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Biomedical subjects

J H Tinker

Publications and source records attributed to J H Tinker.

At least 55 records · Page 3Linked to original sources
PubMed1983

Glucose management in patients undergoing operation for insulinoma removal.

Medical records of 38 patients undergoing anesthesia and surgery for removal of an insulinoma were reviewed to determine 1) the safety of avoiding intraoperative glucose, 2) the appropriate frequency of plasma glucose analysis, and 3) the accuracy of using rebound hyperglycemia as an indication of tumor removal. Plasma glucose was determined approximately every 15 min during operative and recovery-room periods. The changes in plasma glucose concentrations before tumor removal were compared with those occurring after the resection in each patient by separate linear regressions of glucose concentration versus time. The slopes of the preresection regression lines averaged +0.196 (+/- SD 0.577) mg X dl-1 X min-1. The mean of the postresection slopes was +0.624 (+/- SD 0.339) mg X dl-1 X min-1. The mean difference in slope (post- minus pre-) was +0.426 (+/- SD 0.748) mg X dl-1 X min-1, indicating that a significant (P less than 0.02) increase in post-resection slope had occurred. In no case did a preresection plasma glucose concentration decrease to less than 50 mg X dl-1 if the previous value had been 60 mg X dl-1 or greater. Nonetheless, there were nine patients whose plasma glucose did decrease to less than 50 mg X dl-1 at some time during the operative course. Only 39% of patients showed a rebound of 20 mg X dl-1 or more in the first 30 min after resection. The authors conclude that intermittent sampling is safe as long as plasma glucose is kept above 60 mg X dl-1 by infusing glucose.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma, Islet Cell↗
PubMed1983

Beta-adrenergic agonists and antagonists.

Beta adrenergic antagonists are a complex group of agents. The profusion of newer agents will allow us to discover nuances of difference between them, but that will be a future development. Currently, our concerns should be obtaining extensive experience with propranolol, controlling intraoperative and postoperative tachycardia; using beta blockade as adjunctive therapy during vasodilator administration; using beta blockade as part of "balanced" anesthesia, especially in patients with coronary artery disease; and learning sophisticated ways of preoperatively and intraoperatively evaluating hemodynamics so as to be able to decide when and how to best utilize the drugs. Beta agonists recently introduced include dopamine and dobutamine. Differences and similarities are numerous. Overriding in adults, at least, may be the ability of dopamine to stimulate renal dopaminergic receptors to increase renal blood flow.

Adrenergic beta-Agonists↗
PubMed1982

Beneficial effects of multidose coronary artery washout during elective cardiac arrest and cardiopulmonary bypass: biochemical and hemodynamic evaluation.

Coronary artery washout with buffered saline (pH 7.4) during 60 and 120 minutes of elective cardiac arrest was studied in dogs during moderate hypothermic cardiopulmonary bypass. Compared with results in a group undergoing simple ischemic arrest, significantly greater myocardial adenosine triphosphate concentrations were present at 90 and 120 minutes of cardiac arrest in the coronary artery washout group. After 60 minutes of aortic cross-clamping and 60 minutes of reperfusion, left ventricular function was significantly superior in the coronary artery washout group. Coronary artery washout during the period of aortic cross-clamping preserves dynamic myocardial performance during reperfusion and is an important principle of myocardial protection during elective cardiac arrest.

Adenine Nucleotides↗
PubMed1981

A pharmacologic and toxicological study of amygdalin.

Six patients with advanced cancer were treated with amygdalin (laetrile) at dosages similar to those employed by laetrile practitioners. Amygdalin given intravenously at 4.5 g/sq m/day was largely excreted unchanged in the urine and produced no clinical or laboratory evidence of toxic reaction. Amygdalin given orally at 0.5 g three times daily produced significant blood cyanide levels to 2.1 microgram/mL. No clinical or laboratory evidence of toxic reaction was seen in the six patients taking oral amygdalin at this dosage. One patient, however, challenged with a large intake of raw almonds, had transient symptoms of cyanide toxic reaction with escalating blood cyanide levels. This small study indicates that amygdalin in the doses employed produces few clinical side effects. A definite hazard of cyanide toxic reaction must be assumed, however, and possible long-term side effects remain unknown.

Administration, Oral↗
PubMed1981

Hypothermia plus thiopental: prolonged electroencephalographic suppression.

Duration of EEG suppression was compared to three groups of patients undergoing hypothermic cardiopulmonary bypass (CPB) at 25-30 degrees C under halothane-nitrous oxide anesthesia. Group I (n = 8) received three doses of thiopental (8 mg/kg i.v.): 1) for induction of anesthesia, 2) immediately after the institution of CPB, and 3) just after emergence from CPB. Group II (n = 5) received no thiopental. Group III (n = 4) received thiopental, 8 mg/kg administered intravenously, during CPB only. An unexpectedly prolonged duration of EEG suppression (26.1 min) was noticed in Group I patients with thiopental and hypothermia in combination, as compared with 4.8 min of suppression in Group II patients during hypothermic CPB without thiopental. To rule out a possible cumulative effect of thiopental administration, Group III patients were studied. With only a single dose of thiopental, administered during CPB, 29.3 min of EEG suppression was noticed. Mild cardiovascular depression occurred with thiopental administration during induction of anesthesia, whereas mild-to-moderate depression was associated with thiopental administration following emergence from CPB. It appears that thiopental and hypothermia, when administered in combination in modest doses during CPB, result in profound depression of cerebral electrical activity and presumably cerebral metabolism.

Adult↗
PubMed1980

Hypothermia after cardiopulmonary bypass in man: amelioration by nitroprusside-induced vasodilation during rewarming.

The incidence, time course, and magnitude of hypothermia following apparently adequate rewarming from hypothermic cardiopulmonary bypass (defined as a nasopharyngeal temperature [NPT] of 37 C) were studied in 20 adult patients (Group I). In each patient a decrease in NPT (averaging 2.6 +/- .2 C) occurred during the 80-min intraoperative postbypass period. The NPT had stabilized approximately 45 min after the end of bypass. Eight additional patients (Group II) received pharmacologic vasodilation with nitroprusside during the rewarming period. Pump flow was increased as nitroprusside was infused to maintain mean arterial pressure greater than or equal to 70 torr. Group II patients maintained NPT significantly better in the postbypass period than did Group I patients (NPT decrease of 1.5 +/- .4 C, P < 0.01, a 42 per cent improvement). As in Group I, NPT in Group II had stabilized 45 min after bypass. Ambient air temperatures between 18 and 23 C had no effect on NPT decrease. Presumed peripheral heat delivery was found to be greater in Group II. It is concluded that postbypass NPT decreases occurred in all patients, but that these decreases were significantly lessened by pharmacologic vasodilation plus deliberately increased pump flow during rewarming on bypass.

Cardiopulmonary Bypass↗
PubMed1980

Anesthesia for patients with ischemic heart disease.

The suggested anesthetic management of patients with potentially ischemic myocardium is as follows: 1. Careful work-up before proceeding if angina is present preoperatively. 2. Heavy premedication, attention to factors of preoperative anxiety, and avoidance of unnecessary painful procedures in the awake patient. Do not stop propranolol. 3. Monitoring of ST segments via V5 lead during anesthesia. Do not permit large fluctuations in systolic blood pressure or large increases in heart rate. 4. Maintenance of patient's temperature to obviate postoperative shivering. 5. Treatment of increased heart rate and ST segment changes with propranolol in 0.25-mg I.V. increments every 1 to 3 minutes until improvement noted (reasonable acute dose limit is 2 to 3 mg). 6. Treatment of ventricular arrhythmias with lidocaine bolus (50 to 100 mg) and infusion if more than one bolus is required (1 to 2 mg/70 kg/min), plus usual blood gases and electrolytes.

Anesthesia↗
PubMed1978

Myocardial reinfarction after anesthesia and surgery.

During the years 1974 and 1975 at our institution, 587 patients who had suffered previous myocardial infarctions underwent anesthesia and surgery. Thirty-six (6.1%) had a reinfarction and 25 (69%) died. Patients operated on within three months of the previous infarction had a 27% reinfarction rate. This decreased to 11% if the infarct had occurred three to six months previously and stabilized at 4% to 5% if the interval was more than six months. Risk factors associated with significantly increased reinfarction rates included preoperative hypertension, intraoperative hypotensive episodes, and noncardiac thoracic or upper abdominal operations of more than three hours' duration. Time under anesthesia was strikingly correlated with reinfarction rates in the entire group. Postoperative intensive care unit admission did not significantly affect the reinfarction rate, nor did diabetes, angina, patient age or sex, or site of the previous myocardial infarction.

Adult↗
PubMed1978

Discontinuing anticoagulant therapy in surgical patients with cardiac valve prostheses. Observations in 180 operations.

Between 1962 and 1975, a total of 159 patients with previously implanted man-made cardiac valve prostheses underwent 180 subsequent noncardiac operations at Mayo Clinic. All of these patients were receiving anticoagulants. The overall incidence of their documentable thromboembolic complications was approximately 10%. None of the postoperative complications occurred while the patient was in hospital, with the earliest such complication seen two years later. Patients receiving anticoagulants on a long-term basis did, however, have a 13% incidence of various difficulties with hemostasis during and following the later operations. We conclude that there is minimal risk to patients with cardiac valve prostheses who are receiving anticoagulants when the drug regimen is stopped for one to three days preoperatively and one to seven days postoperatively.

Adolescent↗