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Biomedical subjects

M R Zeiderman

Publications and source records attributed to M R Zeiderman.

14 recordsLinked to original sources
PubMed1991

Influence of epidural analgesia upon postoperative fatigue.

This study examined the effect of epidural analgesia on the development of postoperative fatigue and the ability to ambulate after surgery. Seventeen patients admitted for elective abdominal surgery were randomized to receive postoperative analgesia with a continuous infusion of epidural fentanyl (epidural group) or intermittent intramuscular morphine (non-epidural group). Fatigue was assessed on an analogue scale of 1 (fit) to 10 (fatigued). Steady state measurements of respiratory gas exchange, respiratory rate, tidal volume and heart rate were made before operation and repeated on the third postoperative day. Energy expenditure was calculated from Weir's formula. Ambulatory measurements were made during treadmill walking at a work rate of 20 kpm min-1 (3.3 W). At rest, patients in both groups had a similar cardiorespiratory response to surgery irrespective of the method of analgesia. Subjective feelings of fatigue were significantly greater in those patients who had received epidural analgesia (P less than 0.01) and patients in this group expended significantly more energy in performing the postoperative exercise test than did those in the non-epidural group (P less than 0.05). The use of epidural opiate analgesia does not limit postoperative fatigue in patients undergoing upper abdominal surgery.

Abdomen↗
PubMed1990

Changes in cardiorespiratory and muscle function associated with the development of postoperative fatigue.

An understanding of the factors which contribute to postoperative fatigue may benefit the rehabilitation of patients after surgery. Subjective feelings of fatigue and fatigue measured objectively in the adductor pollicis muscle after ulnar nerve stimulation have been studied in relation to changes in cardiorespiratory function and muscular efficiency both at rest and when walking on a treadmill at a work rate of 20 and 56 kpm min-1. Twelve patients admitted for elective abdominal surgery were studied before operation and again on the third postoperative day. The postoperative period was characterized by an increased feeling of fatigue. Surgery had no effect upon fatigue in the adductor pollicis muscle suggesting that the genesis of postoperative fatigue is partly central in origin. Muscular efficiency (s.d.) fell from 34(6) per cent before operation to 22(3) per cent (P less than 0.05) on the third postoperative day and was accompanied by a 19 per cent rise in the net energy (s.d.) expenditure (7.3(0.8) to 8.6(0.3) kJ min-1; P less than 0.03) required to perform a given workload. The increased cardiorespiratory effort and reduced muscular efficiency associated with the performance of low-intensity exercise may limit mobilization after surgery and contribute to a greater feeling of fatigue.

Adult↗
PubMed1989

Metabolic changes in human liver associated with preoperative intravenous nutrition.

1. This study examined the influence of pre-operative intravenous nutrition upon carbohydrate stores, glucose metabolism and protein synthesis in the liver of patients undergoing laparotomy. 2. Thirty patients with gastrointestinal cancer and weight loss (greater than 5 kg in 3 months) were randomized to receive a hospital diet only or a hospital diet plus intravenous nutrition (0.18 g of N + 125 kJ day-1 kg-1) for 3 or 7 days before laparotomy. Patients who had not lost weight received the hospital diet only and formed a control group. 3. Wedge biopsies of liver were obtained at laparotomy and analysed for glycogen concentration, the activity of three key enzymes of glucose metabolism, 6-phosphofructokinase (EC 2.7.1.11), fructose bisphosphatase (EC 3.1.3.11) and hexokinase (EC 2.7.1.1), and the capacity for protein synthesis. 4. Compared with controls and the hospital diet group, both phosphofructokinase and fructose bisphosphatase activity were reduced in patients who received intravenous nutrition, suggesting the utilization of glucose for glycogen synthesis with a reduction in the glycolytic flux. Consistent with these changes, patients who received intravenous nutrition had a significantly higher glycogen concentration compared with the control and hospital diet groups. 5. Maximal rates of protein synthesis were achieved after only 3 days of intravenous nutrition. 6. The provision of intravenous nutrition was associated with changes in hepatic metabolism suggestive of repletion of energy stores and a higher capacity for protein synthesis.

Aged↗
PubMedDate not supplied

Influence of preoperative intravenous nutrition upon hepatic protein synthesis and plasma proteins and amino acids.

The influence of 3 and 7 days of preoperative intravenous nutrition (IVN) on the capacity for protein synthesis in liver and on concentrations of plasma proteins and amino acids were investigated in patients with gastrointestinal malignancy. Thirty patients with gastrointestinal neoplasms who had lost more than 5 kg of weight over 3 months were randomized into three groups to receive preoperatively: (a) no IVN, (b) IVN for 3 days (0.18 gN/kg/day as amino acid; 30 kcal/kg/day as glucose), or (c) IVN for 7 days. Free access to a hospital diet was available to all patients including 10 patients who had not lost weight who served as controls. In the three groups of patients who had lost weight, median transferrin and fibronectin were lower than for controls, whereas other proteins and amino acids were comparable. After feeding, samples of liver were obtained peroperatively and the potential rates of protein synthesis were calculated from the in vitro incorporation of (14C)-leucine, into protein. Preoperative IVN significantly increased the potential rate of protein synthesis in liver after 3 days. Plasma amino acids were comparable with controls whereas in the unfed-group concentrations suggested utilization of alanine and breakdown of muscle. Three days of IVN also increased plasma fibronectin and IgA but increases of prealbumin, IgM, and complement C3 were only significant in the group fed for 7 days. On the 7th postoperative day plasma proteins were decreased similarly in each group. This study shows that concentrations of several plasma proteins, in preoperative patients reflect net rates of hepatic protein synthesis and are susceptible to depletion during starvation and repletion by 3 or 7 days of IVN.

Aged↗