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Biomedical subjects

P M Kempen

Publications and source records attributed to P M Kempen.

At least 19 recordsLinked to original sources
PubMed1999

Right ventricular rupture during closed-chest cardiopulmonary resuscitation after pneumonectomy with pericardiotomy: a case report.

SETTING: The collapse of a patient immediately after right pneumonectomy with right pericardiotomy resulted in closed-chest cardiopulmonary resuscitation, subsequent thoracotomy, and demise secondary to right ventricular rupture. INTERVENTIONS: Closed-chest resuscitation with opened and closed chest tubes and medical and fluid interventions were inadequate, necessitating subsequent thoracotomy. MAIN RESULTS AND CONCLUSIONS: Right ventricular rupture during resuscitation was found during subsequent thoracotomy. This rupture and inadequacy of closed-chest resuscitation were felt to be associated with the operative pneumonectomy and pericardiotomy. Pathophysiology and the role of open-heart vs. closed-chest resuscitative measures are discussed.

Cardiopulmonary Resuscitation↗
PubMed1998

Complete analgesia during pleurodesis under thoracic epidural anesthesia.

Pain during pleurodesis is frequently severe and poorly suppressed with intravenous narcotics and/or local anesthetic installation. Epidural analgesia is very effective for all types of severe pain including surgical anesthesia, yet has not been reported in treating pleurodesis pain. Thoracic epidural can be safely and extremely effectively utilized when neural pathways are considered, as this case history demonstrates.

Adult↗
PubMed1997

A risk index for pregnancy during anesthesia.

STUDY OBJECTIVE: To determine the validity of limiting pregnancy testing only to females older than 14 years, hypothesizing that (1) if this recommendation were valid, we would find no incidence of pregnant patients receiving anesthesia in our department under age 15, and (2) by identifying all patients receiving anesthesia while pregnant versus those who are not pregnant might allow calculation of a relative risk index for pregnancy per age group. DESIGN: A retrospective chart review. SETTING: Department of Anesthesiology at Louisiana State University Medical Center in Shreveport. MEASUREMENTS AND MAIN RESULTS: The relative numbers and ages of 1) all male versus female patients treated, 2) females presenting with viable pregnancy receiving anesthetic care, and 3) ages of conception in the youngest females were quantified to 4) correlate relative rates for pregnancy/anesthetic at each age. Of 16,033 anesthetics administered, 1,849 pregnant patients ages 13 to 44 years received 1,968 anesthetics (12.5% of total). One patient conceived at the age of 12. The rates of pregnant 13 (n = 4) and 14 (n = 24) year-olds in our anesthetized population equaled rates found with patients in the third and fourth decades of life, respectively. CONCLUSIONS: Louisiana State University Medical Center's current departmental guideline to preoperatively test all patients aged 12 to 44 years is supported by the desire to identify pregnancy prior to anesthesia and the encountered pregnancy distribution and incidence. Although radiation is a known danger to fetal development, our radiology department tests only females who "fail to confirm in writing a nonpregnant state." While females younger than 15 years deserve the same consideration as 30- and 40-year-old patients, multiple ethical, pragmatic, economic, and theoretical considerations may mitigate the need for mandatory testing of all patients.

Adolescent↗
PubMed1997

Preoperative pregnancy testing: a survey of current practice.

STUDY OBJECTIVE: To examine contemporary practices and opinions regarding preoperative testing requirements, with special emphasis on perioperative pregnancy recognition and consequences thereof. DESIGN AND SETTING: Anonymous questionnaire survey distributed to 300 (almost exclusively American) physicians attending the 1996 Society of Obstetric Anesthesia and Perinatology meeting. MEASUREMENTS AND MAIN RESULTS: Responses from 169 anesthesiologists indicated that approximately one-third mandated pregnancy testing via departmental policy. More anesthesiologists (p = 0.02) mandated routine pregnancy testing of all elective (30%) versus all emergency (17%) surgical patients. Sixty-six percent versus 20% percent, respectively, would require rather than simply offer pregnancy testing when history indicated possible pregnancy; 20% and 15%, respectively, of those surveyed indicated elective surgery would be canceled by the anesthesiologist if the patient were pregnant or refused testing (p = NS). Although 98% of respondents recognized a legal requirement to report child abuse, and 82% believed pregnancy in a juvenile (i.e., the child's age is under local legal defined age for consent to sex) by definition constituted child abuse, fewer than 4% would report this information to the police, even if the impregnating male were known to be an adult. CONCLUSIONS: The desire to identify pregnancy using patient history was most prevalent among anesthesiologists, with less than one third using mandatory, departmentally imposed screening programs. Positive test results in minors are shared primarily with surgeons and patients, occasionally with parents and social services, but rarely with police, although a positive test almost universally signified child abuse, and mandatory reporting laws were acknowledged by anesthesiologists surveyed.

Adolescent↗
PubMed1997

Assessing blunt cannulae as replacements for hypodermic needles during intravenous therapy: safety and utility.

OBJECTIVE: Recently, blunt 18-gauge (ga) metal cannulae have become nationally commercially available as safety products. The ability of these blunt cannulae to prevent needlestick injury and to enable direct access of all standard latex ports and vial membranes, thus eliminating hypodermic needles entirely from the intravenous (i.v.) drug administration process, is assessed. DESIGN AND SETTING: In the laboratory setting, the needlestick injury potential of small-bore blunt cannulae versus hypodermic needles was studied using blinded and randomized methods. Insertion force requirements were studied for cannulae and needles. Metal 18-ga blunt cannulae were inserted into four brands of standard Y-ports and vial stoppers to assess postpuncture integrity and force requirements. RESULTS: Needlestick injury did not occur using small-bore blunt cannulae (P < .001; n = 51). Metal 18-ga cannulae passed into prepierced standard Y-ports as easily as hypodermic needles and without loss of Y-port integrity. Insertion of metal 18-ga cannulae without prior port puncture was possible, but was associated with substantial coring and loss of integrity of the port seal, except for IVAC brand ports (P < .03). CONCLUSIONS: Metal 18-ga cannulae can be inserted through virtually all intact standard rubber vial membranes or standard Y-ports to allow safe IV access. A single prepuncture of any standard latex membrane allows economical blunt metal cannula access equally efficiently as with expensive pre-slit membranes and without loss of membrane integrity.

Equipment Design↗
PubMed1996

Full body forced air warming: commercial blanket vs air delivery beneath bed sheets.

PURPOSE: Single-use commercial forced air warming blankets serve only to distribute heated air from a blower. Standard bed sheets may be equally effective in delivering hot air within a lower body field and at lower cost. METHODS: Heated forced air at 38 degrees and 43 degrees was delivered within a simulated full-body field beneath standard hospital bed sheets or via a BAIR Model 315 commercial blanket. The air temperatures maintained within, as well as the caloric uptake of standard bodies containing 1000 ml water, were studied under standard simulated operating room conditions. Thermal input was provided by one Bair Hugger Model 500 Warming Unit and hospital acquisition cost for materials were calculated. RESULTS: Air temperatures measured within the full body field at the three test sites were as great or greater using bed sheets (33.4-35.8 degrees) as with the commercial blanket (31.1-33.9 degrees), in spite of the 5 degrees cooler outlet temperature air settings @ 38 degrees vs 43 degrees, respectively (P = 0.003). Forced air delivered beneath bed sheets heated standardized thermal bodies twice as effectively as commercial blankets using identically warmed (38 degrees) forced air and heated as well as, or better, at the 38 degrees setting than did the commercial blanket at the 43 degrees setting. Calculated acquisition costs for sheets vs commercial blankets were $0.76 vs $18.00 US, respectively. CONCLUSION: The simplicity, efficacy and economy of containing 38 degrees warm air beneath bed-sheets offer several advantages over commercial blankets and warrant further study.

Bedding and Linens↗