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Biomedical subjects

J F Schauble

Publications and source records attributed to J F Schauble.

17 recordsLinked to original sources
PubMed1998

Prevalence of latex allergy among anesthesiologists: identification of sensitized but asymptomatic individuals.

BACKGROUND: Occupational exposure to natural rubber latex has led to sensitization of health-care workers. However, the prevalence of latex allergy among occupationally exposed workers in American hospitals has not been reproducibly determined. The objectives of the current study were to determine the prevalence of and risk factors for latex sensitization among a cohort of highly exposed health-care workers. METHODS: Participants were 168 of 171 eligible anesthesiologists and nurse anesthetists working in the Department of Anesthesiology and Critical Care Medicine. A clinical questionnaire was administered, and testing was performed using a characterized nonammoniated latex reagent for puncture skin testing, a Food and Drug Administration-approved assay to quantify latex-specific immunoglobulin E antibody in serum, and, when required for clarification, a validated two-stage (contact-inhalation) latex glove provocation procedure. RESULTS: The prevalence of latex allergy with clinical symptoms and latex sensitization without clinical symptoms was 2.4% and 10.1%, respectively. The prevalence of irritant or contact dermatitis was 24%. The risk factors identified for latex sensitization were atopy (odds ratio, 14.1; 95% CI, 1.8-112.1; P = 0.012); history of allergy to selected fruits, such as bananas, avocados, or kiwis (odds ratio, 9.8; 95% CI, 1.6-61.9; P = 0.015); and history of skin symptoms with latex glove use (odds ratio, 4.6; 95% CI, 1.6-13.4; P = 0.006). CONCLUSIONS: The prevalence of latex sensitization among anesthesiologists is high (12.5%). Of these, 10.1% had occult (asymptomatic) latex allergy. Hospital employees may be sensitized to latex even in the absence of perceived latex allergy symptoms. These data support the need to transform the health-care environment into a latex-safe one that minimizes latex exposure to patients and hospital staff.

Adult↗
PubMed1988

Aortic disease associated with pregnancy.

Our experience with the management of two patients with life-threatening aortic disease during pregnancy is presented with a review of the literature. One of our patients had intimal disruption caused by trauma; the other had probable Ehlers-Danlos type IV syndrome, causing an acute dissection of the descending thoracic aorta and eventually requiring replacement of the aorta from the left subclavian artery to common iliac arteries. The challenge of treating both the pregnant woman and the fetus was managed successfully by an emergent cesarean section followed by Dacron graft replacement of the descending thoracic aorta. The literature reviewed disclosed that aneurysm expansion producing symptoms and dissection is most common during the third trimester and during labor and delivery in patients with or without Marfan's syndrome. Half of the aortic dissections in women less than 40 years of age occur in association with pregnancy. The available evidence indicates that patients with known valvular or aortic disease should have surgical repairs during the first or second trimester and thereafter have delivery by cesarean section. However, patients with acute aortic problems near term appear to be better managed by cesarean section followed promptly by treatment of the aortic disease.

Adult↗
PubMed1985

Limitations of thermodilution ejection fraction: degradation of frequency response by catheter mounting of fast-response thermistors.

The present study examined whether catheter-mounting of a fast-response thermistor impaired the thermistor's ability to measure rapid temperature changes during thermodilution measurement of ejection fraction (EF). The response to a square-wave temperature change of six fast-response thermistors mounted on commercially available, pulmonary artery balloon-flotation catheters was compared to the response of a similar but unmounted fast-response thermistor. The response of the catheter-mounted fast-response thermistors recorded only 82% to 92% of a step-temperature change at 0.5 sec, and 88% to 96% of the step change at 1.0 sec. In contrast, the unmounted fast-response thermistor responded to 100% of the step change in 125 msec. The response of the catheter-mounted fast-response thermistors demonstrated an important slow component (second time constant) introduced by the catheter body, so that equilibration to a temperature change was not complete for about 6 sec. This slow equilibration lowered EF measured by thermodilution below true EF.

Cardiac Output↗
PubMed1982

Overestimation of pediatric cardiac output by thermal indicator loss.

The accurate measurement of pediatric cardiac output by thermodilution requires that the quantity of cold indicator introduced into the central circulation be known. This study defines an important source of error in the correction factor for the amount of heat gained by small volumes of cold injectate during passage through pediatric catheter systems. This error may result in significant overestimation of cardiac output (as much as 59%) when blood at body temperature is withdrawn into the injection lumen of the pediatric catheter before the injection.

Age Factors↗
PubMed1976

Left ventricular function during aortic surgery.

Fourteen patients undergoing surgery for aneurysm or occlusive disease of the abdominal aorta were studied. Thirteen patients had a history of hypertension or myocardial infarction; two patients had chronic obstructive pulmonary disease. Tachycardia, hypertension, and elevated pulmonary artery occluded. (PAo) pressure occurred in response to laryngoscopy and intubation in two patients; elevation of PAo pressure in response to aortic cross-clamping occurred in two patients. In three of these four patients, electrocardiographic evidence of myocardial ischemia appeared. These events are important in a consideration of the occurence of myocardial infarction in patients undergoing abdominal aortic surgery. Satisfactory treatment of myocardial ischemia has been accomplished with the use of propranolol hydrochloride and sodium nitroprusside.

Aged↗
PubMedDate not supplied

The difficult airway: mechanisms for effective dissemination of critical information.

The perioperative management and dissemination of critical information regarding a patient with an unexpected difficult intubation, including successful application of a difficult airway algorithm (Figure 1), are described. Documentation and dissemination of critical information include entry of patient data into an in-hospital computerized Difficult Airway/Intubation Registry, simultaneous application of a highly visible Difficult Airway/Intubation Patient Wrist Band (coded for access to computer registry), summary reports distributed to health care providers, and enrollment of the patient in the Medic Alert Foundation International's newly established category difficult airway/intubation for 24-hour access. We postulate that the widespread use of the procedures described in this report may reduce the contribution of unexpected difficult airway/intubation to anesthetic morbidity and mortality.

Algorithms↗
PubMedDate not supplied

Scanner technology for data-based decision making.

Scanner systems offer several benefits to nurse executives. Clinical, educational, and administrative data can guide the nurse executive's decisions providing greater control over patient care outcomes. Information from large patient care data sets provides a powerful tool for persuading executives in other departments. Additionally, the nurse executive who can eliminate the need for personnel to conduct time consuming and costly manual data entry, may be able to justify financial support for continued development of the nursing department's information system and technological training for the staff. In this way, scanner technology meets the immediate need for information and serves as an entry to more advanced communications systems.

Electronic Data Processing↗