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Biomedical subjects

R J Kitz

Publications and source records attributed to R J Kitz.

At least 19 recordsLinked to original sources
PubMed1984

An analysis of major errors and equipment failures in anesthesia management: considerations for prevention and detection.

Adaptations of the critical-incident technique were used to gather reports of anesthesia-related human error and equipment failure. A total of 139 anesthesiologists, residents, and nurse-anesthetists from four hospitals participated as subjects in directed or open-ended interviews, and 48 of them functioned as "trained observers." A total of 1,089 descriptions of preventable "critical incidents" were collected. Of these, 70 represented errors or failures that had contributed in some way to a "substantive negative outcome." From these incidents, ten potential strategies were developed for prevention or detection of incidents. Overall patterns observed in this wider study were similar to those of our earlier report. The incidents most frequently reported included breathing circuit disconnections, drug-syringe swaps, gas-flow control errors and losses of gas supply. Only 4% of the incidents with substantive negative outcomes involved equipment failure, confirming the previous impression that human error is the dominant issue in anesthesia mishaps. Among the broad categories of key strategies for mishap prevention were additional technical training, improved supervision, improved organization, equipment human-factors improvements, and use of additional monitoring instrumentation. The data also suggest that less healthy patients are more likely to be affected adversely by errors. It is suggested that, in future studies of anesthesia mortality and morbidity, untoward events should be classified according to preventive strategy rather than outcome alone as an aid to those who wish to apply the experience of others to lessen the risk in their individual practice.

Accident Prevention↗
PubMed1976

Mode of action of trichloroethylene on squid axon membranes.

The mode of action of trichloroethylene on electrical properties of squid giant axons has been studied by means of voltage clamp techniques. Trichloroethylene decreased the resting membrane potential in a manner dependent upon the concentration, the depolarization by 50% saturated trichloroethylene attaining 28.4 and 32.7% of the initial value at 20 and 10 degrees C, respectively. Leakage conductance was decreased to 34.6% of the control by 30% saturated trichloroethylene at 10-12 degrees C. It appears that the trichloroethylene-induced depolarization is at least in part due to a decrease in resting potassium permeability. Both peak transient and steady-state conductance increases were suppressec by trichloroethylene, and the curve relating the steady-state conductance to the membrane potential was shifted in the depolarizing direction while the peak transient conductance curve was not appreciably shifted. The reversal potential for the peak transient current was greatly shifted by trichloroethylene in the direction of hyperpolarization in a manner dependent on the concentration, the maximum shift amounting to 25 mV at 10 degrees C. This effect was less pronounced at 20 degrees C. The shift in the reversal potential is mostly due to a decrease in selectivity of the peak transient channel and partly due to an accumulation of sodium ions inside. Analyes of dose-response relation in suppressing peak transient and steady-state conductances show that trichloroethylene interacts with receptor on a one-to-one stoichiometric basis. Steady-state sodium inactivation curve was shifted by trichloroethylene in the direction of hyperpolarization. All of these effects were partially reversed after washing the axon with anesthetic-free media. The accumulation of sodium ions inside would be much more pronounced in small nerve fibers in the brain than in giant axon and, together with the observed decrease in the selectivity of peak transient channels, would play a significant role in general anesthesia.

Action Potentials↗
PubMed1975

The effect of tubocurarine on indirectly elicited train-of-four muscle response and respiratory measurements in humans.

The effect of tubocurarine on the respiratory function of conscious, non-medicated volunteers was correlated with the degree of neuromuscular blockade measured with the train-of-four technique (the evoked response of the adductor pollicis brevis muscle to trains of four supramaximal ulnar nerve stimuli at 2 Hz, repeated once every 10 sec). Respiratory frequency, tidal volume, vital capacity, inspiratory force and peak expiratory flow rate were measured, (a) before administration of tubocurarine, (b) when the ratio of the amplitude of the fourth response to the amplitude of the first response of the train-of-four reached 60%, and (c) during recovery of the ratio until the control (100%) value was reached. Respiratory frequency, tidal volume and peak expiratory flow rate were not altered. Vital capacity and inspiratory force were both reduced significantly at the 60% level and the former also at the 70% level when compared with the control. The magnitude of change in all variables is of minor clinical importance, however, since the lowest measured values are well above acceptable minimum limits required for adequate respiratory function.

Dose-Response Relationship, Drug↗
PubMed1975

Decamethonium and serum potassium in man.

Decamethonium and succinylcholine were used to study the effects of depolarizing muscle relaxants on serum potassium in 60 patinets, free of neuromuscular disease, during major orthopedic surgery. Significant increases in serum K+ were found after administration of decamethonium or succinylcholine in the usual clinical doses. The abnormal elevations of serum K+ found in patients with burns, massive trauma, or muscle denervation are thus accentuations of the process that occurs in normal man following use of these depolarizing drugs. The administration of any depolarizing agent to these abnormal patient groups would, therefore, appear contraindicated.

Adult↗
PubMed1971

Neuromuscular blocking activity of a new series of quaternary N-substituted choline esters.

1. The neuromuscular blocking activity of a new group of mono- and diquaternary N-substituted choline esters of several carboxylic acids has been evaluated in various whole animal preparations in the mouse, rat and cat.2. A basic non-depolarizing mechanism was present in all but one compound-a depolarizing agent, which was studied for comparison. There was evidence of facilitatory activity and nicotinic stimulation in the monoquaternary compounds. These effects were diminished in the diquaternary compounds.3. The presence of a bulky aromatic ring system on the nitrogen atom appeared to increase both neuromuscular blocking potency and facilitatory activity in the experimental animal. A similar relationship had previously been demonstrated in vitro in another study.4. The duration of action, although short in most compounds, did not correlate well with previously determined in vitro hydrolysis rates, possibly because of species differences.5. The general pharmacology of each compound appeared to depend considerably upon the structure of the choline moiety.

Animals↗