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James A. Felts

Bio: James A. Felts is an academic researcher from Washington University in St. Louis. The author has contributed to research in topics: Catecholamine & Neostigmine. The author has an hindex of 5, co-authored 6 publications receiving 1870 citations.

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Journal ArticleDOI
TL;DR: The ASA Physical Status Classification is useful but suffers from a lack of scientific precision.
Abstract: The American Society of Anesthesiologists' (ASA) Physical Status Classification was tested for consistency of use by a questionnaire sent to 304 anesthesiologists. They were requested to classify ten hypothetical patients. Two hundred fifty-five (77.3 percent) responded to two mailings. The mean number of patients rated consistently was 5.9. Four patients elicited wide ranges of responses. Age, obesity, previous myocardial infarction, and anemia provoked controversy. There was no significant difference in responses from different regions of the country. Academic anesthesiologists rated a greater number identical than did those in private practice (P less than 0.01). There was no difference in ratings between those who used the classification for billing purposes and those who did not. The ASA Physical Status Classification is useful but suffers from a lack of scientific precision.

1,857 citations

Journal ArticleDOI
TL;DR: It was concluded that N2O is associated with an increased prevalence of nausea and vomiting and Fentanyl, given postoperatively for pain, did not increase the prevalence of vomiting.

75 citations

Journal ArticleDOI
TL;DR: The concept that enflurane anesthesia blocks the sympathetic response to surgical stress more effectively than low dose fentanyl anesthesia is supported.
Abstract: During intra-abdominal surgery, plasma levels of norepinephrine in peripheral venous blood were higher in 11 patients who received fentanyl-nitrous oxide-oxygen than in 10 patients who received enflurane-nitrous oxide-oxygen [703 +/- 95 vs 463 +/- 38 (SEM) pg/ml]. At the same time, systolic blood pressure (143 +/- 6 vs 121 +/- 4 torr), mean blood pressure (108 +/- 4 vs 98 +/- 3 torr), and pulse rate (87 +/- 3 vs 98 +/- 4 beats per minute) also differed significantly (p less than 0.05); plasma levels of epinephrine (235 +/- 61 vs 113 +/- 21) did not. These values did not differ significantly between the two groups before induction of anesthesia, after induction but before skin incision, or in the recovery room. These data support the concept that enflurane anesthesia blocks the sympathetic response to surgical stress more effectively than low dose fentanyl anesthesia.

38 citations

Journal ArticleDOI
TL;DR: The increase in cardiac muscarinic activity following injection of anticholinesterases can be minimized by the long-acting anticholinergic drug glycopyrrolate, which was found to reduce the incidence of new postoperative cardiac dysrhythmias in patients with pre-existing cardiovascular disease.
Abstract: The increase in cardiac muscarinic activity following injection of anticholinesterases can be minimized by the long-acting anticholinergic drug glycopyrrolate. In a series of 50 patients 65 years of age or older who had received glycopyrrolate (0.88 +/- 0.15 mg) mixed with neostigmine (4.40 +/- 0.66 mg) or pyridostigmine (17.46 +/- 2.92 mg) to antagonize neuromuscular blockade, the incidence of new postoperative cardiac dysrhythmias was 16 per cent. All dysrhythmias occurred in patients with pre-existing cardiovascular disease. There was no statistically significant relationship between the incidence of cardiac dysrhythmias and the choice of anaesthetic technique or anticholinesterase drug.

16 citations


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Journal ArticleDOI
TL;DR: The guidelines for the prevention of surgical wound infections (SSI) were published by the Centers for Disease Control and Prevention (CDC) in 1999 as discussed by the authors, with the goal of reducing infectious complications associated with these procedures.

4,730 citations

Journal ArticleDOI
TL;DR: The “Guideline for Prevention of Surgical Site Infection, 1999” presents the Centers for Disease Control and Prevention's recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections, and replaces previous guidelines.
Abstract: The “Guideline for Prevention of Surgical Site Infection, 1999” presents the Centers for Disease Control and Prevention (CDC)'s recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections. This two-part guideline updates and replaces previous guidelines.Part I, “Surgical Site Infection: An Overview,” describes the epidemiology, definitions, microbiology, pathogenesis, and surveillance of SSIs. Included is a detailed discussion of the pre-, intra-, and postoperative issues relevant to SSI genesis.

4,059 citations

Journal ArticleDOI
11 Jan 1995-JAMA
TL;DR: This prospective epidemiologic study of SIRS and related conditions provides the first evidence of a clinical progression from SirS to sepsis to severe sepsi and septic shock, and stepwise increases in mortality rates in the hierarchy.
Abstract: Objective. —Define the epidemiology of the four recently classified syndromes describing the biologic response to infection: systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, and septic shock. Design. —Prospective cohort study with a follow-up of 28 days or until discharge if earlier. Setting. —Three intensive care units and three general wards in a tertiary health care institution. Methods. —Patients were included if they met at least two of the criteria for SIRS: fever or hypothermia, tachycardia, tachypnea, or abnormal white blood cell count. Main Outcomes Measures. —Development of any stage of the biologic response to infection: sepsis, severe sepsis, septic shock, end-organ dysfunction, and death. Results. —During the study period 3708 patients were admitted to the survey units, and 2527 (68%) met the criteria for SIRS. The incidence density rates for SIRS in the surgical, medical, and cardiovascular intensive care units were 857,804, and 542 episodes per 1000 patient-days, respectively, and 671,495, and 320 per 1000 patient-days for the medical, cardiothoracic, and general surgery wards, respectively. Among patients with SIRS, 649 (26%) developed sepsis, 467 (18%) developed severe sepsis, and 110 (4%) developed septic shock. The median interval from SIRS to sepsis was inversely correlated with the number of SIRS criteria (two, three, or all four) that the patients met. As the population of patients progressed from SIRS to septic shock, increasing proportions had adult respiratory distress syndrome, disseminated intravascular coagulation, acute renal failure, and shock. Positive blood cultures were found in 17% of patients with sepsis, in 25% with severe sepsis, and in 69% with septic shock. There were also stepwise increases in mortality rates in the hierarchy from SIRS, sepsis, severe sepsis, and septic shock: 7%, 16%, 20%, and 46%, respectively. Of interest, we also observed equal numbers of patients who appeared to have sepsis, severe sepsis, and septic shock but who had negative cultures. They had been prescribed empirical antibiotics for a median of 3 days. The cause of the systemic inflammatory response in these culture-negative populations is unknown, but they had similar morbidity and mortality rates as the respective culture-positive populations. Conclusions. —This prospective epidemiologic study of SIRS and related conditions provides, to our knowledge, the first evidence of a clinical progression from SIRS to sepsis to severe sepsis and septic shock. ( JAMA . 1995;273:117-123)

2,039 citations

Journal ArticleDOI
TL;DR: A risk index was developed to predict a surgical patient's risk of acquiring an SWI as mentioned in this paper, ranging from 0 to 3, is the number of risk factors present among the following: a patient with an American Society of Anesthesiologists preoperative assessment score of 3, 4, or 5, an operation classified as contaminated or dirty-infected, and an operation lasting over T hours, where T depends upon the operative procedure being performed.

1,369 citations