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Biomedical subjects

T L Rao

Publications and source records attributed to T L Rao.

At least 37 records · Page 2Linked to original sources
PubMed1984

A review of pulmonary artery catheterization in 6,245 patients.

From July 1977 to December 1982, 6,245 patients requiring cardiac and noncardiac operations had pulmonary artery (PA) catheterizations for perioperative monitoring. Their ages ranged from 4 to 94 years. PA catheters were inserted through the external or internal jugular vein in 6,146 patients, while arm veins were used in 99 patients. Complications included persistent PVCs requiring therapy in 193 (3.1%), right bundle branch blocks in three (0.048%), left bundle branch and complete heart block each in one patient (0.016%), intrapulmonary hemorrhage in four (0.064%), minor pulmonary infarcts in four (0.064%), perforation of right ventricle in one (0.016%), and death from uncontrollable pulmonary hemorrhage in one patient (0.016%). This investigation reveals a low incidence of morbidity associated with PA catheterization.

Adolescent↗
PubMed1984

Metoclopramide and cimetidine to reduce gastric fluid pH and volume.

Eighty female patients undergoing outpatient laparoscopy were divided into four equal groups to investigate the effect of cimetidine and metoclopramide on the gastric fluid volume and pH. Group I patients received two placebo tablets. Group II patients were given metoclopramide, 10 mg, and one placebo tablet. Group III patients received cimetidine, 300 mg, and one placebo tablet. Group IV patients received metoclopramide, 10 mg, and cimetidine, 300 mg. Gastric fluid volume in group I patients was 83.9 +/- 2.3 ml; in group II patients, 11.1 +/- 0.63 ml; in group III patients, 51 +/- 2.33 ml; and in group IV patients, 12.05 +/- 0.79 ml. Gastric fluid pH was 1.38 +/- 0.12, 2.6 +/- 0.21, 4.04 +/- 0.32, and 4.64 +/- 0.28 in groups I through IV, respectively. Gastric fluid volume was significantly less (P less than 0.0001) in groups II and IV than in groups I and III. Gastric fluid pH was significantly higher (P less than 0.0001) in groups III and IV than in groups I and II. It is concluded that administration of metoclopramide and cimetidine two hours prior to induction of anesthesia significantly decreases the gastric fluid volume and increases gastric fluid pH, thereby decreasing both the likelihood of aspiration of gastric contents and the likelihood of severe pulmonary reaction, should aspiration occur.

Adult↗
PubMed1983

Reinfarction following anesthesia in patients with myocardial infarction.

The authors studied the incidence of and factors related to recurrent perioperative myocardial infarction retrospectively during 1973-1976 (Group 1) and prospectively during 1977-1982 (Group 2). Reinfarction occurred in 28 of 364 (7.7%) patients in Group 1 and 14 of 733 (1.9%) in Group 2 (P less than 0.005). When the previous infarction was 0-3 and 4-6 months old, perioperative reinfarction occurred in 36% and 26% of Group 1 patients, respectively, and only 5.7% and 2.3% of Group 2 patients, respectively, (P less than 0.05). In both groups, patients with associated congestive heart failure had a higher reinfarction rate. Patients who had intraoperative hypertension and tachycardia or hypotension develop had a higher incidence of reinfarction in both groups. The results suggest that preoperative optimization of the patient's status, aggressive invasive monitoring of the hemodynamic status, and prompt treatment of any hemodynamic aberration may be associated with decreased perioperative morbidity and mortality in patients with previous myocardial infarction. Which of these factors, if any, contributed to the improved outcome was not determined in this study.

Aged↗
PubMed1983

Ventilator-induced barotrauma in controlled mechanical ventilation versus intermittent mandatory ventilation.

Retrospective analysis of pulmonary barotrauma incidence in 292 patients ventilated greater than or equal to 24 h was conducted. From 1971-1973, 156 patients with acute respiratory insufficiency were managed with controlled mechanical ventilation (CMV) and PEEP. During 1973-1976, 136 patients were supported with IMV and CPAP. Despite higher mean peak and end-expiratory airway pressure, the IMV-CPAP group exhibited a significantly lower incidence of ventilator-induced barotrauma; 7% vs 22% (p less than 0.01). We suspect the difference is related to fewer mechanical breaths with IMV and not to the level of end-expiratory pressure employed.

Barotrauma↗
PubMed1983

Noncardiac pulmonary edema precipitated by tracheal intubation in patients with inhalation injury.

Ten patients with body surface burn and clinical evidence of inhalation injury developed transient, reversible pulmonary edema within 5 min after endotracheal intubation. Hemodynamic studies within 1 hr after intubation revealed normal cardiac output and pulmonary artery wedge pressure (WP). Additionally, in the latter 4 patients, protein concentration of edema fluid (EF) aspirated from the trachea was 58-104% of plasma (P) total protein. These findings suggest that altered capillary permeability was responsible for this transient pulmonary edema. It is postulated that glottic generated expiratory retard may increase alveolar pressure, thus preventing pulmonary edema. Bypass of glottis by tracheal intubation may render alveolar pressure atmospheric and facilitate edema formation.

Adolescent↗
PubMed1982

Epidural triamcinolone and adrenal response to hypoglycemic stress in dogs.

The effect of an epidural steroid injection (triamcinolone) on plasma cortisol levels was studied in twelve beagle dogs following an insulin-induced hypoglycemic stress. The control group (n = 6) received epidural bupivacaine only. This group consistently increases their plasma cortisol values in response to the hypoglycemic stress induced by 0.6 units of insulin/kg administered intravenously. Dogs in the study group (n = 6) received epidural bupivacaine plus 2 mg/kg of triamcinolone. This group was unable to increase their plasma cortisol values in response to similar insulin-induced hypoglycemic stress for four weeks. Return to normal function occurred five weeks following epidural triamcinolone. The authors hypothesize that the inability of the dogs to respond to hypoglycemic stress by increasing their plasma cortisol may interfere with homeostasis and decrease their tolerance to other types of stress up to 4 weeks following epidural triamcinolone administration.

Animals↗
PubMed1982

Hemodynamic response to changes in ventilatory patterns in patients with normal and poor left ventricular reserve.

Hemodynamic effects of controlled mechanical ventilation (CMV), intermittent mandatory ventilation (IMV), and intermittent mandatory ventilation with 5 cm H20 PEEP (IMV 5 peep) were studied in 20 patients after aortocoronary bypass surgery. Significant increases in cardiac index (CI) and stroke volume index (SI) (p less than 0.01) resulted in patients with normal left ventricular end-diastolic pressure (LVEDP) and ejection fraction (EF) changing from CMV to IMV. With a change from IMV to IMV 5 peep, the CI and SI returned to CMV values. However, in patients with increased LVEDP with an EF of less than 0.6, suggesting poor ventricular function and reserve, when the mode of ventilation was changed from CMV to IMV, right atrial pressure (RAP) and pulmonary artery occlusion pressure (PAOP) significantly increased (p less than 0.01) with an associated significant decrease in mean arterial pressure (MAP), CI, SI (p less than 0.01). When these patients were placed on IMV 5 peep, the hemodynamic variables returned to the values obtained during CMV. We conclude that changing from CMV to IMV has salutory effects on the patient's hemodynamic values with normal left ventricular function. But in patients with failing left ventricle, volume overload of right ventricle which occurs with the institution of spontaneous respiration during IMV has deleterious effects on the hemodynamic variables. These deleterious effects can be effectively negated by the application of IMV 5 peep.

Blood Pressure↗
PubMed1981

Anticoagulation following placement of epidural and subarachnoid catheters: an evaluation of neurologic sequelae.

The incidence of neurologic complications arising from anticoagulant therapy, following epidural and subarachnoid catheterization in 3,164 and 847 patients, respectively, was determined. Twenty patients experienced minor neurologic complications or low back pain which was self-limiting and resolved with time. There was no incidence of peridural hematoma leading to spinal cord compression. This investigation shows that the occurrence of symptomatic hematomas following anticoagulation in patients with epidural or subarachnoid catheters is a very rare complication, assuming proper patient selection, an atraumatic technique, and appropriate monitoring of anticoagulant activity.

Adult↗
PubMed1981

Deliberate hypotension and anesthetic requirements of halothane.

Following determination of minimum alveolar anesthetic concentration (MAC) of halothane during normotension, 18 dogs were divided into three groups. Dogs in each group then received either pentolinium, trimethaphan, or sodium nitroprusside, and mean arterial pressure was decreased to 60% of control values for 1 hour. The MAC of halothane was determined during hypotension and then arterial pressure was returned to control values and MAC was redetermined at normotension. The MAC of halothane decreased significantly during hypotension in all three groups: in the pentolinium group from a control MAC of 1.2 +/- 0.14 (SEM) to a MAC of 0.7 +/- 0.11 during hypotension, in the trimethaphan group from a control MAC of 1.02 +/- 0.06 to a MAC of 0.72 +/- 0.07 during hypotension, and in the nitroprusside group from a control MAC of 1.02 +/- 0.07 to a MAC of 0.73 +/- 0.07 during hypotension. Upon return of mean arterial pressure to normotensive levels, MAC of halothane returned to control values in dogs given pentolinium and trimethaphan, but in dogs given nitroprusside MAC remained at the hypotensive value. There was no correlation between the changes in MAC and carotid blood flow or cardiac index. These data indicate that anesthetic requirements decrease during deliberate hypotension irrespective of the drug used to produce hypotension.

Anesthesia, Inhalation↗
PubMed1980

Intravenous albumin administration for prevention of spinal hypotension during cesarean section.

Five percent albumin in Ringer's lactate with 5% dextrose solution (D5RL) (15 ml/kg) was prophylactically infused preanesthetically over 15 to 20 minutes to prevent hypotension during spinal anesthesia in 46 patients undergoing elective cesarean section. Apgar scores and the incidence and severity of hypotension were compared to results obtained in 41 patients who were given D5RL solution without albumin (15 ml/kg). The incidence of hypotension was significantly less in patients given 5% albumin than in patients hydrated with D5RL alone. Mean arterial pressure decreased up to 18 torr from control values in patients hydrated with D5RL but mean arterial pressure did not change significantly in patients given 5% albumin. The Apgar scores, both at 1 minute and 5 minutes, were significantly higher (p < 0.01) in infants born of mothers given albumin than in infants whose mothers were given D5RL solution. Prophylactic administration of 5% albumin in D5RL solution is an effective method for prevention of spinal hypotension.

Adolescent↗
PubMed1980

Pulmonary function following 'pretreatment' dose of pancuronium in volunteers.

The effect of a pretreatment dose (0.014 mg/kg) of pancuronium bromide on pulmonary function tests in 15 healthy volunteers was investigated. Ventilatory flow volume loops and maximum voluntary ventilation were determined before and 1 and 3 minutes following administration of the pancuronium. Calculation of the pulmonary function from the flow volume loops revealed statistically significant decreases in forced expiratory flow at 50% of expired volume, forced expiratory volume at 1 second and 3 seconds, peak inspiratory flow, peak inspiratory flow at 50% of inspired volume, forced vital capacity, and maximum voluntary ventilation. Significant pulmonary dysfunction associated with dyspnea was seen in four subjects and one subject had to be artificially ventilated and pancuronium had to be reversed with prostigmine. Ventilation should be closely monitored in patients following pretreatment doses of pancuronium in view of frequent atypical responses.

Adult↗