Showing papers in "Anesthesia & Analgesia in 1971"
TL;DR: This study presents the results obtained when ketamine was injected in doses of 0.2 mg./lb.
Abstract: INCE the introduction of ketamine as a S clinical anesthetic agent, numerous reports have referred not only to its usefulness as a dissociative anesthetic agent, providing apparently profound analgesia, but also to the undesirable psychic side-effects associated with its us8.l-3 We were interested in determining whether useful clinical analgesia could be produced by this drug if it were injected in smaller amounts than the usual clinical dose of 2 mg./lb. of body weight. This study presents the results obtained when ketamine was injected in doses of 0.2 mg./lb. (0.44 mg./kg.).
188Â citations
TL;DR: The patient's response or analgesic demand is a measure of the pain and all its associated phenomena.
Abstract: Pain may be described in terms of operant behavior. Behavior, a function of its past consequences, is predictable on the basis of the contingency which exists between a response and a consequence. When, for example, an animal in an enclosure is free to press a movable bar which causes the delivery of food or the termination of a painful stimulus, the rate of response (bar pressing) is the basic, most direct measure of behavior and is closely related to probability of response.' The behavior of a patient in pain can be structured in analogous fashion. When the patient is allowed to operate a demand system directly controlling analgesic dosage, he responds to his pain by pressing an analgesic-demand button until his personal criteria for pain relief are satisfied. The analgesic-demand button affects an electromechanical system, causing the administration of a small dose of analgesic. In this way, the pain and analgesic are titrated against each other. The patient's response or analgesic demand is a measure of the pain and all its associated phenomena.
144Â citations
TL;DR: Test the hypothesis that this unusual cerebral functional response to ketamine may be accompanied by an unusual effect on cerebral metabolism as well, and a relationship between functional and metabolic effects has been established for sodium thiopental.
Abstract: NPLEASANT dreams or hallucinations U are reported by up to 30 percent of adult patients following the anesthetic state produced by ketamine hydrocholoride. 112 Such an effect is not common to other anesthetics when administered in effective concentrations. This study was designed to test the hypothesis that this unusual cerebral functional r&ponse to ketamine may be accompanied by an unusual effect on cerebral metabolism as well. Such a relationship between functional and metabolic effects has been established for sodium thi0pental.3
142Â citations
TL;DR: It is shown that if the thorax or abdomen was open during attempted CPR, the aorta was sometimes deliberately compressed in an effort to divert blood flow from the lower portion of the body to the coronary and cerebral vessels.
Abstract: EPOR'IS of attempts to supplement carR diopulmonary resuscitation (CPR) by compression of the viscera span half a century.1,2 If the thorax or abdomen was open during attempted CPR, the aorta was sometimes deliberately compressed in an effort to divert blood flow from the lower portion of the body to the coronary and cerebral vessels. Attempts to achieve this objective by manual compression of the upper abdomen have also been described.3~4 However, resultant liver lacerations have led to doubt as to the wisdom of these maneuvers.
141Â citations
TL;DR: Croup is an acute infection of the upper respiratory tract and several viral agents can now be identified as the pathogens, the most common being parainfluenza 2 (CA).
Abstract: ARYNGOTRACHEOBRONCHITIS, or infectiL ous croup, is an acute infection of the upper respiratory tract. Several viral agents can now be identified as the pathogens, the most common being parainfluenza 2 (CA) .I** The condition is generally seen in children, ages 6 months through 3 years, but may occur up to 14 years.3 Croup is manifest by signs and symptoms of laryngeal and sublaryngeal edema. This idammatory swelling results in respiratory distress of varying degree: hoarseness with barking cough; stridorous, noisy, labored breathing; intercostal, sternal, and suprasternal retractions. As in other forms of respiratory obstruction, restlessness and the extreme anxiety of hypoxia may occur before cyanosis is evident. This picture is identical to the postintubation croup msionally seen in children after endotracheal anesthesia.
81Â citations
TL;DR: As intramuscular injection is possible and cerebration is not observed in children under ketamine anesthesia, the drug seems especially suitable for pediatric use, including ophthalmic operations, although nystagmus may be considered an undesirable effect of the drug.
Abstract: N I M P O R T A N T advantage of (21-581 A (ketamine) (2(O-chlorophenyl)-2methyl amino cyclohexanone HCl) in pediatric surgical operations is that the drug produces anesthesia without respiratory depression in the surgical-operation stage shortly after administration. Also, as intramuscular injection is possible and cerebration is not observed in children under ketamine anesthesia, the drug seems especially suitable for pediatric use, including ophthalmic operations, although nystagmus may be considered an undesirable effect of the drug.
74Â citations
63Â citations
61Â citations
TL;DR: With the development of surface-recording electrodes, interest in the human electroencephalogram (EEG) was accelerated, the discipline of electroencephalography was born, and the effect of anesthesia on human brain potentials was observed.
Abstract: OT LONG after it was observed that there N were electric potentials in animal brains, it was noted that these were affected by chloroform anesthesia. With the development of surface-recording electrodes, interest in the human electroencephalogram (EEG) was accelerated, the discipline of electroencephalography was born, and the effect of anesthesia on human brain potentials was observed. These EEG changes were thought practical for use in the operating room; here they could supplement the reflex changes described by Guedel and communicate to the anesthesiologist information concerning the level of anesthesia.l
56Â citations
55Â citations
Journal Article•
TL;DR: This study attempts to elucidate some of the physical factors involved at the cuff-tracheal wall interface due to cuff design and cuff inflation and introduces a new design for the cuff.
Abstract: HE LOCAL complications of prolonged T intubation with d e d endotracheal and tracheoatomy tubes are dilation, ulceration, hemorrhage, necrosis, rupture, tracheoesophageal fistula, and stenoak These complications, although infrequent, are relatively formidable and tend to negate to a varying degree the lifesaving potential of prolonged artificial ventilation. These complications have been shown to be cuff-induced,1.2 and the pathophysiology of this effect as well as criticisms of cuff design has been the subject of several papers.3.4 These previous studies have implicated for the most part local ischemia due to high-cuff pressure or asymmetrical cuff inflation or both and have led to proposals for "ideal" cuffs. No attempt has been made to analyze cuffs from a biomedical engineering standpoint. This study attempts to elucidate some of the physical factors involved at the cuff-tracheal wall interface due to cuff design and cuff inflation and introduces a new design for the cuff.
TL;DR: Since the work of Fink,l 15 years ago, S anesthesiologists have been aware of the dangers of hypoxia in the early postoperative period when patients are awaking from nitrous oxide (N,O) anesthesia.
Abstract: INCE the work of Fink,l 15 years ago, S anesthesiologists have been aware of the dangers of hypoxia in the early postoperative period when patients are awaking from nitrous oxide (N,O) anesthesia. Because the solubilities of nitrogen and N,O differ so greatly (the latter is over 30 times more soluble in blood), the amount of N,O excreted during the period of equilibration with room air exceeds the amount of nitrogen being taken up from the alveoli. This discrepancy results in the dilution of alveolar gases by N,O during the first several minutes of breathing air. Fink measured a 5 to 10 percent fall in Saoy during this period and stated that values below 90 percent were often obtained.
TL;DR: This work designed and clinically evaluated a ventilator which costs less than $1500 and is extremely simple to operate and probably has prevented their wider use.
Abstract: HE NEED for controlled-volume ventilaT tion in the treatment of respiratory distress syndrome of the newborn has become increasingly apparent in the past few years. Until recently, however, little attention has been focused on the development of ventilators specifically for infants, and physicians engaged in their care have had to use modified adult models. The few ventilators available for pediatric application are expensive andlor complicated. As these factors probably have prevented their wider use, we have designed and clinically evaluated a ventilator (fig. 1) which costs less than $1500 and is extremely simple to operate.
TL;DR: Anomalies that arise in these areas, however, may preclude successful intubation, whereas the knowledge of these anomalies may forewarn the anesthesiologist of necessary precautions or modifications for the proper placement of the endotracheal tube.
Abstract: In a previous paper1 we (V.L.B.) discussed the importance of the articulations of the cervical spine and the atlanto-occipital joint. In the present paper, we wish to discuss anatomic and pathologic factors relating to the temporomandibular joint, the mandible, and associated structures. That such information needs presentation is attested by the fact that one textbook dedicated to anatomy for anesthesiology does not even mention these structures.2 Anomalies that arise in these areas, however, may preclude successful intubation, whereas the knowledge of these anomalies may forewarn the anesthesiologist of necessary precautions or modifications for the proper placement of the endotracheal tube.
TL;DR: Kidney transplantation in humans has in the last decade changed from a promising clinical investigation to a practical reality and the consequent problems encountered during the anesthetic management of patients undergoing kidney homograft operations have been documented.
Abstract: IDNEY transplantation in humans has in K the last decade changed from a promising clinical investigation to a practical reality. A common denominator in the preoperative condition of the recipient is terminal renal failure, which often is exacerbated by concomitant diseases. The consequent problems encountered during the anesthetic management of patients undergoing kidney homograft operations have been documented by many authors.'-14
TL;DR: A severely burned child must undergo many surgical procedures to repair the burned areas, the anesthesiologist faces a complex and difficult problem.
Abstract: HEN A severely burned child must W undergo many surgical procedures to repair the burned areas, the anesthesiologist faces a complex and difficult problem. After the patient has survived the initial shock and has responded to measures for controlling fluid and electrolytes, anemia, and infection, his life is still in jeopardy until the initial operation for debridement and skin grafting has reduced the risk of infection and the loss of fluid elements through damaged body surfaces. Thereafter it is usually necessary to carry out a series of surgical procedures until all defects are covered and the patient can safely be discharged, to return later for reconstructive surgery, if necessary.
TL;DR: P pulmonary air embolism was recognized as a possible complication of surgical operation on patients in a sitting position and occlusion of the site of the embolus by tamponade of the open or torn vein could prevent progression to a fatal outcome.
Abstract: ONG BEFORE the discovery of general anL esthesia, pulmonary air embolism was recognized as a possible complication of surgical operation on patients in a sitting position. A number of embolic episodes were recorded during the 19th century and a specific syndrome was recognized. An unanesthetized patient undergoing a surgical procedure above the level of the clavicles and in the sitting position would express a feeling of impending doom. Cardiovascular collapse and death would soon follow. The catastrophe was frequently accompanied by an audible sucking sound in the wound, and it was recognized at that early date that occlusion of the site of the embolus by tamponade of the open or torn vein could prevent progression to a fatal outcome.'
TL;DR: An endotracheal tube holder adapted to supportively balance, suspend, harness, and reliably hold the tube in given position in the trachea and mouth of a patient is described in this paper.
Abstract: An endotracheal tube holder adapted to supportively balance, suspend, harness, and reliably hold the tube in given position in the trachea and mouth of a patient A prescribed length of adhesive tape has a median portion wrapped around and adhesively attached to a predetermined portion of the tube The free end portions of the tape are tautened lengthwise across the patient''s left and right cheeks, respectively, and are adjustably and detachably fastened to clamps These clamps are oriented with like loops, more particularly, a pair of ear encircling adapters These adapters are made from plastic tubing and are applied to the ears of the patient prior to intubation, if desired The rearward curvate end portion of each adapter is lodged and seated in the deepest groove behind the cartilage directly above the earlobe and adhesively held in place The adapter proper encircles the ear, resides flatwise against the patient''s cheek and locates a complemental clamp in the place and position desired Accordingly, the clamped and harnessed tape functions to properly suspend and prevent displacement of the tube
TL;DR: Reports of investigations to evaluate the eventual effect of such lubricants on the incidence of postoperative sore throat are rather confusing.
Abstract: Reports of investigations to evaluate the eventual effect of such lubricants on the incidence of postoperative sore throat are rather confusing. Lund and Daos' found a significant fall in incidence of sore throat after lidocaine ointment but no fall after a \"light\" lubricant with or without local anesthetic. Conway and associates2 found a significant rise in such incidence after lubrication with an ointment containing cinchocaine and no effect after the use of other lubricants containing local anesthetic.
TL;DR: The effect of four commonly-used inhalation anesthetics, diethyl ether, cyclopropane, halothane, and methoqflurane, on blood levels of some metabolites and insulin in man is concentrated on.
Abstract: ARBOHYDRATE metabolism encompasses c a staggering number of biochemical reactions and can be studied in any species at any level, from mitochondria1 respiration to the whole body respiratory quotient. This paper concentrates on the effect of four commonly-used inhalation anesthetics, diethyl ether, cyclopropane, halothane, and methoqflurane, on blood levels of some metabolites and insulin in man.
TL;DR: No reliable means has been found to prevent the occurrence of V.F., but many factors, such as pH and ionic deviations, type of anesthesia, and extrinsic cardiac stimulation, are known to influence the incidence.
Abstract: ENTRICULAR fibrillation (V.F.) continV ues to be a significant drawback to the use of hypothermia in clinical medicine. More than two decades of extensive investigation have failed to identify the fundamental mechanism(s) responsible for this arrhythmia. Many factors, such as pH and ionic deviations, type of anesthesia, and extrinsic cardiac stimulation, are known to influence the incidence of V.F., but no reliable means has been found to prevent its occurrence.
TL;DR: A 41-year-old obese and mentally-retarded woman with a basal-cell nevus syndrome was admitted to the University of Virginia Hospital for excision of numerous basal- cell carcinomas, with split thickness skin grafts to follow.
Abstract: REPORT OF A CASE A 41-year-old obese and mentally-retarded woman with a basal-cell nevus syndrome was admitted to the University of Virginia Hospital for excision of numerous basal-cell carcinomas, with split thickness skin grafts to follow. She gave a history of multiple surgical procedures over the preceding 10 years, including amputation of the right forearm for an invasive basal-cell carcinoma, bilateral oophorectomy for multinodular ovarian fibromas, bilateral subtotal thyroidectomy for follicular adenoma, and multiple excisions of basal-cell carcinomas of the lower abdomen and sacral region.