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Biomedical subjects

G E Larijani

Publications and source records attributed to G E Larijani.

At least 19 recordsLinked to original sources
PubMed2000

The efficacy and safety of EMLA cream for awake fiberoptic endotracheal intubation.

EMLA Cream (EC; Astra, Westborough, MA) has been widely used as a local anesthetic. Limited safety information is available with respect to the application of EC to the oral mucous membranes. The purpose of this pilot study was to evaluate the efficacy and safety of EC when applied to oral mucosa for fiberoptic intubation. Twenty ASA physical status I-IV patients (11 women and 9 men), 28-57 yr old, who were scheduled for awake, fiberoptic, intubation participated in this open-label study. A total of 4 g of EC was used for 5 min until the patient showed no evidence of a gag reflex (this was evaluated clinically by the patient's acceptance of the William's airway and considered the endpoint for assessing adequate topicalization of the oropharynx). The measured peak plasma concentration of lidocaine or prilocaine did not reach toxic levels in any patient. Methemoglobin levels did not exceed normal values (1.5%) in any patient, and there was no relationship between methemoglobin levels and patient weight, amount of EC used, measured peak plasma concentration, or times to measured peak concentrations of prilocaine or lidocaine. We conclude that EC provided satisfactory topical anesthesia allowing for successful oral fiberoptic intubation in all patients and should be considered a safe alternative for anesthetizing the airway of patients requiring awake oral fiberoptic intubation.

Adult↗
PubMed2000

Relationship between benign prostatic hyperplasia and history of coronary artery disease in elderly men.

STUDY OBJECTIVE: To assess the relationship between the occurrence of benign prostatic hyperplasia (BPH), an androgen-dependent disease, and coronary artery disease (defined as history of coronary artery bypass grafting, coronary angioplasty, myocardial infarction) in elderly men. DESIGN: Retrospective chart review. SETTING: Urology practice. PATIENTS: Seven hundred two elderly men aged 65-80 years. INTERVENTION: The men's charts were reviewed for data pertaining to coronary artery disease, risk factors for coronary artery disease, and serum prostate-specific antigen (PSA) levels. Men who had medical conditions, pharmacologic interventions, or surgical procedures that could alter PSA, and those taking lipid-lowering agents were not included. MEASUREMENTS AND MAIN RESULTS: PSA levels correlate positively with prostatic volume of BPH. In men with levels under 1.0 pg/L (no BPH) and over 1.0 microg/L (BPH present), the frequency of coronary artery disease was 9% and 29%, respectively (p<0.03). No significant differences were noted between groups in other accepted risk factors for coronary artery disease including age, smoking, diabetes mellitus, or hypertension. CONCLUSION: Smooth muscle proliferation is an important and possibly androgen-dependent step in the development of atherosclerosis and BPH. Prospective studies are required to assess the effect of antiandrogens on atherosclerosis.

Aged↗
PubMed1999

Clinical pharmacology of rapacuronium bromide, a new short-acting neuromuscular blocking agent.

Rapacuronium is a new steroidal, nondepolarizing, neuromuscular blocking agent. It appears to be the least potent of all available nondepolarizing muscle relaxants. Its onset of action resembles that of succinylcholine, and its recovery times are shorter than those of other nondepolarizing agents. The clinical duration of rapacuronium can be shortened significantly with early (2 min) administration of neostigmine, which may be beneficial in patients with difficult airway or failed intubation. Rapacuronium appears to be free of significant cardiovascular complications.

Adult↗
PubMed1999

Peripheral neuropathy in healthy men volunteers anesthetized with 1.25 MAC sevoflurane for 8 hours.

Two men volunteers developed peripheral neuropathy after prolonged anesthesia with 1.25 minimum alveolar concentration sevoflurane at an inflow rate of 2 L/minute of fresh gas that caused concurrent administration of relatively large doses (ppm-hrs) of the degradation product of sevoflurane, compound A. Other similarly treated volunteers had lesser degrees of transient neuropathy. This result does not prove but raises the question of whether compound A or other factors associated with sevoflurane anesthesia can predispose patients to peripheral neuropathy.

Adult↗
PubMed1996

Sevoflurane versus isoflurane for maintenance of anesthesia: are serum inorganic fluoride ion concentrations of concern?

Sevoflurane administration can result in increased serum inorganic fluoride ion concentrations, which have been associated with inhibition of renal concentrating ability. We measured serum fluoride levels, renal function, and recovery variables as a function of time in ASA grade I-III patients administered general anesthesia with isoflurane or sevoflurane for at least 1 h. Fifty patients were exposed to sevoflurane (< or = 2.4% inspired concentration) or isoflurane (< or = 1.9% inspired concentration) for maintenance of anesthesia as part of a multicenter trial. Blood was collected for determination of serum fluoride ion concentration, electrolytes, blood urea nitrogen, and creatinine at various time points pre- and postoperatively. Mean serum fluoride levels were significantly increased in sevoflurane versus isoflurane groups at all time points; the mean peak serum levels were 28.2 +/- 14 mumol/L at 1 h for sevoflurane and 5.08 +/- 4.35 mumol/L at 12 h for isoflurane. Sevoflurane-mediated increases in serum fluoride levels peaked at 1 h and, in general, decreased rapidly after discontinuation of the anesthesia. Three of 24 patients exposed to sevoflurane had one or more fluoride levels > 50 mumol/L. One of these patients had a serum inorganic fluoride ion level > 50 mumol/L at 12 h after sevoflurane, and an additional patient had fluoride levels > 33 mumol/L for up to 24 h after sevoflurane discontinuation. Those two patients also demonstrated an increase in serum blood urea nitrogen and creatinine at 24 h after sevoflurane administration compared with baseline. The elimination half-life of serum fluoride ion was 21.6 h. The results of this study suggest the possibility of sevoflurane induced nephrotoxicity.

Adult↗
PubMed1994

Postoperative nystagmus and nausea.

OBJECTIVE: To evaluate the presence and the relationship between postoperative nystagmus and nausea. DESIGN: Open-label study. SETTING: University hospital. PATIENTS: Sixty-six patients recovering from general anesthesia following elective ambulatory surgeries. INTERVENTIONS: Patients were tested postoperatively for nystagmus using an electronystagmography, and were monitored for nausea and vomiting for the first postoperative day. MAIN OUTCOME MEASURES: A comparison of the incidence of nausea was made among patients with and without postoperative nystagmus. RESULTS: Twenty-four patients (36 percent) experienced postoperative nausea and 28 patients (42 percent) had nystagmus. There were no significant differences in age, weight, height, dosage of fentanyl, or postoperative use of narcotics between those who experienced postoperative nausea or had nystagmus than those who did not. A significantly greater percentage of female patients compared with male patients had nausea during the first postoperative day. Sixty percent of patients with nystagmus experienced nausea in the hospital compared with 18 percent of the patients without nystagmus (p < 0.01, 95 percent confidence interval [CI] of the difference = 11.3 to 61.3 percent). Twenty-two patients (78 percent) with nystagmus experienced nausea during the first postoperative day compared with 14 patients (36 percent) with no nystagmus (p < 0.01, 95 percent CI of the difference = 20.1 to 63.3 percent). Eighty-three percent of the nauseated patients experienced vomiting during the first postoperative day. CONCLUSIONS: The presence of nystagmus in the early part of recovery from general anesthesia is associated with a higher incidence of nausea and vomiting during the first postoperative day.

Adolescent↗
PubMed1992

Continuous noninvasive cardiac output as estimated from the pulse contour curve.

We developed a noninvasive computer-based system for estimating continuous cardiac output by a modified pulse contour method using a finger pressure waveform. The method requires no individual patient calibration or baseline cardiac output. First, we calibrated the system in a "learn" group of 20 patients. The computer-based cardiac output was then compared with thermodilution cardiac output in 27 patients undergoing coronary artery bypass surgery. A total of 94 cardiac outputs were performed (three averaged per determination) at four predetermined time periods: preinduction, postinduction, prebypass, and postbypass. During determination of each thermodilution cardiac output, the pulse wave data were simultaneously recorded on cassette tape. The patients had cardiac outputs ranging from 2.9 to 6.4 L/min. The correlation coefficient was 0.75. The average thermodilution cardiac output was 4.50 (+/- 0.83 SD) L/min, while the cardiac output derived from the finger pressure wave was 4.48 (+/- 0.7 SD) L/min (95% confidence interval [CI] of difference, 0-3.2%). The mean difference between the two methods was 0.02 (+/- 0.55 SD) L/min. The 95% CI for the bias was 0.0001 to 0.036 L/min. The 95% CI for the lower limit of agreement was -1.12 to -1.06 L/min; the upper limit for the 95% CI was 1.09 to 1.16 L/min. The program demonstrated that information about cardiac output can be obtained by using the Finapres device (Ohmeda, Boulder, CO). The cardiac output values obtained by this continuous noninvasive technique were within +/- 20% of the simultaneous thermodilution values 87% of the time. This was true over the narrow range of cardiac outputs (2.9 to 6.4 L/min) and wide range of heart rates (45 to 140 beats/min).

Adult↗
PubMed1992

Comparative evaluation of the neuromuscular and cardiovascular effects of pipecuronium, pancuronium, atracurium, and vecuronium under isoflurane anesthesia.

The neuromuscular and cardiovascular effects of intubating doses of pipecuronium 80 micrograms/kg, pancuronium 100 micrograms/kg, atracurium 500 micrograms/kg, and vecuronium 100 micrograms/kg were compared in 62 patients under isoflurane (end-tidal concentration = 0.5-1%) anesthesia. Pipecuronium, pancuronium, and vecuronium had no significant effect on systolic or diastolic blood pressure. In one patient the administration of atracurium resulted in significant hypotension. Heart rate was significantly increased only after the administration of pancuronium. The neuromuscular-blocking effect of pipecuronium and pancuronium appears to be twice as long as that of vecuronium and atracurium. Administration of neostigmine resulted in significantly faster recovery of muscle function in patients receiving vecuronium or atracurium. Although pipecuronium's neuromuscular-blocking effect is similar to that of pancuronium, its lack of cardiovascular effects more closely resembles that of vecuronium.

Adolescent↗
PubMed1992

The effect of desmopressin acetate on postoperative hemorrhage in patients receiving aspirin therapy before coronary artery bypass operations.

It has been suggested that desmopressin acetate has been effective in reducing hemorrhage after coronary artery bypass grafting in patients receiving aspirin before operation. We conducted a prospective, randomized, placebo-controlled, double-blind trial to determine the effectiveness and safety of desmopressin in these patients. Sixty-five patients pretreated with aspirin within 7 days before their scheduled elective coronary artery bypass grafting were randomized to receive desmopressin (0.3 micrograms/kg) or placebo after cessation of bypass and reversal of heparin with protamine. The demographic characteristics and last dose of aspirin were similar in both groups. There was a significant reduction in postoperative blood loss noted between groups for both chest tube blood loss (833 +/- 311 ml for the 1-desamino-8-D-arginine vasopressin [desmopressin] group versus 1176 +/- 674 ml for the placebo group; p = 0.016) and total blood loss (1215 +/- 381 ml for the desmopressin group versus 1637 +/- 761 ml for the placebo group; p = 0.0097). Despite the differences in blood loss between the two groups, the red cell transfusions were not significantly different, but the use of platelets was less in the desmopressin group and almost achieved statistical significance (p = 0.053). Neither was there a difference in the occurrence of thrombotic complications between groups. It appears that desmopressin in this specific subgroup of patients receiving preoperative aspirin is effective as a prophylactic agent for reduction of postsurgical hemorrhage.

Aged↗
PubMed1991

Clinical pharmacology of the neuromuscular blocking agents.

Neuromuscular blocking agents are among the most commonly used drugs during general anesthesia. They compete with acetylcholine and interfere with the transmission of nerve impulses resulting in skeletal muscle relaxation. Based on their mechanism of action, neuromuscular blocking agents are classified as either depolarizing or nondepolarizing. Succinylcholine is a short-acting depolarizing agent. Commonly used nondepolarizing agents are curare (long-acting), pancuronium (long-acting), atracurium (intermediate-acting), and vecuronium (intermediate-acting). Neuromuscular blocking agents are used clinically to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgery. This article provides an overview of the physiology of the neuromuscular transmission and summarizes our current knowledge on the use of these agents during general anesthesia.

Atracurium↗
PubMed1991

Treatment of postoperative nausea and vomiting with ondansetron: a randomized, double-blind comparison with placebo.

Postoperative nausea and vomiting are common after recovery from general anesthesia. The antiemetic effect and safety of ondansetron, a selective serotonin type 3 (5-HT3) receptor antagonist, was determined in 36 patients suffering from nausea or vomiting during recovery from intravenous anesthesia by giving either a single intravenous dose of ondansetron (8 mg, n = 18) or placebo (n = 18) over 2-5 min in a randomized, double-blind manner. A "rescue" antiemetic was provided in case of continued vomiting or at the patient's request. Antiemetic efficacy was defined as no request for rescue antiemetic and/or no vomiting episode during the next 4 h. There was no significant difference in the demographic data between the groups. Administration of ondansetron or placebo had no significant effect on vital signs. Ondansetron was an effective antiemetic in 78% (14/18) and placebo was effective in 28% (5/18) of the patients. Laboratory studies 24 h later showed no signs of hematologic, hepatic, or renal alterations. Ondansetron at a dose of 8 mg administered intravenously over 2-5 min appears to be a safe and effective antiemetic for the treatment of nausea and/or vomiting after intravenous anesthesia.

Adolescent↗
PubMed1990

Characterization of dexamethasone binding in normal and uremic human serum.

The purpose of this study was to examine the extent and linearity of dexamethasone binding over a wide concentration range in normal and uremic serum. Tritiated dexamethasone was added to both untreated and charcoal-treated pooled normal serum and to pooled uremic serum to produce concentrations similar to those attained therapeutically (10-1000 ng/mL). Protein binding was determined by equilibrium dialysis at 37 degrees C. Dexamethasone serum binding was linear over the entire range of concentrations for each set of pooled serum. The mean (+/- SD) percent bound (mean +/- SD) for dexamethasone was similar for untreated (75.1 +/- 3.6 percent) and charcoal-treated (77.3 +/- 3.5 percent) normal serum. Dexamethasone binding (69.2 +/- 1.8 percent, p less than 0.05) and serum albumin concentrations (39.9 vs. 55.1 mmol/L) were significantly less in uremic vs. normal serum, respectively. These results suggest that (1) the binding of dexamethasone is linear and occurs primarily to albumin, with little or no binding to corticosteroid-binding globulin; (2) endogenous cortisol does not compete with dexamethasone for protein binding sites; and (3) steroid pharmacokinetics may be altered in uremic patients due to the 24 percent higher free fraction of dexamethasone in this population.

Adult↗
PubMed1989

A dose-response evaluation of pipecuronium bromide in elderly patients under balanced anesthesia.

Pipecuronium bromide is a new steroidal non-depolarizing muscle relaxant currently under investigation. It is similar to pancuronium with respect to the duration of action, but lacking its cardiovascular side effects. We examined the dose-response relation of pipecuronium in 27 patients, ages 66-79 years, utilizing the incremental dose method under balanced anesthesia. The ED50, ED90 and ED95 were 22.42 (5.2) mcg/kg, 31.81 (6.9) mcg/kg and 35.12 (7.8) mcg/kg, respectively (log probit method). Our recovery data also demonstrate that residual neuromuscular blockade due to pipecuronium can easily be antagonized with neostigmine as long as spontaneous recovery of T1- at the time of reversal administration is greater than 13%. The authors conclude that under balanced anesthesia the cumulative dose-response of pipecuronium in the elderly patients is consistent with those previously described for younger population. Therefore, no dose adjustment appears necessary for the elderly. However, as with all medications, careful administration is appropriate.

Aged↗
PubMed1989

Does vecuronium accumulate in the renal transplant patient?

Twenty ASA physical status Class III patients undergoing cadaver renal transplantation were studied. After 90 per cent T1 recovery, as determined by train-of-four measurement, from 1.0 mg.kg-1 succinylcholine to facilitate tracheal intubation, nine patients received atracurium 0.25 mg.kg-1 (Group I) and 11 patients received vecuronium 0.05 mg.kg-1 (Group II) intravenously. The following measurements were made: time to maximum block onset (first dose Max), injection to start of recovery (start REC1), injection to 25 per cent T1 twitch recovery (REC 251), injection to 75 per cent T1 (REC 75(1], injection to 90 per cent T1 (REC 90(1] and time from 25-75 per cent recovery T1 (REC 25-75(1]. Maximum blockade (Max block 1) was also measured. At 90 per cent T1 recovery, if time permitted, an identical dose of the appropriate relaxant was administered. Time from second dose to onset of maximum block (second dose Max) and 90 per cent recovery after second dose (REC 90(2] were then measured. At the conclusion of surgery, neuromuscular blockade was reversed with neostigmine 2.5 mg and glycopyrrolate 0.5 mg. One way ANOVA was performed to determine significance between the groups and a p less than 0.05 was considered significant. A paired t test was also performed between REC 90(1) and REC 90(2) for atracurium and vecuronium respectively. A p less than 0.05 was again considered significant. Measurement of first dose Max, start REC1, REC25(1), REC 75(1), REC 90(1), REC 25-75(1) and Max block 1 revealed no difference between the patients receiving an initial dose of atracurium and those receiving vecuronium.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗