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Biomedical subjects

M M Saied

Publications and source records attributed to M M Saied.

11 recordsLinked to original sources
PubMed1997

Morphine-midazolam combination doses for presurgical analgesia in children.

We have examined the use of presurgical morphine-midazolam combination in 80 children aged 2-10 y undergoing repair of hypospadias. They were allocated randomly, in a double-blind study, to receive one of four morphine-midazolam combination doses (n = 20 each); (group I: 75 microg/kg each) [corrected] (group II: 75 microg/kg [corrected] morphine, 50 microg/kg [corrected] midazolam); (group III: 50 microg/kg [corrected] morphine, 75 microg/kg [corrected] midazolam); (group IV: 50 microg/kg [corrected] each). Drugs were given after induction of anesthesia and before the start of surgery. Observational scoring system, using crying, movement, agitation, posture and localization of pain as scoring criteria, was used to assess the children during their stay in the recovery room together with their sedative and/or analgesic requirement. Pre-surgical morphine-midazolam administration produced stable hemodynamic variables with satisfactory postoperative analgesia suggesting 75 microg/kg [corrected] dose of both morphine and midazolam as upper permissible dose, and 50 microg/kg [corrected] each as lower effective dose.

Analgesics, Opioid↗
PubMed1995

Hemodynamic and oxygenation variables during radical cystectomy. Does the anesthetic technique really matter?

The effect of anesthetics on hemodynamic variables (HV) has been clarified, but ambiguity existed concerning their effect on oxygenation variables (OV). Radical cystectomy provided a clinical setting for studying the effect of anesthetics on perioperative HV and OV. Patients subjected to radical cystectomy (n = 33) were assigned through balanced randomization to receive one of four anesthetic modalities, namely; group I: inhalation anesthesia using N2O:O2, halothane, d-tubocurarine (n = 11); group II: inhalation anesthesia using N2O:O2, halothane, d-tubocurarine, and supplemented with epidural analgesia (EA) (n = 11); group III: total intravenous anesthesia (TIVA) using ketamine 10-30 ug.kg-1.min-1, propofol 2 mg.kg-1.h-1, d-tubocurarine, and supplemented with continuous EA (n = 6): and group IV:TIVA using ketamine 20-50 ug.kg-1.min-1, midazolam in increments of 1.5 to 5 mg, and supplemented with intermittent EA (n = 5). Monitoring entailed continuous ECG, pulse oximerty, invasive arterial pressure, and pulmonary artery catheter for HV (HR, MAP, PAP, PAOP, CO, SVR, and PVR) and OV. (PaO2, SaO2, PvO2, SvO2, a-vDO2, O2ext, Qs/Qt, DO2, and VO2). The heart rate was lower in TIVA while other HV did not show striking differences, Group I showed higher arterial oxygen tension than group II and IV. Mixed venous oxygen tension and saturation were higher in group I over group IV. Other OV did not show remarkable differences. In conclusion, HV and OV in 4 anesthetic modalities did not elicit striking differences.

Adult↗
PubMed1993

Presurgical analgesia in children subjected to hypospadias repair.

We have examined the use of different pre-surgical analgesic techniques in 30 children aged 2-10 yr undergoing repair of hypospadias. They were allocated randomly, in a double-blind, placebo-controlled study, to receive one of three analgesic techniques (n = 10): lumbar extradural analgesia using 0.5% bupivacaine 1 mg kg-1 plus morphine 50 micrograms kg-1; morphine 100 micrograms kg-1 i.m.; or subpubic block using 0.5% bupivacaine 0.5 mg kg-1 for each side. Analgesics were given after induction of anaesthesia and before the start of surgery. Children given extradural analgesia had more stable haemodynamic variables and smaller catecholamine concentrations and needed less anaesthetic supplementation, with no analgesic requirement in the postoperative period. Nausea or vomiting were not reported in children given subpubic block.

Analgesia, Epidural↗
PubMed1993

Does timing of hemodilution influence the stress response and overall outcome?

This study was designed to assess the stress response of acute hemodilution (AH) in patients subjected to radical cystectomy. Forty adult male patients were randomly allocated into a control group (n = 10) where homologous blood transfusion was used, a preinduction AH group (n = 20) where AH was performed before lumbar epidural block and induction of anesthesia, and into a postinduction group (n = 10) where AH was performed after induction of anesthesia. Monitored variables included hemodynamic, hematological and coagulation factors, liver function tests, and serum hormones. AH performed in awake or in anesthetized patients did not result in significant hemodynamic disruption, or result in detectable end-organ or stress-hormone changes when compared to control patient outcomes after radical cystectomy. Hemodilution can be performed by protocol for patients who are undergoing this procedure without major adverse effects.

Adult↗
PubMed1993

Ketamine anesthesia for short transurethral urologic procedures.

Ketamine (K) is a good analgesic and anesthetic agent in short procedures, but the associated cardiovascular responses and emergence reactions limit its use. Benzodiazepines have been used to improve recovery with favourable reports for midazolam (M). Methylphenidate (MPH), the mild CNS stimulant, improves behaviour and mental concentration and can be used to improve recovery from K anesthesia. This was tested, alone and in combination with M by a double-blind study in 30 patients subjected to short transurethral urologic procedures. Patients were randomized into 3 equal groups to receive K-MPH, K-M or K-M-MPH. M (7.5 mg) was mixed with K and MPH (20 mg) was given at the end of urologic procedures. Perioperative monitoring included pulse rate, blood pressure, ECG, and plasma catecholamines. Recovery was assessed by a triad VAS and recovery area was calculated. Distribution-free statistics were used to assess intergroup differences of similar variables. Ketamine produced satisfactory anesthesia for short transurethral urologic procedures. Addition of M did not change the cardiovascular responses of K but resulted in smooth recovery with no changes in the recovery scores. MPH did not improve the recovery scores but increased the incidence of vomiting, excessive talking, and limb movements.

Adult↗
PubMed1992

Renal effect of dopexamine hydrochloride in patients with chronic renal dysfunction.

Dopexamine hydrochloride, a dopamine analogue, has been reported, both experimentally and clinically, to increase renal blood flow (RBF) and improve renal function in normal kidneys. The availability of computer-enhanced radionuclide scintigraphy, which provides accurate non-invasive measurement of changes in RBF, enabled us to study the renographic effects of dopexamine hydrochloride in patients with chronic renal dysfunction (CRD). Ten patients suffering from CRD and ten normal kidney donors were the study population. Renography was performed, heart rate (HR) and blood pressure (BP) measured, and hematological and biochemical tests carried out before and after intravenous infusion of dopexamine 2 micrograms kg-1 min-1 for 60 min. The patient population displayed significant increases in total cortical and medullary RBF and renographic clearance rate (CR), while in kidney donors the RBF was increased in all kidney regions with no change in CR. HR increased in both groups, while BP showed no significant changes. The hematological and biochemical changes were transient and returned to preinfusion levels after 24 h. It is concluded that dopexamine hydrochloride 2 micrograms kg-1 min-1 increases RBF and CR in patients with CRD.

Adult↗
PubMed1992

Neuromuscular blocking activity of tubocurarine in patients with diabetes mellitus.

Previous clinical reports have suggested that deep tendon reflexes of diabetic patients are delayed and experimental studies have reported differential sensitivity of motor endplates to neuromuscular blocking drugs. These observations prompted us to study the neuromuscular effect of tubocurarine in 25 diabetic and 15 non-diabetic patients during urological surgery. Anaesthesia was induced with thiopentone followed by suxamethonium and maintained with nitrous oxide in oxygen and increments of butorphanol. Muscle relaxation was provided with tubocurarine in an initial dose of 0.25 mg kg-1 and increments of 20% of the initial dose. At the end of surgery, residual neuromuscular block was antagonized with increments of neostigmine 0.5 mg and atropine 0.2 mg. There was a delay in the onset of action of tubocurarine in diabetic patients. A no-response state was obtained in some patients, and its duration correlated with post-tetanic count (PTC) in diabetic patients, and with post-tetanic twitch height percent (PTTH%) in the control group. We concluded that, in diabetic patients, the onset of action of tubocurarine was delayed compared with control patients, and the reliable predictor of the duration of the no-response time was PTC in diabetic patients and PTTH% in non-diabetic subjects.

Adult↗
PubMed1992

Spinal versus epidural anesthesia during transurethral resection of the prostate.

The operative superiority of epidural anesthesia during transurethral resection of the prostate (TURP) stimulated this study. Twenty patients scheduled for TURP were randomly allocated to receive either spinal anesthesia (n = 10) with 8 ml bupivacaine 0.5%+ 5ml lignocaine 2%. During and after the operative procedure, PR, BP, ECG, and pulse oximetry were monitored, and blood Hb and Hct, plasma free Hb, and serum sodium and potassium levels were measured. Both techniques resulted in similar PR and BP changes. TURP with spinal anesthesia resulted in more prolonged period of hyponatremia and more increased duration of raised plasma free Hb.

Aged↗
PubMed1991

Spinal and interpleural bupivacaine for percutaneous nephrolithotomy.

The promising interpleural block (IPB) technique stimulated the comparison of its adjuvant effect to spinal analgesia for percutaneous nephrolithotomy (PCNL) with that of meperidine-diazepam. Twenty five patients receiving spinal analgesia 15 mg 0.5% heavy bupivacaine for PCNL were randomly allocated to receive the adjuvant effect of either meperidine 1 mg/kg IV and diazepam 10 mg total dose (n = 10) or IPB with 10 ml 0.5% plain bupivacaine (n = 15). It was found that IPB produced a totally pain free operation and needed less frequent administration in the postoperative period, while meperidine-diazepam produced a pain free in 20% of patients and needed more frequent postoperative meperidine (1 mg/kg IM) administration.

Adult↗
PubMedDate not supplied

Does spinal anesthesia affect cerebral oxygenation during transurethral prostatectomy?

BACKGROUND AND OBJECTIVES: Transurethral resection of the prostate (TURP) is associated with the unique complication of transurethral resection of prostate syndrome (TURS), which is attributed to the absorption of irrigating fluid. This study was initiated to investigate the effects of spinal anesthesia and TURP on cerebral oxygen balance. METHODS: Thirty patients scheduled for TURP were included. Jugular bulb oxygen saturation (SjbO2) was measured via retrograde cannulation of jugular venous bulb. Spinal anesthesia was initiated by 3 mL hyperbaric 0.5% bupivacaine injected at L3-L4 in the sitting position, producing a block to the T10 dermatome. Hemodynamic measurements and arterial and jugular bulb blood gasometry were performed before and after spinal anesthesia, throughout surgery, and during the postoperative period. RESULTS: A significant decrease of cerebral perfusion pressure after spinal anesthesia was accompanied by a significant decrease of SjbO2 below a preoperative value of 61% +/- 1. Eight patients developed yawning, irritability, restlessness, and nausea toward the end of surgery, and these were considered to be early signs of TURS. These patients demonstrated SjbO2 below 55% and 50% in 63% and 42% of respective data set points. CONCLUSION: The neurologic symptoms in patients undergoing TURP during spinal anesthesia might not only be caused by absorption of irrigating fluid but also by impairment of cerebral oxygenation.

Aged↗