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Biomedical subjects

R B Hecker

Publications and source records attributed to R B Hecker.

15 recordsLinked to original sources
PubMed1997

The haemodynamic effects of rocuronium and vecuronium are different under balanced anaesthesia.

BACKGROUND: Rocuronium has been reported to have minimal haemodynamic effects. However, this conclusion has been drawn primarily from investigations conducted under narcotic-based anaesthesia. This study was designed to evaluate the cardiovascular effects of rocuronium under isoflurane/N2O/fentanyl anaesthesia and to compare rocuronium's haemodynamic effects to those of vecuronium and pancuronium. METHODS: Anaesthesia was induced with fentanyl 2 micrograms/kg, thiopentone 4 mg/kg, and suxamethonium 0.5 mg/kg in 75 ASA I or II patients. After tracheal intubation, anaesthesia was maintained with isoflurane 0.5% and N2O 50% in oxygen. Five min after intubation (baseline), patients randomly received either vecuronium 100 micrograms/kg, rocuronium 600 micrograms/kg, rocuronium 900 micrograms/kg, rocuronium 1200 micrograms/kg, or pancuronium 140 micrograms/kg. One min after administration of muscle relaxant, mean arterial pressure (MAP) and heart rate (HR) were recorded and were subsequently measured at 1-min intervals for the next 4 min. RESULTS: HR decreased significantly (P < 0.05) at all times compared to baseline in patients receiving vecuronium. HR significantly (P < 0.05) increased in those receiving rocuronium 1200 micrograms/kg or pancuronium. Patients who received vecuronium had a significant (P < 0.05) decrease in MAP at all times compared to baseline. Comparing results between groups, patients who received rocuronium or pancuronium had significantly (P < 0.05) higher MAP compared to those administered vecuronium. CONCLUSION: The haemodynamic effects of rocuronium and vecuronium are different under balanced anaesthesia. Rocuronium may attenuate the fall in MAP that often occurs under balanced anaesthesia without surgical stimulation.

Adolescent↗
PubMed1997

Myocardial ischemia and stunning induced by topical intranasal phenylephrine pledgets.

This case study describes myocardial ischemia and stunning after the topical application of phenylephrine-soaked pledgets (0.25%) in a 63-year-old female undergoing elective endoscopic sinus surgery. The patient had no previous history of cardiovascular disease or illicit drug use. Transient myocardial ischemia was associated with acute hypertension, chest pain, and S-T segment changes 4 minutes after pledget placement. Angiography revealed normal coronary blood flow and severe left ventricular systolic and diastolic dysfunction. Follow-up echocardiography demonstrated improved left ventricular function within 1 week and total resolution of dysfunction by 4 weeks after ischemia.

Administration, Intranasal↗
PubMed1996

Bayesian analysis of noninvasive versus oral temperature measurements to determine hypothermia in postoperative patients.

Measurement of body temperature in the postanesthesia care unit (PACU) is an important parameter in patient management. Failure to reach minimal acceptable body temperature standards has been associated with physiologic derangements, the application of additional therapy, and prolonged PACU stays. Newer methods to monitor temperature introduced into the PACU have been touted to be adequate for detecting clinically significant changes in temperature. In this study, skin core-temperature-corrected liquid crystal thermography (LCT), axillary (AT) electronic, and infrared tympanic membrane (ITT) temperatures were compared with oral thermistor thermometry (OT) in 205 PACU patients. Regression analysis suggests that when compared with the oral method, ITT tends to overestimate and AT and LCT tend to underestimate oral temperatures. Mean temperatures obtained by LCT (35.5 +/- 1.0 degrees C), AT (35.1 +/- 0.9 degrees C), and ITT (36.3 +/- 0.8 degrees C) differed significantly from OT (36.0 +/- 0.7 degrees C) mean temperatures. We applied Bayesian analysis to assess the sensitivity and specificity of each method, using a hypothermia reference of < 36 degrees C. Results suggest that the definition of hypothermia may depend on the modality used to assess body temperature in the PACU.

Adult↗
PubMed1996

Primary varicella-zoster-induced rhabdomyolysis.

Acute rhabdomyolysis after uncomplicated, primary varicella-zoster infection is a rare condition that is sparsely reported in the literature. We report a case of acute rhabdomyolysis due to varicella-zoster infection and review the literature regarding the etiology, diagnosis, and management of this potentially life-threatening condition. Rapid recognition, along with appropriate treatment, should result in an excellent recovery without adverse sequelae.

Acute Disease↗
PubMed1994

A comparison of noninvasive body temperature monitoring devices in the PACU.

Critical measurement of patient body temperature in the PACU is an important parameter in patient management. Failure to achieve minimal acceptable body temperature standards has been associated with physiological derangement, the application of additional therapy, and prolonged PACU stays. Newer methods to monitor temperature have been introduced into the PACU that have been touted to be adequate for detecting clinically significant changes in temperature. This study compares skin core temperature-corrected liquid crystal thermography, axillary electronic, and oral electronic thermistor readings with temperatures obtained by infrared tympanic membrane thermometry in 215 PACU patients. Regression analysis suggests that when compared with tympanic temperature, the oral method is more accurate and has greater precision than either the liquid crystal or axillary methods. That the incidence of hypothermia depends on the method chosen to assess body temperature is a significant nursing implication.

Adult↗
PubMed1992

Update on monoclonal antibody therapy in the gram-negative sepsis syndrome.

Two multicenter controlled clinical trials of genetically engineered monoclonal antibodies directed against endotoxin, a potent mediator of inflammation in the gram-negative sepsis syndrome, were recently reported in the medical literature. One of these antiendotoxin antibodies was derived from a murine (mouse) source, and the other antibody was derived mainly from a human source (nebacumab [negative bacteria human monoclonal antibody]). This article reviews recent literature concerning the use of these agents in the treatment of gram-negative sepsis syndrome. It also projects economic assessment data regarding the use of nebacumab in the United States.

Antibodies, Monoclonal↗
PubMed1992

Effect of volume on spinal anesthesia level with hyperbaric tetracaine.

The purpose of this prospective, randomized, double-blind study was to determine if the volume of a fixed milligram dose of hyperbaric tetracaine hydrochloride injected into the subarachnoid space affected the average maximal dermatomal spread of sensory anesthesia, determined by pinprick testing. One hundred two adults received spinal hyperbaric tetracaine in a volume of 2 mL, 3 mL, or 4 mL with the dose based on the patient's height. The addition of 0.2 mg of epinephrine to the anesthetic solution was allowed at the discretion of the attending anesthesiologist. A two-way analysis of variance (ANOVA) demonstrated that neither the dose selected nor the use of epinephrine affected anesthetic spread. ANOVA showed that anesthetic volume insignificantly affects the spread of sensory anesthesia. A Tukey HSD multiple comparisons test demonstrated a mean difference greater than 1 sensory dermatome between volumes of 2 mL and 4 mL, which was clinically detectable but statistically insignificant. Increasing the volume of hyperbaric spinal tetracaine solutions to improve anesthetic spread is unjustified.

Adolescent↗
PubMed1990

Intra-abdominal palpation of a nasogastric tube in the stomach does not assure appropriate placement.

Improperly placed nasogastric (NG) tubes have been associated with considerable morbidity. The only reliable indicator of correct NG tube placement appears to be the aspiration of gastric contents. We have reported a case of major morbidity from an improperly placed NG tube that perforated the cervical esophagus, dissected the mediastinum, and terminated in the omental bursa. No gastric aspirate was obtained by suctioning of the tube, but correct placement was presumed based upon the surgeon's direct intraoperative palpation of the tip of the tube. Failure to aspirate gastric contents should alert the practitioner to the possibility of improper NG tube placement.

Abdomen↗
PubMed1990

Rectus sheath hematoma: report of a case.

Rectus sheath hematoma is an uncommon problem caused by the acute disruption of epigastric vessels or rupture of a rectus muscle that can clinically mimic an acute surgical abdomen. Although this entity usually is self-limiting and can be managed conservatively, bleeding into the rectus muscle in an anticoagulated patient is potentially life threatening. We report a case of a 21-year-old female student who presented with an acute onset of abdominal pain after physical fitness training.

Abdominal Muscles↗
PubMed1985

Circulation time during standard and modified manual CPR determined by retinal photoangiography.

We used retinal fluorescein photoangiography to determine the circulation time (CTv-a) from the inferior vena cava (IVC) to the retinal artery in anesthetized, intubated, paralyzed, and fibrillated dogs. Animals received either standard CPR (SCPR) (n = 11) or modified CPR (MCPR) (n = 11) manually at 60 compressions per minute in both groups. MCPR consisted of simultaneous ventilation-compression with abdominal binding to 40 mm Hg. SCPR or MCPR was begun immediately after inducing ventricular fibrillation and was performed for an average of 4.5 minutes prior to bolus injection of fluorescein dye (0.7 mL, 25% solution). To compare CTv-a in the two groups, dye was injected through a catheter into the IVC (below the diaphragm) and timed, rapid, sequential retinal photoangiography was begun. The time to first appearance of dye in the retinal vasculature initially was determined visually by the camera operator and later was substantiated photographically. The camera simultaneously photographed the retinal vasculature and the built-in timer, thus displaying the elapsed time from injection on each frame. Our results showed a significantly shorter CTv-a in the MCPR group (58.9 seconds +/- 18.6) when compared to the SCPR group (112.6 seconds +/- 47.4; P less than .01). In addition, we have documented retinal blood flow during CPR.

Animals↗
PubMedDate not supplied

A comparison of pulse oximeters during helicopter flight.

Pulse oximetry would be an invaluable parameter to monitor during patient transport. While original models of oximeters were not battery powered nor very portable, this has changed. Seven currently available commercial pulse oximeter models were evaluated in the noisy vibration-prone environment of a helicopter. Three (3) units were judged to be unacceptable on the basis of weight, duration of battery life, or lack of ease of use. In two (2) units, the sampling algorithms appeared to interface with their performance. Of the seven (7) units tested, two (2) units were found to be reliable, portable, and easy to use. The use of portable pulse oximetry monitors should rapidly become routine during the transport of critically ill patients.

Aircraft↗
PubMedDate not supplied

High-frequency ventilation: is there a clinical role?

Mechanical ventilation of the lungs is an integral component of modern medical practice, being utilized predominantly in the operating room and intensive care unit. The first mechanical ventilators were of the negative-pressure type. Currently, positive-pressure mechanical ventilation with frequency rates of up to 60 breaths per minute is referred to as conventional mechanical ventilation. In the 1960s, Sjöstrand developed the concept of high-frequency positive-pressure ventilation. This development was a logical continuation of physiology studies that built on earlier observations, which were then directly applied to clinical use. This paper is a synopsis of the current rationale for the clinical use of high-frequency ventilation.

Carbon Dioxide↗
PubMedDate not supplied

A review of ventilatory modalities used in the intensive care unit.

Mechanical ventilation of the lungs is an integral component of modern medical practice in the operating room and intensive care unit settings. Most ventilators available in the operating room are capable of providing only controlled mechanical ventilation. With the increasing use of the microprocessor-controlled ventilators in the intensive care unit, there are now a wide variety of ventilatory types and mode choices available to the clinician. This paper summarizes some of the ventilatory choices currently available and mentions some of the newer and experimental modalities available in larger centers.

Critical Care↗