PubMed Health⌕ Search

Biomedical subjects

R J Pollard

Publications and source records attributed to R J Pollard.

9 recordsLinked to original sources
PubMed1999

Somatosensory-evoked potentials during aortic coarctation repair.

OBJECTIVE: To determine the incidence of somatosensory-evoked potential (SSEP) changes and the interventions based on these changes during aortic coarctation repair. DESIGN: Retrospective review. SETTING: Single-institution, university hospital. PARTICIPANTS: Eighty-four children who had undergone surgical repair of aortic coarctation from January 1984 to May 1996. INTERVENTIONS: SSEPs were monitored in all patients throughout the procedure. A persistent decrease in amplitude greater than 50% from baseline was considered significant. Duration of SSEP changes in relation to the time course of surgical repair and whether a surgical or anesthetic intervention resulted from a change in SSEPs were documented. MEASUREMENTS AND MAIN RESULTS: Eighty-four patients underwent 87 surgical procedures. SSEP changes occurred in 40% of the procedures: 38.5% with repair and 15% with test clamp, with 9% occurring during both test clamp and repair. Interventions, which included repositioning the aortic cross-clamp, elevating blood pressure, and aborting surgery, occurred in 26.4% of all procedures based on SSEP changes. No patient sustained a neurologic deficit. CONCLUSION: This is the largest series to date describing the use of SSEPs in aortic coarctation repair. These SSEP changes were often immediately amenable to changes in surgical and anesthetic management. SSEP changes and interventions based on these changes occurred with a considerable frequency.

Adolescent↗
PubMed1999

The relationships among pulmonary function, aerobic fitness, and cognitive functioning in older COPD patients.

STUDY OBJECTIVES: To study the predictive relationships among age, pulmonary function, aerobic fitness, and cognition in people with COPD. DESIGN: Observational study conducted during baseline testing with COPD patients who volunteered to participate in an exercise intervention. PARTICIPANTS: Older adults (age, 56 to 80 years) with COPD. MEASUREMENTS AND RESULTS: Age, depression, education level, aerobic fitness, blood oxygen saturation levels, and pulmonary function were assessed. Participants were randomly assigned to take cognitive tests of (1) fluid intelligence, (2) processing speed and working memory span, or (3) processing speed and inhibition. After controlling for education and depression (F(2,57) = 7.43; r(2) = 0. 21), performance on the 6-min walk (F(1,56) = 15.27; r(2) = 0.17) and age (F(1,55) = 7.52; r(2) = 0.08) were significant predictors of fluid intelligence. On the speed-of-processing task, performance on the 6-min walk (F(1,30) = 8.17; r(2) = 0.20), maximum voluntary ventilation (F(1,29) = 5.81; r(2) = 0.16), and age (F(1,28) = 5.26; r(2) = 0.10) were significant predictors. FVC was a significant predictor (F(1,25) = 6.37; r(2) = 0.18) of working memory span. The ability to inhibit a response was not significantly predicted by any of the variables assessed. CONCLUSIONS: In an older COPD sample, age, aerobic fitness, and pulmonary function are predictive of cognitive performance on various tasks. In particular, age and aerobic fitness are predictive of speed of processing, which is a cognitive variable that may itself underlie performance on a majority of cognitive tasks.

Adult↗
PubMed1998

Aortic stenosis with end-stage liver disease: prioritizing surgical and anesthetic therapies.

A 48-year-old man with end-stage liver disease and aortic stenosis (AS), was being evaluated for liver transplantation. This report focuses on the question of which medical problem to correct first, the end-stage liver disease or the AS. Risk factors for surgical correction of AS and liver transplantation are reviewed and discussed, and the surgical and anesthetic management strategies for this patient are outlined.

Anesthesia, General↗
PubMed1996

Latex allergy in the operating room: case report and a brief review of the literature.

A patient with a history of spina bifida and cerebral palsy was anesthetized for an ileal conduit. The procedure was uneventful until penetration of the abdominal cavity, immediately after which the patient suffered severe hypotension and her peak inspiratory pressure doubled. The patient's skin became flushed and the capnogram tracing was consistent with bronchospasm. The patient was treated with phenylephrine hydrochloride (Neo-Synephrine), and then epinephrine. This was followed with an epinephrine infusion, intravenous (i.v.) methylprednisolone sodium succinate (Solu-Medrol), inhaled albuterol sulfate, and diphenhydramine hydrochloride (Benadryl) i.v.. The patient responded to these interventions and the procedure was completed without further incident. A diagnosis of latex allergy was made based on the patient's clinical status, underlying diseases, and positive postoperative radioallergosorbent test (RAST). Anesthesiologists must be able to diagnose the signs and symptoms of allergic reactions in patients under anesthesia. This article will review the types of hypersensitivity reactions involved, define the risk groups, and examine the treatment protocols available for latex allergy.

Adult↗
PubMed1995

Endotracheal tube location verified reliably by cuff palpation.

To verify a safe location of the endotracheal tube (ETT), palpation of the ETT at the sternal notch is a time-honored technique: After anesthetic induction and confirmation of orotracheal intubation, the patient's head is placed in a neutral position. The ETT is withdrawn or advanced while gentle, repetitive pressure is applied with the fingers at the level of the suprasternal notch. Simultaneously, the pilot balloon is held in the other hand. When the balloon distends from the pressure applied at the notch, the ETT is secured. We tested the efficacy of this technique in men and women who underwent general anesthesia. After the ETT was secured, the distance (in cm) from its tip to the upper incisors, that is, the length of ETT inserted, was measured to confirm its location relative to the carina. The study population consisted of 44 women and 38 men (n = 82) who ranged in age from 16 to 85 yr and in ASA physical status from I to IV. The size of the ETT tube for women ranged from 7.0 to 8.0 and for men, 7.0 to 8.5. Average distance from the tip of the ETT to teeth in women was 20.2 cm (range, 17-23) and in men 21.9 cm (range, 19-25). Average distance to the carina in women was 3 cm (range, 2-5) and in men 3.4 cm (range, 2-6). In this study, palpation of the ETT cuff effectively confirmed ETT location. The technique, which should not be used to verify endotracheal rather than bronchial intubation, should decrease the risk of bronchial intubation or impingement on the carina.

Adolescent↗