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Biomedical subjects

Z Grunwald

Publications and source records attributed to Z Grunwald.

10 recordsLinked to original sources
PubMed1997

[Separation of conjoined twins: the anesthesiologist's perspective].

Managing anesthesia care for separation of conjoined twins poses a special challenge for the anesthesia team. Early preparation, thorough understanding of the anatomical and the physiological consequences of this complex anomaly, as well as careful coordination with the teams of surgeons, nurses and operating room personnel are mandatory to assure successful separation of the conjoined twins. It is recommended that the mother be transferred to and the babies be delivered at a tertiary care medical center, like the Children's Hospital. Special attention is devoted during the surgical procedure to cardiovascular stability, drug disposition, fluid balance and temperature control. The multidisciplinary team approach makes this complex surgery a success. When postoperative survival cannot be guaranteed for both twins, close contact and consultation is mandated with the parents, medical personnel and religious and legal advisors.

Anesthesia↗
PubMed1997

Anesthetic management of labor and postpartum bleeding in a patient with Fontan physiology.

We describe the obstetric anesthetic management of a patient with complex congenital heart anomaly consisting of transposed great arteries, double inlet left ventricle and subpulmonic stenosis. Successful management of a patient with Fontan physiology mandates a thorough understanding of the hemodynamic consequences of this procedure and the alterations during pregnancy. The major considerations are related to the fact that the systemic venous return reaches the pulmonary vasculature without the augmentation of a functioning ventricle.

Adult↗
PubMed1996

Intravenous ondansetron in established postoperative emesis in children. S3A-381 Study Group.

BACKGROUND: In pediatric postsurgical patients, postoperative vomiting is a common occurrence that can delay recovery and result in unplanned hospital admissions after outpatient surgery. This randomized, double-blind, placebo-controlled, multicenter study evaluated the efficacy and safety of ondansetron in the control of established postoperative emesis in outpatients aged 2-12 yr. METHODS: Screened for the study were 2,720 ASA physical status 1-3 children undergoing outpatient surgery during general anesthesia, which included nitrous oxide. Children experiencing two emetic episodes within 2 h of discontinuation of nitrous oxide were given intravenous ondansetron (n = 192; 0.1 mg/kg for children weighing < or = 40 kg; 4 mg for children weighing > 40 kg) or placebo (n = 183). RESULTS: The proportion of children with no emetic episodes and no use of rescue medication was significantly greater (P < 0.001) in the ondansetron group compared with placebo for both 2- and 24-h periods after study drug administration (78% of the ondansetron group and 34% of the placebo group for 2 h; 53% of the ondansetron group and 17% of the placebo group for 24 h). Among patients with at least one emetic episode or with rescue medication use, the median time to onset of emesis or rescue was 127 min in the ondansetron group compared with 58 min in the placebo group (P < 0.001). The median time from study drug administration until discharge was significantly shorter (P < 0.01) in the ondansetron group (153 min, range 44-593 min) compared with the placebo group (173 min, range 82-622 min). The incidence of potentially drug-related adverse events was similar in the ondansetron (3% of patients) and the placebo (4% of patients) groups. CONCLUSION: A single dose of ondansetron (0.1 mg/kg up to 4 mg) is effective and well tolerated in the prevention of further episodes of postoperative emesis in children after outpatient surgery. Administration of ondansetron also may result in a shorter time to discharge.

Antiemetics↗
PubMed1993

The pharmacokinetics of droperidol in anesthetized children.

Despite the wide use of droperidol to reduce nausea and vomiting in children, its pharmacokinetics have not been described in pediatric patients. Twelve ASA Class I-II children, undergoing tonsillectomy and adenoidectomy, received standardized anesthesia; none of the children received premedication. After induction of general anesthesia, droperidol (0.05 mg/kg) was injected intravenously as a bolus. Droperidol plasma concentrations were determined by radioimmunoassay. Pharmacokinetic data were analyzed by model-independent methods. The pharmacokinetic parameters (mean +/- SD) for the studied population were elimination half-life: 101.5 +/- 26.4 min, mean residence time: 127.2 +/- 28.6 min, volume of distribution at steady state: 0.58 +/- 0.29 L/kg and clearance: 4.66 +/- 2.28 mL.kg-1 x min-1. The clearance and volume of distribution at steady state values are lower than those reported for the adult population, and they apparently decreased in a parallel fashion. The smaller volume of distribution at steady state is consistent with the lipophilic distribution of droperidol and the reduced content of adipose tissue in children. The elimination half-time and mean residence time values are similar to those reported previously for adults. The relatively short half-life of droperidol for our pediatric population does not explain its extended antiemetic action. It does, however, reaffirm that the pharmacokinetic duration of a drug's action is only one of the determinants of its clinical duration.

Anesthesia, Inhalation↗
PubMed1985

Coral injury. Case report of injury, late effect and therapy.

A case of coral injury is presented. The injury may be complicated by immediate systemic reactions such as anaphylaxis and collapse, as well as local reactions that may last for months. Deeply seated coral fragments may induce a local inflammatory process of the foreign-body type. This causes pruritus refractory to antihistamines and topical steroid preparations. Satisfactory management consisted of local injection of steroids with a dermojet.

Adolescent↗
PubMedDate not supplied

Effect of sympathectomy on ontogeny of small intestinal disaccharidases in the rat.

In the present study the effect of chemical sympathectomy on the development of small intestinal enzymes in the rat was analyzed. Eight doses of guanethidine sulfate were administered subcutaneously every 48 h to 34 newborn rats, starting at birth. The last dose was given at 14 days of age. Twenty-two littermates served as controls. Intestinal lactase, maltase, sucrase, and alkaline phosphatase were determined at 15, 17, 20, 23, and 25 days of age. Sympathectomy was demonstrated by reduction of the number of perikarya in the superior cervical ganglia in treated rats as compared with control rats. A normal developmental pattern of activities of the disaccharidases in the small intestine was observed in both groups. The activity of alkaline phosphatase was significantly lower (p less than 0.01) in the 15- and 17-day-old treated animals.

Animals↗