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Biomedical subjects

R L Knill

Publications and source records attributed to R L Knill.

At least 19 recordsLinked to original sources
PubMed1998

Myocardial infarction after noncardiac surgery.

BACKGROUND: In this study, the authors intensively monitored isoenzyme and electric activity of the heart for the first 7 days after noncardiac surgery in a large group of patients at risk for postoperative myocardial infarction (PMI). METHODS: After institutional review board approval and written informed consent were received, 323 patients, aged 50 yr or older, who had ischemic heart disease and presented for noncardiac surgery, were enrolled in this prospective, blinded study. After operation, patients had daily clinical assessments, electrocardiograms, and measurements of creatine kinase (CK), CK-2 (mass and activity), and Troponin-T on the operative night, twice daily on postoperative days 1-4, and then daily on days 5-7. A diagnosis of PMI was made if the total CK was > 174 U/l and in the presence of two of the following: (1) CK-2/CK (mass or activity) > 5%, (2) new Q waves lasting > or = 0.04 s and 1 mm deep in at least two contiguous leads, (3) Troponin-T was > 0.2 microg/l, or (4) a positive result of pyrophosphate scan. RESULTS: Eighteen of the 323 patients (5.6%) had a PMI, of which 3 (17%) were fatal. Only 3 of 18 patients had chest pain, whereas 10 of 18 patients (56%) had other clinical findings. The electrocardiographic classification of the PMI was Q wave in 6, non-Q wave in 10, and indeterminate in 2. The PMIs occurred on the day of operation in 8, on day one in 6, on day two in 3, and on day four in 1 patient. CONCLUSIONS: This study determined that PMI was an early event, only occasionally associated with chest pain, and usually non-Q wave in nature.

Aged↗
PubMed1993

Difficult laryngoscopy made easy with a "BURP".

Displacement of the larynx by backward, upward and rightward pressure on the thyroid cartilage or "BURP" may improve visualization of the glottis in some cases of difficult direct laryngoscopy. In a patient with the Treacher-Collins syndrome in whom conventional laryngoscopy had proved impossible and tracheal intubation extremely difficult, this manoeuvre exposed the entire glottis and made tracheal intubation under direct vision easy. In a patient with protruding upper incisors and a prominent premaxilla which precluded a view of the glottis by conventional laryngoscopy, "BURP" again revealed the glottic opening and simplified the placement of an endotracheal tube. This experience suggests that "BURP" be considered as a potential aid in the management of difficult direct laryngoscopy.

Adult↗
PubMed1990

Anesthesia with abdominal surgery leads to intense REM sleep during the first postoperative week.

Characteristics of nocturnal sleep were investigated in six patients after anesthesia and cholecystectomy and in another six after anesthesia and gastroplasty. All night polysomnographic recordings were obtained while each patient slept in a private surgical ward room through two nights before and five or six nights after operation. Anesthesia included thiopental, N2O, isoflurane, and fentanyl. Postoperative analgesia was provided with parenteral morphine. Other aspects of care were routine. Nocturnal sleep was markedly disturbed after both surgical procedures. Throughout the operative night and subsequent one or two nights, sleep was highly fragmented with the usual recurring cycles of sleep stages completely disrupted. Slow wave sleep was suppressed and rapid eye movement (REM) sleep virtually eliminated. During the following 2-4 nights, as other aspects of sleep recovered, REM sleep reappeared and then increased to greater than the preoperative amount. This increased REM sleep was marked by a heavy density of eye movement activity along with frequent patient reports of unusually distressing dreams or vivid nightmares. It is concluded that anesthesia with upper abdominal surgery leads to a severe disruption of nocturnal sleep followed by the release of highly intense REM sleep about the middle of the first postoperative week.

Adult↗
PubMed1988

Isoflurane anesthesia causes a transient alteration in nocturnal sleep.

Nocturnal sleep was studied in eight healthy young volunteers before and after isoflurane anesthesia. All night polysomnographic recordings were obtained for seven consecutive nights from approximately 2300 to 0700 h. On the morning after the third night each subject was anesthetized with isoflurane 1.1 MAC for approximately 3 h. The stages and indices of nocturnal sleep were calculated for each night of study according to standard criteria. The effects of anesthesia on nocturnal sleep were confined to the first postanesthetic night. Slow wave sleep (Stages 3 and 4) was moderately suppressed from 16 +/- 1% to 6 +/- 1%, and Stage 2 sleep reciprocally increased from 52 +/- 2% to 60 +/- 2% (mean +/- SEM, P less than 0.05). There were no detectable changes in the sleep onset latency, the total quantity of sleep, or the proportion of rapid eye movement (REM) sleep. Anesthesia was followed by daytime napping in six of the eight volunteers. Nocturnal sleep was similar in the subjects who napped and those who did not. It is concluded that anesthesia with isoflurane leads to a modest and a transient change in the architecture of nocturnal sleep.

Adult↗