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Biomedical subjects

Peter S A Glass

Publications and source records attributed to Peter S A Glass.

17 recordsLinked to original sources
PubMed2006

Change in pulse pressure during the preclinical phase of preeclampsia.

OBJECTIVE: To measure and compare pulse pressure in early pregnancy between parturients who subsequently did or did not develop preeclampsia. STUDY DESIGN: Retrospective chart review of 44 parturients with preeclampsia and 187 controls without. The groups were compared for blood pressure indices before 15 weeks' gestation and other maternal variables. RESULTS: The preeclampsia group had a higher proportion of African Americans (23% vs. 9.6%, p = 0.005) and higher body mass index (26.2 +/- 7.1 SD vs. 24.0 +/- 4.9 kg/m2, p = 0.03). Before 15 weeks' gestation, women who later developed preeclampsia had higher systolic (114.3 +/- 11.6 vs. 107 +/- 12 mm Hg, p = 0.001), mean arterial (83.7 +/- 8.8 vs. 79.6 +/- 7.6 mm Hg, p = 0.002) and pulse (45.8 +/- 7.7 vs. 42.4 +/- 8.3 mm Hg, p = 0.001) pressure. On multivariable logistic regression analysis, only African American race (OR 3.1; 95% CI 1.13, 8.40; p = 0.028), and pulse pressure (OR 1.05; 95% CI 1.01, 1.1; p = 0.014) were independently associated with the development of preeclampsia. CONCLUSION: Primiparous women who later develop preeclampsia have an elevation in pulse, systolic and mean arterial pressure before 15 weeks.

Adult↗
PubMed2005

Subdural hematoma after atraumatic spinal.

We report a case of subdural hematoma in a 68-year-old white man who underwent left inguinal hernia repair with spinal anesthesia. The patient had a postdural puncture headache (PDPH) on postoperative day 4, but he refused invasive treatment. Instead, he self-administered acetaminophen, aspirin, and caffeine. On postoperative day 11, he was diagnosed with a subdural hematoma. At 49 days postoperatively, a computed axial tomographic scan was taken, the results of which were normal, after no surgical intervention. This patient had none of the risk factors as reported in the literature for this rare complication. Although a headache postoperatively, after spinal anesthesia, is often assumed to be PDPH, clinicians should not rule out the possibility of subdural hematoma, especially if the headache is persistent. We advise that the smallest-bore spinal needles be used when administering spinal anesthesia and that patients be carefully evaluated before their surgery for use of anticoagulants, herbal medications, or history of cerebrovascular disease. Immediate treatment of the PDPH with an epidural blood patch should be considered. If a patient refuses invasive treatment, he should be counseled for the possibility of subdural hematoma. The patient also should be advised to avoid medications with anticoagulant properties.

Aged↗
PubMed2005

Resource utilization in on- and off-pump coronary artery surgery: factors influencing postoperative length of stay--an experience of 1,746 consecutive patients undergoing fast-track cardiac anesthesia.

OBJECTIVE: The purpose of the present investigation was to examine factors influencing resource utilization in patients undergoing on-pump coronary artery bypass graft and off-pump coronary artery bypass (OPCAB) graft surgery at a major university hospital. The resources examined were time to extubation, packed red blood cell (PRBC) transfusion, intensive care length of stay (ICULOS), preoperative and postoperative length of stay (PLOS), and total length of stay (LOS). DESIGN: Observational study of consecutive patients undergoing on- and off-pump coronary artery bypass surgery. SETTING: Tertiary care cardiac referral center. PARTICIPANTS: One thousand seven hundred forty-six consecutive male and female patients undergoing primary coronary artery bypass graft (CABG) surgery over a period of 3 years (1999-2001). Eight hundred eighty-one patients underwent CABG with pump, and 865 patients underwent off-pump coronary artery bypass (OPCAB) surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The mean time to extubation after surgery was 7.4 hours for on-pump patients and 5.8 hours for the OPCAB group (p 72 hours to postoperative tracheal extubation compared with 1.5% in the OPCAB group (p=0.041). Hospital mortality was 2.7% for the on-pump group and 1.0% for the OPCAB group (p=0.010). CONCLUSION: The authors found that patients undergoing on-pump CABG have significantly longer time to tracheal extubation, increased blood use, longer ICULOS, PLOS, and total LOS and higher in-hospital mortality, which would translate into significant differences in the expenses associated with these 2 surgical approaches to coronary surgery.

Aged↗
PubMed2005

Octogenarians undergoing coronary artery bypass graft surgery: resource utilization, postoperative mortality, and morbidity.

OBJECTIVE: The purpose of the present study was to examine resource utilization in octogenarians undergoing coronary artery bypass grafting (CABG) and compare it with usage in their younger cohorts at a tertiary care heart center. The resources examined were time to extubation, packed red blood cell transfusions, intensive care unit (ICU) length of stay (LOS), and preoperative and postoperative LOS. The study also examined differences in postoperative morbidity and mortality. DESIGN: Retrospective hospital follow-up study of consecutive patients undergoing CABG using a prospectively designed database. SETTING: University teaching tertiary care referral center for cardiac surgery. PARTICIPANTS: Seventeen hundred forty-six male and female patients undergoing CABG surgery, including 155 octogenarians and 1591 patients younger than 80 years. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Demographic, mortality, morbidity, and resource utilization data were collected from the records of patients undergoing CABG at the authors' institution over 3 years. There were 1746 patients: 155 octogenarians and 1591 nonoctogenarians. Octogenarians had a significantly higher incidence of preoperative stroke, peripheral vascular disease, chronic obstructive lung disease, congestive heart failure, and left main disease. They weighed significantly less, and had lower preoperative and postoperative hematocrit. There was a significantly higher percentage of women in the octogenarian group. Mean time from the end of surgery to endotracheal extubation was 9.3 hours for octogenarians and 6.3 hours for their younger cohorts (p < 0.001). Blood transfusion was required in 88.4% of octogenarians compared with 58.6% of nonoctogenarians (p < 0.001). Mean ICU LOS was 1.9 days for octogenarians and 1.4 days for nonoctogenarians (p < 0.001). Mean postoperative LOS was 8.7 days for octogenarians and 5.8 days for nonoctogenarians (p < 0.001). Clinical and demographic variables were correlated with age 80 years or older. Multivariate linear and logistic regression models were constructed to show the combined effects of age and comorbid conditions on outcomes. Octogenarians had a significantly higher incidence of postoperative renal failure and neurologic complications. The 30-day mortality rate was 9.0% for the octogenarian group v 1.2% for the younger group (p < 0.001). Age 80 years or older was significantly associated with outcome, and was an independent predictor of increased resource utilization and postoperative mortality and morbidity. CONCLUSIONS: The results demonstrated that octogenarians undergoing CABG required increased resource utilization and had significantly higher morbidity, with increased incidence of postoperative renal failure, neurologic complications, and 30- day mortality. Age 80 years or older was an independent predictor of increased resource utilization, postoperative morbidity, and mortality.

Age Factors↗
PubMed2003

Effective analgesic modalities for ambulatory patients.

The introduction of government-mandated standards for pain management has focused our attention on postoperative pain. With the recent JACHO standards' for ambulatory surgery, it is imperative that all health care workers who care for these patients are familiar with appropriate pain management. Developments in our understanding of the pathophysiology of acute pain have further enhanced our ability to improve pain management for postoperative ambulatory patients. This has led to the concept of preventive analgesia (inhibition of physiological and pathological secondary inflammatory pain). Extensive work has shown that this is best achieved using a multimodel approach usually consisting of an NSAID, opioid, and local anesthetic. NMDA antagonists (ketamine, dextromethorphan) and alpha-2 agnoists (clonodine) show potential supplements to further enhance pain management, especially if given preemptively. Nonpharmacological intervention such as cold therapy or acupuncture may also be considered. The armanentarium for effective pain management has improved substantially over the past few years. The challenge is for health care workers to implement these therapies to obtain optimum pain management in ambulatory surgical patients.

Ambulatory Surgical Procedures↗
PubMed2003

A study of anesthetic drug utilization in different age groups.

STUDY OBJECTIVE: To determine anesthetic drug utilization in different age groups. DESIGN: Retrospective, automated, intraoperative database study. SETTING: Tertiary care medical center. MEASUREMENTS: 30,842 noncardiac general anesthesia case records between January 1991 and July 1997 were studied. We investigated the effect of age on anesthetic requirements for fentanyl (F), midazolam (M), thiopental sodium (T), propofol (P), isoflurane (I), and nitrous oxide (N). Because drugs are not given in isolation we looked at the most common drug combinations, IFNTM, IFNPM, INFT, and PFNM. Regression analyses on log-transformed drug dosages were used to test the significance of age on individual requirements. RESULTS: In each of the above anesthetic drug combinations, reduced doses of fentanyl, propofol, midazolam, thiopental, and isoflurane were used with increasing age. Fentanyl, propofol, thiopental, and isoflurane showed a 10%, 8%, 6%, and 4% reduction in dose per decade of age, respectively, from age of maximum dose to age 80 years. CONCLUSIONS: In clinical practice, increasing age results in decreased anesthetic drug administration. The mechanism of this observation needs to be determined.

Adult↗
PubMed2003

Does gender influence resource utilization in patients undergoing off-pump coronary artery bypass surgery?

OBJECTIVE: The purpose of the present study was to examine if gender influences duration of tracheal intubation, blood transfusion needs, intensive care unit length of stay (ICULOS), postoperative length of stay (PLOS), and total length of stay (LOS) in patients undergoing off-pump coronary artery bypass (OPCAB) surgery. DESIGN: Retrospective study of consecutive patients undergoing OPCAB surgery. SETTING: University teaching hospital. Tertiary care referral center for cardiac surgery. PARTICIPANTS: Three hundred seventy-two consecutive male and female patients undergoing OPCAB surgery. There were 110 women and 262 men. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Gender, duration of tracheal intubation, units of blood transfused, ICULOS, PLOS, and LOS were collected from the records of patients undergoing OPCAB surgery at the authors' institution over a period of 16 months. There were a total of 372 patients: 110 women and 262 men. Median intubation time was 4.5 hours for women and 4.0 hours for men (p = 0.749); 59.1% of women received red blood cells versus 31.3% of men (p < 0.001). Median ICU LOS was 1 day for women and 1 day for men (p = 0.597) Median PLOS was 4 days for women and 4 days for men. Median LOS was 8 days for women and 6 days for men (p = 0.001). CONCLUSION: Female sex was a predictor of increased blood transfusion and longer PLOS and LOS in patients undergoing OPCAB surgery. The study implies that female sex does not predict increased duration of tracheal intubation and mechanical ventilation and ICULOS in this group of patients. Females undergoing OPCAB surgery require increased resource utilization as measured by increases in blood transfusion, PLOS, and LOS.

Aged↗
PubMed2003

Pharmacokinetics in the elderly.

The elderly are an expanding population of patients presenting for anaesthesia. The pharmacokinetics of anaesthetic agents in the elderly deserves special attention because the normal ageing process and the effect of age-related diseases affect organ systems in a heterogeneous way with unpredictable consequences. The pharmacokinetics of each drug is also affected by these changes in a specific way and, together with the pharmacodynamic consequences, makes drug use and drug dosing challenging in this population. Although a decrease in bolus and infusion rates is a common theme, only pharmacokinetic modelling of drug disposition in the elderly will provide accurate dosing guidelines and increase the margin of safety.

Aged↗
PubMed2003

Should a patient's gender alter the anesthetic plan?

PURPOSE OF REVIEW: A significant effort has been made in the past few years to determine whether a patient's gender has a significant effect on their anesthetic requirements or outcome. It remains unclear whether there is sufficient evidence to alter an anesthetic regimen based on a patient's gender. RECENT FINDINGS: In well-controlled studies, subtle pharmacokinetic differences between the sexes can be observed. Pharmacodynamic differences have also been observed between the sexes, particularly for muscle relaxants and opioids. Outcome studies have revealed that women are also more likely to experience adverse side-effects such as postoperative nausea. SUMMARY: There are subtle differences between men and women. However, these differences are of a similar magnitude to those that may exist between other commonly encountered factors, such as smoking versus non-smoking, occasional versus regular ethanol consumption, or perhaps, most importantly, the increased age of the patient. If these are combined with pre-existing medical conditions and other patient variables, such as ethnicity, the potential gender effect on anesthesia may easily be overshadowed.

Journal Article↗
PubMed2003

Blood use in patients undergoing coronary artery bypass surgery: impact of cardiopulmonary bypass pump, hematocrit, gender, age, and body weight.

UNLABELLED: We investigated the impact of cardiopulmonary bypass pump (CPB), hematocrit, gender, age, and body weight on blood use in patients undergoing coronary artery bypass graft surgery at a major university hospital. Participants were 1235 consecutive patients undergoing primary coronary artery surgery over a period of 2 yr (1999 and 2000); 681 patients underwent coronary surgery with use of CPB, and 554 patients underwent off-pump coronary artery bypass surgery using a median sternotomy incision. There were 881 males and 354 females. Average packed red blood cells (PRBC) transfusion for patients on CPB was 3.4 U compared with 1.6 U for the off-pump group (P = <0.001). Patients on CPB received more frequent PRBC transfusion (72.5%) compared with 45.7% of off-pump patients (P = <0.001). Average PRBC transfusion for males was 2.2 U compared with 3.6 U for females (P = <0.001). A lower percentage of males (52.6%) than females (79.4%) received transfusion (P = <0.001). The impact of CPB, off-pump status, preoperative hematocrit <35%, gender, age >or=65 yr, and weight <or=83 kilograms using median values as cut points, on blood use was examined using logistic regression models. Use of CPB, preoperative hematocrit, (<35%) female gender, increasing age, and decreased body weight were significant predictors of transfusion (P = <0.001). Preoperative hematocrit <35% and use of CPB were the strongest predictors of PRBC transfusion. IMPLICATIONS: We examined the impact of cardiopulmonary bypass, preoperative hematocrit, gender, age, and body weight on blood use in patients undergoing primary coronary artery bypass surgery at a tertiary care institution. We found that all five of these variables are significant predictors of blood use in patients undergoing coronary artery bypass surgery.

Adult↗
PubMed2002

Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery.

BACKGROUND: Intraoperative hypovolemia is common and is a potential cause of organ dysfunction, increased postoperative morbidity, length of hospital stay, and death. The objective of this prospective, randomized study was to assess the effect of goal-directed intraoperative fluid administration on length of postoperative hospital stay. METHODS: One hundred patients who were to undergo major elective surgery with an anticipated blood loss greater than 500 ml were randomly assigned to a control group (n = 50) that received standard intraoperative care or to a protocol group (n = 50) that, in addition, received intraoperative plasma volume expansion guided by the esophageal Doppler monitor to maintain maximal stroke volume. Length of postoperative hospital stay and postoperative surgical morbidity were assessed. RESULTS: Groups were similar with respect to demographics, surgical procedures, and baseline hemodynamic variables. The protocol group had a significantly higher stroke volume and cardiac output at the end of surgery compared with the control group. Patients in the protocol group had a shorter duration of hospital stay compared with the control group: 5 +/- 3 versus 7 +/- 3 days (mean +/- SD), with a median of 6 versus 7 days, respectively ( = 0.03). These patients also tolerated oral intake of solid food earlier than the control group: 3 +/- 0.5 versus 4.7 +/- 0.5 days (mean +/- SD), with a median of 3 versus 5 days, respectively ( = 0.01). CONCLUSIONS: Goal-directed intraoperative fluid administration results in earlier return to bowel function, lower incidence of postoperative nausea and vomiting, and decrease in length of postoperative hospital stay.

Algorithms↗
PubMed1995

The influence of lockout intervals and drug selection on patient-controlled analgesia following gynecological surgery.

This study systematically compared 2 opioids, morphine (MOR) and fentanyl (FEN), and 2 lockout intervals, long (L) and short (S) in patients utilizing patient-controlled analgesia (PCA). Seventy-eight women undergoing gynecological surgery were randomly assigned to 1 of 4 groups: MOR-S (7 min), MOR-L (11 min), FEN-S (5 min), FEN-L (8 min). PCA measures obtained during the first 24 h after surgery included: number of demands/h, number of completed deliveries/h, dose/h, and demand/delivery ratio. Visual analog scales of pain and anxiety were also obtained. Results indicated that pain relief was equivalent with minimal side effects for both opioids. The selection of opioid, however, influenced the pattern of PCA use, with an improved demand/delivery ratio initially for FEN. The lockout intervals chosen for this study did not influence pain or anxiety levels.

Adolescent↗