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Biomedical subjects

Robert Groom

Publications and source records attributed to Robert Groom.

4 recordsLinked to original sources
PubMed2005

Fentanyl plasma levels after modified ultrafiltration in infant heart surgery.

Modified ultrafiltration (MUF) is a novel application of ultrafiltration to remove excess water after cardiopulmonary bypass in pediatric patients that was first reported in 1991. It has gained widespread use as an important adjunct to fluid management in neonates, infants, and pediatric cardiac surgery patients. Now more than two decades after its original description, the exact mechanism of action and effects of this therapy are still a matter of discussion. The aim of this study was to determine the effects of MUF on plasma fentanyl levels using a two-phase in vitro and in vivo study. We designed an in vitro experimental model to simulate MUF that allowed measurement of plasma fentanyl levels while eliminating biologic variables. Plasma fentanyl levels were measured during five consecutive operations on neonates and infants undergoing repair of congenital heart defects. Increases in plasma fentanyl levels were found in vitro as well as in vivo. Fentanyl plasma levels more than doubled after MUF (increased by a factor of 2.22, from 12.4 to 27.5 ng/ml in vivo). The increase in plasma fentanyl levels needs to be taken into account when delivering anesthetic care and when analyzing the effect of MUF on outcome variables.

Cardiopulmonary Bypass↗
PubMed2002

A 10-year review of pediatric perfusion practice in North America.

In December 1999, 145 North American pediatric open-heart institutions were mailed an updated survey as a follow-up of two earlier surveys, 1989 and 1994. The survey consisted of 81 questions pertaining to demographics, equipment, techniques and patient monitoring. This survey, following a similar format of the two earlier surveys, provides a 10-year review encompassing both new and founded practices performed during the conduct of pediatric cardiopulmonary bypass. Responses were received from 83 hospitals, for a 57% response rate. Of the respondents, 72 were active pediatric open-heart centers, 67% performing both adult and pediatric cardiac surgery and 33% performing pediatric surgery exclusively. The mean number of pediatric cases performed in 1999 was 169, compared to 101 cases in 1989 and 145 cases in 1993. Of the 72 respondents, 51% were performing greater than 100 cases/year, whereas 3% of centers were performing under 25 cases/year. As the decade progressed, bubble oxygenators were completely replaced by their membrane counterpart. The use of ultrafiltration, reported first in the 1989 survey, has risen by over 30%. The use of colloids in the prime, specifically 25% albumin, has increased in use from 34% in 1989 to 85% in 1999. Rewarming gradients are used by 100% of respondents with a mean gradient of 9.4 degrees C between the patient and water bath. Myocardial protection has seen an increase of close to 20% in the use of blood cardioplegia. The use of safety devices is also on the rise with more centers using level detectors (79%), bubble detectors (88%) and arterial line filters (96%). Centers relying on the use of cardiac assist devices have increased by 25% since 1989. Results of this survey suggest a movement toward a higher volume of cases being performed at fewer centers. While some diversity is seen, movement toward greater homogeneity, first noted in the 1994 survey, continues in 1999.

Adolescent↗