Biomedical subjects

H D Rosen

Publications and source records attributed to H D Rosen.

3 recordsLinked to original sources

PubMed1999

Early and late reversal of rocuronium and vecuronium with neostigmine in adults and children.

UNLABELLED: We investigated the influence of the timing of neostigmine administration on recovery from rocuronium or vecuronium neuromuscular blockade. Eighty adults and 80 children were randomized to receive 0.45 mg/kg rocuronium or 0.075 mg/kg vecuronium during propofol/fentanyl/N2O anesthesia. Neuromuscular blockade was monitored by train-of-four (TOF) stimulation and adductor pollicis electromyography. Further randomization was made to control (no neostigmine) or reversal with 0.07 mg/kg neostigmine/0.01 mg/kg glycopyrrolate given 5 min after relaxant, or first twitch (T1) recovery of 1%, 10%, or 25%. Another eight adults and eight children received 1.5 mg/kg succinylcholine. At each age, spontaneous recovery of T1 and TOF was similar after rocuronium and vecuronium administration but was more rapid in children (P < 0.05). Spontaneous recovery to TOF0.7 after rocuronium and vecuronium administration in adults was 45.7 +/- 11.5 min and 52.5 +/- 15.6 min; in children, it was 28.8 +/- 7.8 min and 34.6 +/- 9.0 min. Neostigmine accelerated recovery in all reversal groups (P < 0.05) by approximately 40%, but the times from relaxant administration to TOF0.7 were similar and independent of the timing of neostigmine administration. Recovery to T1 90% after succinylcholine was similar in adults (9.4 +/- 5.0 min) and children (8.4 +/- 1.1 min) and was shorter than recovery to TOF0.7 in any reversal group after rocuronium or vecuronium administration. Recovery from rocuronium and vecuronium blockade after neostigmine administration was more rapid in children than in adults. Return of neuromuscular function after reversal was not influenced by the timing of neostigmine administration. These results suggest that reversal of intense rocuronium or vecuronium neuromuscular blockade need not be delayed until return of appreciable neuromuscular function has been demonstrated. IMPLICATIONS: These results suggest that reversal of intense rocuronium or vecuronium neuromuscular blockade need not be delayed until return of appreciable neuromuscular function has been demonstrated. Although spontaneous and neostigmine-assisted recovery is more rapid in children than in adults, in neither is return of function as rapid as after succinylcholine administration.

Adult↗

PubMed1996

Oxygen flow through nasal cannulae.

PURPOSE: Since many operating theatres do not have distinct oxygen flowmeters, flow rates of oxygen were measured via nasal prongs at several settings and attachments to three anaesthetic machines. METHODS: Oxygen-flow rates were measured using a Timeter RT-200 Calibration Analyzer at three, five and eight L.min-1 via nasal prongs attached to a distinct flowmeter, the common gas outlet (CGO) and the Y-piece of a circle system with the adjustable pressure release (APL) valve closed, open and partially open at circuit pressures of 10 and 20 cm H2O. RESULTS: The most accurate delivery of oxygen from a distinct flowmeter and the CGO (mean difference 0.2 +/- 0.2 and 0.4 +/- 0.4 respectively). Differences between the flowmeter and CGO were not significant (P = 0.1). Accuracy of flows via the Y-piece were worse than via the flowmeter and CGO (P < 0.0001). Flows via the Y-piece were less than those dialed, especially at high rates. With a partially open APL valve, flow depended upon pressure in the anaesthetic circuit, not upon the flow set. With the APL valve completely open, no flow occurred. CONCLUSIONS: To deliver supplemental oxygen in the operating theatre when there are no distinct flowmeters, nasal prongs should be attached to the CGO of the anaesthetic machine or a flowmeter on a portable E-tank oxygen cylinder. Connecting nasal prongs to the Y-piece of a circle system should be avoided since oxygen delivery is less than dialed, especially when the APL valve is open.

Anesthesia, Closed-Circuit↗

PubMed1987

Ontogenic corticosteroidogenesis of the domestic fowl: response of isolated adrenocortical cells.

Ontogenic adrenocortical function of the domestic was investigated using adrenocortical cells isolated from embryonic chicks (18, 19, 20, and 21 days old) and male and female posthatch birds (1 day, 1 week, and 3 weeks old). Production of the predominant corticosteroids secreted by the chicken adrenal gland, corticosterone, cortisol, and aldosterone, was measured by radioimmunoassay after 2-hr incubation of cells with or without steroidogenic agents. Approaching hatch, basal and maximal ACTH-(1-24) (ACTH)-induced corticosteroid production increased steadily and peaked around 1 day posthatch (5-18 times and 3-9 times, respectively, the production values at 18 days embryonic life). Thereafter, corticosteroid production values decreased steadily to 3 weeks posthatch. Corticosterone predominated over the ages studied: Maximal ACTH-induced corticosterone production averaged 52 and 115 times the production values of aldosterone and cortisol, respectively. In addition, maximal ACTH-induced aldosterone production was roughly 2.2 times greater than cortisol production over the ages studied except for a short-lived, disproportionately greater aldosterone production at 1 day posthatch. In addition to perihatch and age-related differences in cellular corticosteroid production, there were also differences in cellular sensitivity to steroidogenic agents as indicated by the differences in half-maximal steroidogenic concentration values (ED50 values) of the steroidogenic agents. Sensitivity to ACTH increased 2.7 times from Day 18 of embryonic life to 1 day posthatch and then decreased steadily to 3 weeks posthatch. In addition, sensitivity to 8-bromo-cAMP (8-Br-cAMP) increased abruptly at 1 day posthatch (nearly 3 times) but then remained constant thereafter. However, a consistent change in cellular sensitivity to 25-hydroxycholesterol was not observed until 3 weeks posthatch (an increase in sensitivity of 3 times that at Day 18 of embryonic life). These data of cellular sensitivity suggest that there were distinct development and maturational alterations in the cellular loci at which ACTH, 8-Br-cAMP, and 25-hydroxycholesterol acted. Thus, during the transition from embryonic to postembryonic life of the domestic fowl, there are alterations in adrenocortical cell steroidogenic capacity and in the function of some cellular loci comprising the corticosteroidogenic pathway.

8-Bromo Cyclic Adenosine Monophosphate↗