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Biomedical subjects

G M Gurman

Publications and source records attributed to G M Gurman.

At least 19 recordsLinked to original sources
PubMed2005

Insertion of the endotracheal tube, laryngeal mask airway and oesophageal-tracheal Combitube. A 6-month comparative prospective study of acquisition and retention skills by medical students.

OBJECTIVE: To assess the ability of medical students to learn and retain skills of airway manipulation for insertion of the endotracheal tube, the laryngeal mask airway (Laryngeal Mask Company, Henley-on-Thames, UK) and the oesophageal-tracheal Combitube (Kendall-Sheridan Catheter Corp., Argyle, NY, USA). METHODS: A 6-month prospective study was conducted among fifth-year medical students attending a 3-week clerkship in the Division of Anesthesiology and Critical Care Medicine in the Soroka Medical Center. All the students viewed a demonstration of insertion technique for the endotracheal tube, the laryngeal mask airway and the Combitube, followed by formal teaching in a mannikin. At the end of the program, the insertion skills were demonstrated in the mannikin, the success rate on the first attempt was registered and the students were requested to assess (by questionnaire) their ability to execute airway manipulation (phase 1). Six months later, the students were requested to repeat the insertion technique, and a similar re-evaluation applied (phase 2). RESULTS: The success rate, during the first phase, at first attempts was 100% for the laryngeal mask airway and the Combitube, compared to 57.4% for the endotracheal tube (P < 0.02), and 92.6%, 96.2% and 62.9% (P < 0.02) respectively for the second phase of the study. CONCLUSION: Learning and retention skills of medical students, in a mannikin, are more accentuated with the laryngeal mask airway and the Combitube than seen with an endotracheal tube.

Clinical Clerkship↗
PubMed2004

The anaesthetic management of patients with congenital insensitivity to pain with anhidrosis.

BACKGROUND: Congenital insensitivity to pain with anhidrosis (CIPA, or hereditary sensory and autonomic neuropathy type IV) is a rare, autosomal recessive disease, related to a mutation in the TrkA gene, characterized by inability to sweat, insensitivity to pain and recurrent episodes of hyperpyrexia. There are two Bedouin tribes in Israel with different mutations of the TrkA gene: one in the southern region and the other in the northern region. The Soroka University Medical Center is the referral centre for the entire southern region of Israel. One in 4500 anaesthesia cases involves a patient with CIPA. METHODS: We reviewed 40 anaesthesia records of 20 patients with CIPA for anaesthetic technique and incidence of side-effects. RESULTS: Sixteen patients developed complications in the immediate perioperative period: mild hypothermia in one patient and cardiovascular events in 15 others with one case of cardiac arrest. These complications were unrelated to the anaesthetic drug administered. There were no events of hyperthermia or postoperative nausea. CONCLUSIONS: Cardiovascular complications following anaesthesia are common in patients with the southern Israel variant of CIPA. Hyperthermia, previously recognized as a major concern in patients with congenital insensitivity to pain with anhydrous, was not seen in our patients. We conclude that cardiovascular involvement is frequently encountered in CIPA patients following anaesthesia and is the major concern in their anaesthetic management.

Adolescent↗
PubMed2004

Retrograde tracheal intubation: beyond fibreoptic endotracheal intubation.

BACKGROUND: Flexible fibreoptic laryngoscopy is the method of choice for coping with difficult tracheal intubations, a leading cause of catastrophic outcomes in anaesthesia. However, this technique is not always available or feasible. Retrograde intubation is a minimally invasive airway management technique with a flat learning curve and a high level of skill retention. METHODS: A retrospective review of the anaesthesia records of 24 patients who underwent retrograde intubation. The success rate and the incidence of complications were recorded. RESULTS: Retrograde tracheal intubation was successful in all 24 patients. In 21 patients it succeeded on the first attempt. In two patients it succeeded when the technique was changed from sliding over a guide wire to a pulling technique. The most common complication was a sore throat in almost 60% of the patients. Two patients had mild subcutaneous emphysema and one had minimal bleeding at the puncture site. CONCLUSIONS: In these patients retrograde tracheal intubation was easy to perform, had a high success rate and a low incidence of complications. It is a reliable alternative when fibreoptic intubation is precluded, fails or is unavailable.

Adult↗
PubMed2003

A history of neuraxial administration of local analgesics and opioids.

The history of intrathecal and epidural anaesthesia is in parallel with the development of general anaesthesia. As ether anaesthesia (1846) is considered the first modern anaesthetic since its use by Morton 157 yr ago, so Bier made history by using cocaine for intrathecal anaesthesia in 1898. The first published report on opioids for intrathecal anaesthesia belongs to a Romanian surgeon, Racoviceanu-Pitesti, who presented his experience at Paris in 1901. It was almost a century before the opioids were used for epidural analgesia. Behar and his colleagues published the first report on the epidural use of morphine for the treatment of pain in The Lancet in 1979. Epidural and intrathecal opioids are today part of a routine regimen for intra- and postoperative analgesia. Over the last 30 yr, the use of epidural opioids has became a standard for analgesia in labour and delivery, and for the management of chronic pain. Finally, epidural opioids have been shown to have a pre-emptive effect, when used before major surgery. We present the evolution of neuraxial anaesthesia and the history of intrathecal and epidural administration of opioids.

Analgesia, Epidural↗
PubMed2003

Influence of the cortical electrical activity level during general anaesthesia on the severity of immediate postoperative pain in the morbidly obese.

BACKGROUND: The objective of anaesthesia is to provide hypnosis, analgesia and adequate conditions during surgery. It is difficult to establish the appropriate dose of general anaesthetic drugs in the morbidly obese patient. Moreover, there are conflicting data concerning adequate anaesthesia levels and the severity of postoperative pain. The aim of this study was to investigate the relationship between the spectral edge frequency (SEF) during general anaesthesia and the severity of immediate postoperative pain following gastric banding surgery in morbidly obese patients. METHODS: Seventy-one ASA 2 morbidly obese patients (BMI > 35%) undergoing elective laparoscopic gastric banding procedure were recruited for this study. Anaesthesia consisted of midazolam, fentanyl and thiopental for induction, vecuronium for muscle relaxation, N2O and isoflurane with additional fentanyl administrations, according to the clinical judgement of the anaesthesiologist, for maintenance. Continuous SEF monitoring was added to the standard monitors (SpO2, ETCO2, ECG, NIBP, O2 and isoflurane concentration), but the EEG monitor screen was hidden from the anaesthesiologist's sight. SEF postoperative analysis divided the patients into two groups: group 1, SEF-recommended target range of 8-12 Hz, more than 80% of the surgical time; and group 2, SEF-recommended target range of 8-12 Hz, less than 80% of the surgery duration. Pain intensity was assessed in the post anaesthesia care unit using a standard visual analogue scale (VAS) of 10 cm, when patients were awake enough to correct a deliberately given wrong own telephone or ID number. Intravenous morphine was administered for postoperative analgesia in 2-mg increments, every 3-4 min, until the patient felt comfortable. A recovery room nurse unaware of the SEF range recorded during surgery registered pain severity and morphine requirements. RESULTS: The end-tidal isoflurane concentration was significantly higher in group 1 than in group 2 (0.83 vs. 0.7 P = 0.016). The intensity of pain at admission into the recovery room and at discharge was significantly lower in group 1 than in group 2 (VAS 6.1 vs. 6.9-P = 0.0049, and 3.9 vs. 4.2-P = 0.00478, respectively). CONCLUSIONS: Keeping the SEF range between 8 and 12 Hz during anaesthesia for laparoscopic gastric banding for morbid obesity, both the immediate post operative pain intensity and morphine requirement, are significantly reduced.

Adolescent↗
PubMed2002

Should disclosure of the danger of awareness during general anesthesia be a part of preanesthesia consent?

Awareness during anesthesia (AGA) is known as an intraoperative incident which could lead to a series of untoward effects, among them symptoms compatible with the posttraumatic stress syndrome (PTSS). Incidence of AGA ranges between 0.1% and 0.7%, most of the reports indicating a 0.2% rate of all general anesthesias. Nevertheless, some patients are considered to be in a higher than usual risk for developing this incident. The list of AGA high-risk situations include caesarian section, open heart surgical procedures, marked obesity, major trauma with hemodynamic instability and chronic use of drugs, alcohol or tobacco smoking. The usual preanesthetic informed consent does not mention AGA among the possible undesired effects of general anesthesia, neither in Israel nor in other parts of the world. This paper rises the question of the indication to discuss the AGA matter, as part of the informed consent, with any patient who is prone develop it in a significant higher percentage than the general population. The topic can be discussed by the primary care physician or by the surgeon, but this represents the obvious task of the anesthesiologist during his/her first contact with the patient before anesthesia and surgery. It is the authors belief that a preoperative discussion on AGA might substantially reduce the magnitude of repercussions of AGA among high-risk patients to develop this anesthetic complication.

Anesthesia, General↗
PubMed2001

Commercial propofol solutions: is the more expensive also the more effective?

STUDY OBJECTIVE: To compare the efficacy and safety of four commercial propofol solutions marketed in Israel. DESIGN: Prospective, randomized, double-blind study. SETTING: University-affiliated medical center. PATIENTS: 120 ASA physical status I and II nullipara patients undergoing dilatation and curettage for interrupted pregnancy. INTERVENTIONS: Patients were randomized into four groups of 30 patients each. Group 1 was anesthetized with Diprivan (AstraZeneca, UK), group 2 with Recofol (Leiras Oy, Finland), group 3 with Propofol (Abbott), and group 4 with Diprofol (Taro, Israel). MEASUREMENTS AND MAIN RESULTS: The four study groups were similar in mean age and weight. There were no statistically significant differences in the administered doses, quality of anesthesia, recovery time, or adverse effects among the four groups. CONCLUSIONS: Diprivan, Recofol, Diprofol, and Propofol Abbott are equally effective as anesthesia induction drugs for dilation and curettage, with a similar incidence of adverse effects. Because cost limitations have become a significant factor in medical care, the choice of drug in this group should be based solely on cost considerations.

Adult↗
PubMed2001

Vocal cord paralysis as a consequence of peritonsillar infiltration with bupivacaine.

Reduction of postoperative pain is an important goal in the perioperative management of tonsillectomy patients. This is particularly the case for children, who often exhibit resistance to intramuscular or rectal administration of drugs. Peritonsillar bupivacaine infiltration, a relatively safe method of pain control, is in some centers frequently used by otolaryngologists for pain relief. We present the case of a 5-year-old girl who developed bilateral vocal cord paralysis following preoperative peritonsillar bupivacaine infiltration. After an uneventful tonsillectomy and extubation, stridor and respiratory distress developed. Bilateral vocal cord paralysis was seen on laryngoscopy. The patient was reintubated and five hours later was successfully extubated without further sequelae. Anesthesiologists and surgeons should be aware of this uncommon complication than can occur with the use of peritonsillar bupivacaine infiltration for pain control in tonsil surgery.

Anesthetics, Local↗
PubMed2001

Continuous venovenous hemofiltration improves intensive care unit, but not hospital survival rate, in nonoliguric septic patients.

PURPOSE: The purpose of this study was to assess the effect of the early institution of continuous veno-venous hemofiltration on survival rates of nonoliguric, septic patients. MATERIALS AND METHODS: A retrospective study of 48 nonoliguric septic patients with PaO(2)/FIO(2) < or = 250, who were admitted to the General Intensive Care of the Soroka Medical Center. Twenty-six patients were treated with continuous venovenous hemofiltration (CVVH group) and 22 were treated by conventional therapy. The end point of treatment was weaning from mechanical ventilation, adequate oxygenation, and the need for minimal cardiocirculatory support. RESULTS: The study groups were similar in terms of age, gender, percentage of surgical or nonsurgical patients, APACHE II scores, and the Therapeutic Intervention Scoring System (TISS). Baseline serum urea and creatinine levels were similar in the groups, but the PAO(2)/FIO(2) ratio was significantly lower in the CVVH group (150.6 +/- 86 vs. 214.2 +/- 8.9). Twenty of the CVVH patients and 10 of the patients receiving conventional therapy were discharged from the intensive care unit (P =.03), but the hospital discharge rate was only slightly higher in the CVVH group (12 of 26) compared with the conventional therapy group (7 of 22) (P =.145). CONCLUSIONS: In this retrospective uncontrolled study, the mortality rate was considerably lower in nonoliguric septic patients who received continuous venovenous hemofiltration early in the course of the disease. The improved survival rate may be due to the ability of CVVH to eliminate mediators involved in the septic process, thus averting the multiple system organ failure consequent to septic insult.

Analysis of Variance↗
PubMed2000

Evaluation of the VersaMed portable ventilator: clinical trials.

The VersaMed 201 is a lightweight, computer-controlled, electrically driven ventilator, designed for transport, home-ventilation and field use. We have evaluated the device in human beings with healthy and pathological lungs. In the first part of the study, the VersaMed was substituted for a standard operating room ventilator for 15-30 min during elective surgery in 20 subjects. In the second stage of the study, 20 patients with lung pathology who were being ventilated in the critical care department were transferred to the VersaMed for a 30-min period. In all the patients studied, arterial blood gases, haemodynamic parameters and other respiratory variables were maintained at similar values seen with the standard ventilators used. We conclude that the VersaMed 201 is suitable for use in human beings with healthy and pathological lungs as a reliable, portable ventilator.

Adult↗
PubMed2000

Propofol versus midazolam for conscious sedation guided by processed EEG during endoscopic retrograde cholangiopancreatography: a prospective, randomized, double-blind study.

BACKGROUND AND STUDY AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is a complex procedure, which requires appropriate sedation. The aim of this prospective, randomized, double-blind study was to compare the quality and characteristics of sedation with midazolam or propofol in patients undergoing ERCP. PATIENTS AND METHODS: A total of 32 patients undergoing ERCP were randomly allocated for sedation with propofol (n = 15) or midazolam (n = 17). Blood pressure, heart rate, and O2 saturation were monitored. Sedation was maintained at near constant levels by use of the spectral edge frequency (SEF) technique, an EEG-based method for measuring the depth of sedation. Clinical variables, patient cooperation, time to recovery, and amnesia served as outcome variables. RESULTS: There was no significant difference between the two study groups in patient characteristics. The "target SEF" was 13.6 +/- 0.7 Hz for the propofol group and 14.8 +/- 1.1 Hz for the midazolam group (n.s.). The only clinical parameter with a significant difference between the groups was the percent of time in which the heart rate deviated more than 20% from baseline for at least 2 minutes, i.e. 14.6 +/- 2.0 % for propofol and 48.2 +/- 38.0% for midazolam (P<0.01). Patient cooperation was better in the propofol group than in the midazolam group (full cooperation, 13/15 vs. 1/17, respectively; P<0.001). Patient recovery was significantly quicker in the propofol group (P<0.001). The degree of amnesia was similar in both groups; no patient in either group remembered details of the procedure. CONCLUSIONS: ERCP is better tolerated by patients sedated with propofol compared with midazolam, with a shorter recovery time and lesser hemodynamic side effects. Propofol should be considered to be the sedative drug of choice for ERCP.

Adolescent↗
PubMed2000

Predictors of recommendation and acceptance of intrapartum epidural analgesia.

UNLABELLED: We conducted this prospective study to characterize the obstetric and sociodemographic variables that predict physicians' recommendations and patients' acceptance of intrapartum epidural analgesia. The study population consisted of 447 consecutive, low-risk parturients in early active labor. Epidural analgesia was recommended to 393 patients (87.9%), however only 164 (41.7%) consented to receive it. A multiple logistic regression analysis demonstrated that the severity of pain, as assessed by the medical staff (odds ratio [OR] = 1.5, 95% confidence interval [CI] 1.13, 1.93), low parity (OR = 0.57, 95% CI 0.44, 0.74), and low maternal age (OR = 0.89, 95% CI 0.79, 0.99) were significant factors affecting recommendations of epidural analgesia. In a multivariate analysis, severity of subjective pain (OR = 1.39, 95% CI 1.16, 1.68), low parity (OR = 0.80, 95% CI 0.73, 0.99), high education (OR = 90.09, 95% CI 27.02,257.06), and the patients' being secular compared with religious (OR = 2.14, 95% CI 1.08,4.21) were found to be independent predictors of acceptance of epidural analgesia. There are differences between patients offered and those not offered epidural analgesia and between parturients who accept and those who do not accept this analgesia. IMPLICATIONS: We studied the factors that influence the recommendation of epidural analgesia by obstetricians, as well as its acceptance by the laboring patients at a university hospital in Israel. Epidural analgesia was recommended more often to low parity, younger women exhibiting more pain. Parturients who perceived greater pain were more secular, had low parity, and had a higher level of education were more likely to accept it.

Adult↗
PubMed1999

Intranasal salbutamol instillation in asthma attack.

Beta-two sympathomimetic drugs are the treatment of choice for asthmatic attack. Their main effect is to dilate the bronchi by a direct action on beta-two adrenoreceptors on the smooth muscle, and also by mediator release inhibition from mast cells. Salbutamol is widely used in the treatment of bronchial asthma, and is usually administered either by inhalation, orally, or parenterally. The nasal route seems to afford an effective way to administer medications, since the nasal mucosa has a relatively large surface area, and there is no gastrointestinal-hepatic first pass-effect, thus avoiding extensive loss of the administered drug. We describe herein the use of nasal salbutamol in 3 patients with severe asthma attacks who were refractory to conventional therapy, with favorable responses and without significant undesirable effects.

Acute Disease↗
PubMed1999

Accidental intra-arterial injection of propofol.

We report a case of accidental intra-arterial injection of propofol in a 30-year-old woman admitted for curettage. The patient reported pain, which was followed by a hyperaemic area of 6 x 7 cm around the injection site. Later a blanching of the distal part of the hand was noticed, lasting for 3 min. When pain appears during propofol administration, an intra-arterial injection must be excluded.

Adult↗
PubMed1998

Ketamine attenuates the interleukin-6 response after cardiopulmonary bypass.

UNLABELLED: Cardiopulmonary bypass (CPB) has been proposed as a model for studying the inflammatory cascade associated with the systemic inflammatory response syndrome. Serum interleukin-6 (IL-6) concentration seems to be a good indicator of activation of the inflammatory cascade and predictor of subsequent organ dysfunction and death. Prolonged increases of circulating IL-6 are associated with morbidity and mortality after cardiac operations. In the present study, we compared the effects of adding ketamine 0.25 mg/kg to general anesthesia on serum IL-6 levels during and after elective coronary artery bypass grafting (CABG). Thirty-one patients undergoing elective CABG were randomized to one of two groups and prospectively studied in a double-blind manner. The patients received either ketamine 0.25 mg/kg or a similar volume of isotonic sodium chloride solution in addition to large-dose fentanyl anesthesia. Blood samples for analysis of serum IL-6 levels were drawn before the operation; after CPB; 4, 24, and 48 h after surgery; and daily for 6 days beginning the third day postoperatively. Ketamine suppressed the serum IL-6 response immediately after CPB and 4, 24, and 48 h postoperatively (P < 0.05). During the first 7 days after surgery, the serum IL-6 levels in the ketamine group were significantly lower than those in the control group (P < 0.05). On Day 8 after surgery, IL-6 levels were no different from baseline values in both groups. A single dose of ketamine 0.25 mg/kg administered before CPB suppresses the increase of serum IL-6 during and after CABG. IMPLICATIONS: In this randomized, double-blind, prospective study of patients during and after coronary artery bypass surgery, we examined whether small-dose ketamine added to general anesthesia before cardiopulmonary bypass suppresses the increase of the serum interleukin-6 (IL-6) concentration. Serum IL-6 levels correlate with the patient's clinical course during and after coronary artery bypass. Ketamine suppresses the increase of serum IL-6 during and after coronary artery bypass surgery.

Aged↗