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Z Gamulin

Publications and source records attributed to Z Gamulin.

51 records · Page 3Linked to original sources
PubMed1989

Comparison of continuous spinal and continuous epidural anaesthesia for lower limb surgery in elderly patients. A retrospective study.

This retrospective study compared continuous spinal anaesthesia with continuous epidural anaesthesia for lower limb orthopaedic surgery in the elderly. The anaesthetic records of 457 patients who received continuous spinal anaesthesia and 274 who received continuous epidural anaesthesia over a 5-year period were analysed. The patients who had continuous spinal anaesthesia were at a higher anaesthetic risk (ASA 3-4, 76% as compared with 37%, p less than 0.001), but the incidence of failures was significantly lower (1.7%, as compared with 9%, p less than 0.001) and fewer patients showed a decrease in mean arterial pressure of more than 30% (44%, as compared with 65%, p less than 0.001) and (or) received vasopressors (65%, as compared with 77%, p less than 0.01). Our data show continuous spinal anaesthesia to be more reliable and to provide better cardiovascular stability.

Aged↗
PubMed1989

Lung function during anesthesia and respiratory insufficiency in the postoperative period: physiological and clinical implications.

This review covers the physiological and clinical implications of lung function during anesthesia and respiratory insufficiency in the postoperative period. We have divided it into 3 main sections: 1) lung function changes induced by anesthesia and surgery, in which the impact on pulmonary mechanics, ventilation/perfusion changes and gas exchange are examined; 2) physiological implications of postoperative respiratory function secondary to decreased alveolar ventilation, development of atelectasis, and interstitial lung edema; and 3) clinical implications of postoperative respiratory failure. In this last section we analyze the current therapeutic modalities available to reduce the incidence of postoperative respiratory failure, as well as related morbidity and mortality.

Anesthesia, General↗
PubMed1989

Surgical repair of hip fractures using continuous spinal anesthesia: comparison of hypobaric solutions of tetracaine and bupivacaine.

The aim of this study was to compare hypobaric solutions of tetracaine and bupivacaine in 30 geriatric patients undergoing surgical repair of hip fractures while under continuous spinal anesthesia. Tetracaine 1% and bupivacaine 0.5% were mixed with distilled water to prepare hypobaric 0.25% solutions. In a double-blind fashion, all patients received 3 ml (7.5 mg) of either solution in the lateral decubitus position with the operated side up, the table being kept horizontal for 30 minutes after injection. The mean highest sensory levels in both groups, and in both operated and non-operated sides in the same group, were comparable, ranging between T7 and T8.5. Duration of analgesia was 134 minutes with tetracaine and 130 minutes with bupivacaine (NS). In both groups, motor blockade was satisfactory in 29/30 patients on the operated side. The frequency of a decrease in systolic blood pressure of more than 30% was similar in the two groups. The authors conclude that hypobaric solutions of both tetracaine and bupivacaine are suitable for surgical repair of hip fractures in geriatric patients and produce comparable anesthetic and hemodynamic effects.

Anesthesia, Spinal↗
PubMed1986

Multiple complications after internal jugular vein catheterisation.

We report a case of a young female who developed multiple life threatening complications after a single internal jugular vein catheterisation. They consisted of pleural misplacement of the catheter, massive haemorrhage with cardiovascular collapse following catheter removal, and development of arteriovenous fistula, diagnosed 18 months later.

Adolescent↗
PubMed1986

Absence of benefit of incentive spirometry in low-risk patients undergoing elective cholecystectomy. A controlled randomized study.

To determine the potential benefit of incentive spirometry, which has been advocated to prevent pulmonary complications after upper-abdominal surgery, we compared a group of patients receiving incentive spirometry to another group receiving no specialized postoperative respiratory care. Forty patients in the American Society of Anesthesiologists' class 1 and 2 who were undergoing cholecystectomy (through right subcostal incision) were included in the study and were randomly allocated to one of the two groups. Patients receiving incentive spirometry were encouraged by a specialized respiratory physiotherapist to breathe deeply for five minutes hourly, 12 times daily, for three postoperative days. No statistically significant difference between the two groups was found in the radiologic evidence of postoperative pulmonary complications, arterial oxygen pressure, spirometric measurement, and clinical evaluation at the second or fourth postoperative day (or both). In particular, deterioration on the chest x-ray film at the fourth postoperative day was observed in eight of 20 patients in the group receiving incentive spirometry and in six of 20 in the control group. Our study confirms the postoperative deterioration of respiratory function after upper-abdominal surgery and demonstrates the lack of therapeutic values of incentive spirometry in these patients at low risk for pulmonary complications.

Adult↗
PubMed1984

Effects of infrarenal aortic cross-clamping on renal hemodynamics in humans.

While the systemic cardiovascular consequences of infrarenal aortic cross-clamping during aortic abdominal surgery are well documented, its repercussions on renal hemodynamics in humans have not been reported. In 12 patients, scheduled for elective aortic surgery, renal clearances, using 51Cr EDTA and 125I hippuran, were measured before, during, and after infrarenal aortic cross-clamping. A continuous infusion of mannitol 20% at a rate of 100 ml/h was administered throughout the study. Arterial and renal venous blood sampling, obtained at the midpoint of each period, permitted calculation of the extraction fraction of 125I hippuran and accurate determination of renal blood flow and its cortical-extracortical distribution. Although cardiac output and systemic vascular resistance did not change significantly between the three study periods, infrarenal aortic cross-clamping decreased 125I hippuran clearance by 29 +/- 15% (P less than 0.05) and renal blood flow by 38 +/- 14% (P less than 0.001). Simultaneously, an increase of 75 +/- 31% in renal vascular resistance (P less than 0.05) was observed and the extraction fraction of 125I hippuran increased from 0.67 +/- 0.05 to 0.74 +/- 0.05 (P less than 0.01). All of these changes, which indicate global diminution of renal perfusion with a redistribution of renal blood flow toward the cortical compartment, persisted for at least 1 h after release of the aortic clamp. Early signs of renal tubular damage, such as the appearance of lysozyme and ligandine in the urine, however, were never observed. The authors conclude that infrarenal aortic cross-clamping produces profound and sustained alterations in renal hemodynamics and may be harmful in patients with impaired renal function or when surgical occlusion of the aorta is prolonged.

Aged↗
PubMed1981

[Comparative study of sequential analgesic anesthesia (SAA) with continuous-infusion analgesia by fentanyl].

A group of elderly (mean age: 75 years) patients undergoing a prothetic on the hip under analgesic anaesthesia using fentanyl by continuous infusion (7 micrograms.kg.h(-1)) was compared with a similar group receiving sequential analgesic anaesthesia using fentanyl (25 micrograms.kg as a bolus then 7 micrograms.kg(-1).2030mins(-1)). Comparison of the results obtained revealed a variation in mean cardiocirculatory parameters which was less marked in the group receiving fentanyl by infusion than in the group receiving it sequentially. The higher doses used in the sequential analgesia group led in the majority of cases to severe respiratory depression requiring its reversal by an antagonist or postoperative ventilatory assistance, whilst the use of fentanyl by infusion made it possible to reduce total doses of the drug and ensure adequate spontaneous respiration at the end of the operation.

Aged↗
PubMed1976

[Etomidate: cardiovascular effects of a new intravenous anesthetic agent].

The cardiovascular effects of intravenous Etomidate (0.2 mg/kg) were studied in 14 surgical patients with ages varying from 49 to 90. The anaesthetic induction occurs within 10 seconds and the mean duration of anaesthesia is from 6 to 8 minutes. I.V. Etomidate causes a slight lowering of the mean arterial pressure (8.5 per cent), a negligible increase of the heart rate (2.8 per cent) and an insignificant lowering of the mean pulmonary artery pressure (7 per cent). Cardiac output and stroke volume are respectively lowered by 7.6 per cent and 10 per cent. The peripheral vascular resistance is discreetly reduced by 3.8 per cent. From these results, we believe that Etomidate seems to induce sleep with the lightest hemodynamic disturbances in comparison with other agents commonly used. However, some undesirable side effects appeared in some of our patients which can become somewhat annoying, for example myoclonic movements and pain at the point of injection.

Aged↗
PubMed1976

[Effects of Etomidate on ventilation and blood gases].

17 surgical patients, agent 49 to 87, are studied. Their anaesthetic induction was performed by an intravenous injection of Etomidate on a 0,23 mg/kg body weight basiis. Respiratory frequency and minute ventilation were put on continuous recording, PO2, PCO2 and arterial blood pH were measured 1,3 and 5 minutes after injection of the drug. Anaesthetic induction, occuring 10 seconds after injection of the drug, was followed by an increase in respiratory frequency (32 p 100) and a rather modest increase of minute ventilation (9,2 p. 100). Among blood gases measurements, only PaO2 showed a decrease of 6,7 p. 100, when PO2 and pH remained practically unchanged. The small increase in minute ventilation, compared with a relatively important increase in respiratory frequency, suggests some decrease in efficient alveolar ventilation without however affecting blood gases in an important fashion.

Aged↗