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R N Wissler

Publications and source records attributed to R N Wissler.

14 recordsLinked to original sources
PubMed1999

General anesthesia with remifentanil for Cesarean section in a parturient with an acoustic neuroma.

PURPOSE: To describe the anesthetic management of a parturient with a large acoustic neuroma undergoing general anesthesia with remifentanil for Cesarean section. CLINICAL FEATURES: A near-term parturient presented with a large intracranial mass. Cesarean section under general anesthesia was elected one week prior to craniotomy for tumour resection. Remifentanil infusion, 0.2-1.0 microg x kg(-1) x min(-1), was used from induction to emergence of general anesthesia. The neonate was born seven minutes after the remifentanil infusion was started. She had normal umbilical cord pH and her Apgar scores were 7 and 8, at one and five minutes respectively. Although the neonate received supplemental oxygen, she did not require naloxone. Both mother and neonate made an uneventful recovery. CONCLUSION: Remifentanil was effective in producing stable hemodynamic conditions, without severe neonatal respiratory depression, during induction and maintenance of general anesthesia for a Cesarean delivery in a parturient with a large intracranial tumour.

Adult↗
PubMed1999

The effects of needle bevel orientation during epidural catheter insertion in laboring parturients.

UNLABELLED: Lateral needle bevel orientation during identification of the epidural space has been recommended to reduce the risk of postdural puncture headache (PDPH). Rotation to cephalad or caudad orientation before catheter insertion is assumed necessary for analgesic success. We prospectively compared the effects of catheter insertion through lateral- and cephalad-oriented Tuohy needle bevels in laboring parturients. Anesthesiology residents were randomized to identify the epidural space with bevels oriented cephalad or lateral. Catheters were inserted without needle rotation. Outcomes compared included ease of insertion, analgesic effectiveness, and complications. We evaluated 534 catheter insertions in 500 parturients. Initial catheter insertion produced satisfactory analgesia in 80.2% of the lateral group versus 91.1% of the cephalad group (P < 0.001). Resistance preventing catheter insertion accounted for the difference. There were no differences in i.v. cannulation (5.8% vs 5.1%), dural puncture (3.8% vs 2.0%), PDPH (0.4% vs 0.7%), or asymmetric block (31% vs 27%). There was a slightly higher rate of paresthesias in the lateral group (31% vs 23%; P = 0.048). In 78% of parturients experiencing both paresthesias and asymmetric block, the side of the paresthesia and greater extent of block were the same. Analgesic effectiveness, as measured by using a visual analog scale, was not different between the groups. IMPLICATIONS: Two methods of epidural catheter insertion were compared in laboring parturients. Catheter insertion with the needle orifice oriented cephalad was associated with the greatest initial success and the fewest complications.

Adult↗
PubMed1998

Intrathecal hypobaric versus hyperbaric bupivacaine with morphine for cesarean section.

UNLABELLED: Both hyper- and hypobaric solutions of bupivacaine are often combined with morphine to provide subarachnoid anesthesia for cesarean section. Differences in the baricity of subarachnoid solutions influence the intrathecal distribution of anesthetic drugs and would be expected to influence measurable clinical variables. We compared the effects of hyper- and hypobaric subarachnoid bupivacaine with morphine to determine whether one has significant advantages with regard to intraoperative anesthesia and postoperative analgesia in term parturients undergoing elective cesarean section. Thirty parturients were randomized to receive either hyper- or hypobaric bupivacaine (15 mg) with morphine sulfate (0.2 mg). Intraoperative outcomes compared included extent of sensory block, quality of anesthesia, and side effects. Postoperative outcomes, including pain visual analog scale scores, systemic analgesic requirements, and side effects, were monitored for 48 h. Sedation effects were quantified and compared using Trieger and digit-symbol substitution tests. We detected no differences in sensory or motor block, quality of anesthesia, quality of postoperative analgesia, incidence of side effects, or psychometric scores. Both preparations provide highly satisfactory anesthesia for cesarean section and effective postoperative analgesia. IMPLICATIONS: Dextrose alters the density of intrathecal bupivacaine solutions and is thought to influence subarachnoid distribution of the drug. We randomized parturients undergoing cesarean section to one of two often used spinal bupivacaine preparations, hypobaric and hyperbaric. We detected no differences in clinical outcomes between groups.

Analgesics, Opioid↗
PubMed1997

Densities of dextrose-free intrathecal local anesthetics, opioids, and combinations measured at 37 degrees C.

Dextrose-free anesthetic medications are commonly used to provide subarachnoid anesthesia and analgesia. Hypobaricity has been proposed as a mechanism to explain postural effects on the extent of sensory block produced by these drugs. Densities of dextrose-free solutions of local anesthetics and opioids, and commonly used anesthetic/opioid mixtures were determined at 37.00 degrees C for comparison with the density of human cerebrospinal fluid (CSF). Measurements accurate to 0.00001 g/mL were performed using a mechanical oscillation resonance frequency density meter. All undiluted solutions tested are hypobaric relative to human lumbar CSF with the exception of lidocaine 1.5% and 2.0% with epinephrine 1:200,000. All mixtures of local anesthetics and opioids tested are hypobaric. We observed good agreement between measured densities and calculated weighted average densities of anesthetic mixtures. While the influence of baricity on the clinical effects of dextrose-free intrathecal anesthetics remains controversial, attempts to attribute postural effects to the baricity of these drugs requires establishment of accurate density values. These density data may facilitate elucidation of the mechanisms underlying the behavior of dextrose-free intrathecal anesthetics.

Analgesics, Opioid↗
PubMed1996

Maternal posture influences the extent of sensory block produced by intrathecal dextrose-free bupivacaine with fentanyl for labor analgesia.

The cephalad extent of sensory block produced by intrathecal (IT) dextrose-free local anesthetics and opioids has been reported to be quite variable. Most reports describing the effects of IT analgesics do not control for patients posture. Because these medications are hypobaric relative to cerebrospinal fluid (CSF), parturients in a sitting position may develop greater cephalad extents of sensory block than those in a lateral position during IT injection. Parturients in labor were randomized to sitting or lateral position during IT administration of dextrose-free bupivacaine 0.25% with fentanyl 0.005%. Extent of sensory block was evaluated at intervals thereafter. Free flow of CSF was obtained in 20 parturients. Those in a sitting position during IT injection had significantly higher maximal cephalad extent of block than those in a lateral position (mean +/- SD, T-3.1 +/- 2.9 vs T-6.3 +/- 3.4, P = 0.036). Mean cephalad extent of block was greater in the sitting group at 20 and 30 min. When sensory block asymmetry was observed, the extent of block was greater on the nondependent side. Posture during IT injection of this dextrose-free analgesic combination affects extent of sensory block in laboring parturients.

Adult↗
PubMed1996

Density of lumbar cerebrospinal fluid in pregnant and nonpregnant humans.

BACKGROUND: Dextrose-free local anesthetics and opioids, alone and in combinations, are being used increasingly to provide subarachnoid anesthesia and analgesia. These dextrose-free drugs have been described as hypobaric by some and isobaric by others. To accurately classify anesthetics with regard to baricity, the density of cerebrospinal fluid (CSF) must be known. The authors sought to determine the exact density of human CSF, and determine whether CSF density is altered by pregnancy. METHODS: Density measurements accurate to 0.00001 g/ml were made at 37.00 degrees C, using a mechanical oscillation resonance frequency density meter. Cerebrospinal fluid samples were obtained from 44 patients during spinal anesthesia. Five groups were studied: men, and premenopausal, postmenopausal, term pregnant, and postpartum women. RESULTS: Mean CSF densities in men (1.00064 +/- 0.00012 g/ ml), postmenopausal women (1.00070 +/- 0.00018 g/ml), and nonpregnant premenopausal women (1.00049 +/- 0.00004 g/ ml) were significantly greater than in term pregnant (1.00030 +/- 0.00004 g/ml) and postpartum (1.00034 +/- 0.00005 g/ml) women. Cerebrospinal fluid density did not correlate with age. CONCLUSIONS: Mean CSF density varies in different patient subpopulations. Pregnancy and the immediate postpartum period are associated with the lowest CSF densities. In addition, the cutoff values defining hypobaricity (mean CSF density minus three standard deviations) are greater than previously reported. Accurate CSF density values should be used when considering baricity as a mechanism for clinical observations of dextrose-free intrathecal local anesthetics and opioids. Gestational status also should be considered.

Adult↗
PubMed1991

cAMP accumulation in opioid-sensitive SH-SY5Y neuroblastoma cells is modified by estradiol and progesterone.

We have recently demonstrated that acute and chronic treatments with estradiol and progesterone induce changes in the responsiveness of endogenous opioid systems to painful stimulation. In the present study the neuroblastoma SH-SY5Y subclone known to contain predominantly mu opioid receptors was used as a model to characterize the gonadal steroid effect on this opioid receptor system. The function of opioid receptors was assessed by measuring prostaglandin E1 (PGE1)-induced cyclic AMP accumulation after various treatments with estradiol and progesterone. Differentiated SH-SY5Y cells respond to PGE1 with a dramatic increase in cAMP level. Morphine (MOR) inhibits by about 75% the stimulatory effect of PGE1 on cAMP. Pretreatment with 5 nM of estradiol for 6 days resulted in a significant increase of PGE1-stimulated cAMP accumulation. Exposure of cells for 48 h to estradiol in doses of 5 nM or 50 nM did not affect cell sensitivity to the PGE1 effect on cAMP. Moreover, neither dose of estradiol changed the inhibitory effect of morphine on PGE1-induced cAMP response. There was a significant increase in PGE1-stimulated cAMP accumulation after treatment with 100 nM progesterone for 1 h or 15 min and a marked elevation of cAMP levels was also measured after 15 min treatment with 10 nM progesterone. Exposure to either dose of progesterone for 8 h, 48 h or 6 days did not affect basal or PGE1-induced cAMP in neuroblastoma cells. Progesterone-treated groups responded to MOR with 56-67% inhibition of PGE1-stimulated cAMP accumulation. The potency of MOR-induced inhibition was comparable to the MOR effect in cells not treated with the steroid.(ABSTRACT TRUNCATED AT 250 WORDS)

Alprostadil↗
PubMed1986

Prolactin modulates steroidogenesis by rat granulosa cells: II. Effects on estradiol.

The effects of prolactin on secretion of estradiol by rat granulosa cells obtained at two stages of differentiation and cultured under various conditions were determined. Relatively undifferentiated granulosa cells were obtained from immature, diethylstilbestrol-treated, hypophysectomized (HPX) rats and cultured in serum-free medium or with 10% serum. More highly differentiated granulosa cells were obtained on the morning of proestrous from the preovulatory follicles of immature rats in which an estrous cycle had been induced with 4 IU pregnant mare's serum gonadotropin; these cells were cultured in medium containing 10% serum. Cells were cultured for 3 days with graded doses of prolactin (0, 0.02, 0.2, 2, or 10 micrograms/ml) alone or in combination with follicle-stimulating hormone (FSH; 300 ng/ml), testosterone (0.5 microM), or FSH + testosterone. In control cultures (no prolactin) the relatively undifferentiated granulosa cells from HPX rats secreted negligible quantities of estradiol except when both FSH and testosterone were supplied. Prolactin alone or in combination with FSH or testosterone had no effect on estradiol secretion, but prolactin in combination with FSH + testosterone significantly decreased secretion in a dose-dependent fashion. This set of prolactin treatments was applied in both serum-free medium and medium containing 10% serum, with similar results under both culture conditions. The inhibitory effects of prolactin appeared to be reversible if cells were cultured with prolactin for only 1 day, but were not reversed if cells were cultured with prolactin for 2 or 3 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

High spinal anesthesia after epidural test dose administration in five obstetric patients.

BACKGROUND AND OBJECTIVES: A commonly used test dose in parturients receiving continuous lumbar epidural analgesia for labor consists of 3 mL of dextrose-free 1.5% lidocaine with 1:200,000 epinephrine. METHODS: of 1,962 obstetric epidural anesthetics administered over a 17-month period, unintentional subarachnoid placement of the epidural catheter was detected by injection of the test dose in five laboring patients. The characteristics of the resulting subarachnoid blocks were studied. RESULTS: After negative aspiration for cerebrospinal fluid in each case, test dose injection resulted in the rapid onset of high sensory block with associated motor and sympathetic block, accompanied by significant hypotension requiring aggressive treatment. CONCLUSIONS: While this test dose appears to be a sensitive indicator of an unexpected subarachnoid catheter, the resulting excessive spinal blocks in these laboring patients raise the question of its safety.

Adult↗