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Biomedical subjects

E Mankowitz

Publications and source records attributed to E Mankowitz.

16 recordsLinked to original sources
PubMed1992

Standards of practice in anaesthesia--intra-operative monitoring.

Intra-operative monitoring practice during anaesthesia was studied in a randomised selection of hospitals in different categories. Questionnaires from 45 anaesthetists in 20 hospitals provided information on 973 cases. The study showed that in 11% of cases the patient was left at some stage during anaesthesia without the attention of a medical practitioner and that in 7% of cases no record was made of the anaesthetic or of the parameters monitored. Types of monitoring varied considerably between hospitals and often fell short of acceptable minimal standards. Pulse oximetry, which is considered essential, was used in only 53% of cases. One in 18 cases was associated with a peri-operative critical incident and in 7 cases a critical incident occurred where the monitoring was deemed to be inadequate. Pulse oximetry would have assisted the anaesthetist in 6 of these 7 cases. In 3% of cases the anaesthetist admitted to fatigue during the procedure. This study highlights deficits in anaesthetic practice and in available equipment, both of which require urgent attention.

Anesthesia↗
PubMed1985

Indoprofen--a new non-opioid analgesic. A comparison with pethidine.

Indoprofen (400 mg), a non-opioid, non-steroidal anti-inflammatory drug, was compared on a random, double-blind basis with pethidine (1,5 mg/kg) after elective caesarean section (40 patients) and after orthopaedic surgery (40 patients). The drugs were given intravenously during anaesthesia and provided adequate analgesia for a period of up to 2 hours postoperatively. No significant differences between the two drugs were noted in terms of efficacy and side-effects.

Adolescent↗
PubMed1984

Total intravenous anaesthesia using low-dose ketamine infusion for caesarean section. A comparison with a standard inhalation anaesthetic technique.

Anaesthesia was induced in 65 parturients undergoing elective caesarean section with thiopentone 3,5 mg/kg and suxamethonium 1,5 mg/kg intravenously. For anaesthetic maintenance patients were randomly divided into two groups. Patients in group A were ventilated with 50% nitrous oxide in oxygen, supplemented with 0,6-0,8% enflurane and 50 mg pethidine given intravenously after delivery. Group B patients were ventilated with 50% oxygen in nitrogen and received a continuous intravenous infusion of ketamine (70 micrograms/kg/min), with 5 mg diazepam intravenously following delivery. All patients received intravenous alcuronium 0,2 mg/kg. Inspired oxygen concentration (0,5) and end-tidal carbon dioxide tensions (4,0-5,0 kPa), were standardized. Despite a high incidence of predelivery hypotension in group A but not in group B, the fetal acid-base status, materno-placento-fetal exchange and immediate clinical state of the neonates were comparable. Neonatal neurobehavioural assessment scores assessed 2-4 hours after birth favoured the inhalation technique, but this difference disappeared at 24 hours. A higher incidence of factual recall in group B (14,3% v. 7,4%), frequently painful (10,7% v. 0%), the reporting of unpleasant dreams and a lack of significant postoperative analgesia makes the ketamine infusion technique unsatisfactory.

Acid-Base Equilibrium↗
PubMed1982

Maternal medication does temporarily affect neonatal neurobehaviour.

A modified neurodevelopmental assessment technique, the KEH scale, was applied to 60 healthy newborn infants at 2 - 4 hours of age, and again at 24 hours in order to detect any effect of maternal medication on behaviour. Results show that neonates whose mothers received medication during labour were significantly more depressed at 2 - 4 hours as regarded tone, rooting, reflexes and the total neurobehavioural score than those whose mothers did not receive medication. No difference was found at 24 hours. The Apgar scores were similar at 2 - 4 hours and at 24 hours. The KEH scale detects the subtle effects of maternal medication on the behaviour of newborn infants. It may therefore be of value in assessing the effect of drugs and anaesthetic agents administered to the mother on the neonate. Furthermore, it may prove to be of value in detecting similar effects resulting from prematurity, hypoxia in utero or trauma during delivery.

Apgar Score↗
PubMed1982

Intrathecal ketamine with preservative - histological effects on spinal nerve roots of baboons.

Ketamine, an analgesic-cataleptic drug, provides pain relief without respiratory depression. Ketamine with the preservative benzethonium chloride 0.1 mg/ml was injected intrathecally into 4 baboons under Ketamine anaesthesia. A control group of 2 baboons received intrathecal saline. No assessment as to relief from experimental pain was possible, but all the baboons recovered normally from anaesthesia and were found moving about in their enclosures without gross evidence of neurological impairment. No adverse reactions were noted. One month after the intrathecal injection the baboons were sacrificed, and an autopsy was performed within 30 minutes. No macroscopic abnormally of the cord was noticed. Microscopic examination revealed oedema of a few nerve roots in all animals irrespective of whether ketamine or saline had been injected intrathecally. No other changes attributable to ketamine were seen, and its is therefore concluded that, in the doses given, intrathecally injected ketamine would seem to be safe.

Animals↗
PubMed1982

Epidural ketamine. A preliminary report.

Ketamine hydrochloride 4 mg in 10 ml 5% dextrose water was administered epidurally to 7 patients suffering from intractable pain in the back, lower abdomen and legs. Pain relief was obtained in all cases. The duration of action varied from half an hour to more than 6 hours. No adverse side-effects were noted and no detectable neurological damage resulted. Intraspinal ketamine offers and advantage over the opiates, in that respiratory depression is unlikely to occur.

Epidural Space↗
PubMed1982

Effects of intrathecal saline and ketamine with and without preservative on the spinal nerve roots of monkeys.

Ketamine, a cataleptic analgesic substance which theoretically may block pain receptors in the spinal cord, providing pain relief without respiratory depression, was injected intrathecally with or without benzethonium chloride 0.1 mg/ml (a preservative) into 8 monkeys under anaesthesia. Two monkeys received saline (control group). No assessment as to relief from experimental pain was possible. All Monkeys recovered normally from anaesthesia and were found moving about in their enclosures without gross evidence of neurological impairment. No adverse reactions were noted. Ten days after the subarachnoid injection the monkeys are sacrificed. Autopsy was performed within 30 minutes. No macroscopic abnormality of the cord was noticed. Microscopic examination revealed oedema of a few nerve roots in all animals, irrespective of whether ketamine or saline was injected intrathecally. Focal degeneration with loss of myelin and axoplasm was observed within a solitary nerve root in 2 monkeys that had received ketamine, 1 with and 1 without preservative. However, in these animals lumbar puncture proved difficult and bloody taps ensued. Hence trauma could have been a contributing factor in these 2 cases. None of the other monkeys showed these changes, regardless of group.

Animals↗
PubMed1981

Nitrous oxide elimination by the newborn.

The elimination of nitrous oxide by ten infants whose mothers had received 50% nitrous oxide in oxygen and enflurane 0.6-1% during general anaesthesia for Caesarean section was studied. The concentration of nitrous oxide detected in end-expired gas ranged from 1 to 4 vol% (mean 1.9 vol%). These levels are too low to produce significant diffusion hypoxia in vigorous neonates. However, a minority of infants may be adversely affected and it is recommended that oxygen-enriched air be administered to infants whose mothers have received nitrous oxide.

Anesthesia, Inhalation↗
PubMed1980

Drugs and the fetomaternal unit.

Drugs are given to pregnant women for various reasons. The maternal pharmacokinetics, and the short-term and long-term effects that these drugs may have on the newborn infant, are largely unknown. This article presents the current, available knowledge and the factors controlling drug transfer from mother to child.

Female↗
PubMed1979

Lumbar epidural anaesthesia.

An outline of the anatomy, physiology, indications, contraindications, complications and technique of lumbar epidural anaesthesia is presented.

Anesthesia, Epidural↗