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Biomedical subjects

J Eldor

Publications and source records attributed to J Eldor.

At least 19 recordsLinked to original sources

[Jacuzzi-immersion for obstetric analgesia].

The effect of immersion in a jacuzzi in relieving labor pains, and on cervical dilatation was examined in 40 parturients. They were immersed in the jacuzzi during labor for an average of 25.5 minutes. Labor pains decreased during immersion by 2.59 degrees (scale of 0-10) compared with an average increase in labor pains of 0.25 degrees in 40 control women who were not immersed (p < 0.01). The cervical opening increased during immersion by an average of 1.5 cm in the test group, compared with 0.3 cm in the controls (p < 0.01). Immersion in a jacuzzi during labor is apparently associated with analgesia and accelerated cervical dilatation.

Analgesia, Obstetrical

[Anesthesia for cesarean section].

Of 684 parturients who underwent cesarean section between July 1985-August 1990, 371 (54.2%) were given epidural anesthesia; 50 (7.3%) required general anesthesia after a failed attempt at epidural anesthesia; and 5 (0.7%) underwent inadvertent spinal anesthesia because of dural penetration by the epidural needle. In 258 (37.7%) general anesthesia was decided on before operation. The intentional avoidance of spinal anesthesia for cesarean section in this university hospital is criticized.

Anesthesia, Epidural

[Surgical anesthesia in nonagenarians].

63 nonagenarians (average age 93, range 90-97 years) were operated on between 1987-90 (twice or more in 8, total number of operations 75). 29 were done under general anesthesia, 17 epidural, 15 spinal, and 14 local. Mortality in the 6-month postoperative period was 17%; all deaths were within 35 days. Average postoperative mortality was higher among orthopedic patients (26%) than in those after general surgery (19%). 5 died after epidural anesthesia, 3 after general anesthesia, 2 after spinal anesthesia and 1 after local anesthesia.

Aged

A new proposal of CPR based on coronary perfusion pressure.

Closed chest massage and tracheal intubation are not enough. The 70% success rate promised by Kouwenhoven 31 years ago is not realised. Coronary perfusion pressure is the main goal. To achieve this a proposal of a combined new CPR is advocated which encompass the following items besides closed chest massage and tracheal intubation: (a) use of high dose methoxamine (instead of epinephrine), (b) use of continuous abdominal pressure (instead of intermittent pressure), (c) unloading the pump, which means no use of any intravenous fluids, and (d) intracardiac injection of medications until restarting of spontaneous circulation.

Cardiopulmonary Resuscitation

High-dose flunitrazepam anesthesia.

Benzodiazepines have receptors in the nervous system as well as in the kidney, liver, skeletal and ileal muscle, lungs and the heart. Flunitrazepam is a benzodiazepine with pronounced hypnotic effects in the usual dosage. High dose flunitrazepam anesthesia is suggested for prolonged surgical procedures as an alternative to the well known high-dose opiate anesthesia. Its reversal using flumazenil can shorten the post-operative anesthetic effect.

Anesthesia

[Comparative study of conventional spinal anesthesia and combined spinal-epidural anesthesia in gynecological surgery].

A prospective study was carried out to compare the qualities of spinal block with those of combined spinal-epidural anaesthesia (CSEA). It included 63 patients, ranked ASA 1 or 2, aged between 35 and 75 years, scheduled for gynaecological surgery due to last more than 2 hours, and randomly allocated to two groups. In the first group (n = 34), spinal anaesthesia was carried out with the patients sitting, in the L3-4 interspace, using 15 mg of hyperbaric bupivacaine with 0.4 mg of adrenaline. In the second group (n = 29), a catheter was inserted in the epidural space through the L2-3 interspace, and spinal anaesthesia carried out as in the first group, using bupivacaine without adrenaline. Once the highest level of analgesia had been reached, aliquots of 0.5% plain bupivacaine were injected through the epidural catheter, until anaesthesia of T5 was obtained. In the spinal group, general anaesthesia was required in 3 cases, as anaesthesia only reached the T12 level in 2 cases, and as surgery lasted longer than the spinal in the third one. In the CSEA group, excellent analgesia was obtained in all patients. Sensory blockade lasted 308 +/- 48 min at the T12 level, versus 162 +/- 51 min in the spinal group (p < 0.025), and 361 +/- 51 min at the L2 level, versus 210 < 44 min in the other group (p < 0.025). "Topping up" was possible with the epidural catheter only, thus raising the level of sensory blockade, making it deeper, and increasing its duration. It avoids the use of general anaesthesia in case of failed spinal blockade.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

[Combined spinal-epidural anesthesia].

Combined spinal and epidural anesthesia is a new regional anesthetic modality which combines the benefits of both the spinal and epidural approaches. 24 patients (11 after cesarean section and 13 after orthopedic operations on the lower limbs) were studied. Muscle relaxation and anesthesia were excellent, and regional anesthesia can be prolonged after the original spinal anesthesia wears off. No other anesthetics were needed. Methadone or morphine were given through the epidural catheter in the recovery room for postoperative analgesia. All patients were followed for 24 hours postoperatively.

Analgesia

Intra-anesthetic awareness.

Awareness during anesthesia is as old as anesthesia itself. Using muscle relaxing drugs, operations can be done on a relaxed but fully aware patient. The problem of intra-anesthetic awareness still exists despite the advances in anesthetic drugs and monitoring. This article reviews the subject from some aspects including its causes, signs, tests and medico-legal points. Awareness during anesthesia can be looked at as 'the invisible scars of surgery.'

Anesthesia, General

Over-transfusion ascites.

A 12-year-old girl was injured in a traffic accident and suffered fractures of all the long bones of both legs. During the operation she received 10 l of lactated Ringer's solution, 3 l of 0.9% NaCl, and 2 l of 5% glucose, until blood was available, because of difficulty in its cross-matching. Her hemoglobin dropped to 4.9 g%. After the operation a distension of the abdomen was noted. An abdominal tap confirmed ascites. A simultaneous intravenous pyelogram and retrograde cystogram revealed no leakage from the urinary tract. An over-transfusion ascites was diagnosed combined with pulmonary edema. The patient was treated for 2 days in the ICU, until she was transferred to the orthopedic department with no signs of ascites.

Ascites