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1.
J Clin Anesth ; 2(3): 158-62, 1990.
Article in English | MEDLINE | ID: mdl-2354056

ABSTRACT

Patients undergoing extracorporeal shock wave lithotripsy (ESWL) for nephrolithiasis are anesthetized and immersed in water in a semisitting position. Hypertension and tachycardia have been reported to accompany ESWL, and it was hypothesized that those problems were a result of adrenal medullary release of epinephrine or norepinephrine. Therefore, the effects of ESWL on cardiovascular variables and circulating epinephrine and norepinephrine levels in nine patients anesthetized with 1.1% isoflurane in 50% nitrous oxide and oxygen were studied. End-tidal carbon dioxide (CO2) was maintained at 34 +/- 2 mmHg. Cardiac output (CO) and mean arterial pressure (MAP) were measured, and total peripheral resistance (TPR) was calculated at the following time points: (1) after immersion prior to shock wave therapy (control); (2) after 300 shocks; (3) after 800 shocks; and (4) 5 minutes after the completion of ESWL with the patient still immersed. Circulating epinephrine and norepinephrine concentrations were determined at the above times as well as before and after induction of anesthesia but prior to immersion. There was a statistically significant (p less than 0.05) decrease in CO and an increase (p less than 0.05) in MAP and TPR with ESWL treatment. These values returned to baseline levels when treatment was stopped. Plasma epinephrine and norepinephrine values did not change significantly throughout the study period. It was concluded that these ESWL-associated hemodynamic changes were probably not mediated via epinephrine or norepinephrine.


Subject(s)
Anesthesia, General/adverse effects , Epinephrine/blood , Hemodynamics , Immersion/adverse effects , Lithotripsy/adverse effects , Norepinephrine/blood , Adult , Female , Humans , Hypertension/blood , Hypertension/etiology , Male , Middle Aged , Tachycardia/blood , Tachycardia/etiology
2.
Anesthesiology ; 64(4): 496-500, 1986 Apr.
Article in English | MEDLINE | ID: mdl-3963456

ABSTRACT

The authors compared anesthesia faculties with the rest of medical school faculties at each of four academic ranks and found a significant difference in proportion of men and women anesthesia faculty members at the assistant professor rank only (P less than 0.001). When the faculty status of women and men academic anesthesiologists was examined a significant difference was found in rank distribution in age groups 40 to 44 (P less than 0.005) and 45 to 49 (P less than 0.001), where there was a deficit of professors and a surfeit of instructors among women. Significant differences in distribution continued at age 50-54 (P less than 0.01), 55-59 (P less than 0.001), and 60-64 (P less than 0.005), primarily at professor and assistant professor ranks. In addition, there was significantly lower prevalence of board certification (P less than 0.001) and level of responsibilities for women (P less than 0.001). There was no significant difference in tenure status.


Subject(s)
Anesthesiology , Faculty, Medical , Physicians, Women , Adult , Age Factors , Aged , Certification , Female , Humans , Male , Medicine , Middle Aged , Sex Factors , Specialization , United States
3.
Br J Anaesth ; 56(9): 1037-43, 1984 Sep.
Article in English | MEDLINE | ID: mdl-6466528

ABSTRACT

Renal oxygenation was studied during induced hypotension in mongrel dogs, anaesthetized with 1-1.5% halothane in oxygen. Hypotension was induced with an infusion i.v. of sodium nitroprusside (SNP) 70 +/- 17 micrograms kg-1 min-1 (mean +/- SEM) or trimetaphan (TMP) 36 +/- 16 micrograms kg-1 min-1, or by controlled arterial haemorrhage (45 +/- 6 ml/kg of body weight). Mean arterial pressure (MAP), cortical (Pcto2) and medullary (Pmto2) tissue oxygen tensions, arterial (Pao2), renal venous (Prvo2), and urine (Puo2) oxygen tensions were measured during the 40-min control, hypotension, and recovery periods. MAP was decreased to approximately 60% of the control value. Pcto2 decreased significantly (P less than 0.05) in all three groups while Pmto2 decreased significantly only in the haemorrhage group. Upon restoration of MAP to normal values, renal tissue oxygen tensions recovered in all groups, somewhat more rapidly in the SNP group. There were no significant differences in Pao2, Prvo2, and Puo2 during control, hypotension and recovery periods in the three groups. Tissue oxygen tension values followed the changes in MAP, but were not hypoxic, leading us to believe that both SNP and TMP are hypotensive agents safe for the kidney.


Subject(s)
Ferricyanides , Hypotension, Controlled , Kidney/metabolism , Nitroprusside , Oxygen Consumption , Trimethaphan , Animals , Blood Pressure , Dogs , Ferricyanides/pharmacology , Hemorrhage , Kidney Cortex/metabolism , Kidney Medulla/metabolism , Nitroprusside/pharmacology , Oxygen/blood , Oxygen/urine , Trimethaphan/pharmacology
4.
Anesthesiology ; 60(4): 342-6, 1984 Apr.
Article in English | MEDLINE | ID: mdl-6703388

ABSTRACT

The results of erroneous filling of agent-specific anesthetic vaporizers were studied. The fraction of gas flow through the vaporizer was calculated for three vaporizers set to deliver essentially equipotent final concentrations: halothane, 1% (1.25 MAC); enflurane, 2% (1.19 MAC); and isoflurane, 1.5% (1.30 MAC). These fractional flows, at 22 degrees C, were 0.0188 for 1% halothane, 0.0615 for 2% enflurane, and 0.0295 for 1.5% isoflurane. Concentrations were calculated for cases of total filling of a vaporizer with one of the other two agents. In terms of potency of delivered agent, fourfold underdoses or overdoses could result from such errors. Refilling a 25% full vaporizer with the wrong agent then was considered. In order to calculate the concentrations of each agent that would be delivered in such a case, vapor pressures of each were determined in mixtures of two agents. Enflurane and isoflurane could not be separated satisfactorily by gas chromatography. Halothane, when mixed with enflurane or isoflurane, enhanced vaporization of each agent, as well as being somewhat more easily vaporized itself. Halothane, enflurane, and isoflurane do not form ideal solutions when mixed and the resultant vapor concentrations of each of two agents when mixed may be far from those predicted by an assumption of ideality.


Subject(s)
Anesthesia, Inhalation/instrumentation , Volatilization , Dose-Response Relationship, Drug , Enflurane , Equipment Design , Halothane , Isoflurane , Partial Pressure
5.
J Pharm Sci ; 72(12): 1424-6, 1983 Dec.
Article in English | MEDLINE | ID: mdl-6663479

ABSTRACT

A sensitive and specific high-performance liquid chromatographic assay was developed for the measurement of etomidate in human plasma following extraction of the drug and the internal standard. Using 0.5-ml aliquots of plasma, the assay was linear in the concentration range of 20-2000 ng of etomidate/ml of plasma. This method was used to evaluate a preliminary clinical study of an etomidate infusion regimen for hypnosis in a total intravenous anesthesia protocol in 23 patients. The average duration of the infusion was 30 min, and awakening and alertness occurred 20 and 36 min after the termination of the infusion, respectively, at the respective plasma concentrations of 297 and 214 ng/ml. These results and this assay will be used to design and evaluate an improved etomidate infusion regimen.


Subject(s)
Etomidate/blood , Imidazoles/blood , Anesthesia, Intravenous , Chromatography, High Pressure Liquid/methods , Female , Half-Life , Humans , Kinetics
8.
Anesthesiology ; 54(1): 53-6, 1981 Jan.
Article in English | MEDLINE | ID: mdl-6109470

ABSTRACT

The authors studied anesthetic mutagenesis following exposure in vivo by use of an adaptation of the mouse spermatozoa morphology assay of Wyrobek and Bruce. The epididymal spermatozoa of (C57B1/C3H)F1 mice were examined for morphologic abnormalities following exposure to near-0.1 MAC and greater concentrations of general anesthetics. Twenty exposure hours (4 hr/day x 5 days) were conducted for nitrous oxide, diethyl ether, chloroform, trichlorethylene, halothane, methoxyflurane, enflurane, and isoflurane, each at two concentrations. Twenty-eight days after exposure, epididymal spermatozoa were examined. Statistically significant increases in the percentages of abnormal spermatozoa were found for chloroform, trichloroethylene, and enflurane, compared with controls. These data suggest that direct examination of reproductive cells following exposure to general anesthetics in vivo may be useful in the investigation of the genetic toxicities of these compounds.


Subject(s)
Anesthetics/toxicity , Spermatozoa/drug effects , Animals , Chloroform/toxicity , Enflurane/toxicity , Ether/toxicity , Ethers/toxicity , Halothane/toxicity , Isoflurane/toxicity , Male , Methoxyflurane/toxicity , Mice , Mutagenicity Tests , Nitrous Oxide/toxicity , Trichloroethylene/toxicity
9.
Anesth Analg ; 60(1): 1-7, 1981 Jan.
Article in English | MEDLINE | ID: mdl-7192942

ABSTRACT

The causes of death among anesthesiologists from 1930 through 1946 were determined and compared to the causes of death for contemporaneous physicians as well as anesthesiologists in later eras. Names of US white male anesthesiologists listed in the annual Directories of Anesthetists compiled by the International Anesthesia Research Society were searched for in the death files of the American Medical Association. Among those listed in the Directories 274 deaths were located. Causes were ascertained for 269 deaths and 259 causes were verified from death certificates. The leading causes of death of anesthesiologists and other physicians of the same era were cardiovascular-renal diseases and malignant neoplasms. The death rate from all causes was lower among anesthesiologists than among contemporaneous white men and other physicians. Death rates among anesthesiologists from 1930-1946 were similar to those among anesthesiologists in 1947-1956, but greater than those for 1957-1971. Among deaths from malignant neoplasms, those of the digestive organs were the most frequent and those of the respiratory tract the least. Anesthesiologists practicing in the earlier part of this century had lower death rates and they were less likely to die of malignant neoplasms than contemporaneous white men. The death rates for these anesthesiologists were similar to those for anesthesiologists during 1947-1956, but greater than rates observed for anesthesiologists during 1957-1971. This suggests that exposure to the fluorinated anesthetic agents introduced in the mid-1950s may not be an important health hazard.


Subject(s)
Anesthesiology , Anesthetics/adverse effects , Mortality , Adult , Aged , Cardiovascular Diseases/mortality , Epidemiologic Methods , Humans , Hydrocarbons, Fluorinated/adverse effects , Kidney Diseases/mortality , Male , Middle Aged , Neoplasms/mortality , Physicians , Suicide/epidemiology , United States
10.
Anesth Analg ; 59(10): 772-4, 1980 Oct.
Article in English | MEDLINE | ID: mdl-6448553

ABSTRACT

The incidence of headache after dural puncture in patients being treated for chronic pain was studied prospectively. Dural punctures were performed in 142 patients and headache developed in 13 (9.2%). Four of 32 patients (12.5%) who underwent diagnostic differential spinal and nine of 110 patients (8.2%) given intrathecal steroid injection developed headache. There was a 10.7% incidence of headache when a 22-gauge needle was used as compared to 5% with a 25-gauge needle. This difference was not statistically significant. The incidence decreased with increasing age. The incidence of postdural puncture headache in chronic pain patients does not differ significantly from that previously reported for surgical patients. All patients who developed headache responded to treatment which consisted of intravenous and oral fluids, analgesics, bed rest, and, if necessary, epidural blood patch.


Subject(s)
Back Pain/complications , Headache/etiology , Spinal Puncture/adverse effects , Adult , Age Factors , Aged , Anesthesia, Spinal , Chronic Disease , Dura Mater , Female , Headache/therapy , Humans , Male , Middle Aged , Prospective Studies , Time Factors
11.
Anesthesiology ; 53(4): 354-5, 1980 Oct.
Article in English | MEDLINE | ID: mdl-7425370
13.
Lancet ; 2(8146): 801, 1979 Oct 13.
Article in English | MEDLINE | ID: mdl-90902
14.
JAMA ; 239(25): 2685-6, 1978 Jun 23.
Article in English | MEDLINE | ID: mdl-650843

ABSTRACT

Twenty healthy male volunteers were divided into four groups for a period of recreational physical exercise. Standard blood chemistry determinations were made before exercise and on the two subsequent days. Creatine phosphokinase (CPK), SGOT, and lactic dehydrogenase levels were transiently elevated, but the change was considered significant only in the CPK level after certain types of exercise. Persons having these determinations performed should be questioned about recent physical exertion in the event of abnormal laboratory results.


Subject(s)
Creatine Kinase/blood , Physical Exertion , Adult , Aspartate Aminotransferases/blood , Humans , L-Lactate Dehydrogenase/blood , Male , Muscles/enzymology
15.
Anesth Analg ; 54(6): 701-4, 1975.
Article in English | MEDLINE | ID: mdl-1239203

ABSTRACT

Isoflurane or halothane was administered at two different inspired concentrations to 21 surgical patients whose average age was 62 years. Most were in physical status (ASA) II or III. Patients were premedicated with diazepam and atropine, anesthesia was induced with thiopental, and tracheal intubation was facilitated with succinylcholine. Respiration was controlled manually or with a ventilator. Anesthesia was maintained with 60 percent N2O and halothane 1 percent, then 0.5 percent, or with N2O-isoflurane 1.2 percent, then 0.6 percent in O2. Variations in the cardiovascular responses among patients given the same anesthetic were as great as the variation in responses between anesthetics. Both produced similar decreases in arterial pressure, cardiac output, and stroke volume. Changes in pulse rate were minimal, and total peripheral resistance changes quite variable, for both drugs. Both halothane and isoflurane appear satisfactory for inhalation anesthesia in the elderly.


Subject(s)
Anesthesia, Inhalation , Halothane , Isoflurane , Methyl Ethers , Age Factors , Aged , Blood Pressure , Cardiac Output , Cardiovascular Diseases/chemically induced , Halothane/adverse effects , Heart Rate , Humans , Isoflurane/adverse effects , Middle Aged , Respiration, Artificial
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