Biomedical subjects
Publications and source records attributed to S Bogosyan.
Following repeated metamizole applications a 41-year old intensive-care patient suffering from severe craniocerebral trauma and sepsis developed a drug-induced agranulocytosis. Early G-CSF treatment reduced the neutropenic period to 4 days.
OBJECTIVE: Postoperative shivering is common and has potentially adverse side effects in high-risk patients. Meperidine, which binds to both mu- and kappa-opioid receptors, is reported to be more effective in treating shivering than morphine or fentanyl. Recent data indicate that much of meperidine's special antishivering effect may be mediated by its kappa-opioid receptor activity. Nalbuphine, an opioid agonist/antagonist also has a potent affinity for kappa-receptors. The aim of this study was to evaluate the antishivering effect of nalbuphine in comparison to meperidine. METHODS: 100 ASA physical status I-II patients shivering after elective surgery were included in the study. General anaesthesia was performed with thiopentone, low-dose fentanyl and enflurane in N2O/O2. After arrival in the recovery room patients shivering within 5 min received either meperidine 25 mg or nalbupine 10 mg in a double-blind, randomised manner. The duration and severity of shivering, heart rate, respiratory rate, blood pressure, end-tidal CO2 concentration, O2-saturation and awareness were documented until 20 min after injection. Patients in need of a second injection were excluded from the study. RESULTS: Demographic variables, duration of operation and temperature decreases were not significantly different between treatment groups. The suppression of shivering was achieved within 4.0 +/- 3.5 or 4.6 +/- 4.1 min following the injection of meperidine or nalbuphine, respectively (p = NS). Vital signs and postoperative vigilance showed no significant differences. No adverse side effects were observed. DISCUSSION: The data indicated that nalbuphine suppressed postoperative shivering as effectively and timely as meperidine in equianalgesic doses. The observation is consistent with the hypothesis that stimulation of kappa-opioid receptors is a likely explanation for much of meperidine's antishivering action.
In 16 consecutive patients with diffuse peritonitis 93 staged lavages were undertaken. In a retrospective study the changes of some vital functions due to transport in the operating room and staged lavage were evaluated. 9 patients (56%) survived the diffuse peritonitis. The vital parameters showed no significant changes following staged lavages. Intraabdominal specimen cultures were positive in 62% of cases, showing no correlation of the underlying disease and mortality. Only an elevation of C-reactive protein and rise of thrombocyte count correlated significantly with the outcome of diffuse peritonitis.
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Myocardial contusion is a common, but often undiagnosed complication of a blunt chest trauma and is frequently accompanied by cardiac arrhythmias. Right bundle branch block is an arrhythmia that generally subsides spontaneously. The case of an adult patient is reported who sustained multiple facial fractures in a car accident. The admission ECG showed right bundle branch block without any haemodynamic effects. The patient was admitted to the intensive care unit. After 20 hours the right bundle branch block disappeared spontaneously and one month later, after two facial plastic operations, the patient could be discharged. Some of the clinical features and complications of myocardial contusion and diagnostic methods for its detection are reviewed.
A ten-year-old boy with Kugelberg-Welander syndrome was referred to the Ear-Nose- and Throat department for an emergency tracheostomy operation. There was no time for premedication. General anaesthesia was performed with a combination of thiopentone, halothane and nitrous oxide. The patient was awake soon after the operation but developed severe respiratory depression necessitating mechanical ventilation for 12 hours. The causes of the respiratory depression and the anaesthetic problems presented by these cases are discussed.