PubMed Health⌕ Search

Biomedical subjects

M Torjman

Publications and source records attributed to M Torjman.

18 recordsLinked to original sources
PubMed1998

Postoperative epidural analgesia following radical retropubic prostatectomy: outcome assessment.

BACKGROUND AND OBJECTIVES: We retrospectively examined the effects of epidural analgesia on patients undergoing radical retropubic prostatectomy (RRP). METHODS: Patients (203) underwent radical retropubic prostatectomy under either general or epidural anesthesia alone or a combined general epidural technique. Of those, 143 had an epidural catheter placed and underwent radical retropubic prostatectomy under general anesthesia followed by postoperative epidural analgesia (Group E+G). Twenty-eight patients had the operation under epidural anesthesia followed by epidural analgesia in the postoperative period (Group E). Thirty-two patients had general anesthesia for the operation and postoperative systemic analgesia (Group G). RESULTS: There were no significant differences between the groups with respect to age, height, weight, ASA status, or operation time. The length of postoperative hospital stay was significantly longer in the general anesthesia group patients as compared to the other two groups (P < 0.05). Intraoperative blood loss and blood replacement were significantly higher in the general anesthesia group (P < 0.001). There were no significant differences between the groups with respect to return of bowel function postoperatively, or incidence of complications. CONCLUSIONS: Epidural anesthesia and analgesia following radical retropubic prostatectomy have demonstrated a number of beneficial effects. These include decreased blood loss and shorter hospital stay.

Aged↗
PubMed1997

Transdermal fentanyl system plus im ketorolac for the treatment of postoperative pain.

PURPOSE: To assess the safety and efficacy of transdermal fentanyl plus im ketorolac vs im ketorolac alone in the treatment of postoperative pain. METHODS: Ninety-two patients scheduled for surgery involving moderate to severe postoperative pain were randomized to one of two groups. Group A (n = 46) received an active fentanyl patch and group P (n = 46) received a placebo patch. Patches remained in place for 24 hr. Each patient received intraoperative ketorolac, 60 mg im. Patients were monitored for 36 hr postoperatively and the groups were analyzed for ketorolac usage, pain scores, vital signs, serum fentanyl concentrations, and adverse events. Intramuscular ketorolac was available on demand. RESULTS: Group A had lower pain scores at 8.12, 16 and 24 hr after patch placement (P < 0.05). Group A had lower heart rates, lower respiratory rates and fewer dropouts due to inadequate pain relief (4.3% vs 21.7% P < 0.05). Group A patients also used less ketorolac than group P patients (P < 0.05). The incidence of pruritus was higher in group A patients (19% vs 2%, P < 0.05), while the incidence of nausea and vomiting was not different between the two groups. Transdermal fentanyl was adequate "stand-alone" analgesia in only 23.8% of group A patients while 93.7% of the remaining group A patients receiving a combination of transdermal fentanyl and ketorolac had adequate pain relief. CONCLUSION: The transdermal fentanyl delivery system plus ketorolac im was more effective in controlling post-operative pain than ketorolac im alone. The two treatment modalities were comparable in safety with no difference in serious adverse events.

Administration, Cutaneous↗
PubMed1996

Sevoflurane versus isoflurane for maintenance of anesthesia: are serum inorganic fluoride ion concentrations of concern?

Sevoflurane administration can result in increased serum inorganic fluoride ion concentrations, which have been associated with inhibition of renal concentrating ability. We measured serum fluoride levels, renal function, and recovery variables as a function of time in ASA grade I-III patients administered general anesthesia with isoflurane or sevoflurane for at least 1 h. Fifty patients were exposed to sevoflurane (< or = 2.4% inspired concentration) or isoflurane (< or = 1.9% inspired concentration) for maintenance of anesthesia as part of a multicenter trial. Blood was collected for determination of serum fluoride ion concentration, electrolytes, blood urea nitrogen, and creatinine at various time points pre- and postoperatively. Mean serum fluoride levels were significantly increased in sevoflurane versus isoflurane groups at all time points; the mean peak serum levels were 28.2 +/- 14 mumol/L at 1 h for sevoflurane and 5.08 +/- 4.35 mumol/L at 12 h for isoflurane. Sevoflurane-mediated increases in serum fluoride levels peaked at 1 h and, in general, decreased rapidly after discontinuation of the anesthesia. Three of 24 patients exposed to sevoflurane had one or more fluoride levels > 50 mumol/L. One of these patients had a serum inorganic fluoride ion level > 50 mumol/L at 12 h after sevoflurane, and an additional patient had fluoride levels > 33 mumol/L for up to 24 h after sevoflurane discontinuation. Those two patients also demonstrated an increase in serum blood urea nitrogen and creatinine at 24 h after sevoflurane administration compared with baseline. The elimination half-life of serum fluoride ion was 21.6 h. The results of this study suggest the possibility of sevoflurane induced nephrotoxicity.

Adult↗
PubMed1995

Sedative and ventilatory effects of midazolam infusion: effect of flumazenil reversal.

The purpose of this study was to evaluate the effects of flumazenil (1 mg i.v.) on the ventilatory response of premedicated patients receiving a continuous infusion of midazolam for sedation. After assessing baseline ventilatory function using a modified Read rebreathing method for determining hypercapnic ventilatory drive, 16 healthy outpatients were administered fentanyl, 50 micrograms i.v., and midazolam 2 mg i.v., followed by a variable-rate midazolam infusion, 0.3-0.5 mg.min-1. Upon termination of the midazolam infusion, serum midazolam concentrations were measured and ventilatory function was reassessed. Then, 10 ml either saline or flumazenil (1 mg) were administered according to a randomized, double-blind protocol. Ventilatory function was subsequently measured at 5 min, 30 min and 60 min intervals after study drug. Compared with the baseline value, midazolam infusion reduced tidal volume and increased respiratory rate and alveolar dead space. However, midazolam did not decrease the slope of the CO2-response curve. Flumazenil reduced the degree of midazolam-induced sedation and the decrease in tidal volume (P < 0.05), but not the change in resting respiratory rate. In some patients, the ventilatory response to hypercarbia actually decreased after flumazenil administration compared with the immediate prereversal (sedated) values. It is concluded that midazolam infusion, 0.43 mg.min-1, did not impair CO2-responsiveness. Flumazenil's effect on central ventilatory drive was more variable than its reversal of midazolam-induced sedation.

Adult↗
PubMed1995

Intraoperative hemodynamic, renin, and catecholamine responses after prophylactic and intraoperative administration of intravenous enalaprilat.

This study was designed to evaluate effects of enalaprilat, an angiotensin-converting enzyme inhibitor, on hemodynamic and hormonal responses during surgery at endotracheal intubation, incision, and limb-tourniquet inflation. Thirty patients undergoing limb procedures with general anesthesia (N2O/narcotic technique) and a pneumatic tourniquet were randomized to receive either preoperative enalaprilat (1.25 mg intravenously [i.v.] 20 min prior to induction) or intraoperative enalaprilat (0.625 mg i.v. at the onset of tourniquet-associated hypertension), with appropriate placebo controls. Arterial blood pressure and heart rate increased significantly in response to intubation in the placebo group. Although there were no significant differences in catecholamine levels, plasma renin activity was significantly increased at postincision in the preoperative-enalaprilat group versus the placebo group. This suggests that activation of the renin-angiotensin system may play a key role in mediation of intraoperative hemodynamic responses to endotracheal intubation. With respect to tourniquet hypertension, preoperative or intraoperative treatment with enalaprilat reduced neither the pressor response to tourniquet inflation nor the amount of enflurane subsequently required to control arterial blood pressure. These findings suggest that this response is mediated by pain pathways, and may be treated more effectively with anesthesia/analgesia.

Adolescent↗
PubMed1995

A comparison of four bedside methods of hemoglobin assessment during cardiac surgery.

The purpose of this study was to compare the accuracy of conductivity, adjusted conductivity, photometric, and centrifugation methods of measuring or estimating hemoglobin (Hb) with Coulter measured HB as the reference. These bedside methods were studied in 25 cardiac surgery patients during euvolemia and hemodilution and after salvaged autologous red blood cell transfusion. In vivo patient blood samples were obtained before induction, at the start of cardiopulmonary bypass (CPB), after CPB, and after blood transfusion. In 10 patients, blood was sampled in vitro from units of processed blood. Hb values were determined using conductivity by Stat-Crit, adjusted conductivity by Nova Stat Profile 9, bedside photometry by HemoCue, and centrifugation methods. The calculated bias values of Coulter test method Hb (mean +/- SD) for in vivo patient blood samples (n = 90) were: Stat-Crit = 0.6 +/- 0.8 g/dL; Nova Stat Profile 9 = -0.7 +/- 0.4 g/dL; HemoCue = -0.1 +/- 0.2 g/dL; and centrifuge = 0.1 +/- 0.5 g/dL (P < 0.0001). Hb bias values (g/dL) for in vitro samples (n = 10) obtained from processed blood were Stat-Crit = 5.1 +/- 0.6; Nova Stat Profile 9 = 3.0 +2- 0.6; HemoCue = 0.4 +/- 0.4; and centrifuge = 0.6 +/- 0.3 (P < 0.0001). Hb assessment by different test methods may be significantly affected during hemodilution and after blood transfusion. In vitro conditions exaggerated the inaccuracy of conductivity and adjusted conductivity Hb estimates. The rank order of closest approximation to the Coulter measurement for all in vivo blood samples was provided by bedside photometry, followed by centrifugation, adjusted conductivity, and uncorrected conductivity methods.

Analysis of Variance↗
PubMed1993

The pharmacokinetics of droperidol in anesthetized children.

Despite the wide use of droperidol to reduce nausea and vomiting in children, its pharmacokinetics have not been described in pediatric patients. Twelve ASA Class I-II children, undergoing tonsillectomy and adenoidectomy, received standardized anesthesia; none of the children received premedication. After induction of general anesthesia, droperidol (0.05 mg/kg) was injected intravenously as a bolus. Droperidol plasma concentrations were determined by radioimmunoassay. Pharmacokinetic data were analyzed by model-independent methods. The pharmacokinetic parameters (mean +/- SD) for the studied population were elimination half-life: 101.5 +/- 26.4 min, mean residence time: 127.2 +/- 28.6 min, volume of distribution at steady state: 0.58 +/- 0.29 L/kg and clearance: 4.66 +/- 2.28 mL.kg-1 x min-1. The clearance and volume of distribution at steady state values are lower than those reported for the adult population, and they apparently decreased in a parallel fashion. The smaller volume of distribution at steady state is consistent with the lipophilic distribution of droperidol and the reduced content of adipose tissue in children. The elimination half-time and mean residence time values are similar to those reported previously for adults. The relatively short half-life of droperidol for our pediatric population does not explain its extended antiemetic action. It does, however, reaffirm that the pharmacokinetic duration of a drug's action is only one of the determinants of its clinical duration.

Anesthesia, Inhalation↗
PubMed1992

Time-course of respiratory depression after an alfentanil infusion-based anesthetic.

Postoperative respiratory depression after alfentanil administration has been described in several case reports. The effects of a prolonged alfentanil infusion on the CO2 response curve or cognitive function have not been studied. Twenty-one ASA physical status I or II patients were studied after a prolonged alfentanil infusion (> 90 min) to determine the incidence of postoperative respiratory depression, arterial O2 desaturation, and impairment of cognitive function. Each patient's recovery was observed at 30-min intervals for evidence of respiratory depression (utilizing the Read CO2 rebreathing method), desaturation by pulse oximetry (severe desaturation defined as arterial O2 saturation < 90%), and cognitive function (utilizing Trieger dot and digit substitution tests). Plasma samples were also examined for secondary elevations in alfentanil plasma concentrations. Significant depression of the CO2 response curve and cognitive function was found up to 1 h postoperatively. Arterial O2 desaturation was seen in 11 of 21 patients (52%). No correlation was found between arterial O2 desaturation and cognitive function scores or CO2 rebreathing results. Increased depression of the CO2 response curve was not necessarily associated with severe desaturation episodes. A secondary increase in plasma alfentanil concentration was detected in 5 of the 21 patients (24%), but these patients did not experience further depression of the CO2 response curve. We conclude that prolonged alfentanil administration may result in severe arterial O2 desaturation with significant depression of the hypercapnic respiratory drive during the first hour in the postanesthesia care unit, even though the majority of our patients were easily aroused in response to verbal stimuli.

Adult↗
PubMed1990

Relationship between arterial carbon dioxide and end-tidal carbon dioxide when a nasal sampling port is used.

End-tidal carbon dioxide (ETCO2) values obtained from awake nonintubated patients may prove to be useful in estimating a patient's ventilatory status. This study examined the relationship between arterial carbon dioxide tension (PaCO2) and ETCO2 during the preoperative period in 20 premedicated patients undergoing various surgical procedures. ETCO2 was sampled from a 16-gauge intravenous catheter pierced through one of the two nasal oxygen prongs and measured at various oxygen flow rates (2, 4, and 6 L/min) by an on-line ETCO2 monitor with analog display. Both peak and time-averaged values for ETCO2 were recorded. The results showed that the peak ETCO2 values (mean = 38.8 mm Hg) correlated more closely with the PaCO2 values (mean = 38.8 mm Hg; correlation coefficient r = 0.76) than did the average ETCO2 values irrespective of the oxygen flow rates. The time-averaged PaCO2-ETCO2 difference was significantly greater than the PaCO2-peak ETCO2 difference (P less than 0.001). Values for subgroups within the patient population were also analyzed, and it was shown that patients with minute respiratory rates greater than 20 but less than 30 and patients age 65 years or older did not differ from the overall studied patient population with regard to PaCO2-ETCO2 difference. A small subset of patients with respiratory rates of 30/min or greater (n = 30) did show a significant increase in the PaCO2-ETCO2 difference (P less than 0.001). It was concluded that under the conditions of this study, peak ETCO2 values did correlate with PaCO2 values and were not significantly affected by oxygen flow rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Arteries↗
PubMed1990

A comparison of labetalol and nitroprusside for inducing hypotension during major surgery.

The hemodynamic and intrapulmonary shunt effects of intravenous labetalol and nitroprusside were compared during induced hypotension for major spinal surgery. A randomized, double-blind protocol was used in which 20 patients, ASA physical status I or II, received either nitroprusside infusion (n = 10) or labetalol bolus injections of 10 mg every 10 min (n = 10) until mean arterial blood pressure was reduced to 55-60 mm Hg. Pulmonary artery pressures were measured and mixed venous samples obtained via a pulmonary artery catheter. Nitroprusside increased heart rate significantly more than labetalol during the period of hypotension. When compared with prehypotension baseline values, nitroprusside increased heart rate significantly with a concomitant significant decrease in systemic vascular resistance. Cardiac output increased significantly 60 min after hypotension was achieved in patients treated with nitroprusside. Systemic vascular resistance decreased significantly below baseline levels in patients treated with labetalol but without changes in cardiac output, heart rate, or mean pulmonary artery pressure. There was a 122% increase in intrapulmonary shunt with nitroprusside administration, compared with an 11% increase with labetalol. Labetalol was effective for inducing hypotension and was not associated with an increase in heart rate, intrapulmonary shunt, or cardiac output as seen with nitroprusside.

Adult↗
PubMed1989

Effects of diazepam and flumazenil on sedation and hypoxic ventilatory response.

We evaluated the effects of a benzodiazepine antagonist, flumazenil (Ro 15-1788), 1 mg intravenous, on the hypoxic ventilatory response in 10 healthy patients who had received diazepam 0.97 +/- 0.34 mg/minute (mean +/- SD) for sedation during minor operative procedures. When assessed using a sedation analog scale, flumazenil significantly decreased diazepam-induced sedation. In only two of the five patients with evidence of diazepam-induced depression of the ventilatory response to hypoxia was there significant reversal of this depression after flumazenil administration. Finally, patients in whom the duration of sedation with diazepam was shorter (78 +/- 14 minutes) had a significantly greater decrease in the slope of their hypoxic ventilatory response curve (1.3 +/- 0.8 L.min-1.%sat-1 [-43% from baseline]) than did patients with longer sedation times (145 +/- 37 minutes duration; 2.0 +/- 0.8 L.min-1.%sat-1 [-5% from baseline]). These data suggest that flumazenil, 1 mg intravenous, is only partially effective in reversing diazepam-induced depression of hypoxic ventilatory drive and that tolerance may develop to the respiratory depressant effects of diazepam.

Adult↗
PubMedDate not supplied

Do heated humidifiers and heat and moisture exchangers prevent temperature drop during lower abdominal surgery?

STUDY OBJECTIVE: To compare the effects of using a heated humidifier (HH), a heat and moisture exchanger (HME), or no warming device in maintaining body temperature during surgical procedures of 1 to 4 hours' duration. DESIGN: A randomized, controlled study. SETTING: Operating room, Thomas Jefferson University Hospital, Philadelphia, PA. PATIENTS: 51 ASA physical status I, II, and III patients, age 16 to 69 years, scheduled for a variety of lower abdominal procedures under general endotracheal anesthesia anticipated to last 1 to 4 hours. INTERVENTIONS: We randomly assigned patients to receiving an HH, an HME, or no warming device during the procedure. We then measured the patient's sublingual temperature every 5 minutes prior to induction, every 15 minutes intraoperatively, and every 15 minutes postoperatively until he or she was discharged from the postanesthesia care unit, (PACU). We also measured the esophageal temperature every 15 minutes intraoperatively. MEASUREMENTS AND MAIN RESULTS: Sublingual temperature or esophageal temperature probes placed at the site of maximal heart tones indicated that the patients' temperatures dropped significantly from baseline values in all three groups during the first 60 minutes of surgery, then remained constant during the next 120 minutes of surgery. Patients who had no warming device shivered and felt cold significantly more often than patients in the HH group but not more often than patients in the HME group. There was no difference in shivering between the HH and HME groups. The patients who received an HH tended to have a higher temperature (a mean of 0.5 degrees C) throughout the study, but this did not reach statistical significance. CONCLUSIONS: Results indicate that these warming devices provide little benefit in preventing a temperature drop during procedures of 1 to 4 hours' duration, although patients with an HH tended to have a higher temperature than those with an HME or no device.

Abdomen↗
PubMedDate not supplied

Fenoldopam infusion for the treatment of postoperative hypertension.

STUDY OBJECTIVE: To examine the safety and efficacy of intravenous fenoldopam as compared to placebo for the treatment of postoperative hypertension. DESIGN: Randomized, placebo-controlled, double-blind study. SETTING: Community hospital. PATIENTS: 16 ASA I-III hypertensive patients scheduled for noncardiac surgical procedures. INTERVENTIONS: Treatment with fenoldopam or placebo was initiated immediately after other causes of hypertension had been ruled out. Hypertension was defined as a supine systolic blood pressure (SBP) or diastolic blood pressure (DBP) greater than 20% over the patient's preoperative baseline, which was obtained 6 hours prior to the procedure with the patient lying quietly. The baseline consisted of 3 consecutive blood pressure (BP) measurements obtained at 5-minute intervals and not varying by more than 10%. Fenoldopam or placebo infusion was initiated at 0.1 microgram/kg/min and increased and decreased as necessary until the therapeutic goal BP was reached or treatment failure had occurred. The therapeutic goal BP was a decrease to at least 10% above the preoperative baseline, and failure of treatment was defined as inability to reach this BP level after 15 minutes at 1.5 micrograms/kg/min. MEASUREMENTS AND MAIN RESULTS: BP and heart rate (HR) data were collected consistently throughout the study and 1 hour after termination of infusion. Laboratory studies and 12-lead electrocardiographic results were obtained at the start of the study and repeated 24 hours after termination of infusion. Blood samples were obtained for the measurement of epinephrine, norepinephrine, and dopamine levels and were analyzed using high-performance liquid chromatography with electrochemical detection. Pretreatment BP measurements were significantly elevated from baseline in both groups. Fenoldopam treatment significantly reduced BP to the therapeutic goal in 8 of 8 patients; placebo reduced BP to this goal in only 4 of 8 patients (p < 0.05). At the end of the titration period, the therapeutic goal BP was not significantly different from baseline in the fenoldopam group. HR was significantly elevated (p < 0.05) at goal in the fenoldopam group as compared with the placebo group. Fenoldopam administration lowered SBP and DBP to goal in a mean time of 28 minutes versus 42.5 minutes in the placebo group. There were no significant differences in catecholamine levels at any of the measurement periods. CONCLUSION: Fenoldopam is an effective drug for reducing BP following hypertensive episodes in the postoperative setting. Fenoldopam use is associated with an increase in HR versus placebo.

2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-ben↗
PubMedDate not supplied

Does the use of methylmethacrylate cement in total shoulder replacement induce hemodynamic or pulmonary instability?

STUDY OBJECTIVE: To investigate whether the use of methylmethacrylate cement causes hemodynamic or pulmonary instability during total shoulder replacement surgery. DESIGN: Prospective, nonrandomized study. SETTING: Operating room. PATIENTS: 9 ASA physical status I and II patients. INTERVENTIONS: A 20-gauge radial artery catheter was placed in the wrist opposite the surgical site. Sedation with midazolam was provided, and a pulmonary artery catheter was placed through an 8.5-Fr introducer into the patient's right internal jugular vein. MEASUREMENTS AND MAIN RESULTS: Before induction of anesthesia, systolic, diastolic, and mean arterial blood pressures; heart rate; central venous pressure; systolic, diastolic, and mean pulmonary artery pressures; pulmonary capillary wedge pressure; and thermodilution cardiac output measurements were obtained. Arterial and mixed venous blood gas samples also were collected and analyzed for calculation of Qs/Qt. These hemodynamic and pulmonary parameters were measured again just before cementing of each prosthesis with methylmethacrylate cement and at 1, 5, 10, and 20 minutes after cementing. There were no statistically significant changes in any of the measured hemodynamic parameters at any time. There was no statistically significant difference in the calculated intrapulmonary shunt fraction. CONCLUSION: In this study population, the use of methylmethacrylate for total shoulder replacement was not associated with adverse hemodynamic events or increased intrapulmonary shunting.

Aged↗