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T R Lubenow

Publications and source records attributed to T R Lubenow.

7 recordsLinked to original sources
PubMed1992

Oxygen consumption and mixed venous oxygen saturation monitoring during orthotopic liver transplantation.

Mixed venous oxygen saturation (SvO2) monitoring has been advocated for some critically ill patients. Patients with end-stage hepatic failure have oxygen consumption rates that are lower than normal. Using the Fick equation, oxygen consumption may be calculated if mixed venous and arterial oxygen tensions (and saturations), hemoglobin, and cardiac output are determined simultaneously. This report describes a unique pattern of changes in SvO2 and oxygen consumption in 7 patients undergoing liver transplantation. A previous study correlated plasma carbohydrate (glucose) levels with early hepatic graft survival. After induction, the 7 patients reported here had low oxygen consumption and high SvO2 values. The oxygen consumption rates decreased to the lowest point during the anhepatic phase and rose above baseline by the end of the case. The SvO2 and oxygen consumption data reported here follow the presence of presumed hepatic metabolic activity (increased CO2 and ionized calcium). Further research must be completed to determine whether these measurements indicate early hepatic nonfunction.

Adult↗
PubMed1991

Postoperative epidural analgesia.

Epidural analgesia is an important advance in the treatment of postoperative pain. Improved pain relief and decreased patient morbidity have combined to make this technique more desirable than the use of traditional intramuscular narcotics. Optimal patient care and satisfaction, however, can only be achieved with the education and assistance of experienced nursing staff familiar with postoperative epidural analgesia therapy.

Analgesia, Epidural↗
PubMed1991

Patient-controlled analgesia for postoperative pain.

The use of PCA for the treatment of pain is a valuable and growing practice. The technique for PCA initiation and management has been described. This mode of therapy should be in the therapeutic armamentarium of every clinician managing postoperative pain because PCA provides better analgesia than conventional IM or IV narcotic therapy and is generally associated with fewer side effects.

Analgesia, Patient-Controlled↗
PubMed1990

Intraspinal narcotics for treatment of cancer pain.

Inadequate pain relief remains a problem for many patients with cancer. Narcotic administration by the epidural or subarachnoid route is a relatively recent innovation and is indicated when pain is poorly controlled with high doses of systemic narcotics, or when patients experience limiting narcotic side effects. When given by the epidural or intrathecal route, narcotics have a longer duration of action and a lower dose is effective. These techniques involve personnel trained in catheter insertion and maintenance. Epidural and intrathecal administration of narcotics is an alternative when oral narcotics are ineffective. In this report the term "intraspinal" refers to epidural and/or subarachnoid placement of catheters and drugs.

Analgesia, Epidural↗
PubMed1988

The incidence of venous air embolism during total hip arthroplasty.

Venous air embolism has been reported to occur during total hip arthroplasty. The incidence of venous air embolism, however, has not been previously studied in a large series using Doppler ultrasound and mass spectrometry. Seventy patients undergoing total hip arthroplasty were monitored for venous air embolism with precordial Doppler ultrasound, central venous catheter, end-tidal N2 and CO2 (mass spectrometry), and arterial blood gases (ABG). Changes in the monitored variables consistent with venous air embolism were noted in 57% by Doppler ultrasound, 9% by mass spectrometry, 4% by central venous catheter and 3% of the cases by ABG. A total of 77 Doppler ultrasound events were detected in 40 of the 70 patients studied. Hemodynamic changes consisting of either hypotension, defined as a greater than or equal to 20% decrease in mean arterial pressure (MAP), or cardiac dysrhythmia occurred during 43% of these events. The Doppler ultrasound was the only monitor that detected all cases of venous air embolism with concomitant hemodynamic changes. Air was aspirated from the central venous catheter during 10% of the detections of venous air embolism by Doppler ultrasound. Venous air embolism in total hip arthroplasty is a common event and may be responsible for hemodynamic changes previously ascribed to the use of methylmethacrylate cement. Routine monitoring with Doppler ultrasound appears warranted. The routine use of central venous catheterization may also be warranted.

Blood Gas Monitoring, Transcutaneous↗
PubMed1988

Comparison of continuous epidural infusion of fentanyl-bupivacaine and morphine-bupivacaine in management of postoperative pain.

The short duration of epidural fentanyl has limited its direct comparison with epidural morphine in previous reports. The following study was performed of continuous postoperative epidural infusions at 5 ml/hr fentanyl 10 micrograms/ml (n = 59) or morphine 0.1 mg/ml (n = 48), both with bupivacaine 0.1%, in patients having cesarean sections. Postoperative evaluations included the frequency and magnitude of clinically evident respiratory depression, the adequacy of analgesia, nausea, pruritus, the ability to ambulate, and other side effects for 24 hours. Analgesia and the number of supplemental narcotic injections needed were similar in both groups. The incidence of nausea and pruritus was significantly less in the patients receiving fentanyl. No patient developed respiratory depression in either group. Patient and staff acceptance of the continuous epidural technique was excellent because there were only minor catheter-related problems associated with its use. It is concluded that continuous epidural fentanyl combined with bupivacaine offers excellent postoperative analgesia with minimal side effects.

Bupivacaine↗