Biomedical subjects

Terri Monk

Publications and source records attributed to Terri Monk.

4 recordsLinked to original sources

PubMed2006

Central nervous system injury associated with cardiac surgery.

Millions of individuals with coronary artery or valvular heart disease have been given a new chance at life by heart surgery, but the potential for neurological injury is an Achilles heel. Technological advancements and innovations in surgical and anaesthetic technique have allowed us to offer surgical treatment to patients at the extremes of age and infirmity-the group at greatest risk for neurological injury. Neurocognitive dysfunction is a complication of cardiac surgery that can restrict the improved quality of life that patients usually experience after heart surgery. With a broader understanding of the frequency and effects of neurological injury from cardiac surgery and its implications for patients in both the short term and the long term, we should be able to give personalised treatments and thus preserve both their quantity and quality of life. We describe these issues and the controversies that merit continued investigation.

Cognition Disorders↗

PubMed2004

Isoflurane inhalation enhances increased physiologic deadspace volume associated with positive pressure ventilation and compromises arterial oxygenation.

Abnormally increased physiologic deadspace volume (Vd(phys)), consisting of alveolar deadspace volume and airway deadspace volume, is one of several causative factors predisposing to compromised arterial blood gas exchange. We compared the effects of two methods of general anesthesia on Vd(phys) when combined with positive pressure ventilation (PPV): total IV anesthesia (TIVA) and inhaled anesthesia with isoflurane. Forty patients with no history of pulmonary pathology undergoing elective surgery in the supine position were studied. A crossover design was used, and all patients received both anesthetic methods sequentially in randomized order. PPV and TIVA significantly increased Vd(phys) compared with baseline (preoperative and breathing spontaneously) from 164 +/- 60 mL to 264 +/- 79 mL (P < 0.05). Isoflurane inhalation combined with PPV significantly enhanced this increase, resulting in a twofold increase in Vd(phys) to 315 +/- 80 mL (P < 0.05). Also, alveolar deadspace volume increased by more than 200% with isoflurane. Furthermore, isoflurane inhalation (1.15% end-tidal concentration) resulted in impaired arterial oxygenation, as evidenced by a significant decrease in the Pao(2)/fractional inspired oxygen concentration ratio compared with baseline values from 387 +/- 35 to 310 +/- 70 (P < 0.05). Although significant increases in Vd(phys) resulted with PPV combined with TIVA, these adverse changes were much less compared with isoflurane inhalation and PPV. These findings may apply to subjects with compromised pulmonary function (i.e., acute respiratory distress syndrome or severe inhalational burn injury).

Adult↗

PubMed2002

Effect of single-dose subarachnoid spinal anesthesia on pain and recovery after unilateral percutaneous nephrolithotomy.

PURPOSE: We studied the impact of one dose of subarachnoid spinal analgesia on postoperative pain and recovery after percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: Between August 1999 and May 2000, 20 PCNL patients were randomized into two groups: Group A (N = 9), who received preoperative subarachnoid spinal analgesia with morphine sulfate, and Group B (N = 11), who received no subarachnoid spinal analgesia. Both groups were given general anesthesia, and the nephrostomy site was infiltrated with bupivacaine hydrochloride. Stone size was similar in the two groups, as were ASA classification, age, and body mass index. Pain analog scales (maximum score 10) were completed preoperatively and on the day of surgery (D0), after 1 day (D1), and after 2 days (D2). The amount of morphine sulfate equivalents (MS eq) needed, the activity level, and adverse effects were recorded. RESULTS: In Group A, the average pain score on D0, D1, and D2 was 2.7, 3.7, and 1.4, respectively; in Group B, the average pain score was 4, 4.5, and 2, respectively (P > 0.05). The average MS eq used in Groups A and B were 8.3 v 33.8 (P = 0.002) on D0; 17.7 v 28.7 (P > 0.05) on D1; and 11.1 v 10.1 (P > 0.05) on D2. On D0, in Group A, 56% of the patients were ambulating and 11% complained of nausea, while in Group B, 0 were ambulating and 46% complained of nausea. CONCLUSIONS: A single preoperative dose of subarachnoid spinal analgesia provides a statistically significant decrease in postoperative parenteral pain medication and earlier ambulation. It also appears to reduce the amount of postoperative pain and decrease nausea.

Adult↗

PubMed2002

Postoperative cognitive dysfunction in middle-aged patients.

BACKGROUND: Postoperative cognitive dysfunction (POCD) after noncardiac surgery is strongly associated with increasing age in elderly patients; middle-aged patients (aged 40-60 yr) may be expected to have a lower incidence, although subjective complaints are frequent. METHODS: The authors compared the changes in neuropsychological test results at 1 week and 3 months in patients aged 40-60 yr, using a battery of neuropsychological tests, with those of age-matched control subjects using Z-score analysis. They assessed risk factors and associations of POCD with measures of subjective cognitive function, depression, and activities of daily living. RESULTS: At 7 days, cognitive dysfunction as defined was present in 19.2% (confidence interval [CI], 15.7-23.1) of the patients and in 4.0% (CI, 1.6-8.0) of control subjects (P < 0.001). After 3 months, the incidence was 6.2% (CI, 4.1-8.9) in patients and 4.1% (CI, 1.7-8.4) in control subjects (not significant). POCD at 7 days was associated with supplementary epidural analgesia and reported avoidance of alcohol consumption. At 3 months, 29% of patients had subjective symptoms of POCD, and this finding was associated with depression. Early POCD was associated with reports of lower activity scores at 3 months. CONCLUSIONS: Postoperative cognitive dysfunction occurs frequently but resolves by 3 months after surgery. It may be associated with decreased activity during this period. Subjective report overestimates the incidence of POCD. Patients may be helped by recognition that the problem is genuine and reassured that it is likely to be transient.

Adult↗