PubMed Health⌕ Search

Biomedical subjects

H J Khambatta

Publications and source records attributed to H J Khambatta.

33 records · Page 2Linked to original sources
PubMed1981

Catheter-induced pulmonary artery hemorrhage. Diagnosis and management in cardiac operations.

Three case reports describing catheter-induced pulmonary artery hemorrhage in patients having cardiac operations are presented--a 0.2% incidence of this complication. One patient exsanguinated and died, another survived after undergoing an emergency lobectomy, and the third escaped without surgical intervention. As a result of this experience and the recommendations in the literature, we have developed and describe herein a rational therapy for this highly lethal complication.

Aged↗
PubMed1980

Nitroprusside and mitral stenosis.

The cardiovascular effects of an intravenous nitroprusside infusion were evaluated intraoperatively in seven patients with pure mitral stenosis and seven patients with predominant mitral stenosis. Prior to therapy the adverse hemodynamic consequences of light anesthesia and surgical stimulation were evident in all patients: systemic and/or pulmonary hypertension were present, systemic vascular resistance was twice normal, and cardiac function was depressed. Nitroprusside consistently reduced systemic vascular resistance and systemic arterial as well as pulmonary arterial and wedge pressures, but cardiac index increased only when severe pulmonary hypertension and/or some mitral regurgitation coexisted with mitral stenosis. In the group with predominant mitral stenosis, cardiac index increased from 1.8 to 2.1 L/min/m2 with nitroprusside (p < 0.05). In three individuals who demonstrated severe pulmonary hypertension (one with pure mitral stenosis and two with predominant mitral stenosis), nitroprusside induced an increase of almost 50% in cardiac index and stroke volume. In contrast, patients with pure mitral stenosis and mild pulmonary hypertension showed little change in cardiac index or stroke volume. It is concluded that nitroprusside can safely be used to control systemic or pulmonary hypertension during anesthesia and surgery in patients with mitral stenosis and that if severe pulmonary hypertension and/or mitral regurgitation coexist with mitral stenosis, cardiac function will also improve.

Ferricyanides↗
PubMed1979

Hypertension during anesthesia on discontinuation of sodium nitroprusside-induced hypotension.

The authors had observed that on intraoperative discontinuation of sodium nitroprusside being administered to induce hypotension, mean arterial pressure increased to above the pre-hypotension level. Twelve patients who recieved hypotensive anesthesia for surgical correction of cerebral aneurysms were studied to evaluate the role of the renin-angiotensin system in this phenomenon. In the awake state, mean arterial pressure was 100 +/- 2 torr and plasma renin activity 3.0 +/- 0.1 ng/ml/hr. Thirty minutes after the establishment of stable halothane-nitrous oxide anesthesia, mean arterial pressure decreased to 85 +/- 1 torr and plasma renin activity increased to 4.4 +/- 0.1 ng/ml/hr. No appreciable change in either occurred over the next two hours of operation. During sodium nitroprusside-induced hypotension, mean arterial pressure decreased to 49 +/- 2 torr and plasma renin activity increased to 15.2 +/- 0.2 ng/ml/hr. Thirty minutes after discontinuation of sodium nitroprusside administration, mean arterial pressure increased to 112 +/- 2 torr, which was not only higher than the prehypotension level, but also significantly higher than that recorded in the awake state. Plasma renin activity at that time was 10.9 +/- 0.1 ng/ml/hr. As the half-life of plasma renin is 15 min, the data suggest that the persistently increased plasma renin activity is probably responsible for the increase of arterial pressure following sodium nitroprusside-induced hypotension.

Adolescent↗
PubMed1978

Hypotensive anesthesia for spinal fusion with sodium nitroprusside.

Deliberate induced hypotension for spinal fusion has been used in the past, but a search for better techniques continues. The authors used sodium nitroprusside by intravenous infusion to reduce the mean arterial pressure from 72 to 42 torr in 10 cases. This degree of hypotension provided an optimal surgical field and maintained adequate tissue perfusion as demonstrated by arterial oxygen tensions greater than 600 torr, no development of base deficit, and continuous urinary excretion. There were no complications related to hypotension. None of the patients received blood transfusions, whereas in the past, 2000 ml blood was usually required for this procedure.

Adult↗
PubMed1978

Pulmonary shunts in the prone position.

Pulmonary shunting (Qs/Qt with the FIO2 = 1) was determined in ten young healthy non-obese patients prior to anaesthesia, 30 min after induction in the supine position and 1 h later during surgery in the prone position. Respiration was spontaneous in awake patients and was controlled following the induction of anaesthesia. Halothane was the primary anaesthetic and tubocurarine provided muscle relaxation. Mean PaCO2 was 40.7, 29.5 and 27.9 mmHg respectively in the three study periods. The shunt remained unchanged at 5.7 +/- 0.8% in the awake patients, and 6.0 +/- 1.1% during anaesthesia in the supine position, and 5.2 +/- 1.2% during anesthesia and surgery in the prone position. It is concluded that in this population the prone position does not alter the magnitude of the pulmonary shunt even in those patients who develop shunts of over 10% after the induction of anaesthesia.

Adult↗
PubMed1977

Cerebrospinal fluid levels of d-tubocurarine in man.

Using radioimmunoassay, d-tubocurarine (dTc) was found in the cerebrospinal fluid (CSF) of man after intravenous injection. When dTc was administered in a single dose (0.3 mg/kg) to nine patients, small quantities, 3.5 +/- .26 ng/ml (mean +/- SE), appeared in the lumbar CSF within 5 minutes. The concentration of dTc (0.3 mg/kg) were given at 90 minute intervals. Concentration of dTc in the CSF remained constant for the next 25 minutes, but then began to increase with time to to 9.3 +/- 4.4 ng/ml 30 minutes after injection, 14.5 +/- 4.4 ng/ml at one hour, and 24.9 +/- 6.5 ng/ml at six hours. In another group of six patients, three doses of dTc (0.3 mg/kg) were given at 90-minute intervals. Concentration of dTc in the CSF increased after each injection. The quantities of dTc found in the CSF are unlikely to produce any pharmacologic or adverse effect (e.g., convulsion) in man.

Humans↗
PubMed1976

Pulmonary shunting during anesthesia with deliberate hypotension.

Pulmonary shunting (Qs/Qt with FIO2 = 1) was measured in 18 anesthetized patients during deliberate hypotension. Hypotension was induced in 12 patients with sodium nitroprusside and light halothane anesthesia and in six others with deep halothane anesthesia and mechanical hyperventilation. Similar results were observed in the two groups. During the hypotensive period mean arterial pressure (MAP) was reduced to 49 +/- 2 torr, a 37 per cent decrease from the control level after the onset of operation and a 40 per cent decrease compared with the recovery level during closure of the wound. Qs/Qt, however, remained unchanged throughout the study: 5.2 +/- 0.9 per cent initially, 5.4 +/- 0.8 per cent during hypotension, and 4.7 +/- 0.5 per cent during recovery. It is concluded that pulmonary shunting need not develop during deliberate hypotension induced with either technique.

Adult↗
PubMed1975

Pulmonary shunting during anaesthesia in man.

Qs/Qt was determined during halothane and oxygen anaesthesia in 22 patients. All were believed to have no pulmonary dysfunction. A surgical operation was in progress and respiration was controlled. Qs/Qt was minimal in 15 of these patients (means 3.9 plus or minus 0.3%), indicating that anaesthesia and operation can be conducted in man without a significant increase of pulmonary shunting. The level of shunting was increased in the other seven patients. In neither group was Qs/Qt altered by the passage of time. Age varied between 23 and 61 years and was directly and significantly correlated to Qs/Qt (r=0.57,P less than0.01).

Adult↗
PubMedDate not supplied

Preemptive analgesia in children. Does it exist?

BACKGROUND AND OBJECTIVES: Preemptive analgesia has been evident in animals, but few adult human studies exist demonstrating this concept exist, and there are fewer still in children. Caudal epidural blocks with local anesthetics are often placed for postoperative analgesia in children. This study evaluated whether these blocks are more effective when placed prior to surgical incision. METHODS: Children aged 1-6 years and ASA I and II (n = 51), undergoing elective herniorrhaphy, orchidopexy, or circumcision were randomly assigned to receive a caudal epidural block with 0.6 mL/kg of 0.25% bupivacaine with 1:200,000 epinephrine, either before incision (n = 28) or after surgery (n = 23). In all patients, anesthesia was induced and maintained with oxygen, nitrous oxide, and halothane, and caudal epidural blocks were placed. Postoperative pain was scored by a blinded observer using a Faces Pain Scale in the recovery room and was also assessed at home by the parents. Analgesic requirement during the 24-hour period was recorded. RESULTS: The Faces Pain Scale scores and analgesic requirements did not differ between the groups, either in the recovery room or at home (P > .05). CONCLUSIONS: Although preemptive analgesia has been successfully demonstrated in some earlier clinical studies, our results indicate that pre- and postincisional caudal epidural blocks with 0.25% bupivacaine were equally effective in children.

Abdomen↗