthesia, were evaluated in 45 female patients scheduled for minor breast surgery. The study was designed to compare ICNB with general anesthesia for breast surgery with respect to efficacy, surgical stress and postoperative analgesia and to evaluate epinephrine and ornipressin as vasoconstrictors in the local anesthetic solution. Thirty patients received ICNB of T3-T7 unilaterally using 2% lidocaine plus epinephrine (15 patients, Group A) and 2% lidocaine plus ornipressin (15 patients, Group B). The control group consisted of 15 patients receiving a general anesthetic. The highest median lidocaine plasma level was 2.8 micrograms/ml in those patients who received epinephrine and 5.3 micrograms/ml in those who received ornipressin. There were statistically significantly higher lidocaine plasma levels in Group B than in Group A after 10, 30 and 60 minutes from injection while the two groups did not differ significantly at the 20- and 90-minute time intervals. Before and during surgery, epinephrine and norepinephrine plasma levels were highest in the epinephrine group, whereas, postoperatively, the plasma levels of both catecholamines were highest in the patients receiving general anesthesia. The latter patients experienced significantly more nausea and vomiting than the regional anesthesia groups. Patients with regional anesthesia required significantly less analgesics postoperatively than the patients receiving general anesthesia.

Adult↗