Emeritus (Active) Professor, Anesthesiology, Perioperative and Pain Medicine
Staff Anesthesiologist, VA Palo Alto HCS (1989 - Present)
Faculty, Stanford Center for Biomedical Ethics (2003 - Present)
Founding Co-Director, Biomedical Ethics & Medical Humanities Scholarly Concentration (2003 - 2021)
Founder, Medicine and the Muse Program: Medical Humanities and the Arts (2003 - Present)
Honors & Awards
Leadership and Service Award, inaugural recipient, Health Humanities Consortium (2022)
Ellis N. Cohen MD Achievement Award, Stanford Department of Anesthesiology, Perioperative and Pain Medicine (2018)
Henry J. Kaiser Foundation Award - Outstanding & Innovative Contributions to Medical Education, Stanford University School of Medicine (2007)
AB, Harvard University, Biochemistry
MD, Stanford University, Medicine
Current Research and Scholarly Interests
literature and medicine, humanistic aspects of medicine and anesthesia care, language and medicine, communication, medical humanities, creative writing, arts and healthcare
- Independent Studies (5)
Prior Year Courses
- Reflection and Contextual Medicine
INDE 297 (Win)
- LitMed: Conversations on Structural Violence and Systemic Racism in Medical Practice
SOMGEN 288 (Aut)
- Medical Humanities and the Arts
INDE 212 (Spr)
- Reflection and Contextual Medicine
INDE 297 (Spr)
- Healing, Illness, Stories
THINK 64 (Spr)
- Literature and Medicine
SOMGEN 288 (Aut)
- Literature and Writing for Military Affiliated Students
SOMGEN 203 (Aut, Spr)
- Medical Humanities and the Arts
INDE 212 (Spr)
- Reflection and Contextual Medicine
INDE 297 (Spr)
- The Art of Observation: Enhancing Clinical Skills Through Visual Analysis
SOMGEN 213 (Win)
- Reflection and Contextual Medicine
Med Scholar Project Advisor
Scholarly Concentration Director
- Being Sick With an Englishwoman. Anesthesia and analgesia 2022; 135 (1): 217-218
- Chromatic Scale. JAMA 2022; 327 (23): 2359
Poetry and Medicine.
2022; 40 (2): 359-372
Poetry and medicine are related in multiple ways, including historical interests in healing, defined broadly, through words. More contemporary scholarship explores how poems, which include insights into the human condition, can enlarge our understanding of health, illness, mortality, and health care, including issues of diversity. Anesthesiology and poetry have particular affinities due to their structures, timeframes, and rhythms. Patients, physicians, and health care workers can benefit in terms of well-being by access to reading, reflecting on, and writing poetry.
View details for DOI 10.1016/j.anclin.2022.01.009
View details for PubMedID 35659407
- The Sick-sick patient and the anesthesiologist KevinMD. 2022
- Tears Are Funny That Way Pegasus Review. 2022
- Democracy and the Health of a Nation KevinMD. 2021
- I Can’t Breathe: An anesthesiologist’s perspective KevinMD. 2020
- In reply: "Returning to Frankenstein: the spark of being and the fire of life". Canadian journal of anaesthesia = Journal canadien d'anesthesie 2019
- "A spark of being": Frankenstein and anesthesiology CANADIAN JOURNAL OF ANESTHESIA-JOURNAL CANADIEN D ANESTHESIE 2019; 66 (9): 1022–25
- The Anesthesiologist: A Perspective Pegasus Review. 2019
Medicine and Frankenstein-An Artistic Commemoration of the Novel's Bicentennial.
2018; 320 (16): 1624–26
View details for PubMedID 30357277
The long-term impact of a comprehensive scholarly concentration program in biomedical ethics and medical humanities
BMC MEDICAL EDUCATION
2018; 18: 204
There is a strong and growing interest in biomedical ethics and medical humanities (BEMH) within medical education for facilitating key components of medical professionalism and ethics, clinical communication and observational skills, and self-care and reflective practices. Consequently, United States (US) medical institutions have begun to incorporate BEMH through formal Scholarly Concentrations (SCs). This is the first study to examine the impact of a US BEMH SC, from student experience in medical school to post-graduate development, as perceived by graduate physicians.Graduated students who participated in the BEMH SC or did extensive BEMH research prior to the BEMH SC's establishment (n = 57) were sampled for maximum variation across graduating years. In telephone surveys and interviews, participants discussed the perceived impact of the BEMH SC on (a.) student experience during medical school and (b.) post-graduate development. Interviews were audiotaped, transcribed, and de-identified. The authors iteratively generated a codebook; two raters coded independently, adjudicated codes, and completed inter-rater reliability (IRR) tests. The authors subsequently conducted a team-based thematic analysis, identifying emergent themes.Nineteen BEMH graduates were interviewed. Results were analyzed according to (a.) student experience and (b.) post-graduate development. Overall, respondents perceived impacts in reinforcing knowledge and skills in clinical ethics; solidifying self-care and reflective practices; refining a sense of professional identity and integrity for ethically challenging situations; and promoting student skills, productivity, and later careers involving BEMH.A comprehensive US BEMH SC achieved the purported aims of BEMH in medical education, with graduate physicians perceiving persisting effects into clinical practice. Furthermore, the structure and format of a SC may offer additional advantages in promoting student scholarly skill and productivity, career development, and professional identity formation-core competencies identified across clinical training and ethics programs. Our findings indicate that a BEMH SC is effective in achieving a range of desired immediate and post-graduate effects and represent a particularly promising venue for BEMH in medical education. We believe these findings to be of critical significance to medical educators and administrators when considering how best to incorporate BEMH into SCs and medical curricula.
View details for DOI 10.1186/s12909-018-1311-2
View details for Web of Science ID 000442961400002
View details for PubMedID 30153822
View details for PubMedCentralID PMC6114241
- Your Anesthesiologist Self. Anesthesiology 2018
- Why Frankenstein Matters Stanford Medicine 2018; 35 (1): 6-9
- Healing Arts: The synergy of medicine and the humanities Stanford Medicine. Stanford CA. 2017
- The patient-doctor conversation Elsevier. London. 2017 ; The Lancet (389(10079)): 1597
- Medicine and the muse: opportunities for connection through education, research and shared experience Creative Practices for Improving Health and Social Inclusion edited by Saavedra, J., Español , A., Arias-Sánchez , S., Calderón-Garcia , M. U Seville Press . 2017
- The Little Monsters University of Iowa Carver College of Medicine. Iowa City. 2017 ; The Examined Life (5:2): 147–8
- Falling Fifth: The Neurosurgery Patient and the Anesthesiologist Pulse: Voices from the Heart of Medicine. New York City, NY. 2017 ; Pulse
Design and Implementation of a Perioperative Surgical Home at a Veterans Affairs Hospital.
Seminars in cardiothoracic and vascular anesthesia
2016; 20 (2): 133-140
The innovative Perioperative Surgical Home model aims to optimize the outcomes of surgical patients by leveraging the expertise and leadership of physician anesthesiologists, but there is a paucity of practical examples to follow. Veterans Affairs health care, the largest integrated system in the United States, may be the ideal environment in which to explore this model. We present our experience implementing Perioperative Surgical Home at one tertiary care university-affiliated Veterans Affairs hospital. This process involved initiating consistent postoperative patient follow-up beyond the postanesthesia care unit, a focus on improving in-hospital acute pain management, creation of an accessible database to track outcomes, developing new clinical pathways, and recruiting additional staff. Today, our Perioperative Surgical Home facilitates communication between various services involved in the care of surgical patients, monitoring of patient outcomes, and continuous process improvement.
View details for DOI 10.1177/1089253215607066
View details for PubMedID 26392388
2016; 315 (20): 2238
View details for DOI 10.1001/jama.2016.4645
- Charting Phelan's 'To Suffer a Sea Change' MEDICAL HUMANITIES 2015; 41 (2): 121-127
Charting Phelan's 'To Suffer a Sea Change'.
2015; 41 (2): 121-7
Physicians and healthcare workers usually perceive their medical record entries as documentation rather than construction. In the following article, we extract a medical record from a narrative, Peggy Phelan's pathography of glaucoma, 'To Suffer a Sea Change'. From information about encounters described by Phelan, an ophthalmologist reconstructs progress notes similar to those that would be key to a glaucoma patient's medical record. Rather than condemning the arcane pointilism of the medical record as a poverty of language, or isolating the pathography as an academic text, we hope to instead appreciate what their collaborative dialogue offers the study of disease. While the points of divergence between these texts will demonstrate failures in communication, they will also unearth an enriched dialogue.
View details for DOI 10.1136/medhum-2015-010669
View details for PubMedID 26179595
- Words, Data, and the Weave of Narrative. Anesthesia and analgesia 2015; 121 (4): 843-845
- The ASA 4 Patient at the VA Hospital. Anesthesiology 2015; 122 (4): 950-951
- Electrocardiogram. Anesthesiology 2015; 122 (1): 206-207
- The Anesthesiologist Breathes for You Anesthesiology 2013; 119 (4): 982-983
- The Unscathed Veteran and the Anesthesiologist JAMA 2012; 308 (13): 1301
- Anesthesia Checklist Anesthesiology 2012; 116 (2): 477-478
- Medicine and the arts. Commentary. Academic medicine 2011; 86 (9): 1129-?
- Emergence Anesthesiology 2011; 114 (5): 1236-1237
- Operating Room Suite Anesthesiology 2011; 115 (1): 207-208
- A Foot Anesthesiology 2011; 115 (1): 205-206
- People say there are no accidents: poetry and commentary. The Journal of medical humanities 2010; 31 (3): 257-263
- Feeding...being fed: poetry and commentary. The Journal of medical humanities 2009; 30 (2): 135-141
- "It Blew My Mind" Exploring the Difficulties of Anesthesia Informed Consent through Narrative ANESTHESIOLOGY 2009; 110 (3): 445-446
- Medical Humanities: Demarcations, Dilemmas and Delights Medical Humanities 2009; 35: 3-4
I must tell you in a poem: poetry and commentary.
The Journal of medical humanities
2007; 28 (3): 173-180
View details for PubMedID 17554611
Always a surprise, even a wonder: poetry and commentary.
The Journal of medical humanities
2007; 28 (2): 105-114
View details for PubMedID 17464450
- Bridging science and poetry: a commentary on Nan Cohen's "Rope Bridge" Academic Medicine 2007; 82: 804-5
- Music, medicine, and the art of listening J for Learning through the Arts 2006; 2 (1): art 14
Words and wards: a model of reflective writing and its uses in medical education.
The Journal of medical humanities
2006; 27 (4): 231-244
Personal, creative writing as a process for reflection on patient care and socialization into medicine ("reflective writing") has important potential uses in educating medical students and residents. Based on the authors' experiences with a range of writing activities in academic medical settings, this article sets forth a conceptual model for considering the processes and effects of such writing. The first phase (writing) is individual and solitary, consisting of personal reflection and creation. Here, introspection and imagination guide learners from loss of certainty to reclaiming a personal voice; identifying the patient's voice; acknowledging simultaneously valid yet often conflicting perspectives; and recognizing and responding to the range of emotions triggered in patient care. The next phase (small-group reading and discussion) is public and communal, where sharing one's writing results in acknowledging vulnerability, risk-taking, and self-disclosure. Listening to others' writing becomes an exercise in mindfulness and presence, including witnessing suffering and confusion experienced by others. Specific pedagogical goals in three arenas-professional development, patient care and practitioner well-being - are linked to the writing/reading/listening process. The intent of presenting this model is to help frame future intellectual inquiry and investigation into this innovative pedagogical modality.
View details for PubMedID 17001529
- The Mailbox, Random House 2006
- Literature and medical interventions: An experiential course for undergraduates FAMILY MEDICINE 2005; 37 (7): 469-471
- Gender differences and performance in science SCIENCE 2005; 307 (5712): 1043-1043
Survivor of that time, that place: clinical uses of violence survivors' narratives.
The Journal of medical humanities
2004; 25 (2): 109-127
Narratives by survivors of abuse offer compelling entries into the experiences of abuse and its effects on health. Reading such stories can enlarge the clinician's understanding of the complexities of abuse. Furthermore, attention to narrative can enhance the therapeutic options for abuse victims not only in mental health arenas, but also in other medical contexts. In this article we define the genre of survivor narratives, examine one such narrative in particular (Push by Sapphire, 1996), and explore the clinical implications of narrative in abuse victims' clinical care.
View details for PubMedID 15156758
- Reflections of a part-time physician Academic Medicine 2004; 79: 357
Researching medicine in context: the Arts and Humanities Medical Scholars Program.
2003; 29 (2): 104-108
In 2000, the Arts and Humanities Medical Scholars Program at Stanford University School of Medicine issued its first grants to medical students interested in researching an area of the medical arts or humanities in depth. To date, 34 projects have been funded, including renewals. The projects encompass a range of genres and topics, from a website on Asian American health and culture to an ethnographic study of women physicians in training in Spain. Two projects are highlighted here: an online history of medicine course and a poetry project. Students are mentored by faculty from a wide array of university departments and centres and submit completion documents to the committee overseeing the programme. Students are encouraged to present their work at conferences, such as the programme's annual symposium, as well as in publication or other appropriate formats. Future directions include integration with the scholarly concentrations initiative at the medical school.
View details for DOI 10.1136/mh.29.2.104
View details for PubMedID 23671221
- Stanford University School of Medicine, Arts and Humanities Medical Scholars Program ACADEMIC MEDICINE 2003; 78 (10): 1059-1060
Patient threats present an ethical dilemma for the anesthesiologist
ANESTHESIA AND ANALGESIA
2001; 93 (6): 1544-1545
Patients who receive sedation occasionally divulge thoughts that they would not usually express. This report describes a sedated patient who threatened to murder two family members. Immediate consultation with an attorney and psychiatrist is recommended when the anesthesiologist may be required to breach patient confidentiality to warn potential victims.
View details for Web of Science ID 000172364000033
View details for PubMedID 11726439
- What our patients say FAMILY MEDICINE 2001; 33 (2): 95-96
- Sleep Talker: Poems by a Doctor / Mother 2001
- Anesthesiologists and perioperative communication ANESTHESIOLOGY 2000; 93 (2): 548-555
- A suitable measure of redemption: Poems and commentaries J Med Humanit 2000; 21: 189-98
Complications of sedation with midazolam in the intensive care unit and a comparison with other sedative regimens
CRITICAL CARE MEDICINE
1998; 26 (5): 947-956
To describe the various complications that have been reported with use of midazolam for sedation in the intensive care unit (ICU).Publications in scientific literature.Computer search of the literature.Sedation is required in the ICU in order for patients to tolerate noxious stimuli, particularly mechanical ventilation. Under- and oversedation can lead to complications. To sedate patients in the ICU, midazolam is commonly administered via titrated, continuous infusions. Cardiorespiratory effects tend to be minimal; however, hypotension can occur in hypovolemic patients. Prolonged sedation after cessation of the midazolam infusion may be caused by altered kinetics of the drug in critically ill patients or by accumulation of active metabolites. In addition, paradoxical and psychotic reactions have been rarely reported. Tolerance and tachyphylaxis may occur, particularly with longer-term infusions (> or = 3 days). Benzodiazepine withdrawal syndrome has also been associated with high dose/long-term midazolam infusions. Compared with propofol infusions, midazolam infusions have been associated with a decreased occurrence of hypotension but a more variable time course for recovery of function after the cessation of the infusion. Lorazepam is a more cost-effective choice for long-term (> 24 hrs) sedation.Continuous infusion midazolam provides effective sedation in the ICU with few complications overall, especially when the dose is titrated.
View details for Web of Science ID 000073471900027
View details for PubMedID 9590327
- Medicine and the Arts: Their Eyes Were Watching God Academic Medicine 1997; 72: 288-9
- Medicine and the Arts: The River Styx Runs Upstream (Simmons) Academic Medicine 1997: 1082-3
Preoperative anxiety and fear: A comparison of assessments by patients and anesthesia and surgery residents
ANESTHESIA AND ANALGESIA
1996; 83 (6): 1285-1291
We sought to compare self-assessment of preoperative anxiety levels and selection of worst fears by surgical patients with the assessments made by the anesthesia and surgery residents providing intraoperative care for those patients. One hundred inpatients at a Veterans Affairs hospital (Group 1) and 45 patients at a University hospital (Group 2) were asked to complete a brief questionnaire; the residents were asked to complete the same questionnaire. Group 1 results showed that median patient visual analog scale (VAS) scores were lower for anxiety about anesthesia compared to surgery (16 vs 22, P < or = 0.05). Anesthesia resident VAS scores were higher than patient or surgery resident scores. Neither type of resident was able to predict their individual patient's VAS score (Kendall's tau). The fear chosen with the greatest incidence by Group 1 patients and residents was "whether surgery would work". A significant number of residents (34%, anesthesia or surgery, P < or = 0.05) matched their patient's fear choice. Residents commonly chose fears related to their specialty (e.g., anesthesia residents chose anesthesia-related fears more often than surgery residents, 50% vs 28%, P < or = 0.001). In Group 2, residents demonstrated an improved ability to predict patient scores. For instance, both surgery and anesthesia residents were able to predict individual University patient VAS scores (P < or = 0.01). The fear chosen with the greatest frequency by Group 2 patients was "pain after the operation". Sixty percent of anesthesia residents matched their patients' fear choice (P < or = 0.001). This study indicates a variable ability of anesthesia and surgery residents to predict patient anxiety and fear which may be due, in part, to difficulty in understanding a Veterans Affairs hospital patient population.
View details for Web of Science ID A1996VV54300027
View details for PubMedID 8942601
- METAPHOR AND ANESTHESIA ANESTHESIOLOGY 1995; 83 (6): 1331-1342
A CALL FOR NARRATIVE, THE PATIENTS STORY AND ANESTHESIA TRAINING
LITERATURE AND MEDICINE
1994; 13 (1): 124-142
Narrative plays a key role in medical education and knowledge, via the case history, the case presentation, or even the patient's chart. Hospitalization for elective surgery provides the structure for a discrete story in a person's life. The details make the story unique for each patient. By analyzing themes and content of narratives obtained from patients and medical trainees, the reader gains insight into the realms of patients' and residents' lives. We believe that even anesthesiologists, who work at the procedure-oriented end of the spectrum of patient care, can benefit from a narrative approach to understanding the patient's perspective. An unanticipated reward of the study is the therapeutic benefit that some of the patients express in their narratives. Patients write that they hope future patients will benefit ("Use this information to the betterment of anyone in need & etc" [patient 15]) or physicians and nurses will improve their interactive skills (patient 09). Perhaps physicians may share the rewards of narrative creation that patient 10 expresses when he triumphantly exclaims, "EUREKA!!! ... I hope you learn something from it (as I have from remembering it)." Patients can provide medical personnel not only with signs and symptoms, but also with insight into the human aspects of the medical process. Reading or writing narratives about such processes may enhance physicians' understanding of their patients' experiences.
View details for Web of Science ID A1994NG28000009
View details for PubMedID 8007726
- PHARMACOKINETIC VARIABILITY OF MIDAZOLAM INFUSIONS IN CRITICALLY ILL PATIENTS CRITICAL CARE MEDICINE 1990; 18 (9): 1039-1041
- New agents and techniques for outpatient anesthe¬sia Anesthesiology Report 1990; 3: 82-96
OUTPATIENT PREMEDICATION - USE OF MIDAZOLAM AND OPIOID ANALGESICS
1989; 71 (4): 495-501
The perioperative effects of administering sedative and analgesic drugs prior to outpatient surgery were evaluated. One hundred fifty adult outpatients were randomly assigned to one of six study groups according to a double-blind protocol design. Patients were given placebo (saline) or midazolam (5 mg im) 30-60 min prior to surgery, and then either placebo, oxymorphone (1 mg iv), or fentanyl (100 micrograms iv) 3-5 min prior to a standardized anesthetic technique. Preoperatively, midazolam premedication was associated with a significantly lower anxiety level (37 +/- 29 mm vs. 50 +/- 32 mm, P less than 0.05), higher sedation level (254 +/- 136 mm vs. 145 +/- 109 mm, P less than 0.01), worsening of psychomotor skill (5 +/- 5 vs. 2 +/- 2 dots missed, P less than 0.01; midazolam vs. placebo), and impaired recall abilities. In addition, use of midazolam did not prolong the discharge time. Compared to control patients, those who received fentanyl had a decreased incidence of intraoperative airway difficulties such as coughing (28% vs. 0%, P less than 0.01). Although use of opioids increased the incidence of postoperative nausea (42% vs. 18%, P less than 0.01) and vomiting (23% vs. 2%, P less than 0.01; opioid vs. no opioid), average recovery times were not affected by opioid administration. Oxymorphone use was associated with a lower incidence of pain at home compared with that following fentanyl (46% vs. 74%, P less than 0.05). Finally, preoperative administration of both midazolam and fentanyl or oxymorphone prior to a standardized methohexital-nitrous oxide anesthetic technique did not adversely affect recovery after outpatient surgery.
View details for Web of Science ID A1989AT19300003
View details for PubMedID 2478048
BENZODIAZEPINE ANTAGONISM DOES NOT PROVOKE A STRESS RESPONSE
1989; 70 (4): 636-639
Acute anxiety reactions have been reported following antagonism of benzodiazepine-induced sedation. In this study, the level of sedation and anxiety was assessed in 30 patients randomly assigned to receive either saline or flumazenil (a benzodiazepine antagonist) after midazolam sedation according to a double-blind protocol. Carefully titrated doses of flumazenil, 0.8 +/- 0.2 mg (mean +/- SD), effectively reversed residual midazolam-induced sedation without producing significant changes in the patients' level of anxiety. In addition, plasma epinephrine, norepinephrine, vasopressin, and beta-endorphin concentrations were measured in a subset of patients (n = 5) from each group. The levels of these stress hormones did not acutely change following flumazenil (or saline). These results indicate that flumazenil, 0.6-1.0 mg iv, can antagonize midazolam sedation without producing acute anxiety or evidence of a stress response.
View details for Web of Science ID A1989T906500015
View details for PubMedID 2564753
PHARMACOKINETICS AND PHARMACODYNAMICS OF PROPOFOL INFUSIONS DURING GENERAL-ANESTHESIA
1988; 69 (3): 348-356
The pharmacokinetic and pharmacodynamic properties of propofol were studied in 50 surgical patients. Propofol was administered as a bolus dose, 2 mg/kg iv, followed by a variable-rate infusion, 0-20 mg/min, and intermittent supplemental boluses, 10-20 mg iv, as part of a general anesthetic technique that included nitrous oxide, meperidine, and muscle relaxants. For a majority of the patients (n = 30), the pharmacokinetics of propofol were best described by a two-compartment model. The propofol mean total body clearance rate was 2.09 +/- 0.65 1/min (mean +/- SD), the volume of distribution at steady state was 159 +/- 57 l, and the elimination half-life was 116 +/- 34 min. Elderly patients (patients older than 60 yr vs. those younger than 60 yr) had significantly decreased clearance rates (1.58 +/- 0.42 vs. 2.19 +/- 0.64 l/min), whereas women (vs. men) had greater clearance rates (33 +/- 8 vs. 26 +/- 7 l.kg-1.min-1) and volumes of distribution (2.50 +/- 0.81 vs. 2.05 +/- 0.65 l/kg). Patients undergoing major (intraabdominal) surgery had longer elimination half-life values (136 +/- 40 vs. 108 +/- 29 min). Patients required an average blood propofol concentration of 4.05 +/- 1.01 micrograms/ml for major surgery and 2.97 +/- 1.07 micrograms/ml for nonmajor surgery. Blood propofol concentrations at which 50% of patients (EC50) were awake and oriented after surgery were 1.07 and 0.95 microgram/ml, respectively. Psychomotor performance returned to baseline at blood propofol concentrations of 0.38-0.43 microgram/ml (EC50). This clinical study demonstrates the feasibility of performing pharmacokinetic and pharmacodynamic analyses when complex infusion and bolus regimens are used for administering iv anesthetics.
View details for Web of Science ID A1988P966800011
View details for PubMedID 3261954
PROPOFOL NITROUS OXIDE VERSUS THIOPENTAL-ISOFLURANE NITROUS OXIDE FOR GENERAL-ANESTHESIA
1988; 69 (1): 63-71
One hundred and twenty patients undergoing elective operations were randomly assigned to receive anesthesia with either thiopental, 4 mg/kg-isoflurane, 0.2-3%-nitrous oxide, 60-70% (control) or propofol, 2 mg/kg-propofol infusion, 1-20 mg/min-nitrous oxide, 60-70% (propofol). Although anesthetic conditions were similar during the operation, differences were noted in the recovery characteristics. For non-major (superficial) surgical procedures, the times to awakening, responsiveness, orientation, and ambulation were significantly shorter in the propofol group (4 +/- 3, 5 +/- 4, 6 +/- 4, and 104 +/- 36 min) than in the control group (8 +/- 7, 9 +/- 7, 11 +/- 9, and 142 +/- 61 min, respectively). In addition, less nausea and vomiting (20 vs. 45%) and significantly less psychomotor impairment was noted in the non-major propofol (vs. control) group. Following major abdominal operations, recovery characteristics did not differ between propofol and control groups. Delayed emergence (greater than 20 min), significant psychometric impairment, and a high overall incidence of postoperative side effects (55-60%) were noted in both drug treatment groups. The authors conclude that propofol-nitrous oxide compares favorably to thiopental-isoflurane-nitrous oxide for maintenance of anesthesia during short outpatient procedures. However, for major abdominal operations, propofol anesthesia does not appear to offer any clinically significant advantages over a standard inhalational anesthetic technique.
View details for Web of Science ID A1988P032400010
View details for PubMedID 3291646
STRESS RESPONSE FOLLOWING REVERSAL OF BENZODIAZEPINE-INDUCED SEDATION
EUROPEAN JOURNAL OF ANAESTHESIOLOGY
View details for Web of Science ID A1988N614200022
- Stress response following reversal of benzodiazepine-induced sedation Eur J Anaesth Supplement 1988; 2: 173-82
NAUSEA AND VOMITING - CAUSES AND PROPHYLAXIS
SEMINARS IN ANESTHESIA
1987; 6 (4): 300-308
View details for Web of Science ID A1987M122100008
- Nausea and vomiting: causes and use of prophy¬laxis in outpatients Seminars in Anesthesia 1987; 6: 300-8
PHARMACOKINETICS AND PHARMACODYNAMICS OF ALFENTANIL INFUSIONS DURING GENERAL-ANESTHESIA
ANESTHESIA AND ANALGESIA
1986; 65 (10): 1021-1028
The pharmacokinetic and pharmacodynamic properties of alfentanil were studied in 64 surgical patients. Alfentanil was administered as a loading infusion (25-130 micrograms/kg) followed by a maintenance infusion (0.25-1.3 micrograms X kg-1 X min-1) as part of a nitrous oxide-narcotic-muscle relaxant technique. Although alfentanil doses of at least 50 micrograms/kg (in combination with thiopental, 2 mg/kg) were required to prevent hemodynamic changes during intubation, apnea or chest wall rigidity frequently occurred with alfentanil loading infusions exceeding 75 micrograms/kg. The alfentanil clearance rate was significantly lower in patients with liver dysfunction (2.3 +/- 1.3 vs 4.2 +/- 2.0 ml X kg-1 X min-1, mean +/- SD). In addition, the patients who required opioid antagonists to reverse postoperative respiratory depression had lower clearance rates (1.5 +/- 0.7 vs 4.1 +/- 1.9 ml X kg-1 X min-1) and longer elimination half-life values (406 +/- 304 vs 87 +/- 53 min). For maintenance of hemodynamic stability during superficial and intraabdominal operations, alfentanil serum concentration-response curves revealed ED95 values exceeding 300 ng/ml and 400 ng/ml, respectively. Our study also demonstrated a wide range of clinical responses to fixed doses of alfentanil. At equivalent doses, some patients required supplemental anesthetics, whereas others required an opioid antagonist. Careful titration of the alfentanil maintenance infusion is recommended to minimize the possibility of postoperative respiratory depression.
View details for Web of Science ID A1986E037100005
View details for PubMedID 2875678
- COMPARISON OF ALFENTANIL WITH FENTANYL FOR OUTPATIENT ANESTHESIA ANESTHESIOLOGY 1986; 64 (1): 99-106
COMPARATIVE PHARMACOLOGY OF THE KETAMINE ISOMERS - STUDIES IN VOLUNTEERS
BRITISH JOURNAL OF ANAESTHESIA
1985; 57 (2): 197-203
The clinical and electroencephalographic (EEG) effects of the individual ketamine isomers were compared with the racemic mixture in five volunteers who received each drug on a separate occasion. Racemic ketamine 275 +/- 25 mg, s(+) ketamine 140 +/- 21 mg or R(-) ketamine 429 +/- 37 mg produced an anaesthetic state lasting 6 +/- 2 min (mean +/- SD). However, the EEG evaluation of the R(-) isomer revealed less overall slowing, and an absence of the large slow wave complexes produced by the S(+) isomer and the racemic mixture. The pharmacokinetic profiles for the individual isomers of ketamine did not differ significantly from the racemic mixture. Even though the apparent anaesthetic state produced in these healthy volunteers did not differ qualitatively between the three drug groups, recovery times (assessed using a standardized battery of psychometric tests) were consistently shorter following the individual isomers compared with the racemic mixture. The serum ketamine concentrations associated with regaining consciousness and orientation were consistent with an S(+):R(-) isomer potency ratio of 4:1. In terms of their ability to impair psychomotor function, the S(+):R(-) potency ratio varied from 3:1 to 5:1. After comparable degrees of CNS depression, we conclude that the more potent S(+) isomer of ketamine was associated with a more rapid recovery of psychomotor skills than the currently used racemic mixture.
View details for Web of Science ID A1985ADV4200013
View details for PubMedID 3970799
- USE OF A FENTANYL INFUSION IN THE INTENSIVE-CARE UNIT - TOLERANCE TO ITS ANESTHETIC EFFECTS ANESTHESIOLOGY 1983; 59 (3): 245-248
GANGLIOTETRAOSYLCERAMIDE IS A T-CELL DIFFERENTIATION ANTIGEN ASSOCIATED WITH NATURAL CELL-MEDIATED CYTO-TOXICITY
JOURNAL OF IMMUNOLOGY
1980; 124 (4): 1691-1694
Thymocytes and splenic T cells from C57BL/6 mice were analyzed for their content of glycosphingolipids (GSL) by high performance liquid chromatography. Glucosylceramide and lactosylceramide were shown to be the major GSL of thymocytes from mice 1 to 30 weeks of age, whereas a third GSL, asialo GM1, was found only in trace amounts. In splenic T lymphocytes, however, asialo GM1 was shown to increase in concentration with age. It reached a peak at 5 to 10 weeks of age, at a concentration 10 to 20 times that of thymocytes or neonatal splenic T cells. These studies confirm the previous finding with antibodies to asialo GM1, that this glycosphingolipid is a true differentiation antigen in the mouse. Subsequent analysis of C57BL/6 bg/bg (beige) mice, which lack natural killer function, demonstrates that levels of asialo GM1 in the splenic T cell population do not increase with age but remain at the level of 2- to 3-week-old normal mice, indicating that asialo Gm1 may be an important cell surface component in the generation of natural cell-mediated cytotoxicity.
View details for Web of Science ID A1980JK28800023
View details for PubMedID 6965956
- EFFECT OF DIPYRIDAMOLE ON ADENOSINE UPTAKE BY PLATELETS EXVIVO THROMBOSIS RESEARCH 1977; 11 (5): 611-618
- FORMATION OF GANGLIOSIDE INTERNAL ESTERS BY TREATMENT WITH TRICHLOROACETIC ACID PHOSPHOTUNGSTIC ACID REAGENT JOURNAL OF NEUROCHEMISTRY 1977; 28 (5): 1133-1136