Biomedical subjects

U L Mahisekar

Publications and source records attributed to U L Mahisekar.

2 recordsLinked to original sources

PubMedDate not supplied

Infusion of large particles of thiopental sodium during anesthesia induction.

STUDY OBJECTIVE: To determine the potential clinical significance of admixtures of thiopental sodium and acidic drugs, which are used during induction of general anesthesia and can cause the formation of particles of thiopental. DESIGN: Using an infusion setup similar to that used for a rapid-sequence induction of general anesthesia, injection of either pancuronium bromide or vecuronium bromide caused formation of particles of thiopental that were measured using a particle analyzer. The effects of delaying the injection of the muscle relaxant on particle formation and the effects of plasma on particle dissolution were studied. MEASUREMENTS AND MAIN RESULTS: The thiopental particles had a diameter of 17 to 39 microns, with a concentration of 15,000 to 20,000 particles/ml. Particle formation was prevented when a 30-second delay preceded administration of pancuronium or vecuronium following injection of thiopental. No particle formation was detected when succinylcholine was injected. Human plasma was far more effective than a crystalloid solution in dissolving thiopental particles. CONCLUSIONS: It is unlikely that clinically significant particles of thiopental will remain intact upon entering the bloodstream. However, mixing thiopental with pancuronium or vecuronium has the potential of disrupting intravenous access due to occlusion with particles.

Anesthesia, General↗

PubMedDate not supplied

Continuous spinal anesthesia and post dural puncture headache: a retrospective study.

Continuous spinal anesthesia (CSA) fell into disuse because of a presumed high incidence of post dural puncture headache (PDPH). A careful retrospective study of 226 continuous spinal anesthetics administered for a variety of surgical (not obstetric) procedures was carried out and indicated that none of the patients developed PDPH. While 62% of the patients were older than 60 years of age, a group with a low incidence of PDPH, it was expected that some of the younger patients would develop this complication, especially since 94% of the dural punctures were carried out with 17- and 18-gauge needles. This study also revealed only a 12% incidence of hypotension, an impressive finding because 64% of the patients were considered ASA III or IV. There were no other intraoperative or postoperative complications or deaths due to CSA. This retrospective study indicates that CSA, properly carried out with 17- and 18-gauge needles, is not necessarily associated with a high incidence of PDPH; and in view of its low morbidity and mortality, CSA is particularly useful and safe in the poor-risk elderly patient. This study also raises the question as to whether there is a need for the recently developed (and expensive) microcatheters that fit through very small-bore needles.

Adult↗