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Biomedical subjects

G D Puri

Publications and source records attributed to G D Puri.

At least 37 records · Page 2Linked to original sources
PubMed1998

The effect of magnesium sulphate on hemodynamics and its efficacy in attenuating the response to endotracheal intubation in patients with coronary artery disease.

UNLABELLED: Laryngoscopy and endotracheal intubation may produce adverse hemodynamic effects. Magnesium has direct vasodilating properties on coronary arteries and inhibits catecholamine release, thus attenuating the hemodynamic effects during endotracheal intubation. We studied 36 patients with coronary artery disease (CAD) scheduled for elective coronary artery bypass grafting to evaluate the hemodynamic effects of magnesium and its efficacy in attenuating the response to endotracheal intubation. Patients received either 0.1 mL/kg (50%) magnesium sulfate (50 mg/kg) (Group A, n = 19) or isotonic sodium chloride solution (Group B, n = 17) before the induction of anesthesia and 0.05 mL/kg of isotonic sodium chloride solution (Group A) or lidocaine 2% (1 mg/kg) (Group B) before intubation. The hemodynamic variables were recorded before induction, after the trial drug, after induction, and after endotracheal intubation. Automatic ST segment analysis was performed throughout the study period. Magnesium sulfate administration was associated with increased cardiac index (P < 0.01), a minimal increase in heart rate, and a significant decrease in mean arterial pressure (MAP) and systemic vascular resistance (SVR) (P < 0.001). None of the patients in the magnesium group had significant ST depression compared with three patients in the control group. The magnesium group patients had a significantly lesser increase in MAP (P < 0.05) and SVR (P < 0.01) compared with the control group patients who received lidocaine before endotracheal intubation. Thus, magnesium is an useful adjuvant to attenuate endotracheal intubation response in patients with CAD. IMPLICATIONS: Endotracheal intubation produces adverse hemodynamic effects, which may be more detrimental in patients with coronary artery disease than in healthy patients. The present study shows that magnesium administered before endotracheal intubation can attenuate this response better than lidocaine.

Anesthetics, Local↗
PubMed1996

Respiratory variables during thoracotomy for PDA ligation.

Physiological deadspace fraction of tidal volume (VD/VT), arterial to end-tidal carbon dioxide tension differences [P(a-E')CO2], arterial oxygen tension (PaO2) and respiratory system compliance were studied in twenty patients with patent ductus ateriosus scheduled for multiple ligation and transfixation through posterolateral thoracotomy under general anaesthesia with controlled ventilation. The study period was divided into six stages: stage 1--supine posture under anaesthesia, stage 2--lateral posture before start of surgery, stage 3--after chest opening before lung manipulation, stage 4--after ductus ligation and lung re-expansion before chest closure, stage 5--lateral posture, chest closed, stage 6--supine stage before reversal. There was a significant (P < 0.01) increase of VD/VT on attaining the lateral posture. The fraction decreased significantly (P < 0.05) on opening of the chest (stage 3) and subsequently increased at stage 4. There was no significant change in mean P(a-E')CO2 at various stages of thoracotomy. PaO2 fell significantly on opening of the chest and was lowest before chest closure (stage 4). PaO2 increased following chest closure but was still significantly lower than the pre-surgical supine stage. Respiratory system compliance was lowest at stage 4. Changes in deadspace fraction VD/VT do not correspond favourably to arterial oxygen tensions during posterolateral thoractomy.

Adolescent↗
PubMed1995

Analgesic and urodynamic effects of epidural meperidine and pentazocine--a comparative study.

Meperidine 1 mg kg-1 and pentazocine 0.3 mg kg-1 were administered epidurally to investigate their effect on vesical function in twenty American Society of Anesthesiologists Classification I (ASA-1) adult males. Cystometry was performed before and 45 minutes following epidural administration of meperidine and pentazocine. There was no significant change in maximum cystometric capacity, detrusor pressure at which detrusor reflex occurred and in vesical compliance following epidural administration of meperidine in ten patients and also in ten patients who received epidural pentazocine. The mean onset of analgesia after epidural administration of meperidine was 8 minutes which lasted for more than 360 minutes whereas mean onset of analgesia after epidural administration of pentazocine was 4 minutes which lasted for more than 360 minutes. There was no significant change in heart rate, blood pressure and respiratory rate after epidural administration of either meperidine or pentazocine. None of the subjects in either of the groups experienced any difficulty in passing urine, frequency or urgency of micturition. Side-effects like nausea, vomiting, pruritus and respiratory depression were not observed. It is concluded that epidural administration of meperidine 1 mg kg-1 or pentazocine 0.3 mg kg-1 produces significant analgesia of faster onset without altering vesical function as documented, both subjectively by voiding symptoms and objectively by cystometry.

Adult↗
PubMed1993

Midazolam as an induction agent in mitral stenosis patients for closed mitral commissurotomy.

In 30 patients of rheumatic heart disease with mitral stenosis (MS) belonging to NYHA class II and III scheduled for closed mitral commissurotomy anaesthesia was induced with morphine 0.15 mg/kg followed by either thiopentone (group A, n = 15) or midazolam (group B, n = 15) titrated to produce sleep. Patients were intubated with pancuronium bromide in a dose of 0.12 mg/kg. Minimum mean arterial blood pressure following induction was significantly lower in thiopentone group (77 +/- 7 mm Hg) than midazolam group (85 +/- 6 mm Hg; P < 0.05). After intubation blood pressure was significantly higher in thiopentone group (99 +/- 8 mm Hg) than midazolam group patients (89 +/- 7 mm Hg). Heart rate was significantly higher in thiopentone treated patients both before and after endotracheal intubation. During surgery, three patients in group A had hypotensive episodes (mean arterial blood pressure 20% below basal at two successive readings 5 min apart) while one in group B had a hypotensive episode. Average duration of surgery was comparable between the two groups (102 +/- 15 and 95 +/- 18 min) and postoperatively there was no significant difference in sedation score and incidence of nausea and vomiting between the two groups.

Adult↗
PubMed1992

Ventilatory effects of laparoscopy under general anaesthesia.

We have studied 14 female patients undergoing elective laparoscopy under general anaesthesia with peritoneal insufflation of carbon dioxide in order to examine changes in physiological deadspace (VDphys), arterial to end-tidal carbon dioxide partial pressure difference (PaCO2-PE' CO2) and PaCO2. VCO2 increased after insufflation of carbon dioxide with a mean (SD) maximum increase of 32 (28)% compared with the preinsufflation value. PaCO2 increased also, with a mean (SD) maximum increase of 0.6 (0.58) kPa immediately before carbon dioxide deflation. VDphys and (PaCO2-PE' CO2) increased during laparoscopy, but this was not significant (P greater than 0.05).

Adult↗
PubMed1992

Respiratory dead space under anaesthesia in patients with mitral stenosis.

Physiological deadspace (VDphys) and arterial to end-tidal carbon dioxide tension difference [P(a-E)CO2] were calculated under anaesthesia in 27 patients with mitral stenosis planned for close mitral commissurotomy and in 15 healthy individuals for elective non-thoracic surgical procedures. A square wave inspiratory flow pattern and an end-inspiratory pause (25% and 10% of cycle time respectively) were given with a SERVO 900B ventilator used at respiratory rate of approximately 16 per min. An infra-red CO2 analyser was used to measure CO2 production and end-tidal CO2 concentration. Measurements were made prior to the start of the surgery after a minimum of 10 min of stable ventilation to avoid the effect of surgery. Patients with multiple stenosis had significantly higher VDphys (4.28 +/- 1.02 ml kg-1 as compared to 2.10 +/- 0.52 ml kg-1 in controls, P less than 0.001), higher P(a-E)CO2 [0.43 +/- 0.51 kPa as compared to -0.02 +/- 0.23 kPa, P less than 0.01] and lower respiratory system compliance (Crs). Péco2 was positively correlated with PaCO2 in both groups (P less than 0.01). PaO2 was lower in mitral stenosis patients and P(A-a)O2 negatively correlated to Crs (P less than 0.01).

Adult↗
PubMed1991

End-tidal CO2 monitoring in mitral stenosis patients undergoing closed mitral commissurotomy.

Arterial to end-tidal carbon dioxide difference (P(a-E')CO2) was recorded in 20 mitral stenosis patients (group A) for closed mitral commissurotomy and 20 healthy individuals (group B) for elective limb surgery. Mitral stenosis patients showed a greater difference than group B patients. Repeated measurements of P(a-E')CO2 in mitral stenosis patients at various stages of closed mitral commissurotomy not only showed a mean increase from before thoracotomy but there was also no correlation between P(a-E')CO2 before thoracotomy with that after thoracotomy, after commissurotomy or after chest closure. This indicated that end-tidal CO2 monitoring was unsuitable to measure adequacy of ventilation during closed mitral commissurotomy.

Adult↗
PubMed1991

Physiological dead space & arterial to end-tidal CO2 difference under controlled normocapnic ventilation in young anaesthetised subjects.

Physiological dead space and its components were determined in 27 young, otherwise healthy anaesthetised individuals before start of surgery. A squarewave inspiratory flow pattern and an end inspiratory pause (25 and 10% of cycle time respectively) were used at a respiratory rate of around 16 bpm with minute ventilation adjusted to maintain normocapnia. The physiological dead space was found to be 2.23 ml/kg with anatomical dead space forming 110.66 +/- 27.55 ml out of 125.55 +/- 27.06 ml. While VD alv was positively correlated to pause pressure, VD ant was correlated to age, weight, and body surface area. Mean arterial end tidal carbon dioxide difference was quite low (0.24 +/- 0.44 kPa).

Adult↗
PubMed1989

Nifedipine attenuates the intraocular pressure response to intubation following succinylcholine.

Forty patients without eye disease, undergoing elective nonophthalmic surgery, were studied to evaluate the efficacy of sublingual nifedipine in attenuating the intraocular pressure response to succinylcholine administration, laryngoscopy and intubation. The patients were randomly given either nifedipine 10 mg or placebo sublingually 20 minutes before induction of anaesthesia. Intraocular pressure (IOP) and systolic blood pressure (SBP) were recorded before and after induction of anaesthesia. The IOP response to succinylcholine administration, laryngoscopy and intubation was significantly less in patients receiving nifedipine (P less than 0.01). The mean maximum rise in IOP above basal level at one minute post-intubation was 7.82 mmHg in the control group compared with 0.15 mmHg in the nifedipine pre-treated group. These results suggest that sublingual nifedipine is effective in attenuating the IOP response after succinylcholine administration, laryngoscopy and intubation.

Adult↗
PubMed1988

Effect of nifedipine on cardiovascular responses to laryngoscopy and intubation.

The efficacy of sublingual nifedipine in attenuating the pressor responses to laryngoscopy and intubation was studied in 40 patients undergoing elective surgery. Anaesthesia was induced with thiopentone 5.5 mg kg-1 i.v. and tracheal intubation was facilitated with suxamethonium 1.5 mg kg-1 i.v. Patients were allocated randomly to receive sublingual nifedipine 10 mg or placebo capsules 10 min before induction. Patients receiving placebo capsule showed significant increases in heart rate and arterial pressure associated with tracheal intubation (P less than 0.001). The increases in arterial pressure and rate-pressure product were reduced in nifedipine treated patients (P less than 0.001). Heart rate increased significantly in both groups immediately after intubation.

Administration, Sublingual↗
PubMed1988

Attenuation of pulse rate and blood pressure response to laryngoscopy and tracheal intubation by clonidine.

Forty healthy patients (ASA class 1) of both sexes, aged between 20 and 45 years, undergoing routine surgical procedures were included in this double-blind randomized study. They were divided into two groups of 20 each. Patients in group A received no pretreatment, while patients in group B received oral clonidine 5 micrograms kg-1 90 min before induction of anesthesia. All patients received thiopentone (5 mgs kg-1) followed by suxamethonium (1.5 mgs kg-1) to facilitate endotracheal intubation. Control patients showed a significant increase in heart rate and blood pressure; they were significantly lower in the clonidine treated group immediately after intubation (p less than 0.001). The data suggest that the rise in heart rate and blood pressure associated with laryngoscopy and intubation during a routine induction sequence can be attenuated by the use of oral clonidine.

Adult↗
PubMed1987

Awareness under anaesthesia due to a defective gas-loaded regulator.

Awareness under anaesthesia occurred in two patients due to a defect in an anaesthesic machine, which caused an inadequate supply of nitrous oxide. A defective fail-safe gas-loaded regulator was found to have caused communication between the pipelines for oxygen and nitrous oxide. This resulted in oxygen flow through the nitrous oxide flowmeter. A simple test to detect this type of defect is suggested.

Anesthesia, Inhalation↗