PubMed Health⌕ Search

Biomedical subjects

R D Truog

Publications and source records attributed to R D Truog.

69 records · Page 4Linked to original sources
PubMed1991

Changes in the pharmacodynamic response to fentanyl in neonates during continuous infusion.

Tolerance to opioid-induced sedation has been reported in neonates sedated with fentanyl by continuous infusion while undergoing extracorporeal membrane oxygenation. We undertook a prospective analysis of eight newborn infants sedated with fentanyl during extracorporeal membrane oxygenation therapy for respiratory failure. We recorded daily mean fentanyl infusion rate, measured serial plasma fentanyl concentrations, and documented the occurrence of spontaneous motor activity or respiratory effort. Mean fentanyl infusion rate increased steadily during the period of infusion from a mean of 9.2 +/- 1.9 (SEM) micrograms/kg per hour on day 1 to a mean of 21.9 +/- 4.5 micrograms/kg per hour by day 6. Mean plasma fentanyl concentrations increased steadily during the period of fentanyl infusion from 3.1 +/- 1.1 (SEM) ng/ml on day 1 to 13.9 +/- 3.2 ng/ml on day 6. All infants exhibited movement in response to gentle tactile stimulation throughout the period of infusion, and seven of eight infants manifested spontaneous movement of the extremities and eye opening. Our results indicate that when fentanyl is used for sedation in neonates, the plasma concentrations required for satisfactory sedation steadily escalate, possibly indicating the rapid development of tolerance to the sedating effects of fentanyl.

Extracorporeal Membrane Oxygenation↗
PubMed1990

Tolerance and dependence in neonates sedated with fentanyl during extracorporeal membrane oxygenation.

We undertook a retrospective chart review of 37 neonates who received fentanyl by continuous infusion while undergoing extracorporeal membrane oxygenation (ECMO) between May 1986 and October 1988. We quantified the doses of all sedatives utilized, determined the incidence of neonatal abstinence syndrome (NAS), and identified risk factors associated with NAS. We determined peak fentanyl infusion rate, mean fentanyl infusion rate, total fentanyl dose, and duration of ECMO therapy. NAS was observed in 21 of 37 neonates (57%). In both the NAS and non-NAS neonates, mean infusion rate increased steadily during ECMO therapy, from a mean of 11.6 +/- 6.9 (SD) micrograms.kg-1.h-1 on day 1 to a mean of 52.5 +/- 19.4 (SD) micrograms.kg-1.h-1 by day 8. Total fentanyl dose and duration of ECMO were significantly greater in neonates with NAS. We found that neonates with a total dose greater than 1.6 mg/kg or an ECMO duration greater than 5 days had a significantly greater incidence of NAS (chi-squared test, P less than 0.01 and P less than 0.005; odds ratios = 7.0 and 13.9, respectively). With multiple logistic regression, ECMO duration was found to be the most powerful predictor of the occurrence of NAS. We also measured plasma fentanyl concentrations in a separate group of 5 neonates receiving fentanyl by continuous infusion for sedation. Fentanyl concentrations increased steadily during the period of infusion, suggesting the development of tolerance to the sedating effects. We conclude that continuous administration of fentanyl for sedation is associated with the uniform development of tolerance and a significant incidence of dependence. Alternative approaches to sedation should be investigated.

Drug Tolerance↗
PubMed1990

Allowing to die.

Explore the source record for details and available documents.

Coma↗
PubMed1990

Fetal pulmonary vasodilation by histamine: response to H1 and H2 stimulation.

We measured pulmonary vasodilation induced by histamine, H1 and H2 antagonists, and H1 and H2 agonists in chronically prepared, normally oxygenated fetal sheep in order to study the response of H1 and H2 stimulation in late gestation. Blood flow was measured in the left pulmonary artery; pressures were measured in the main pulmonary artery and abdominal aorta. Histamine administered into the left pulmonary artery caused dose-dependent increases in left pulmonary blood flow without changes in either pulmonary arterial or aortic pressures. Cimetidine (H2 antagonist) and/or diphenhydramine (H1 antagonist) shifted the histamine dose-response curve to the right. 2-Pyridylethylamine (H1 agonist) and dimeprit (H2 agonist) caused vasodilation which was selectively blocked by its respective antagonist. We conclude that both H1 and H2 stimulation cause pulmonary vasodilation in the ovine fetus.

Animals↗
PubMedDate not supplied

Triage in the ICU.

Some patients in intensive care units are too sick to derive much benefit from being there, while others are too well to require the technology and skills offered. When ICU resources are scarce, they may ethically be withdrawn from either sort of patient in favor of one more likely to benefit from the care.

Critical Care↗
PubMedDate not supplied

Is it time to abandon brain death?

Despite its familiarity and widespread acceptance, the concept of "brain death" remains incoherent in theory and confused in practice. Moreover, the only purpose served by the concept is to facilitate the procurement of transplantable organs. By abandoning the concept of brain death and adopting different criteria for organ procurement, we may be able to increase both the supply of transplantable organs and clarity in our understanding of death.

Brain Death↗