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Biomedical subjects

G Rolly

Publications and source records attributed to G Rolly.

At least 19 recordsLinked to original sources
PubMed1992

Influence of converting enzyme inhibition on isoflurane-induced hypotension for cerebral aneurysm surgery.

Twenty-five patients (aged 18 to 72 years), who recovered after the first bleed from a cerebral aneurysm, were operated on under neuroleptanaesthesia. Isoflurane was added to induce hypotension. It was found that the required hypotension (51 (SEM 1) mmHg) could be obtained and maintained at much lower isoflurane concentrations (less than 1%) after blockade of the angiotensin converting enzyme activity by enalaprilat (2.5 mg i.v.) than without such inhibition. During the hypotension which lasted 78 (SEM 10) min, only minor adjustments of the isoflurane concentration (0.70 (0.04%) were needed. The desired level of hypotension was obtained with preservation of the cardiac output and without tachycardia. No resistance to the blood pressure lowering effect of isoflurane was observed. On recovery from anaesthesia, a small increase of blood pressure above control values was seen in 16 patients and was easily reversed by small doses of clonidine (mean total dose: 220 (61) micrograms). The operative conditions were excellent and the postoperative recovery was uneventful and complete in 23 patients.

Adolescent↗
PubMed1992

Effect of intravenous hypnotics on the actions of pipecuronium.

Seventy-five ASA Grades I-III patients (18-85 years, 45-90 kg) were randomized into five groups. All patients received N2O/O2 (2/1) and alfentanil: loading dose (LD) 0.015 mg kg-1 and maintenance dose (MD) 0.045 mg kg-1 h-1 (groups 1-4). Group 1 received propofol (LD 2 mg kg-1 and MD 6 mg kg-1 h-1); Group 2 etomidate (LD 0.3 mg kg-1 and MD 0.6 mg kg-1 h-1); Group 3 midazolam (LD 0.2 mg kg-1 and MD 0.120 mg kg-1 h-1); Group 4 methohexitone (LD 1.5 mg kg-1 and MD 4 mg kg-1 h-1); Group 5 dehydrobenzperidol 0.05-0.23 mg kg-1 and alfentanil (LD 0.100 mg kg-1 and MD 0.060 mg kg-1 h-1). The neuromuscular block induced by pipecuronium (50 micrograms kg-1) was evaluated. No statistically significant differences were found between the five groups as concerned degree of block (expressed as % twitch amplitude in response to the first of the TOF stimuli (Ta1) at intubation, T1 minimum and recovery to Ta1 = 20%, 25% and 75%. Slightly faster intubation was possible when midazolam was used in comparison with propofol, methohexitone or NLA and when etomidate was used in comparison with propofol. A wide range of individual values of maximal neuromuscular blocking activity was found.

Adult↗
PubMed1979

Influence of enflurane on cerebral blood flow in man.

Cerebral blood flow was measured by means of a 10-channel cerebrograph in anesthetised patients before and during 2% enflurane. This investigation was carried out after carotid angiography; 2-3 mCi Xe133 was injected into the internal carotid artery. The clearance curves of Xe133 were captured by 10 scintillation counters. In addition to regional cerebral blood flow (rCBF), arterial blood pressure, heart rate, stroke volume, cardiac output and arterial blood gases were measured in seven adult patients. During 2% enflurane, a small, and in two regions a significant decrease in rCBF was observed. Mean arterial pressure and heart rate decreased significantly, but cardiac output did not. The decrease in PaCO2 was not significant.

Anesthesia, Inhalation↗
PubMed1979

Double blind study of meptazinol versus pentazocine and placebo in postoperative pain treatment.

The purpose of this double blind study was to evaluate the efficiency and safety of a new analgesic drug meptazinol, compared to pentazocine and placebo, in patients suffering from postoperative pain. Subjective and objective parameters were controlled. It appeared clearly that meptazinol had a potent analgesic effect with rapid onset, but rather short duration. Analgesic effect of pentazocine appeared more slowly, but persisted for a longer time. The two active drugs had no effects on the objective parameters measured.

Azepines↗
PubMed1979

Emergency surgery for acute hyperparathyroidism: anesthetic aspects.

Hyperparathyroid crisis with hypercalcemia which is resistant to medical treatment, is a rare clinical condition which requires prompt surgical intervention. Preoperative problems, anesthetic management and postoperative evolution are discussed. A case report is described.

Acute Disease↗
PubMed1978

Advantages and dangers of artificial ventilation.

In modern anesthesiology artificial ventilation has many advantages, especially when compared to manual ventilation, nonetheless the "educated hand" of the anesthesiologist. However many dangers and pitfalls exist during controlled ventilation. A survey of them is given. In more detail are discussed: hyperventilation, hypoventilation, accidental deconnection of the tubings, accidental hyperpression, failure of the cycling mechanism, faults in fresh gas administration. A plea is made for immediate observation of the patient and respiratory dynamics when connecting a respirator.

Humans↗
PubMed1978

Two cases of burns caused by misuse of coagulation unit and monitoring.

Two cases of severe burns with monitoring apparatus are described. In a female patient of 45 years, a severe third degree burn occurred by misuse of coagulation apparatus (inversion of the poles of an older Bovie apparatus), in the presence of a non-floating ECG monitoring device. A high intensity current was established from the coagulation unit, via the earth plate under the buttocks, to the indifferent electrode placed on the chest, where burns occurred. In an 8 month female baby, having laparotomy for a neuroblastoma, a third degree burn of 5 cm diameter occurred with a non-floating ECG monitor. A twin-wired disposable earth plate was placed just beneath the indifferent ECG electrode on the leg. A burning current was established between the Bovie coagulation unit and the monitor.

Burns, Electric↗
PubMed1977

Elective induction of labor conducted under lumbar epidural block. I. Labor induction by amniotomy and intravenous oxytocin.

Epidural analgesia (bupivacaine) was administered during labor after amniotomy, in some cases supplemented by intravenous oxytocin. A higher incidence of transient uterine hypertonus was seen after blocking. Fetal heart rate changes mainly took the form of bradycardia (in association with uterine hypertonus). At birth, the maternal biochemical condition was characterized by a lower degree of metabolic acidosis, compared to normal unanesthetized controls. The fetuses displayed a slight degree of hypoxia and hypercapnia. The mechanisms underlying these modifications are discussed. Epidural blockade in combination with elective induction of labor, whether or not supplemented by intravenous oxytocin, may carry a risk. Its magnitude is considered acceptable for both mother and fetus provided they are constantly under close surveillance, limited amounts of bupivacaine are administered and the second stage of labor is kept short. However, some warnings against epidural analgesia apply to patients with placental insufficiency and very active labor.

Adult↗
PubMed1977

Elective induction of labor conducted under lumbar epidural block. II. Labor induction by amniotomy and intravenous prostaglandin.

Labor was electively induced at term in 117 clinically normal nulliparae and parous women by combining low amniotomy with intravenous administration of prostaglandin F2 alpha (n = 64) or prostaglandin E2 (n = 53). Analgesia was obtained by continuous lumbar epidural block with bupivacaine. The procedure was very effective in producing vaginal delivery within 24 h after prostaglandin infusion (n = 115), but it was accompanied by an extremely high incidence of uterine hypertonus. Tentative explanations for the transient uterine hyperstimulation are a direct stimulatory effect of the local anesthetic on the contractility of the myometrial fiber and/or a temporarily higher amount of circulating oxytocic compound reaching the myometrium due to local vasodilatation as a result of sympathetic nerve blockade. In some cases uterine hypertonus was associated with slowing of the basal fetal heart rate and, when severe, with the appearance of late deceleration patterns and fetal acidosis. In other cases the fetal heart rate deceleration is explained by the toxic effect of bupivacaine on the myocard. Since both the myometrial hyperactivity and the FHR alterations were temporary, fetal biochemical parameters were unaffected at completion of the first stage of labor. Because with intravenous prostaglandin uterine hyperstimulation is more difficult to avoid and regional analgesia further increases the hazard of both hypertonus and fetal heart rate deceleration, the combined application of an intravenous prostaglandin and continuous epidural analgesia should not be introduced into obstetrical practice.

Adult↗
PubMed1977

Duration of action of analgesic supplements to anesthesia. A double-blind comparison between morphine, fentanyl and sulfentanil.

In a double-blind trial, in a total of 45 patients, sulfentanil was compared with fentanyl and morphine in equipotent doses, as a narcotic supplement to anesthesia. Initially, morphine was shown to have a significantly longer duration of effect than fentanyl and sulfentanil, which for the first 3 doses had similar durations of action to each other. Later doses of fentanyl, however, had an extended effect, presumably because of cumulation. This was not seen with sulfentanil.

Adjuvants, Anesthesia↗
PubMed1977

I.C.I. 35868 - The effect of a change of formulation on the incidence of pain after intravenous injection.

I.C.I. 35868 is a promising new intravenous induction agent, but intravenous injection of the initial 2% formulation frequently caused pain. The solvent vehicle of the 2% formulation, which contained Cremophor E.L. and ethanol, was therefore investigated to see if this could be the cause of the pain. Twenty volunteers received both 5 ml isotonic saline and 5 ml solvent vehicle intravenously. The injection of saline never caused pain, but the solvent caused mild or moderate pain in 9 patients. I.C.I. 35868 was therefore reformulated in a 1% solution, excluding ethanol from the solvent. When intravenous injection of I.C.I. 35868 1% was compared to methohexitone 1% in 24 patients, both agents caused pain. Four out of 12 patients reveiving I.C.I. 35868 1% felt pain, with a total pain "score" of 6, but 6 out of 12 patients who received methohexitone 1%, felt pain, with a total pain "score" of 12. In no instance was intravenous injection followed by persistant pain, or evidence of thrombosis or phlebitis.

Anesthesia, Intravenous↗
PubMed1977

Total intravenous anesthesia with etomidate. III. Some observations in adults.

An investigation was undertaken to determine the dosage of etomidate required to maintain sleep in adults undergoing surgery under regional local anesthesia. Premedication of diazepam 10 mg and atropine 0.5 mg was given, and sleep was induced and maintained by intermittent intravenous injections of etomidate 0.1/mg/kg, given whenever the patient would open his eyes on request. A mean overall dose of etomidate 17.4 microgram/kg/min. was required to maintain sleep, but great individual variation occurred, with older patients requiring less drug. The investigation was discontinued after 18 patients because of the frequency and intensity of side-effects, particularly pain and myoclonia, which caused the technique to be abandoned in two cases. It is considered unlikely that etomidate will prove to be the hypnotic of choice for a totally intravenous anesthetic technique in adults because of the high incidence of myoclonia after prolonged administration. In several patients uncontrollable muscle movements persisted for many minutes after complete recovery of consciousness.

Adolescent↗
PubMed1977

Clinical experiences with naloxone in neuroradiology.

In 17 patients, the reversal by naloxone of a short duration narcotic anesthesia done for neuroradiology, was studied. Neuroleptanalgesic technique comprised d-hydrobenzperidol (5-10 mg) and fentanyl (+/- 0.4 mg) after barbiturate induction, and curarization with pancuronium, reversed by neostigmine. In group A 2 microgram/kg naloxone I.V. was given and 1 microgram/kg I.M. 30 min. later and in group B 1 micrometer/kg I.V. and 30 min. later 0.5 micrometer/kg. Reversal of narcotic depression was good and well maintained for 60 min. in both groups, as evidenced by respiratory rate, respiratory minute volume, pHa, PaCO2. Marginal temporarily cardiovascular stimulation occurred with arousal. Tolerance was good. It is concluded that antagonisation of respiratory depression due to narcotic anesthesia is possible with small titrated dosis of naloxone.

Adjuvants, Anesthesia↗